Figure - available from: Surgical and Radiologic Anatomy
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The similarity of the oval shape of the coracoid process base is well shown in the coracoid optimal view for 10 different scapulae. *Indicates the virtual screw insertion point
Source publication
Purpose
Coracoid fractures represent approximately 3–13% of all scapular fractures. Open reduction and internal fixation can be indicated for a coracoid base fracture. This procedure is challenging due to the nature of visualization of the coracoid with fluoroscopy. The aim of this study was to develop a fluoroscopic imaging protocol, which helps s...
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Citations
... This study stemmed from the expectation of longer screw insertion and the concern about iatrogenic injury caused by screw penetration. Ogawa type I coracoid process fractures are rare; therefore, surgeons have a poor experience in surgical xation, which increases the risk of misplacement of screws [17]. Long screw xation of Ogawa type I coracoid process fracture-related iatrogenic injuries, including neurovascular injuries: the coracoid process is close to the lateral funiculus of the brachial plexus and the axillary vessels, and the distance between the suprascapular nerve vascular area and the neck of the scapula is short, which may be accidentally damaged during screw placement [18,19]. ...
... The axial superimposition of the coracoid process cortical bone essentially formed the boundary line of this fusiform region. When the screws did not penetrate the boundary in the axial perspective view, the screws were located entirely in the bone [17,20]; however, intraoperative reproduction of the fusiform region imaging is relatively tricky. This is related to factors such as lack of reduction for the coracoid process fracture, obstruction of the clavicle, selection of the patient position, light transmission performance of operating bed, or di culty placing the C-arm Mobile X-Ray systems. ...
... There is no uniform standard for the screw entry point [17,20,[23][24][25]. In this study, an area of about 1-2 mm anterior to the coracoclavicular ligament on the posterior edge of the superior surface of the coracoid process was chosen as the screw entry point (Fig. 2a). ...
Purpose
This study aimed to find the safe zone of two-dimensional (2D) fluoroscopy images in open reduction and internal fixation (ORIF) with long screws for Ogawa type I coracoid process fractures through three-dimensional (3D) simulation operations performed. Preliminary verification was carried out in cadaveric bone and clinical operations.
Methods
Shoulder computed tomography data of 100 adult participants were collected and reconstructed into 3D models. Virtual screws were created and placed to simulate long screw fixation. 3D models were adjusted to the Y-view of the scapula to be observed for 2D fluoroscopy, and quadrants were established with the centre of the glenoid of the shoulder as the origin. The positions of the screw tips were recorded, and the screw lengths (L1 and L2) and angles (α1, α2, β1, and β2) were measured. A scatter diagram was used to record the position of the screw tips and screw positions. Then the scatter diagram was switched to a thermal diagram to find the safe zone. Verification was carried out in both cadaveric bone and clinical operation.
Results
A fan-liked arc was obtained in the Y-view of the scapula of the 3D simulation. Most of the screw tips were located in the inferior posterior quadrant. According to the density of screw tips in the quadrant, the safe zone for screw placement was obtained. The screw lengths L1 and L2 were 53.44 ± 5.37 mm and 40.74 ± 6.02 mm, and the angles α1, α2, β1 and β2 were 30.43°±8.04°, 42.43°±6.44°, 65.14°±14.07° and − 1.7°±26.41°, respectively. Sex-dependent differences were found in L1, L2, and β1, P < 0.05. There was no statistical difference between the sexes in α1, α2, and β2, P > 0.05. Excellent results were obtained both in cadaveric bone and clinical operation based on this safe zone.
Conclusions
In this study, the safety zone of long screws in Ogawa type I coracoid process fracture was obtained, helps reduce iatrogenic injuries caused by screw penetration. For the best placement of screws, personalised simulated placement of screws was recommended before surgery.
... Trikt et al. reported a useful fluoroscopic view based on simple landmarks for fixation of fractures of the coracoid base [31]. Their approach is similar to ours, and an optimal trajectory for the placement of screws in the base fracture of the coracoid process was also obtained. ...
Background
Fractures of the base of the coracoid process are relatively rare, but an increasing number of studies have reported using screws to fix coracoid process base fractures. This study was performed to simulate the surgical procedure and obtain the ideal diameter, length, insertion point and angle of the screw from a 3-D axial perspective in Chinese patients.
Methods
We randomly collected right scapula computed tomography (CT) scans from 100 adults. DICOM-formatted CT scan images were imported into Mimics software. A 3D digital model of the right scapula was established. Two virtual cylinders representing two screws were placed from the top of the coracoid process to the neck of the scapula and across the base of the coracoid process to fix the base of the coracoid process. The largest secure diameters and lengths of the virtual screws were measured. The positions of the insertion points and the directions of the screws were also examined.
Results
The screw insertion safe zone can exhibit an irregular fusiform shape according to the reconstructed scapula model. The mean maximum diameters of the medial and lateral screws were 7.08 ± 1.19 mm and 7.34 ± 1.11 mm, respectively. The mean maximum lengths of the medial and lateral screws were 43.11 ± 6.31 mm and 48.16 ± 6.94 mm, respectively. A screw insertion corridor with a diameter of at least 4.5 mm was found in all patients. We found sex-dependent differences in the mean maximum diameters and maximum lengths of the two screws. The positions of the two insertion points were statistically different across sexes.
