Influence of Surgeon's Expertise on the Duration of Approach and Closure during Osteosynthesis of Distal Radius Fractures

Abstract

Abstract Background The aim of this study was to determine whether the duration of the approach (PII) and closure (PV) phases for minimally invasive plate osteosynthesis (MIPO) of distal radius fractures varied according to the surgeon's level of expertise. The main hypothesis was that the PII or PV duration was inversely proportional to the level of expertise. Methods The method measured the duration of PII and PV for 50 videos of MIPO operated by one surgeon with level 3E expertise, three with level 4E, and one with level 5E. The videos were viewed to identify any technical errors. Results The average PII duration was 3 minutes 8 seconds for level 5E, 4 minutes 7 seconds for 4E, and 6 minutes 19 seconds for 3E. Average PV duration was 2 minutes 12 seconds for level 5E, 2 minutes 36 seconds for 4E, and 2 minutes 41 seconds for 3E. The average duration of PII + PV was 5 minutes 20 seconds for level 5E, 6 minutes 37 seconds for 4E, and 9 minutes for 3E. These findings indicate that both PII and PV duration was the longest in the level 3E surgeons' practice. Six technical errors were identified for levels 3E and 4E during PII (hemostasis control, multiple incisions, instrument handling, improper use of the fluoroscope, time-outs) and PV (intradermal reattachment). Clinical Relevance The main hypothesis was verified since the duration of PII or PV was inversely proportional to the surgeon's level of expertise. This study identified technical errors in hand surgery practices of new surgeons. By early identification and correcting these minor errors, it would be possible to speed up the learning curve. We recommend surgical videos to be systematically recorded and analyzed to improve hand surgery practices. Type of Study/Level of Evidence Therapeutic/Level IIIa.