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Simulation-based surgical skills training addresses several concerns associated with the traditional apprenticeship model, including patient safety, efficient acquisition of complex skills, and cost. The surgical specialties already recognize the advantages of surgical training using simulation, and simulation-based methods are appearing in surgical education and assessment for board certification. The necessity of simulation-based methods in surgical education along with valid, objective, standardized techniques for measuring learned skills using simulators has become apparent. The most commonly used surgical skill measurement techniques in simulation-based training include questionnaires and post-training surveys, objective structured assessment of technical skills and global rating scale of performance scoring systems, structured assessments using video recording, and motion tracking software. The literature shows that the application of many of these techniques varies based on investigator preference and the convenience of the technique. As simulators become more accepted as a teaching tool, techniques to measure skill proficiencies will need to be standardized nationally and internationally.

Introduction Following successful closed reduction, the ideal timing of operative fixation for ankle fracture–dislocations is not well understood. We sought to describe the rate at which initial reduction is lost between the Emergency Department (ED) and clinic visits, and to identify factors associated with loss of reduction. Materials and methods We identified 30 patients with isolated, closed ankle fracture–dislocations that were successfully reduced and splinted in the ED prior to operative intervention. The maintenance of reduction at follow-up clinic visit was defined as a success, and loss of reduction was defined as a failure. Results There were 17 (57%) successes and 13 (43%) failures. When the ratio of posterior malleolus (PM) fracture fragment size to complete articular surface was >0.1, rate of failure was 65% compared with 18% when the ratio was ≤0.1 (p = 0.016). Conclusion Ankle fracture–dislocations with a larger PM fracture fragment size may warrant consideration of earlier operative intervention. Level of evidence IV, Case Series. Matson AP, Green CL, Hurwitz SR, Zura RD. Stability of Ankle Fracture–dislocations following Successful Closed Reduction. The Duke Orthop J 2017;7(1):58-63.

Outcomes following ankle fracture surgery have been well studied; however, factors associated with surgical wound healing specifically are less clear. We aimed to study the relationship between wound healing and body mass index, as well as other variables following surgical treatment of ankle fractures. There were 127 consecutive, isolated, closed, malleolar ankle fractures treated with open reduction and internal fixation at a level-1 trauma center from 2008 to 2012. Patient, injury, and treatment variables were recorded and clinical records were reviewed to identify wound complications. There were 6 major and 18 minor wound complications. The overall rate of wound complication of any type was significantly lower in obese patients at 11.7% (7/60) compared with 25.4% (17/67, P < .05) in nonobese patients. When controlling for other variables obesity was associated with a significantly lower risk of developing a wound complication (OR 0.267, 95% CI 0.087-0.822), as was low energy mechanism (OR 0.246, 95% CI 0.067-0.906). No other covariates tested were associated with an increased risk of a wound infection. Ankle anatomy may present a unique situation whereby obesity may be protective against wound complications. Further studies are needed to confirm this clinical observation, and to demonstrate the mechanism through which this may occur.Levels of Evidence: Therapeutic, Level IV: Retrospective

Simulation-based surgical skills training is recognized as a valuable method to improve trainees’ performance and broadly perceived as essential for the establishment of a comprehensive curriculum in surgical education. However, there needs to be improvement in several areas for meaningful integration of simulation into surgical education. The purpose of this focused review is to summarize the obstacles to a comprehensive integration of simulation-based surgical skills training into surgical education and board certification and suggest potential solutions for those obstacles. First and foremost, validated simulators need to be rigorously assessed to ensure their feasibility and cost-effectiveness. All simulation-based courses should include clear objectives and outcome measures (with metrics) for the skills to be practiced by trainees. Furthermore, these courses should address a wide range of issues, including assessment of trainees’ problem-solving and decision-making abilities and remediation of poor performance. Finally, which simulation-based surgical skills courses will become a standard part of the curriculum across training programs and which will be of value in board certification should be precisely defined. Sufficient progress in these areas will prevent excessive development of training and assessment tools with duplicative effort and large variability in quality.

Background: The indications and criteria for meniscal repair are expanding in parallel with new understanding in biomechanics, joint pathophysiology, and increased physician education. Purpose: To describe the practice patterns of arthroscopic meniscal treatment in recent years, compare the trends of arthroscopic meniscal repair versus arthroscopic meniscectomy, and compare sports fellowship–trained versus non–sports fellowship–trained surgeons in terms of arthroscopic meniscal treatment techniques among American Board of Orthopaedic Surgery (ABOS) candidates from 2004 to 2012. Study Design: Descriptive epidemiology study. Methods: The ABOS database was used to identify cases of meniscal repair, partial meniscectomy, and anterior cruciate ligament (ACL) reconstruction from 2004 to 2012. The number of surgeons contributing cases for each calendar year was also recorded, along with the number who had sports fellowship training. Rates were calculated as the number of procedures per surgeon per year. Trends were analyzed using Poisson regression analysis to model the rate of each procedure over time. Results: The rate of all meniscal procedures per surgeon decreased 12% from 18.4 cases per surgeon in 2004 to 16.2 cases per surgeon in 2012. There was a smaller decrease for sports fellowship–trained surgeons (7%) than for non–sports fellowship–trained surgeons (32%). The rate of meniscal repair cases per surgeon increased 37% from 1.6 to 2.2 cases per surgeon. The rate of meniscectomy cases decreased 17% from 16.8 to 14.0 cases per surgeon. When comparing fellowship-trained surgeons to non–fellowship-trained surgeons, there was no significant difference in meniscal repair rates over time. There was a decrease of 35% in rates of meniscectomy among non–fellowship-trained surgeons compared with 11% among fellowship-trained surgeons. Conclusion: This study provides insight into the current practice trends of recent orthopaedic training graduates in the treatment of meniscal tears. The results suggest that reported meniscal procedures have decreased overall among ABOS candidates but that meniscal repair cases have increased. The findings support the recent shift toward evidence-based medicine, with changing practice patterns that may reflect the dissemination of recent findings from large, high-quality research studies in this field.