Hip fracture surgery performed by cadaveric simulation-trained versus standard-trained orthopaedic trainees: a preliminary multicentre randomized controlled trial
Aims: To evaluate if, for orthopaedic trainees, additional cadaveric simulation training or standard training alone yields superior radiological and clinical outcomes in patients undergoing dynamic hip screw (DHS) fixation or hemiarthroplasty for hip fracture. Methods: This was a preliminary, pragma...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2023-08-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.48.BJO-2022-0143.R1 |
| _version_ | 1797672269524238336 |
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| author | Hannah K. James Giles T. R. Pattison James Griffin Joanne D. Fisher Damian R. Griffin |
| author_facet | Hannah K. James Giles T. R. Pattison James Griffin Joanne D. Fisher Damian R. Griffin |
| author_sort | Hannah K. James |
| collection | DOAJ |
| description | Aims: To evaluate if, for orthopaedic trainees, additional cadaveric simulation training or standard training alone yields superior radiological and clinical outcomes in patients undergoing dynamic hip screw (DHS) fixation or hemiarthroplasty for hip fracture. Methods: This was a preliminary, pragmatic, multicentre, parallel group randomized controlled trial in nine secondary and tertiary NHS hospitals in England. Researchers were blinded to group allocation. Overall, 40 trainees in the West Midlands were eligible: 33 agreed to take part and were randomized, five withdrew after randomization, 13 were allocated cadaveric training, and 15 were allocated standard training. The intervention was an additional two-day cadaveric simulation course. The control group received standard on-the-job training. Primary outcome was implant position on the postoperative radiograph: tip-apex distance (mm) (DHS) and leg length discrepancy (mm) (hemiarthroplasty). Secondary clinical outcomes were procedure time, length of hospital stay, acute postoperative complication rate, and 12-month mortality. Procedure-specific secondary outcomes were intraoperative radiation dose (for DHS) and postoperative blood transfusion requirement (hemiarthroplasty). Results: Eight female (29%) and 20 male trainees (71%), mean age 29.4 years, performed 317 DHS operations and 243 hemiarthroplasties during ten months of follow-up. Primary analysis was a random effect model with surgeon-level fixed effects of patient condition, patient age, and surgeon experience, with a random intercept for surgeon. Under the intention-to-treat principle, for hemiarthroplasty there was better implant position in favour of cadaveric training, measured by leg length discrepancy ≤ 10 mm (odds ratio (OR) 4.08 (95% confidence interval (CI) 1.17 to 14.22); p = 0.027). There were significantly fewer postoperative blood transfusions required in patients undergoing hemiarthroplasty by cadaveric-trained compared to standard-trained surgeons (OR 6.00 (95% CI 1.83 to 19.69); p = 0.003). For DHS, there was no significant between-group difference in implant position as measured by tip-apex distance ≤ 25 mm (OR 6.47 (95% CI 0.97 to 43.05); p = 0.053). No between-group differences were observed for any secondary clinical outcomes. Conclusion: Trainees randomized to additional cadaveric training performed hip fracture fixation with better implant positioning and fewer postoperative blood transfusions in hemiarthroplasty. This effect, which was previously unknown, may be a consequence of the intervention. Further study is required. Cite this article: Bone Jt Open 2023;4(8):602–611. |
| first_indexed | 2024-03-11T21:27:31Z |
| format | Article |
| id | doaj.art-126c1a76c91b4ae7be6049416bb3026e |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-03-11T21:27:31Z |
| publishDate | 2023-08-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-126c1a76c91b4ae7be6049416bb3026e2023-09-27T15:00:36ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622023-08-014860261110.1302/2633-1462.48.BJO-2022-0143.R1Hip fracture surgery performed by cadaveric simulation-trained versus standard-trained orthopaedic trainees: a preliminary multicentre randomized controlled trialHannah K. James0Giles T. R. Pattison1James Griffin2Joanne D. Fisher3Damian R. Griffin4Department of Trauma & Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UKDepartment of Trauma & Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UKWarwick Clinical Trials Unit, Warwick Medical School, Coventry, UKWarwick Clinical Trials Unit, Warwick Medical School, Coventry, UKDepartment of Trauma & Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UKAims: To evaluate if, for orthopaedic trainees, additional cadaveric simulation training or standard training alone yields superior radiological and clinical outcomes in patients undergoing