Orto&Trauma with Dr. Polotrauma

Surgical simulation is changing how orthopaedic trainees learn fracture surgery. In this episode, we break down a review by Marchand and colleagues, published in the Journal of the American Academy of Orthopaedic Surgeons in 2020, on simulation training in fracture surgery. We start with why the traditional apprenticeship model is under pressure from work hour limits and cost constraints. Then we walk through the four main simulation modalities: composite bone models, virtual reality, cognitive task analysis, and cadaver specimens. We look at the evidence that simulator practice improves proficiency and transfers to real surgery, most clearly for hip fracture fixation with the dynamic hip screw. We cover the barriers too, including that twenty five percent of US programs lack simulation facilities and eighty seven percent of directors cite funding. Finally, we discuss why simulation must sit inside a formal curriculum alongside didactic teaching, never as a replacement for mentorship. Simulation Training in Fracture SurgeryMarchand LS, Sciadini MF · Journal of the American Academy of Orthopaedic Surgeons, 2020https://doi.org/10.5435/JAAOS-D-20-00076 Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma

Elbow and forearm injuries are a daily reality in emergency care, and a few of them can threaten the limb. In this episode we break down the 2020 review by Hanlon and Mavrophilipos in Emergency Medicine Clinics of North America. The elbow is the second most commonly dislocated large joint in adults: 90% of dislocations are posterolateral, one in three carries an associated fracture, and ulnar nerve injury appears in 8% to 21% of posterior dislocations. We cover the four-way range of motion test that can rule out the need for radiographs, point-of-care ultrasound that detects as little as 1 to 3 mL of joint fluid, the Mason classification for radial head fractures, and the Monteggia pattern whose radial head dislocation is missed in 20% to 50% of first evaluations. We close with reduction techniques, splinting positions, and why immobilization beyond three weeks ruins outcomes. The Emergent Evaluation and Treatment of Elbow and Forearm InjuriesHanlon DP, Mavrophilipos V · Emergency Medicine Clinics of North America, 2020https://doi.org/10.1016/j.emc.2019.09.005 Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma

Gastrocnemius recession is a popular procedure to release isolated calf tightness, a recognized contributor to forefoot overload, plantar fasciitis, flatfoot and foot pain. But planning the incision by visual landmarks alone can be deceiving: calf shapes vary so much that the incision may be off by several centimeters, and cutting the underlying soleus effectively converts the operation into an Achilles lengthening. In this episode we review the technique described by Toomey and Seibert: a quick preoperative ultrasound scan, done in the holding area with the same machine used for nerve blocks, that reproducibly locates the gastrocnemius-soleus junction and allows a smaller, precisely placed incision with an isolated release of the gastrocnemius fascia. We also cover the supporting outcome data from cited series: pain scores improving from 8/10 to 2/10 with 93 percent satisfaction, peak torque recovering to 74 percent of the opposite limb by 18 months, and a 6 percent adverse event rate across 126 cases with all patients achieving a single limb heel rise at 6 months. The Use of Ultrasound to Isolate the Gastrocnemius-Soleus Junction Prior to Gastrocnemius RecessionToomey EP, Seibert NR · Foot and Ankle Clinics of North America, 2014https://doi.org/10.1016/j.fcl.2014.08.008 Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma

When a partial knee replacement becomes infected, surgeons must decide whether to remove the implant or try to save it. This episode reviews a systematic review and meta-analysis on debridement, antibiotics, and implant retention for periprosthetic joint infection after unicompartmental knee arthroplasty. Pooling nine studies and 165 patients from several countries, the authors found that the implant-saving approach achieved an infection-free survival of 72 percent, with all-cause implant survival around 67 percent. However, roughly one in three patients eventually required conversion to a total knee replacement, and about one in six needed a repeat debridement. Staphylococcus aureus was the most common infecting organism, found in about 39 percent of cases, and most infections were acute. The evidence comes mainly from small case series, so quality is limited, but the message is practical: for an acute infection with a well-fixed implant, DAIR is a reasonable first-line treatment, provided patients are counseled honestly about the real chance of further surgery. Debridement, Antibiotics, and Implant Retention in Periprosthetic Joint Infection after Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-AnalysisBałoniak A, Jancevski T, Campos Martins E · The Journal of Arthroplasty, 2026https://doi.org/10.1016/j.arth.2026.05.035 Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma

A nationwide survey of 185 department heads reveals that 55 percent of German O and T clinics have unfilled positions. We break down the severity of the junior doctor shortage, the impact of administrative burden, and what needs to change to secure the future of the specialty.

A nationwide survey of 185 department heads reveals that 55 percent of German O and T clinics have unfilled positions. We break down the severity of the junior doctor shortage, the impact of administrative burden, and what needs to change to secure the future of the specialty.

This episode breaks down Barouk's 12-year experience with proximal medial gastrocnemius lengthening. We cover why medial-only release matches combined techniques in a blinded comparison, how 79 percent of patients normalized dorsiflexion at two years, and why this approach may be a practical alternative to the distal Strayer procedure for equinus contracture.

This episode breaks down Barouk's 12-year experience with proximal medial gastrocnemius lengthening. We cover why medial-only release matches combined techniques in a blinded comparison, how 79 percent of patients normalized dorsiflexion at two years, and why this approach may be a practical alternative to the distal Strayer procedure for equinus contracture.

This episode breaks down Barouk's 12-year experience with proximal medial gastrocnemius lengthening. We cover why medial-only release matches combined techniques in a blinded comparison, how 79 percent of patients normalized dorsiflexion at two years, and why this approach may be a practical alternative to the distal Strayer procedure for equinus contracture.

This episode breaks down Barouk's 12-year experience with proximal medial gastrocnemius lengthening. We cover why medial-only release matches combined techniques in a blinded comparison, how 79 percent of patients normalized dorsiflexion at two years, and why this approach may be a practical alternative to the distal Strayer procedure for equinus contracture.

This episode covers the largest single-centre review of guided growth using tension band plates for angular deformity of the knee. We break down why idiopathic deformity achieves 89.5 percent success while tumour and infection-related cases carry significantly higher failure rates, and what that means for clinical decision-making.

This episode covers the largest single-centre review of guided growth using tension band plates for angular deformity of the knee. We break down why idiopathic deformity achieves 89.5 percent success while tumour and infection-related cases carry significantly higher failure rates, and what that means for clinical decision-making.

This episode breaks down a retrospective study on tension band plating for juvenile and adolescent Blount disease. We cover why a 53 percent success rate in zone minus four deformities challenges previous reports, how 4-screw constructs may reduce implant failure, and why BMI is a critical factor clinicians should address early.

This episode covers the original 1998 study by Métaizeau and colleagues that introduced percutaneous epiphysiodesis using transphyseal screws. We break down how a 10-minute procedure achieves 79 to 86 percent growth arrest, why 82 percent of patients finish within one centimeter of equal, and what makes this technique reversible compared to drilling or curettage.

This episode covers the original 1998 study by Métaizeau and colleagues that introduced percutaneous epiphysiodesis using transphyseal screws. We break down how a 10-minute procedure achieves 79 to 86 percent growth arrest, why 82 percent of patients finish within one centimeter of equal, and what makes this technique reversible compared to drilling or curettage.