Is virtual reality effective to teach prevention of surgical site infections in the operating room? study protocol for a randomised controlled multicentre trial entitled VIP Room study

INTRODUCTION: Some surgical site infections (SSI) could be prevented by following adequate infection prevention and control (IPC) measures. Poor compliance with IPC measures often occurs due to knowledge gaps and insufficient education of healthcare professionals. The education and training of SSI preventive measures does not usually take place in the operating room (OR), due to safety, and organisational and logistic issues. The proposed study aims to compare virtual reality (VR) as a tool for medical students to learn the SSI prevention measures and adequate behaviours (eg, limit movements…) in the OR, to conventional teaching. METHODS AND ANALYSIS: This protocol describes a randomised controlled multicentre trial comparing an educational intervention based on VR simulation to routine education. This multicentre study will be performed in three universities: Grenoble Alpes University (France), Imperial College London (UK) and University of Heidelberg (Germany). Third-year medical students of each university will be randomised in two groups. The students randomised in the intervention group will follow VR teaching. The students randomised in the control group will follow a conventional education programme. Primary outcome will be the difference between scores obtained at the IPC exam at the end of the year between the two groups. The written exam will be the same in the three countries. Secondary outcomes will be satisfaction and students' progression for the VR group. The data will be analysed with intention-to-treat and per protocol. ETHICS AND DISSEMINATION: This study has been approved by the Medical Education Ethics Committee of the London Imperial College (MEEC1920-172), by the Ethical Committee for the Research of Grenoble Alpes University (CER Grenoble Alpes-Avis-2019-099-24-2) and by the Ethics Committee of the Medical Faculty of Heidelberg University (S-765/2019). Results will be published in peer-reviewed medical journals, communicated to participants, general public and all relevant stakeholders

Navigation for lower limb alignment during internal fixation of complex tibial-plateau fractures

International audienceIn complex fractures of the proximal tibial metaphysis and epiphysis, possible adverse outcomes after internal fixation include not only joint surface incongruity, but also lower limb malalignment requiring revision surgery. Navigation has been proven effective for the intraoperative control of lower limb alignment during osteotomy and knee arthroplasty. In complex traumatic fractures, temporary fixation by a locking screw plate allows sensor positioning followed by navigation maneuvers to adjust lower limb alignment. If malalignment is found, the construct can be modified economically by altering the diaphyseal fixation without modifying the metaphyseal screws. The objective of this study was to describe the use of navigation in three patients who required internal fixation of tibial-plateau fractures

Produits laitiers à base de lait de chamelle, les nouvelles possibilités au Turkménistan

International audienceINTRODUCTION:The aim of this study was to assess the differential laxity after reconstruction of the anterior cruciate ligament (ACL) by the TLS® technique using a single tendon, the semitendinosus in four-strand graft, compared with the hamstring technique which uses both the gracilis and semitendinosus. We hypothesised that this surgical technique would provide post-surgical differential laxity measurements at least as good as those of the hamstring technique.MATERIALS AND METHODS:We carried out a prospective monocentric study on patients undergoing unilateral anterior cruciate ligament repair between December 2014 and June 2016. All patients were followed up for at least 12 months. The series compares 61 patients operated on using the TLS® technique by the same surgeon, with 33 patients operated on using the hamstring technique by a second surgeon. The main objective of the study was to compare the post-operative differential laxity, measured using the KT1000, between the two techniques.RESULTS:There was no significant difference in the patients' epidemiological characteristics and pre-operative scores between the two groups. Average pre-operative differential laxity was 6.5 mm ± 2.1 (min 3; max 12) in the TLS group and 6.4 mm ± 2.0 (min 0; max 11) in the hamstring group, with no statistically significant difference. The average post-operative difference in laxity was - 0.1 mm ± 1.9 (min - 5; max 4) in the TLS group and 0.3 mm ± 2.0 (min - 7; max 5) in the hamstring group. Again, no significant difference was observed between groups.DISCUSSION:This study demonstrates a level of post-operative differential laxity control using TLS comparable with that of the ACL reconstruction technique using a hamstring graft with preserved tibial insertio

