The Use of Clinical Reasoning Skills in the Setting of Uncertainty: A Case of Trial Femoral Head Migration

A comparison of three techniques for the osteosynthesis after minimal invasive osteotomies for hallux valgus

PURPOSE

Third and fourth-generation minimal invasive osteotomies (MIO) for the treatment of hallux valgus (HV) have become popular procedures worldwide with promising results due to the improvement in the fixation method. The tricortical cannulated screw placement remains a complex procedure that is technically challenging and requires a long skill learning curve with high radiation exposure mainly in the form of intensifier shots (IS) required for the MIO fixation. This study aims to compare the number of X-ray IS required using three different techniques for the cannulated guide placement.

METHODS

A retrospective cross-sectional observational and comparative study was conducted to assess the number of X-rays IS required for correct cannulated screw guide placement using three different techniques: traditional perforator, the drill and joystick, and K-wire first techniques.

RESULTS

A total of 53 MIS procedures from thirty-one patients in two different hospitals were included. IS X-rays were 155.1 ± 29.7 in the traditional technique (n = 14), 143.0 ± 43.2 in the drill and joystick technique (n = 22), and 85 ± 18.7 in the K-wires first technique (n = 17), p =  < 0.001 using one-way ANOVA.

CONCLUSIONS

The K-wire first technique statistically significantly decreases X-ray IS numbers p ≤ 0.001. There were no statistically significant differences between the traditional (after osteotomy K-wire placement) and the drill and joystick techniques (p = 0.36).

Payment with knowledge: A method for a training of anatomy near-peer teachers and formation of future anatomists

Near-peer teaching has been widely implemented in medical schools and the benefits for the near-peer teachers (NPTs), the students, and the institution have been well documented. However, NPT training methods and perceptions of such have been limited. A four-year clinical anatomy and surgical training program was established (est. 2019) as part of the continuous training timeline for NPTs (n > 60 total) formation at the Universidad Autónoma de Nuevo León, in Mexico. The program provides various training courses for the NPTs according to their hierarchy, including teaching skills, professional development, psychosocial aspects, and career objectives. A "Clinical Anatomy and Surgical Training Diploma" was planned with 12 modules to aid in developing these abilities, along with a higher understanding of clinical anatomy shared by expert clinical specialists, and diverse clinical and surgical skills such as suturing, catheterization, and basic surgical procedures. The program has a completion rate of approximately 15 NPTs/year. All, while creating an environment with a sense of belonging, and facilitating mentorship between fellow NPTs and educators. Near-peer teachers develop leadership, communication, and teaching skills. The program has provided a constant source of anatomy educators, avoiding any shortage.

Trendelenburg (Head-Down Tilt) and Head Rotation: Ultrasonographic effects on the internal jugular vein for catheterization safety

Most guidelines fail to specify patient positioning during central venous catheterization. The objective was to determine the effects of head-down tilt (Trendelenburg position) and head rotation on the internal jugular vein (IJV). A prospective, observational, longitudinal, and descriptive study using healthy adult volunteers, of both sexes, was performed. The change in position and cross-sectional areas (CSA) of the right IJV and common carotid artery (CA) were measured by ultrasonography during Trendelenburg position (TP) (0°, 5°, 10°, and 15°) and contralateral head-rotation (HR) (0°, 45°, and 90°) for a total of 12 positions. The neutral supine position was first, randomizing the other 11 positions, with 5-minute rest intervals in between. Vital signs and symptoms were recorded. A total of 54 volunteers were recruited between the ages of 21 and 32, of which 30 were men. Any degree of TP or HR significantly increased the CSA. The largest area obtained was 1.78cm² with a TP15HR90 which did not have a statistical difference with TP10HR45 1.59cm² . A HR90 tended to displace the IJV medially, overlaying the CA. Any degree of TP or HR will significantly increase CSA or the right IJV. A 5° to 10° TP is recommended when the patient's condition allows it, with a 45° HR, without significantly displacing the IJV anterior to the CCA. This article is protected by copyright. All rights reserved.