Analyzing the Impact of COVID-19 Pandemic on Different Educational Aspects of Surgical Specialties’ Residency Program: A Preliminary Report

Introduction: The lifestyle and learning of trainees from different surgical specialties have been severely affected by the COVID-19 pandemic. Despite the growing body of research, the extent to which their surgical or educational performance is affected is not yet well-understood. We investigated the Iranian multi-specialty surgical residents nationwide to clarify the extent this new pandemic’s has affected their surgical and educational activities. Material and Methods: Our specialized board designed a questionnaire which was sent to residents from the 18th of May to 12th of Jun 2020. The questionnaire comprised demographic data, questions on the clinical, surgical, and educational activities during and before the pandemic. Results: Out of 700 eligible residents, 543 (77%) submitted their answers to all questions. 417 (76.8%) of the respondents declared they had spent their residency program at a hospital that was the main referral center for patients with COVID-19 infection. The weekly number of the outpatient and emergent visits decreased by one third (P<0.001) and one-half (P<0.001), respectively, following the pandemic. Also, the amount of surgeries has dramatically decreased (P<0.001). The median weekly hours devoted to face-to-face activities decreased, while the study time increased and the share of virtual education has a five-fold increase (P<0.001). Conclusion: This pandemic had a significant impact on many aspects of training in surgical specialties’ residency program in Iran. Increasing the time available to study is an opportunity, and online education, despite its challenges, has been effective

Congenital hip dysplasia treated by total hip arthroplasty using cementless tapered stem in patients younger than 50 years old: results after 12-years follow-up

Background Congenital hip dysplasia may lead to severe acetabular and femoral abnormalities that can make total hip arthroplasty a challenging procedure. We assessed a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using cementless tapered stem and here we report the outcomes at long-term follow-up. Materials and methods Twenty-eight patients (24 women and 4 men) aged between 44 and 50 years (mean 47 years) were observed. Clinical evaluation was rated with the Harris Hip Score. Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowe’s classification, 16 hips presented dysplasia grade 1, 14 grade 2, and 4 grade 3. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis). Six patients were operated bilaterally, with a totally of 34 hips operated. After surgery, the patients were clinically and radiographically checked at 3, 6, and 12 months and yearly thereafter until an average follow-up of 12 years (range 10–14 years). Results Average Harris Hip Score was 56 ± 9 (range 45–69) preoperatively, 90 ± 9 (range 81–100) 12 months after surgery, and 91 ± 8 (range 83–100) at last follow-up. Radiographic evaluation demonstrated excellent osteointegration of the implants. Signs of bone resorption were present in 6 hips, nevertheless no evidence of loosening was observed and none of the implants has been revised. Conclusions Even in dysplasic femur, the tapered stem allowed adequate stability and orientation of the implant. We consider tapered stem a suitable option for total hip arthroplasty in developmental hip dysplasia, also in case of young patients, thanks to the favourable long-term results

In vitro experimental studies and numerical modeling to investigate the biomechanical effects of surgical interventions on the spine

This paper offers a comprehensive systematic review of biomechanical research on the spine and on in vitro and numerical methods of investigation. This review focuses on interventions on the ligaments, on the facets, and on the lamina (facetectomies, laminectomies, and laminoplasties). Surgical interventions on the facets and lamina in some cases yield dissatisfactory clinical follow-up. Patient outcome is strongly related to the effects that such interventions have on the biomechanical functionality of the spine. The papers examined include those addressing the untreated spine (range of motion and stiffness), but the focus is on experimental and numerical investigations studying the role of the ligaments and of the posterior structures (including their role in granting spine stability and the biomechanical behavior of each ligament). The papers were classified based on the different investigation approaches. In vitro experiments exploit dedicated biomechanical spine testers to measure the mechanical properties of physical specimens. Numerical modeling (multibody dynamics, finite-element analysis) allows predicting the effect of different conditions. All the papers indicate that interventions on the ligaments, facets, and lamina increase range of motion and decrease stability. The quantitative results show great variability across studies. This review shows how it is possible to use in vitro and numerical methods to investigate the biomechanical effects of surgical interventions

Minimally invasive technique for curettage of chondroblastoma using endoscopic technique.

