Abstract
Abstract Background Economic burden and personnel shortages lead to a reduction in the time spent on surgical training of young resident physicians. This underlines the importance of courses for learning and optimizing surgical skills. Particularly for orthopaedic trauma surgery, training on fractured cadaveric specimens has proven highly useful. The present study investigates a method to induce realistic fracture patterns in fresh frozen elbow specimens, leaving the skin and soft tissue envelope intact. Methods For fracture simulation, 10 human cadaveric specimens with intact soft tissue envelopes were placed in 90° flexion in a custom-made high-impact test bench and compressed by an impactor. The fractures were subsequently classified using conventional x‑rays. Results Of the 10 specimens, 6 could be classified as distal humerus fractures and 4 as olecranon fractures. The fractures of the distal humerus were mainly type C according to Arbeitsgemeinschaft Osteosynthesefragen (AO) criteria, the olecranon fractures were mainly type IIB according to the Mayo classification. Subsequently, all 10 specimens would have been appropriate for use in musculoskeletal trauma courses. Conclusion With the given setup it was possible to induce realistic fracture patterns in fresh frozen cadaveric specimens. The advantage of the presented technique lies in the preservation of soft tissue. With their intact soft tissue envelopes, these pre-fractured preparations could be used in courses to precisely train resident physicians directly on human cadaver preparations. Further research should focus on finding reliable predictors to improve the precision of fracture induction in specimens.
Highlights
Economic burden and personnel shortages lead to a reduction in the time spent on surgical training of young resident physicians
The specimens had been checked via fluoroscopy for any relevant pre-existing trauma or significant degeneration of the joints or implants potentially interfering with fracture simulation
Based on the present findings, we conclude that simulation of fractures of the distal humerus and the olecranon on fresh frozen human cadaveric specimens with an otherwise intact skin and muscle envelope is possible using an axial impaction unit
Summary
10 fresh frozen human cadaveric upper extremities (5 right and 5 left extremities) were used. Thereafter, over a length of 5 cm, the humeral shaft of the specimens was dissected free of any muscle and other soft tissues Prepared in this way, the humerus was potted in steel cylinders using polymethyl methacrylate (PMMA). The applied kinetic energy was estimated based on the constitution of the specimen, as specimens vary in bone density and stability. To achieve fractures of the distal humerus and the olecranon, specimens were placed in 90° flexion of the elbow below the impactor The steel plate of the potting cylinders was mounted on the distal end of the impactor in a way that the humeral shaft ended up in a position vertical to the ground plate. Differences in the applied kinetic energy between olecranon and distal humerus fractures were analysed using a two-sample t-test. The level of significance was set at p ≤ 0.05
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