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=====The Effect of Casting Simulation on Maintenance of Fracture Alignment Following Closed Reduction of Pediatric Distal Radius Fractures: Does More Simulation Matter?=====

====Abstract====
BACKGROUND: The purpose of this study was to evaluate the effectiveness of a simulation curriculum on performance of closed reduction (CR) and casting of distal radius and distal both-bone forearm fractures by orthopaedic surgery residents. The secondary aim was to identify if repeated simulation training during the clinical rotation provided additional benefit. METHODS: Orthopaedic surgery residents performed simulated distal radius fracture (DRF) reduction and cast application near the beginning and end of their 6-month pediatric orthopaedic clinical rotation at a tertiary care children’s hospital. A subgroup of trainees were randomly assigned additional simulation training halfway through their rotation. Clinically, 28 residents treated 159 distal radius and/or distal both-bone forearm fractures with CR and casting during the study period. Radiographic evaluations were performed comparing postreduction fracture angulation, displacement, cast index, and loss of reduction (LOR) rates at the beginning of a resident’s rotation (presimulation cases) and at the end of the resident’s rotation (postsimulation cases). Comparisons were also made between residents who had and did not have additional simulation training exposure during their rotation. RESULTS: Overall, postreduction radius angulation, maximal angulation, and cast index were lower in the postsimulation group than in the presimulation group with means 1.8°, 2.6°, and 0.75 vs 4.0°, 4.4° and 0.77, respectively. LOR rate was also lower (14% vs 30%). No significant differences were demonstrated for postreduction ulna angulation as well as for radius, ulna, or maximal displacement between these 2 groups. No significant differences were observed in radiographic parameters, cast indices, or LOR rates between residents who underwent additional mid-rotation training vs those who did not. CONCLUSIONS: The incorporation of a simulation training curriculum for CR and casting of pediatric distal forearm fractures resulted in statistically significant, however, marginally improved postreduction radiographic parameters and LOR rates among orthopaedic residents. The utility of repeated additional simulation training during the course of a clinical rotation remains unclear in the short term.

====Commentary====
> Each training module was 2.5 hours and included instruction on distal radius fracture reduction, cast application, and cast removal. Trainees were specifically asked to perform a simulated CR of a distal radial fracture, to apply a well-molded short arm cast, and to subsequently remove the cast using standard oscillating cast saws. Before the simulation, residents were provided with reading and video materials demonstrating techniques for applying, molding, bivalving, and removing casts. A didactic lecture was also provided prior to the training. During the simulation, participants received feedback from an attending orthopaedic surgeon regarding cast application and removal. The simulation exercise was similar to that performed by Moktar and colleagues13 and met the standards of The International Nursing Association for Clinical Simulation and Learning (INACL). In brief, subjects in that study applied a short arm plaster cast to a synthetic forearm model that was fixed to a multiangle bench-top clamp. Each participant was filmed (and later de-identified) during the process of cast application so that an attending surgeon could later rate the technical proficiency of the cast application

===Simulation training===
  * 2.5 hours
  * didactic lecture
  * simulated CR on a ?model?
  * apply a cast
  * remove the cast
  * feedback  

Was training assessed? No

What was the model used?

====Source=====
Rabinovich, R. V., Shore, B. J., Glotzbecker, M., Kalish, L. A., & Bae, D. S. (2021). The Effect of Casting Simulation on Maintenance of Fracture Alignment Following Closed Reduction of Pediatric Distal Radius Fractures: Does More Simulation Matter? Journal of Surgical Education, S1931720421000568. https://doi.org/10.1016/j.jsurg.2021.03.003
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