Conclusions
The study provides a valuable guideline for determining the largest secure corridor for two screws in fixing a fracture at the base of the coracoid process. For ideal screw placement, we suggest individualised preoperative 3D reconstruction simulations. Further biomechanical studies are needed to verify the function of the screws.
... The cephalad and lateral angulations (30 to 40°each) of the fluoroscopic beam directed at the coracoid tip demonstrates the entire profile of the superior coracoid pillar ('superior pillar view') and the cephalad and medial angulations (30 to 40°each) of the fluoroscopic beam demonstrates the entire 'inferior coracoid pillar'. van Trikt et al. [77] described the coracoid tunnel view based on simple landmarks of the scapular bone. They found the optimal passageway of a screw through the coracoid base into the neck of the scapula as the coracoid tunnel. ...
... After fracture reduction, a 2.0-mm K-wire is used to temporarily maintain the reduction. A correct and accurate screw placement is essential to achieve adequate stability and prevent fixation failure [75][76][77][78][79]. As mentioned before, the sharp, hooked, and thin coracoid tip precludes the screw placement starting from this landmark. ...
... As mentioned before, the sharp, hooked, and thin coracoid tip precludes the screw placement starting from this landmark. Therefore, the screw must be placed down the coracoid body through the coracoid base and into the neck of the scapula, which is the coracoid tunnel [77]. In the vast majority of cases, the drill must be positioned perpendicular to the coracoid process and parallel to the longest axis of the glenoid cavity and the screw must be placed parallel to the glenoid fossa. ...
Fractures of the scapula are rare and usually associated with high-energy trauma. The unfavorable scapular anatomy, combined with the complexity of the approaches for fracture fixation, make the treatment challenging, even for experienced surgeons. Furthermore, the literature is controversial regarding surgical indications and rationale for treatment. The present review article was designed to address and discuss critical aspects of decision-making for the management of scapular fractures, including surgical indications and patient safety considerations.
Purpose
Modern surgical practice is continuously changing as technology develops. New techniques are often implemented after a surgeon has made the transition to independent clinical practice. There is therefore a need to ‘retool’ technical skills. Additionally, practicing surgeons must maintain and develop skills such as leadership, communication, critical thinking, teaching, and mentoring. Our aim was to perform a scoping review to assess the current status of simulation education for practicing Orthopedic Surgeons (OS).
Methods
A 10 year search of PubMed, ERIC, and Web of Science was performed with a medical librarian. Controlled vocabulary Medical Subject Headings terms and natural language were developed with subject matter experts describing simulation, training and OS. Two trained reviewers evaluated all abstracts for inclusion. Exclusion criteria were articles that did not assess simulation education involving practicing OS. Data were extracted from the included full text articles by two reviewers: details of study design, type of participants, type of simulation and role of OS in the educational event.
Results
Initial search identified 1824 articles of which 443 were duplicates, and 1381 articles were further screened. Of these, 1155 were excluded, 226 full text articles were assessed for eligibility and 80 included in analysis. Most were published in the last 6 years and from the United States. The majority (99%) described technical skill simulations (arthroscopy 56%, screw placement 23%, ligament reconstruction 19%). OS were rarely the only learners with 91% studies also having residents participate. OS were the targeted learner in 6% studies. OS provided content validity for 15 (19%) and construct validity in 59 (74%) studies.
Conclusions
Simulation training to educate practicing OS is rare. OS are often used to validate work rather than being the center of an educational endeavor. A refocusing is needed to provide adequate training for practicing surgeons to retool skills as new techniques become available.
Introduction:
COVID-19 will undoubtedly change the future landscape of medical and surgical education. The economic and environmental advantages of virtual learning are clear, while access to a wider range of resources and subject specialists makes the adoption of virtual learning within surgical education an attractive prospect.
Aims:
This literature review aims to evaluate evidence on the effectiveness of virtual education in orthopaedics and how we might implement positive changes to educational practice in the future, as a result of lessons learned during the COVID-19 pandemic.
Methodology:
We performed a review of the literature reporting on efficacy of learning outcomes achieved as a result of virtual education within orthopaedic surgery. Electronic searches were performed using NICE healthcare databases from the date of inception to March 2021. Relevant studies were identified, data extracted, and qualitative synthesis performed.
Results:
14 manuscripts with a total of 1548 participants (orthopaedic trainees or medical students) were included for analysis. Nine studies (n = 1109) selected compared e-learning to conventional learning material (control group). All nine studies reported significantly higher outcome scores for e-learning participants compared to control participants (p < 0.001 to p < 0.05). The remaining studies compared blended e-learning approaches or evaluated pre/post intervention improvements in learning outcomes. All studies demonstrated a significant improvement in learning outcomes (p < 0.0001 to p < 0.01). The majority of studies (64%) used a blended approach. No studies were identified reporting efficacy of webinars or videoconferencing within orthopaedic education.
Conclusion:
A blended approach, combining virtual teaching, face-to-face instruction and distance learning tools, based on the evidence we have provided, would improve the quality of knowledge reception and retention, and learner satisfaction. However, in order to be successful, it is vital that these educational programmes are designed with the needs of the learner in mind, and an awareness of best practice for virtual teaching and learning.
