Fractures around the hip: inducing life-like fractures as a basis for enhanced surgical training
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TRAUMA SURGERY
Fractures around the hip: inducing life‑like fractures as a basis for enhanced surgical training Andreas Harbrecht1,2 · Valentin Rausch1,3 · Kilian Wegmann1 · Michael Hackl1 · Stephan Uschok1 · Tim Leschinger1 · Lars P. Müller1 Received: 17 March 2020 / Accepted: 30 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction In this study we investigated if realistic fracture patterns around the hip can be produced on human cadaveric specimens with intact soft tissue envelope. Possible applications of such fractured specimens would be in surgical training. Materials and methods 7 cadaveric specimens (2 male, 5 female, 2 formalin-fixed, 5 fresh-frozen) were fractured. 2 specimens were fractured on both femurs, 5 only on one side, resulting in 9 fractures total. 5 fractures were set in our custommade drop-test bench, 2 fractures by inducing axial force using a hammer, and the remaining 2 fractures by a direct dorsal approach and a chisel. AO/OTA and Pauwels classification were used to classify the fractures on the specimens by two independent trauma surgeons. Results In our drop-test bench, axial load with the femur adducted by 10° resulted in an intertrochanteric fracture (AO type A1.3), adducted by 20° resulted in a femoral neck fracture (Pauwels type III). Fracture induction using a hammer resulted in two intertrochanteric fractures (AO type A2.2 right, A3.3 left). The use of a chisel resulted in both cases in a femoral neck fracture. The acetabulum could be fractured multifragmentarily through use of a hemiprosthesis as a stamp. Conclusion A high energetic impulse induced by a custom-made drop-test bench can successfully simulate realistic proximal femur and acetabular fractures in cadaveric specimens with intact soft tissue. Furthermore, axial load using a hammer as well as using a chisel through a direct dorsal approach represent additional methods for fracture induction. These pre-fractured specimens can be utilized in surgical education to provide a realistic teaching experience for specialized trauma education courses. Keywords Surgical education · Realistic fracture simulation · Acetabulum fractures · Intertrochanteric fractures · Femoral neck fractures
Introduction Fractures of the proximal femur are among the most common fractures of the human body [1–3]. A quick and stable fixation of these fractures is mandatory in all cases to avoid * Andreas Harbrecht andreas.harbrecht@uk‑koeln.de 1
Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
2
Department of Anatomy I, Medical Faculty, University of Cologne, Cologne, Germany
3
Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle‑de‑la‑Camp‑Platz 1, 44789 Bochum, Germany
early complications [4]. As surgeons face these kinds of fractures frequently, practicing fixation techniques in a safe environment with life-like pre-fractured specimens can be a valuab
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