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Topic:

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Issue:

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Category:

Oncology

Title:

Closing-wedge Osteotomies: Can We Do and Teach Better?

Author:

Weltsch, Daniel MD, MPH; Juels, Michaela BS; Chen, Kevin Yining BA; Talathi, Nakul MD; Silva, Mauricio MD; Thompson, Rachel M. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

March 2024

Reference:

44(3): p 174-178, DOI: 10.1097/BPO.0000000000002577

Level Of Evidence:

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# of Patients:

24

Study Type:

Observational cohort study

Location:

Not specified

Summary:

The study aims to assess the accuracy and effectiveness of various measuring and marking methods used in performing wedge-shaped osteotomies on long bones, specifically in a cohort of orthopedic residents.

Methods:

Participants: 24 residents (6 females, 25%) from postgraduate years 1 to 5. Intervention: Orthopedic residents performed 30-degree wedge osteotomies on sawbone femurs using a standard oscillating saw. Three measuring conditions were tested: No measurement tool. 30-degree triangle. Goniometer. Marking Methods: Marking pen. Pin placement. Outcome Measures: Quality of the osteotomy (perfect, mild step-off, or gross surface irregularity), completion time, and accuracy.

Exclusions:

Not specified

Results:

Female residents took longer to complete the osteotomy compared to male residents (138 vs. 99 seconds, P=0.003), though there was no difference in surface quality or angle accuracy. No significant difference in accuracy or surface quality between measuring techniques. The goniometer and 30-degree triangle resulted in longer completion times compared to no visual aid (P=0.002 and 0.007, respectively). The marking pen was associated with significantly shorter completion times (P<0.001), higher surface quality (P<0.001), and better accuracy (P<0.001) compared to pin placement.

Conclusions:

The study recommends using a marking pen with the surgeon’s preferred measuring tool to optimize performance in closing wedge osteotomies. While female residents took longer, their performance in terms of quality and accuracy was similar to male residents, suggesting that slower pace should not be seen as poor performance but as an opportunity for effective teaching. Further research is needed to verify these findings in more complex settings, such as cadaveric studies.

Relevance:

Limitations:

Perspective:

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