dynamic hip screw (DHS) fixation or hemiarthroplasty for hip fracture. Methods: This was a preliminary, pragmatic, multicentre, parallel group randomized controlled trial in nine secondary and tertiary NHS hospitals in England. Researchers were blinded to group allocation. Overall, 40 trainees in the West Midlands were eligible: 33 agreed to take part and were randomized, five withdrew after randomization, 13 were allocated cadaveric training, and 15 were allocated standard training. The intervention was an additional two-day cadaveric simulation course. The control group received standard on-the-job training. Primary outcome was implant position on the postoperative radiograph: tip-apex distance (mm) (DHS) and leg length discrepancy (mm) (hemiarthroplasty). Secondary clinical outcomes were procedure time, length of hospital stay, acute postoperative complication rate, and 12-month mortality. Procedure-specific secondary outcomes were intraoperative radiation dose (for DHS) and postoperative blood transfusion requirement (hemiarthroplasty). Results: Eight female (29%) and 20 male trainees (71%), mean age 29.4 years, performed 317 DHS operations and 243 hemiarthroplasties during ten months of follow-up. Primary analysis was a random effect model with surgeon-level fixed effects of patient condition, patient age, and surgeon experience, with a random intercept for surgeon. Under the intention-to-treat principle, for hemiarthroplasty there was better implant position in favour of cadaveric training, measured by leg length discrepancy ≤ 10 mm (odds ratio (OR) 4.08 (95% confidence interval (CI) 1.17 to 14.22); p = 0.027). There were significantly fewer postoperative blood transfusions required in patients undergoing hemiarthroplasty by cadaveric-trained compared to standard-trained surgeons (OR 6.00 (95% CI 1.83 to 19.69); p = 0.003). For DHS, there was no significant between-group difference in implant position as measured by tip-apex distance ≤ 25 mm (OR 6.47 (95% CI 0.97 to 43.05); p = 0.053). No between-group differences were observed for any secondary clinical outcomes. Conclusion: Trainees randomized to additional cadaveric training performed hip fracture fixation with better implant positioning and fewer postoperative blood transfusions in hemiarthroplasty. This effect, which was previously unknown, may be a consequence of the intervention. Further study is required. Cite this article: Bone Jt Open 2023;4(8):602–611.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.48.BJO-2022-0143.R1simulationeducationtraininghip fracturehip fracture surgeryhemiarthroplastiesblood transfusionsrandomized controlled trialleg length discrepancydynamic hip screw (dhs)postoperative complicationsmulticentre randomized controlled trialhip fracture fixations |
| spellingShingle | Hannah K. James Giles T. R. Pattison James Griffin Joanne D. Fisher Damian R. Griffin Hip fracture surgery performed by cadaveric simulation-trained versus standard-trained orthopaedic trainees: a preliminary multicentre randomized controlled trial Bone & Joint Open simulation education training hip fracture hip fracture surgery hemiarthroplasties blood transfusions randomized controlled trial leg length discrepancy dynamic hip screw (dhs) postoperative complications multicentre randomized controlled trial hip fracture fixations |
| title | Hip fracture surgery performed by cadaveric simulation-trained versus standard-trained orthopaedic trainees: a preliminary multicentre randomized controlled trial |
| title_full | Hip fracture surgery performed by cadaveric simulation-trained versus standard-trained orthopaedic trainees: a preliminary multicentre randomized controlled trial |
| title_fullStr | Hip fracture surgery performed by cadaveric simulation-trained versus standard-trained orthopaedic trainees: a preliminary multicentre randomized controlled trial |
| title_full_unstemmed | Hip fracture surgery performed by cadaveric simulation-trained versus standard-trained orthopaedic trainees: a preliminary multicentre randomized controlled trial |
| title_short | Hip fracture surgery performed by cadaveric simulation-trained versus standard-trained orthopaedic trainees: a preliminary multicentre randomized controlled trial |
| title_sort | hip fracture surgery performed by cadaveric simulation trained versus standard trained orthopaedic trainees a preliminary multicentre randomized controlled trial |
| topic | simulation education training hip fracture hip fracture surgery hemiarthroplasties blood transfusions randomized controlled trial leg length discrepancy dynamic hip screw (dhs) postoperative complications multicentre randomized controlled trial hip fracture fixations |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.48.BJO-2022-0143.R1 |
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