Variability of Orthopedic Physician Fracture Location Identification: Implications for Bone Stimulator Treatment

Scott Huff; Joseph D. Henningsen; Breanna Dominguez; Andrew W. Froehle; Andrew D. Schneider; Fady Y. Hijji; Jennifer L Jerele; Michael J. Prayson

doi:10.1016/j.otsr.2020.04.022

Variability of Orthopedic Physician Fracture Location Identification: Implications for Bone Stimulator Treatment

Scott Huff, Joseph D. Henningsen, Breanna Dominguez, Andrew W. Froehle, Andrew D. Schneider, Fady Y. Hijji, Jennifer L Jerele, Michael J. Prayson

Orthopedic and Plastic Surgery

Research output: Contribution to journal › Article › peer-review

Abstract

<p> <h3 id="x-x-x-sect0010"> Introduction </h3> <p id="x-x-x-spar0005"> Aseptic non-union is a significant complication in approximately 5% of long-bone fractures. External bone stimulation treatment is often attempted before more invasive surgical interventions. Bone stimulators can have favorable results, but have a limited 1.7 cm therapeutic radius. This study evaluated the accuracy by which clinicians locate a fracture on a cadaveric model. This has implications for the clinician's ability to accurately counsel patients on daily bone stimulator placement. Additionally, physicians (orthopedic attending surgeons and residents) were compared with pre-clinical (M1 and M2) medical students to evaluate if higher levels of training improved accuracy. <h3 id="x-x-x-sect0015"> Hypothesis </h3> <p id="x-x-x-spar0010"> Orthopedic physicians and pre-clinical medical students will localize a radiographic fracture within 1.7 cm less than 100% of the time, which represents the ideal consistency for patient care. Furthermore, orthopedic physicians will achieve a higher percentage accuracy than pre-clinical medical students. <h3 id="x-x-x-sect0020"> Materials and methods </h3> <p id="x-x-x-spar0015"> The sample included 20 orthopedic physicians and 16 pre-clinical medical students. Upper (radius) and lower (tibia) extremity cadaver models were prepared by inducing a single, transverse diaphyseal fracture. Plain reference radiographs of each model were obtained. Participants placed a radiopaque marker onto each model at the perceived fracture location, and radiographs were taken to document placement. Perpendicular marker-to-fracture distance was measured to the nearest mm along each bone's long axis using the PACS system. <h3 id="x-x-x-sect0025"> Results </h3> <p id="x-x-x-spar0020"> Placement within the therapeutic radius was achieved by 70–80% of physicians, and 69–75% of medical students. In the remaining participants, improper placement distances were lower among physicians than among medical students (radius: 2.1 ± 0.5 vs. 3.6 ± 0.9 cm, <em> p </em> = 0.02; tibia: 2.6 ± 0.5 vs 3.5 ± 0.5 cm, <em> p </em> = 0.89). <h3 id="x-x-x-sect0030"> Discussion </h3> <p id="x-x-x-spar0025"> In two cadaveric fracture models, up to 30% of orthopedic surgeons perceived a fracture location to be outside a bone stimulator's 1.7 cm therapeutic radius. This finding suggests that physicians and their patients may benefit from additional methods for specifying the location of a non-union before commencing daily bone stimulator treatment. <h3 id="x-x-x-sect0035"> Level of evidence </h3> <p id="x-x-x-spar0030"> Level IV, prospective cohort study-evidence from a well-designed prospective cohort study. </p> </p> </p> </p> </p> </p></p>

Original language	American English
Journal	Orthopaedics and Traumatology: Surgery and Research
DOIs	https://doi.org/10.1016/j.otsr.2020.04.022
State	Published - Oct 1 2020

