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The objective of this study was to evaluate the effectiveness of immersive virtual reality training in orthopedic surgery education in comparison to the standard technique guide for fixed-bearing medial unicompartmental knee arthroplasty DESIGN: Participants included 22 orthopedic surgery residents who were randomized to undergo fixed-bearing medial unicompartmental knee arthroplasty (UKA) surgical training with either an immersive virtual reality technology or by studying the traditional technique guide. Participants were randomized within their training year via block randomization. Participants then performed a medial UKA on a SawBone model using standard industry system surgical trays and equipment. Proficiency, timing, number of errors made, and subjective data were obtained during and after the SawBone procedure. A blinded observer was utilized to obtain objective data.Community Memorial Health System, a primary clinical care institution in Ventura, California.Twenty-two orthopedic surgery residents were randomly selected. There were 7 PGY-1 residents (3 TG, 4 VR), 7 PGY-2s (4 TG, 3 VR), 3 PGY-3s (1 TG, 2 VR), 3 PGY-4s (2 TG, 1 VR), and 2 PGY-5s (1 TG, 1 VR) in total. Eligibility criteria were 1) an active orthopedic surgery resident, 2) no prior immersive VR surgical training, and 3) no prior experience with the Zimmer PPK implants or its technique guide. All participants completed the study.Residents were randomized evenly in the virtual reality (n = 11) and technique guide groups (n = 11). Analysis showed that residents who trained with the immersive VR executed significantly more steps correctly (33 vs. 27, p0.01) and completed their procedure in significantly faster time (26.7 vs. 35.4 minutes, p0.01). They also scored higher in all global assessment categories reaching significance in 4 of 5 categories. Subjective questionnaire responses demonstrated positive feedback within both groups with a trend toward virtual reality. No adverse events were recorded.Immersive virtual reality was more effective than traditional training for the participants of this study. There are numerous potential applications of this technology and it provides an alternative learning modality to accommodate different learning styles.

Patient: Male, 17 Final Diagnosis: Acute exertional compartment syndrome Symptoms: Foot drop • leg pain • paresthesia Medication: — Clinical Procedure: Fasciotomy Specialty: Orthopedics and Traumatology Objective: Rare disease Background: Acute exertional compartment syndrome (AECS) is a rare cause of leg pain often associated with a delay in diagnosis and potentially leading to irreversible muscle and nerve damage. Case Report: We present the case of a previously healthy, high-level athlete who presented with the acute onset of unilateral anterior leg pain and foot drop the day after a strenuous workout. He was diagnosed with compartment syndrome and rhabdomyolysis. His management included emergent fluid resuscitation, fasciotomies, debridement of necrotic muscle from his anterior compartment, and delayed primary closure. After six months of intensive outpatient physical therapy, including the use of blood flow restriction treatments, the patient returned to sports and received a NCAA Division I Football scholarship. Conclusions: We describe the details of this patient’s case and review the literature related to acute exertional compartment syndrome. The occurrence of acute compartment syndrome in the absence of trauma or fracture, though rare, can have devastating consequences following delays in treatment. AECS requires prompt diagnosis and surgical intervention to prevent these consequences. Diagnosis of atraumatic cases can be difficult, which is why awareness is equally as important as history and physical examination. While diagnosis is primarily clinical, it can be supported with direct intra-compartmental pressure measurements and maintaining a high index of suspicion in acute presentations of exertional limb pain.

The incidence of wound complications after open reduction with internal fixation (ORIF) of tibial plateau fractures in young patients has been reported to range from approximately 5 to 15%. Reports on wound complication rates in the elderly patients are limited. This study investigates the incidence of post-operative wound complications in elderly patients undergoing ORIF of their tibial plateau fractures. A retrospective study was performed within three accredited level 1 trauma centres. Patients > 60 years of age undergoing open reduction and internal fixation of their tibial plateau fractures were included. The primary outcome measure was wound complications of the surgical site. These were divided into superficial infections versus deep infections. One hundred two patients matched the inclusion criteria. Of these, 16 patients (15.7%) developed a post-operative wound infection. The analysis of underlying co-morbidities and risk factors revealed that patients with American Society of Anaesthesiologists (ASA) classes 3 and 4 were at significantly increased risk of sustaining a wound complications as compared to ASA classes 1 and 2 (23.7 versus 5.1%, p = 0.015). The overall infection rates in elderly patients undergoing ORIF for tibial plateau fractures is in a similar range to published data on younger patient populations. In particular, elderly patients without significant co-morbidities seem to be appropriate candidates for ORIF of their tibial plateau fractures. However, elderly patients with significant co-morbidities must be considered as high risk and alternative treatment options, such as nonoperative treatment or less invasive surgical options, should be explored in these patients.

Diagnosis of lower limb pain in an athlete can be a challenging task due to the variety of potential etiologies and ambiguity of presenting symptoms. Five of the most commonly encountered causes of limb pain in athletes are chronic exertional compartment syndrome (CECS), medial tibial stress syndrome (MTSS), tibial stress fractures, soleal sling syndrome, and popliteal artery entrapment syndrome (PAES). Of these, the least frequent but potentially most serious of the pathologies is PAES. With an incidence of less than 1% seen in living subject studies, the condition is rare. However, a missed diagnosis will likely lead to progression of the disease and potential for unnecessary invasive procedures (McAree et al. 2008). In this paper, we present a young athlete misdiagnosed and treated for chronic exertional compartment syndrome. In both descriptive and a quick-reference table format, we review current literature and discuss how best to distinguish functional PAES from other causes of activity-related leg pain.