Role of computer-assisted surgery in osteotomies around the knee

International audiencePURPOSE:The goal of this article is to present our experience on navigation for osteotomies around the knee and especially osteotomies for coronal deformities. The first computer-assisted osteotomy was performed in March 2001 and since that time more than 1000 osteotomies have been performed in our department.METHODS:All the osteotomies were performed with the Orthopilot® device (B-Braun-Aesculap, Tuttlingen, Germany). The main indication was for genu varum deformities but several cases were operated for genu valgum. The surgical procedure as well as the indications and the rationale for each osteotomy (high tibial osteotomy-HTO, double-level osteotomy-DLO, femoral osteotomy-FO) are addressed in the article.RESULTS:The results are focused on several papers published by the authors since more than 10 years. Regarding HTO for genu varum, the preoperative goal (HKA angle: 184° ± 2°) was reached in 96 % of cases and the difference was statistically significant compared to the non-navigated series (71 %: p < 0.05). Regarding DLO for genu varum, the preoperative goal was reached in 92.7 % for the HKA angle and in 88.1 % for the medial proximal tibial mechanical angle (MPTMA). Regarding genu valgum deformity, the preoperative goal was achieved in 86.2 % of cases for the HKA angle and 100 % of cases for the MPTMA.CONCLUSION:According to these results, one can say that, regardless the type of osteotomy, the procedure is reliable, reproducible and accurate. Since 15 years, all the osteotomies around the knee are navigated in our department. Provided that one uses a reproducible radiograph protocol, navigation allows to perform double-level osteotomies, both for genu varum and genu valgum, with optimal accuracy in order to avoid oblique joint line, which will be difficult to revise to TKA.LEVEL OF EVIDENCE:IV

Comparison of knee extensor strength after anterior cruciate ligament reconstruction using either quadriceps tendon or hamstring tendon autografts

Purpose The aim was to assess the consequences of quadriceps tendon (QT) harvest on knee extensor strength after anterior cruciate ligament reconstruction (ACL-R) compared to hamstring tendon (HT) autograft. Secondary objectives were to evaluate flexor strength recovery and search for correlation between strength status and functional outcome. Methods This a retrospective cohort of 44 patients who underwent ACL-R using either QT (25) or HT (19). Median age was 31.1 years. We assessed thigh muscle strength thanks to concentric iso kinetic evaluation (peak torque) at 60 degrees.s(-1), 180 degrees.s(-1), 240 degrees.s(-1) and eccentric at 30 degrees.s(-1), 7 months on average after surgery. Muscle strength values were compared to the uninjured leg in order to calculate a percentage of deficit as well as unilateral hamstring/quadriceps (H/Q) ratios. KOOS score was obtained at a mean follow-up of 18 months. Results Extensor strength deficit (concentric 60 degrees.s(-1)) was one average 33.1% in the QT group and 28.2% in the HT group (p = 0.42). Difference of flexor strength deficit (concentric 60 degrees.s(-1)) was close to be significant with 5% and 12% of deficit in the QT and HT group, respectively (p = 0.1), and statistically significant for high angular velocity (14% versus 3% at 240 degrees.s(-1), p = 0.04). H/Q ratios were comparable in both groups ranging from 0.62 to 0.78. Quadriceps muscle strength deficit was negatively correlated with the KOOS score (Pearson coefficient = -0.4; p = 0.005). Conclusion QT autograft harvest does not yield significant quadriceps muscle weakness after ACL-R, which appear to be a pejorative factor for functional outcome

Comparison of knee extensor strength after anterior cruciate ligament reconstruction using either quadriceps tendon or hamstring tendon autografts

