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J Wrist Surg
DOI: 10.1055/s-0044-1779285
Scientific Article

Influence of Surgeon's Expertise on the Duration of Approach and Closure during Osteosynthesis of Distal Radius Fractures

Laurine Cafarelli
1   Department of Hand Surgery, Strasbourg University Hospital, FMTS, Strasbourg, France
,
Camille Graëff
2   IHU, Institute of Image-Guided Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
3   ICube CNRS UMR7357, Strasbourg University, Strasbourg, France
,
Thomas Lampert
2   IHU, Institute of Image-Guided Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
3   ICube CNRS UMR7357, Strasbourg University, Strasbourg, France
,
Nicolas Padoy
2   IHU, Institute of Image-Guided Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
3   ICube CNRS UMR7357, Strasbourg University, Strasbourg, France
,
Nicolas Meyer
4   Department of Public Health, Strasbourg University Hospital, FMTS, Strasbourg, France, 1 avenue de l’hôpital, Strasbourg, France
,
Armaghan Dabbagh
5   Faculty of Health Sciences, Western University, London, Ontario, Canada
,
Laela El Amiri
1   Department of Hand Surgery, Strasbourg University Hospital, FMTS, Strasbourg, France
,
Philippe Liverneaux 
1   Department of Hand Surgery, Strasbourg University Hospital, FMTS, Strasbourg, France
3   ICube CNRS UMR7357, Strasbourg University, Strasbourg, France
› Author Affiliations Funding This work of the Interdisciplinary Thematic Institute HealthTech, as part of the ITI 2021-2028 program of the University of Strasbourg, CNRS and Inserm, was supported by IdEx Unistra (ANR10-IDEX-0002) and SFRI (STRAT’US project, ANR-20-SFRI-0012) under the framework of the French Investments for the Future Program. This work was also partially supported by French state funds managed by the ANR within the Investments for the future program under Grant ANR-10- IAHU-02 (IHU Strasbourg), Btw, MOSaiC.
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Abstract

Background The aim of this study was to determine whether the duration of the approach (PII) and closure (PV) phases for minimally invasive plate osteosynthesis (MIPO) of distal radius fractures varied according to the surgeon's level of expertise. The main hypothesis was that the PII or PV duration was inversely proportional to the level of expertise.

Methods The method measured the duration of PII and PV for 50 videos of MIPO operated by one surgeon with level 3E expertise, three with level 4E, and one with level 5E. The videos were viewed to identify any technical errors.

Results The average PII duration was 3 minutes 8 seconds for level 5E, 4 minutes 7 seconds for 4E, and 6 minutes 19 seconds for 3E. Average PV duration was 2 minutes 12 seconds for level 5E, 2 minutes 36 seconds for 4E, and 2 minutes 41 seconds for 3E. The average duration of PII + PV was 5 minutes 20 seconds for level 5E, 6 minutes 37 seconds for 4E, and 9 minutes for 3E. These findings indicate that both PII and PV duration was the longest in the level 3E surgeons' practice. Six technical errors were identified for levels 3E and 4E during PII (hemostasis control, multiple incisions, instrument handling, improper use of the fluoroscope, time-outs) and PV (intradermal reattachment).

Clinical Relevance The main hypothesis was verified since the duration of PII or PV was inversely proportional to the surgeon's level of expertise. This study identified technical errors in hand surgery practices of new surgeons. By early identification and correcting these minor errors, it would be possible to speed up the learning curve. We recommend surgical videos to be systematically recorded and analyzed to improve hand surgery practices.

Type of Study/Level of Evidence Therapeutic/Level IIIa.

Keywords

operative time - surgical videos - approach - closure - expertise - distal radius fracture

Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Strasbourg University Hospitals.


Consent to Participate

Informed consent was obtained from the patients included in the study.


Consent to Publish

The authors affirm that human research participants provided informed consent for publication of the videos.


Authors' Contribution

All authors contributed to the study. Conception and design were done by L.C., T.L., N.P., and P.L.). Material preparation, data collection and analysis were performed by C.G., L.E.A.. The first draft of the manuscript was written by P.L., L.C., and C.G.. Statistics was done by N.M.. Language editing was done by D.A.. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.




Publication History

Received: 15 July 2023

Accepted: 26 December 2023

Article published online:
08 March 2024

© 2024. Thieme. All rights reserved.

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