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Nurses often function as capsule endoscopy "pre-readers" to save physicians' time and potentially increase diagnostic yield. Training pre-readers is time consuming, not standardized, and may not be feasible during regular business hours. A way to evaluate the progress and accuracy of pre-readers is needed to ensure competency. The aim of this study was to introduce a feedback and progress assessment tool for training novice capsule endoscopy pre-readers. We created a 1-page form with listings of potential findings for each segment of the examination. Findings could be circled or written in. The trainee reviewed capsule studies and filled out the form on each of 220 patients. The physician reviewers subsequently critiqued the data forms, providing feedback regarding missed lesions, overcalls, and overall agreement. Our trainee achieved consistent agreement with the physician reviewers, after reading 80 studies. In conclusion, a simple, 1-page standardized data sheet can be used to facilitate training of novice capsule pre-readers without significant time commitment from the supervising physician. Future studies may validate this resource-efficient instrument as a training and assessment tool for nurses, physicians, and other practitioners learning capsule endoscopy.

BACKGROUND Intramedullary nail (IMN) perforation through the cortex of the distal femur is a risk of intramedullary stabilization of proximal femur fractures. This study was performed to identify information that is available before operation that can pick out patients at risk for this complication. METHODS A retrospective review of records and roentgenograms of 150 patients treated with intramedullary stabilization of a proximal femur fracture during a 4-year period at a Level I trauma center was performed. The position of the tip of the IMN in the distal femur was measured on postoperative lateral roentgenograms and grouped into anterior, middle, or posterior one third positions. Patients in whom the tip of the nail contacted or penetrated through the anterior cortex were designated as having cortical impingement. RESULTS Nail tip position was in the anterior one third of the distal femur in 71 (47%) of 150 patients, and 38 (25%) of these patients fit the definition for cortical impingement. The radiographic femoral angle of incidence strongly correlated with an anterior nail tip position (p < 0.0001) and cortical impingement (p < 0.0001). Shorter patients were also more likely to have cortical impingement (p < 0.005), and patients less than 160 cm in height had a 49% likelihood of impingement. A starting point in the posterior one third of the greater trochanter increased the likelihood of having an anterior nail tip position as well (p < 0.007). CONCLUSION Of the 150 patients in whom an IMN was used for stabilization of a proximal femur fracture, 71 (47%) had the distal part of their nail positioned in the anterior one third of the distal femur. Patients who are shorter and/or had an increased femoral bow as measured on a lateral roentgenogram are more likely to have an anterior nail tip position or cortical impingement. Posterior starting points should be avoided to prevent this complication. LEVEL OF EVIDENCE Prognostic study, level III; therapeutic study, level IV.

ABSTRACT We have utilized computer navigation to perform osteotomies around the knee. The goal of this article is to present our rationale, indications, and surgical technique of computer-assisted high tibial and doublelevel osteotomies for genu varum deformity. The results are based on 2 studies: (1) a comparative cohort study of computer-assisted versus conventional high tibial osteotomy, showing a 96% reproducibility in achieving a mechanical axis of 184 T 2 degrees in the computer-navigated group versus 71% in the conventional osteotomy group (P G 0.0015); (2) a prospective study on double-level osteotomy showing that the preoperative goal (182 T 2 degrees) has been achieved in 91% of the cases.