Purpose The aim was to assess the consequences of quadriceps tendon (QT) harvest on knee extensor strength after anterior cruciate ligament reconstruction (ACL-R) compared to hamstring tendon (HT) autograft. Secondary objectives were to evaluate flexor strength recovery and search for correlation between strength status and functional outcome. Methods This a retrospective cohort of 44 patients who underwent ACL-R using either QT (25) or HT (19). Median age was 31.1 years. We assessed thigh muscle strength thanks to concentric iso kinetic evaluation (peak torque) at 60 degrees.s(-1), 180 degrees.s(-1), 240 degrees.s(-1) and eccentric at 30 degrees.s(-1), 7 months on average after surgery. Muscle strength values were compared to the uninjured leg in order to calculate a percentage of deficit as well as unilateral hamstring/quadriceps (H/Q) ratios. KOOS score was obtained at a mean follow-up of 18 months. Results Extensor strength deficit (concentric 60 degrees.s(-1)) was one average 33.1% in the QT group and 28.2% in the HT group (p = 0.42). Difference of flexor strength deficit (concentric 60 degrees.s(-1)) was close to be significant with 5% and 12% of deficit in the QT and HT group, respectively (p = 0.1), and statistically significant for high angular velocity (14% versus 3% at 240 degrees.s(-1), p = 0.04). H/Q ratios were comparable in both groups ranging from 0.62 to 0.78. Quadriceps muscle strength deficit was negatively correlated with the KOOS score (Pearson coefficient = -0.4; p = 0.005). Conclusion QT autograft harvest does not yield significant quadriceps muscle weakness after ACL-R, which appear to be a pejorative factor for functional outcome

Long-term outcomes of tension band wiring with a single K-wire in Rockwood type IV/V acute acromio-clavicular dislocations: 25 cases

International audienceBACKGROUND:Our objective was to evaluate the long-term functional and radiological outcomes of tension band wiring with a single K-wire for acute Rockwood types IV and V acromio-clavicular dislocation (ACD).METHODS:Single-centre cross-sectional non-randomised observational cohort study of 25 shoulders treated surgically between January 2002 and December 2004, in 25 patients, 23 males and 2 females, with a mean age of 35±11years (24-46). The evaluation criteria were the absolute and weighted Constant scores, QuickDASH score, subjective shoulder value (SSV), visual analogue scale (VAS) pain score at rest and during activities, and radiographic features in clinically symptomatic patients.RESULTS:Mean values were as follows: follow-up, 150±17months (133-167); absolute Constant score, 88±17 (71-105); weighted Constant score, 92.5±12.5 (80-105); QuickDASH, 15.5±7 (8.5-22.5); SSV, 88±17% (71-105); VAS pain score at rest, 0.2±0.7 (0-0.9); and VAS pain score while active, 1.4±2.3 (0-3.7). The weighted Constant score was less than 70% in only 8% of patients. Of the 17 patients for whom radiographs were obtained, 8 had acromio-clavicular osteoarthritis. Mean coraco-clavicular distance was 12.3±4.3mm (8-16.6) and mean acromio-clavicular distance was 5±5mm (0-10). The recurrence rate was 8%.CONCLUSION:Tension band wiring with a single K-wire for acute acromio-clavicular dislocation reliably provides good long-term functional outcomes. Recurrences are uncommon and few patients experience symptoms (8%).LEVEL OF EVIDENCE:IV, retrospective study

Comparative study of computer-assisted total knee arthroplasty after opening wedge osteotomy versus after unicompartmental arthroplasty

International audienceAIMS:The role of high tibial osteotomy (HTO) is being questioned by the use of unicompartmental knee arthroplasty (UKA) in the treatment of medial compartment femorotibial osteoarthritis. Our aim was to compare the outcomes of revision HTO or UKA to a total knee arthroplasty (TKA) using computer-assisted surgery in matched groups of patients.PATIENTS AND METHODS:We conducted a retrospective study to compare the clinical and radiological outcome of patients who underwent revision of a HTO to a TKA (group 1) with those who underwent revision of a medial UKA to a TKA (group 2). All revision procedures were performed using computer-assisted surgery. We extracted these groups of patients from our database. They were matched by age, gender, body mass index, follow-up and pre-operative functional score. The outcomes included the Knee Society Scores (KSS), radiological outcomes and the rate of further revision.RESULTS:There were 20 knees in 20 patients in each group. The mean follow-up was 4.1 years (2 to 18.7). The mean total KSS at last follow-up was 185.7 (standard deviation (sd) 5) in group 1 compared with 176.5 (sd 11) for group 2 (p = 0.003). The mean hip-knee-ankle angle was 180.2° (sd 3.2°) in group 1 and 179.0° (sd 2.2°) in group 2. No revision was required.CONCLUSION:We found that good functional and radiological outcomes followed revision of both HTO and UKA to TKA. Revision of HTO showed significantly better functional outcomes. These results need to be further investigated by a prospective randomised controlled trial involving a larger group of patients. Cite this article: Bone Joint J 2016;98-B:1620-4