Keywords

Radiographic Identification
Fracture Localization
Bone Simulator
Non-Union

Disciplines

Medical Specialties
Medicine and Health Sciences
Orthopedics
Plastic Surgery

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@article{7f43e5350c1543029a9438cf64790bfd,

title = "Variability of Orthopedic Physician Fracture Location Identification: Implications for Bone Stimulator Treatment",

abstract = " Introduction Aseptic non-union is a significant complication in approximately 5% of long-bone fractures. External bone stimulation treatment is often attempted before more invasive surgical interventions. Bone stimulators can have favorable results, but have a limited 1.7 cm therapeutic radius. This study evaluated the accuracy by which clinicians locate a fracture on a cadaveric model. This has implications for the clinician's ability to accurately counsel patients on daily bone stimulator placement. Additionally, physicians (orthopedic attending surgeons and residents) were compared with pre-clinical (M1 and M2) medical students to evaluate if higher levels of training improved accuracy. Hypothesis Orthopedic physicians and pre-clinical medical students will localize a radiographic fracture within 1.7 cm less than 100% of the time, which represents the ideal consistency for patient care. Furthermore, orthopedic physicians will achieve a higher percentage accuracy than pre-clinical medical students. Materials and methods The sample included 20 orthopedic physicians and 16 pre-clinical medical students. Upper (radius) and lower (tibia) extremity cadaver models were prepared by inducing a single, transverse diaphyseal fracture. Plain reference radiographs of each model were obtained. Participants placed a radiopaque marker onto each model at the perceived fracture location, and radiographs were taken to document placement. Perpendicular marker-to-fracture distance was measured to the nearest mm along each bone's long axis using the PACS system. Results Placement within the therapeutic radius was achieved by 70–80% of physicians, and 69–75% of medical students. In the remaining participants, improper placement distances were lower among physicians than among medical students (radius: 2.1 ± 0.5 vs. 3.6 ± 0.9 cm, p = 0.02; tibia: 2.6 ± 0.5 vs 3.5 ± 0.5 cm, p = 0.89). Discussion In two cadaveric fracture models, up to 30% of orthopedic surgeons perceived a fracture location to be outside a bone stimulator's 1.7 cm therapeutic radius. This finding suggests that physicians and their patients may benefit from additional methods for specifying the location of a non-union before commencing daily bone stimulator treatment. Level of evidence Level IV, prospective cohort study-evidence from a well-designed prospective cohort study. ",

keywords = "Radiographic Identification, Fracture Localization, Bone Simulator, Non-Union",

author = "Scott Huff and Henningsen, {Joseph D.} and Breanna Dominguez and Froehle, {Andrew W.} and Schneider, {Andrew D.} and Hijji, {Fady Y.} and Jerele, {Jennifer L} and Prayson, {Michael J.}",

year = "2020",

month = oct,

day = "1",

doi = "10.1016/j.otsr.2020.04.022",

language = "American English",

journal = "Orthopaedics and Traumatology: Surgery and Research",

}

TY - JOUR

T1 - Variability of Orthopedic Physician Fracture Location Identification: Implications for Bone Stimulator Treatment

AU - Huff, Scott

AU - Henningsen, Joseph D.

AU - Dominguez, Breanna

AU - Froehle, Andrew W.

AU - Schneider, Andrew D.

AU - Hijji, Fady Y.

AU - Jerele, Jennifer L

AU - Prayson, Michael J.