Chondroblastoma is a rare benign bone tumor. The treatment for chondroblastoma usually consists of curettage of the lesion and packing the tumor cavity with bone grafts or bone cement. However, chondroblastomas are known to recur in 10% to 20% of cases after excision, possibly because the incomplete removal of pathological tissue at surgery. We present a case of chondroblastoma in the distal femur treated by endoscopic curettage, which allowed a complete resection of tumor tissue and a minimal damage of the bone. The patient had relief of symptoms, rapid function restoration and no local recurrence. Endoscopic curettage is a promising new treatment for chondroblastoma. In fact, the extra-articular technique enters the tumor cavity via a tunnel drilled through the medullary canal, allowing to visualize possible residual tumor tissue or defects of the articular surface, without violating the joint and without taking away a much bigger cortical window

Single level anterior cervical discectomy and interbody fusion

Learning targets \u2022 To learn the anatomy and technique of Smith-Peterson anterior cervical spine approach. \u2022 To learn anterior cervical discectomy and decompression technique of the cervical spine. \u2022 To learn interbody fusion technique using stand-alone cage. \u2022 To understand the importance of sagittal segmental alignment and sagittal alignment of the cervical spine restoration

The effect of cage type on local and total cervical lordosis restoration and global spine alignment in single-level anterior cervical discectomy and fusion based on EOS® imaging: A comparison between standalone conventional interbody polyether ether ketone cage and integrated cage and plate (Perfect-C®)

Background: There is a small level of evidence regarding the alterations in global spine alignment following the restoration of cervical lordosis using anterior cervical discectomy and fusion (ACDF). Different cage types are available to restore cervical lordosis through ACDF. In this study, we evaluate the impact of two types of these cages on local and global spine alignments. Patients and Methods: Thirty-two patients with a mean age of 46 ± 10 who underwent ACDF for cervical disc herniation were included in this retrospective study. Patients were divided according to their cage type into two groups, 17 patients with standalone conventional polyether ether ketone cages and 15 patients with integrated cage and plate (ICP) (Perfect-C®). Cervical alignment and global spine alignment were evaluated on the pre- and post-operative EOS® images. Results: Three months after the ACDF, total cervical lordosis correction was higher in patients with ICP (P = 0.001), while the local cervical lordosis correction was not significantly different between conventional cages and prefect-C cages (P = 0.067). Lumbar lordosis and pelvic tilt change were significantly higher among patients with Perfect-c cages (P = 0.043). Conclusion: In patients undergoing ACDF, alignment of the global spine changes along with the restoration of the cervical spine. Cage type affects this association, mainly through the compensatory alteration of pelvic tilt

Transforaminal lumbar interbody fusion

How to perform a posterior spine fusion and a transforaminal lumbar interbody fusion

Surgical tricks for open lumbar discectomy

Learning objectives \u2022 To explain the pathophysiology of herniated disc. \u2022 To show the clinical appearance, physical examination and surgical indication for S1 root radiculopathy. \u2022 To learn anatomy and surgical technique related to lumbar discectomy. \u2022 To explain surgical tricks when performing an open lumbar discectomy

Surgical treatment of aseptic forearm nonunion with plate and opposite bone graft strut. Autograft or allograft?

Purpose of the study: Adequate treatment of forearm nonunion should achieve both biological stimulation of the bone and mechanical stability. The use of bone graft could enhance the healing of a nonunion providing osteogenic, osteoconductive and osteoinductive stimulation and an optimal stability of the fixation. We retrospectively reviewed two cohorts of patients affected by forearm nonunion and treated with plate and opposite bone graft to determine whether the use of autograft versus allograft differs in terms of (1) rate of healing of the nonunion and (2) time of healing. Materials and methods: Thirty-four patients were treated for aseptic forearm nonunion with cortical graft strut with opposite plate and intercalary graft in case of segmental bone defect. In 20 patients an autograft harvest from the fibula (group A) and in 14 (group B) an allograft provided by the bone bank of our institution were used. Results: All the nonunions healed in a mean of four months in both groups, ranging from two to 12 months in group A and from three to ten months in group B. At the latest follow up forearm function and pain were satisfactory in both groups. Conclusion: The use of plate and opposite bone graft demonstrated to be effective in promoting the healing of forearm nonunions, without significant differences in terms of rate and time of healing in the two groups. Considering the higher surgical time and the comorbidity of the donor site, if a bone bank is available, we suggest to use homologous cortical bone strut graft with opposite plate and screw fixation for the treatment of aseptic forearm nonunion rather than autograft