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Abstract Background Training in delicate spinal dura mater suturing techniques poses significant challenges due to patient safety and medicolegal concerns, driving the need for alternative training methods beyond traditional mentorship models. This study aimed to introduce and validate a training model for orthopaedic residents using perfusion-based porcine spines to simulate intraoperative durotomy and subsequent repair. Methods Nine junior orthopaedic residents were invited to participate. Three attending orthopaedic spine surgeons were included in the control group. Fresh porcine spines were used for the simulation, and a perfusion-based system was implemented to replicate cerebrospinal fluid circulation and apply hydrostatic pressure to the dura. Durotomies were made and mended with 6–0 prolene sutures, and the participants’ performance was assessed across six trials for repair speed and leakage pressure. Additionally, the self-confidence levels of the residents were analyzed before and after the training. Results While attending surgeons showed consistent performance across trials, residents demonstrated a 70% reduction in mean total time and a 62% increase in mean leakage pressure after training. Residents showed significant improvements in repair speed from Trial 4 and in repair quality from Trial 3 compared with Trial 1 as the baseline. The difference compared with attending surgeons became insignificant in repair speed from Trial 4 and in repair quality from Trial 2, indicating that the residents' performance approached that of the attending surgeons. Residents’ self-confidence increased significantly from a mean pre-training score of 1.1 to a mean post-training score of 4.3. Conclusions This simulation model, which utilizes fresh porcine spines and a perfusion-based system, is an accessible, cost-effective, and high-fidelity training method for dural repair during spinal surgery.

Background: Fracture of the tibia shaft accounts for 17% of lower extremity fractures, with concurrent fibula fracture in about 78% of these cases. Intramedullary fixation for fibula fractures can restore fibula alignment and thus facilitate fracture reduction, especially in cases with comminuted shaft or distal metaphyseal tibia fractures. Methods: Patients who had internal fixation of comminuted tibia shaft or distal metaphyseal tibia fracture and a concurrent fibular fracture treated with intramedullary Steinman pin fixation were included in this study. Patients' demographic data and fracture patterns were analyzed retrospectively. Postoperative X-rays were used for fracture union evaluation and alignment analysis. Results: Nine males and one female were included in the present study. Tibia fractures were classified as four OTA42 and as six OTA43, including one type I, two type II, one type IIIA, and three type IIIB open fractures. Intramedullary nail and locking plate were used as definitive fixation in four and six cases, respectively. Complications required additional surgeries including wound debridement for one patient, bone graft for three patients, and revision surgery from a broken plate to an intramedullary nail for one patient. A total of 14 fibula fractures were identified in ten patients due to four segmental fractures. Eight were Weber type C, one was Weber type B, and five were midshaft fractures. The mean duration of fibula fracture healing according to radiographs was 6.9 months. Conclusions: This study suggests that intramedullary Steinmann pin fixation for concurrent fibula fracture is a critical procedure when dealing with comminuted shaft or distal metaphyseal tibia fractures.

Although spontaneous rupture of the extensor tendon of the knee is more likely to occur in uremic patients with secondary hyperparathyroidism, simultaneous ruptures of bilateral knee extensor tendons is a rarely reported condition. We describe a 30-year-old man with uremia who underwent subtotal parathyroidec-tomy because of secondary hyperparathyroidism with very high serum parathyroid hormone (PTH) level (1940.4 pg/mL). Two weeks later, he complained of a sharp pain in both knees without trauma when he walked downstairs with his left knee forward and right knee behind. Spontaneous simultaneous ruptures of the right patellar tendon and the left quadriceps tendon were diagnosed and surgically repaired. The mechanism of spontaneous tendon rupture in uremic patients with secondary hyperparathyroidism seems to be related to high PTH level which results in osteolytic bone resorption at the tendon insertion site. Early surgical repair, control of secondary hyperparathyroidism, early use of vitamin D analogs, and total parathyroidectomy with or without autotransplantation of part of the parathyroid gland, can treat and prevent tendon rupture or re-rupture with satisfactory results.