Procedural simulation training in orthopaedics and traumatology: Nationwide survey among surgeon educators and residents in France

International audienceBackgroundSimulation is among the tools used in France to train residents specialising in orthopaedic and trauma surgery (OTS). However, implementing simulation-based training (SBT) is complex and poorly reported. The objective of this study was to describe the use of simulation for OTS training in France.HypothesisNationwide, SBT is not used to its full capacity for teaching OTS in France, and differences in opinions about SBT may exist between surgeon educators and residents.Study designNationwide questionnaire survey in France.Materials and MethodsWe built two specific self-questionnaires then e-mailed them between December 2020 and February 2021 to the surgeon educators who were members of the national university council and to the residents specialising in OTS during the current academic year. The questions were about the 2018–2019 academic year, before the COVID-19 pandemic. Two classes of residents who were still medical students during this period were not included, leaving three classes for the analysis.ResultsThe participation rates were 57% (67/117) for the educators and 24% (87/369) for the three classes of residents. Of the 67 educators, 47 (70%) reported being involved in SBT and identified the university (70%) and industry (53%) as the main funders of this teaching modality. The educators indicated that the mean number of SBT laboratories in their region was 1.4 ± 0.9 (range, 0–4). The main types of simulators were saw bones (77%); cadavers (85%); and commercial simulators (74%), notably for the knee (87%) and shoulder (78%). The educators estimated that they had achieved a mean of 33% ± 23% (range, 0%–100%) of the teaching objectives set out in the OTS curriculum and that the main obstacles were insufficient funding (81%) and lack of time (67%). Only 21% of educators reported conducting SBT research. The residents reported that they accessed SBT via the OTS teaching module (28/87, 32%), local university degrees (23/87, 26%), their hospital department (17/87, 18%), or the industry (15/87, 17%); 25/87 (29%) had never received SBT. On a 0–10 scale (0, completely disagrees; 10, completely agrees), the mean score for SBT effectiveness was 8.6 ± 2.1 for residents and 7.1 ± 3.0 for educators (p < 0.001); the corresponding values for the quality of SBT integration in the region were 1.5 ± 1.8 and 3.8 ± 2.6, respectively (p < 0.001).ConclusionSBT is not yet used to its full potential for teaching OTS in France. Insufficient funding and lack of time were identified by the educators as the main obstacles to greater use of SBT. Both the residents and the educators felt that SBT mightbe beneficial for training.Level of evidenceIV, nationwide survey

Influence of preoperative biological parameters on postoperative complications and survival in spinal bone metastasis. A multicenter prospective study

International audienceIntroduction: Onset of spinal bone metastasis is a turning point in the progression of tumoral disease; although incidence is increasing, management is not standardized. Various prognostic scores are available, but advances in medical and surgical treatment have made them less well adapted, and sometimes discordant for a given patient. It would therefore be useful to develop new prognostic instruments. The aim of the present study was to identify biologic risk factors for onset of postoperative complications and death following spinal bone metastasis surgery.Material and methods: A prospective multicenter study included all patients operated on for spinal bone metastasis between November 2015 and May 2017. The main epidemiologic data and biologic data (CRP, albuminemia, calcemia) were collected preoperatively. Surgical strategy, death and/or postoperative complications were collected prospectively.Results: Five of the initial 264 patients died during the immediate postoperative course, and 107 within 6 months. At 1 year, 57 patients remained alive. Twenty-six (10%) were lost to follow-up. Preoperative albuminemia 2.6 nmol/L (8%) and CRP > 10 mg/L (47.5%) were associated with significantly elevated mortality. Only CRP elevation correlated with postoperative complications rate.Conclusion: The study confirmed the prognostic value of 3 biologic parameters (CRP level, albuminemia, calcemia) for survival after spinal bone metastasis surgery. A hybrid score taking account of not only clinical but also biologic parameters should be developed to improve estimation of survival

Surgical treatment of peri-acetabular metastatic disease: Retrospective, multicentre study of 91 THA cases

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Prise en charge opératoire des métastases péri-acétabulaires. Étude rétrospective d’une série multicentrique de 91 arthroplasties totales de hanche

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Surgical treatment of bone metastasis from osteophilic cancer. Results in 401 peripheral and spinal locations

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