PY - 2020/10/1

Y1 - 2020/10/1

N2 - Introduction Aseptic non-union is a significant complication in approximately 5% of long-bone fractures. External bone stimulation treatment is often attempted before more invasive surgical interventions. Bone stimulators can have favorable results, but have a limited 1.7 cm therapeutic radius. This study evaluated the accuracy by which clinicians locate a fracture on a cadaveric model. This has implications for the clinician's ability to accurately counsel patients on daily bone stimulator placement. Additionally, physicians (orthopedic attending surgeons and residents) were compared with pre-clinical (M1 and M2) medical students to evaluate if higher levels of training improved accuracy. Hypothesis Orthopedic physicians and pre-clinical medical students will localize a radiographic fracture within 1.7 cm less than 100% of the time, which represents the ideal consistency for patient care. Furthermore, orthopedic physicians will achieve a higher percentage accuracy than pre-clinical medical students. Materials and methods The sample included 20 orthopedic physicians and 16 pre-clinical medical students. Upper (radius) and lower (tibia) extremity cadaver models were prepared by inducing a single, transverse diaphyseal fracture. Plain reference radiographs of each model were obtained. Participants placed a radiopaque marker onto each model at the perceived fracture location, and radiographs were taken to document placement. Perpendicular marker-to-fracture distance was measured to the nearest mm along each bone's long axis using the PACS system. Results Placement within the therapeutic radius was achieved by 70–80% of physicians, and 69–75% of medical students. In the remaining participants, improper placement distances were lower among physicians than among medical students (radius: 2.1 ± 0.5 vs. 3.6 ± 0.9 cm, p = 0.02; tibia: 2.6 ± 0.5 vs 3.5 ± 0.5 cm, p = 0.89). Discussion In two cadaveric fracture models, up to 30% of orthopedic surgeons perceived a fracture location to be outside a bone stimulator's 1.7 cm therapeutic radius. This finding suggests that physicians and their patients may benefit from additional methods for specifying the location of a non-union before commencing daily bone stimulator treatment. Level of evidence Level IV, prospective cohort study-evidence from a well-designed prospective cohort study.

AB - Introduction Aseptic non-union is a significant complication in approximately 5% of long-bone fractures. External bone stimulation treatment is often attempted before more invasive surgical interventions. Bone stimulators can have favorable results, but have a limited 1.7 cm therapeutic radius. This study evaluated the accuracy by which clinicians locate a fracture on a cadaveric model. This has implications for the clinician's ability to accurately counsel patients on daily bone stimulator placement. Additionally, physicians (orthopedic attending surgeons and residents) were compared with pre-clinical (M1 and M2) medical students to evaluate if higher levels of training improved accuracy. Hypothesis Orthopedic physicians and pre-clinical medical students will localize a radiographic fracture within 1.7 cm less than 100% of the time, which represents the ideal consistency for patient care. Furthermore, orthopedic physicians will achieve a higher percentage accuracy than pre-clinical medical students. Materials and methods The sample included 20 orthopedic physicians and 16 pre-clinical medical students. Upper (radius) and lower (tibia) extremity cadaver models were prepared by inducing a single, transverse diaphyseal fracture. Plain reference radiographs of each model were obtained. Participants placed a radiopaque marker onto each model at the perceived fracture location, and radiographs were taken to document placement. Perpendicular marker-to-fracture distance was measured to the nearest mm along each bone's long axis using the PACS system. Results Placement within the therapeutic radius was achieved by 70–80% of physicians, and 69–75% of medical students. In the remaining participants, improper placement distances were lower among physicians than among medical students (radius: 2.1 ± 0.5 vs. 3.6 ± 0.9 cm, p = 0.02; tibia: 2.6 ± 0.5 vs 3.5 ± 0.5 cm, p = 0.89). Discussion In two cadaveric fracture models, up to 30% of orthopedic surgeons perceived a fracture location to be outside a bone stimulator's 1.7 cm therapeutic radius. This finding suggests that physicians and their patients may benefit from additional methods for specifying the location of a non-union before commencing daily bone stimulator treatment. Level of evidence Level IV, prospective cohort study-evidence from a well-designed prospective cohort study.

KW - Radiographic Identification

KW - Fracture Localization

KW - Bone Simulator

KW - Non-Union

UR - https://corescholar.libraries.wright.edu/orthopaedics/44

U2 - 10.1016/j.otsr.2020.04.022

DO - 10.1016/j.otsr.2020.04.022

M3 - Article

C2 - 33041244

JO - Orthopaedics and Traumatology: Surgery and Research

JF - Orthopaedics and Traumatology: Surgery and Research

ER -

Variability of Orthopedic Physician Fracture Location Identification: Implications for Bone Stimulator Treatment

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