Scott M LaValva1, Benjamin H Rogers2, Alexandre Arkader3,4, Apurva S Shah3,4. 1. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA. 2. Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA. 3. Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA. 4. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND: At many institutions, junior orthopaedic surgery residents perform the closed reduction and casting of pediatric distal radius fractures (DRFs). The purpose of this study was to evaluate the competency of junior residents compared to senior residents in the initial management of pediatric DRFs. METHODS: This investigation was a case-control study analyzing the outcomes of children with displaced DRFs treated by junior versus senior residents. The cohorts were matched with respect to fracture type. Radiographs were measured to assess fracture angulation, displacement, and cast index. Comparisons of patient characteristics, fracture characteristics, and outcome variables were made between the cohorts. RESULTS: A total of 132 patients (99 males; mean age 10.7±2.6 years) were included. Junior residents achieved a similar rate of acceptable initial reduction compared to senior residents (82% versus 79%; p=0.66). Twenty-four (23%) patients were found to have loss of reduction (LOR), though the rate of LOR was similar in the junior (16.7%) and senior resident (28.9%) cohorts (p=0.13). Overall, only 6 patients (3.7%) required surgery (1.5% in junior versus 7.6% in senior; p=0.09). The odds of LOR were 2.7 times higher in the first three reductions of the rotation for all residents (p=0.049). CONCLUSION: Junior residents perform similarly to senior residents in the closed reduction and casting of pediatric DRFs. However, residents performing one of their first three closed reductions during a rotation-regardless of seniority-were more likely to experience subsequent loss of reduction, suggesting the need for close supervision during the beginning of each rotation.Level of Evidence: III.
BACKGROUND: At many institutions, junior orthopaedic surgery residents perform the closed reduction and casting of pediatric distal radius fractures (DRFs). The purpose of this study was to evaluate the competency of junior residents compared to senior residents in the initial management of pediatric DRFs. METHODS: This investigation was a case-control study analyzing the outcomes of children with displaced DRFs treated by junior versus senior residents. The cohorts were matched with respect to fracture type. Radiographs were measured to assess fracture angulation, displacement, and cast index. Comparisons of patient characteristics, fracture characteristics, and outcome variables were made between the cohorts. RESULTS: A total of 132 patients (99 males; mean age 10.7±2.6 years) were included. Junior residents achieved a similar rate of acceptable initial reduction compared to senior residents (82% versus 79%; p=0.66). Twenty-four (23%) patients were found to have loss of reduction (LOR), though the rate of LOR was similar in the junior (16.7%) and senior resident (28.9%) cohorts (p=0.13). Overall, only 6 patients (3.7%) required surgery (1.5% in junior versus 7.6% in senior; p=0.09). The odds of LOR were 2.7 times higher in the first three reductions of the rotation for all residents (p=0.049). CONCLUSION: Junior residents perform similarly to senior residents in the closed reduction and casting of pediatric DRFs. However, residents performing one of their first three closed reductions during a rotation-regardless of seniority-were more likely to experience subsequent loss of reduction, suggesting the need for close supervision during the beginning of each rotation.Level of Evidence: III.
Authors: Michael J Sumko; William Hennrikus; Jennifer Slough; Kelly Jensen; Douglas Armstrong; Stephen King; Kenneth Urish Journal: J Pediatr Orthop Date: 2016-03 Impact factor: 2.324
Authors: Matthew D Putnam; Elspeth Kinnucan; Julie E Adams; Ann E Van Heest; David J Nuckley; Janet Shanedling Journal: J Surg Educ Date: 2014-12-24 Impact factor: 2.891