THE EFFECTIVENESS OF A BASIC REGIONAL EXTERNAL FIXATION COURSE.

Abstract

Introduction: To assess the effectiveness of a regional basic external fixation trauma course.

Methods: Effectiveness of an annual, low-cost, Royal College of Surgeons of England approved, regional basic ex-fix course, led by consultant trauma experts from Yorkshire, UK, covering anatomy, surgical techniques, biomechanics, early management of open fractures and temporary external fixation placement was assessed. Pre- and post-course questionnaires asking grade, current hospital, previous experience, and a mini-test to design a temporary ex-fix construct for four fracture patterns (IIIb open tibia, open book pelvis, Schatzker 6, and total articular pilon) were used. Designs were assessed for stability, safe corridors and plastics assess.

Results:

• - 10/22 participants had not previously attended an ex-fix course.

• - Pre- vs. post-course score (out of 4) = 2.5 vs. 3.7 (p< 0.001, Mann-Whitney U)

• - All participants Teaching Hospitals vs. DGHs:

• - Pre-course scores = 2.9 vs. 1.9 (p< 0.01)

• - Post-course scores = 3.6 vs. 3.8 (not significant)

• - Pre-course scores by grade of participant:

• - SHO vs. Senior SHO = 2.6 vs. 1.5 (p< 0.05)

• - SpR vs. Senior SHO = 3.0 vs. 1.5 (p< 0.05)

• - SpR vs. SHO = 3.0 vs. 2.6 (not significant)

• - Post-course scores by grade:

• - SpR vs. Senior SHO vs. SHO = 4.0 vs. 3.8 vs. 3.3 (not significant).

Discussion: Recently Pearse and Naique reported a 48% fixation revision rate in open tibial fractures transferred for tertiary care, suggesting that improved core skills are required to ensure appropriate packaging of patients prior to transfer with open, complex articular and pelvic fractures.

Participation in a simple ex-fix course improves knowledge of ex-fix design. Retention of knowledge must be reassessed after several months.

This course fills a gap in education of basic external fixation for orthopaedic trainees. We recommend every region with a tertiary referral system for complex trauma utilises this course.