Closing-wedge Osteotomies: Can We Do and Teach Better?

Area of Science:

• Orthopaedic Surgery
• Pediatric Orthopaedics
• Limb Deformity Correction

Background:

• Wedge osteotomies are common in pediatric orthopaedics and limb deformity surgery.
• No single methodology is universally preferred for these procedures.
• This study evaluates methods for wedge-shaped osteotomies in long bones.

Purpose of the Study:

• To determine the relative accuracy and effectiveness of measuring and marking methods for wedge osteotomies.
• To guide best practices for trainees performing these procedures.

Main Methods:

• Observational cohort study involving orthopaedic residents (postgraduate years 1-5).
• Residents performed 30-degree wedge osteotomies on sawbone femurs using different measuring tools (none, triangle, goniometer) and marking methods (pen, pin).
• Osteotomy performance (quality, time, accuracy) and demographic data were assessed using multivariate regressions and ANOVA.

Main Results:

• Marking pen use resulted in shorter completion times, higher surface quality, and better accuracy compared to guide pins.
• Goniometer and triangle use were associated with longer completion times than no visual aid.
• Female residents had longer completion times but comparable accuracy and quality.

Conclusions:

• Recommends using a marking pen with a preferred measuring guide to optimize trainee performance in closing wedge osteotomies.
• Suggests future research in higher-fidelity settings like cadaveric studies.
• Highlights that slower completion times in some trainees do not equate to poor performance, informing diverse training approaches.