Clinical Readiness Evaluation - Uniplanar External Fixation

This is an open-book examination to evaluate clinical readiness after the learner has demonstrated technical competence on the simulator and feels confident to proceed to clinical cases.

For Question #1, the learner will require access to their completed Training Logbook checklist that should be saved as a PDF on their mobile device or computer and access to the 5 photos of their Self-Assessment Framework that should be saved on their cellphone or computer.

For Questions #2-#11, the learner can use the four recommended references below that explain the differences between the actual clinical procedure versus this simulation-based skills training are:

  1. https://www.appropedia.org/Uniplanar_External_Fixation_for_an_Open_Tibial_Shaft_Transverse_Fracture#Learning_Objectives
  2. https://www.appropedia.org/Uniplanar_External_Fixation/Knowledge_Review/Uniplanar_External_Fixation#Sterile_Prepping_and_Draping_Technique
  3. https://www.appropedia.org/Uniplanar_External_Fixation_for_an_Open_Tibial_Shaft_Transverse_Fracture#Procedure_Steps
  4. https://www.appropedia.org/Uniplanar_External_Fixation/Training_Logbook

The learner can repeat this examination as many times as necessary to achieve the required minimum passing score of 11 (100% correct).

Date of Evaluation (month, day, year):__________________

Learner's First and Last Nameː____________________________________

1 Were all the Training Logbook checklist items (except for the steps that cannot be performed during this simulation-based skills training) rated as "Done Correctly"?

Yes
No

2 What are the differences between how sterile preparation and draping is performed during the actual clinical procedure versus this simulation-based skills training? Select all correct answers.

Normally, assistant #1 will wear gloves and use both gloved hands to support the patient's foot to lift up the injured leg. However, assistant #1 can skip wearing gloves to reduce material costs during this simulation-based skills training.
Normally, the surgical practitioner and assistant #2 will wear sterile gowns and sterile gloves during sterile preparation and draping. However, the surgical practitioner and assistant #2 can skip wearing sterile gowns and sterile gloves to minimize material costs during this simulation-based skills training.
Normally, the surgical practitioner will use 3 sterile sponge sticks, and 3 sterile folded up gauze pads dipped in sterile preparation solution during sterile preparation and draping. However, the surgical practitioner can use 1 non-sterile sponge stick and 1 non-sterile folded up gauze pad and skip using the sterile preparation solution to minimize material costs during this simulation-based skills training.
Normally, the surgical practitioner and assistant #2 will use sterile sponge sticks, sterile folded up gauze pads, sterile drapes, sterile towel clamps, a sterile towel, and a sterile gauze roll during sterile preparation and draping. However, the surgical practitioner and assistant #2 can re-use non-sterile materials and equipment to minimize material costs during this simulation-based skills training.
There are no differences between how sterile preparation and draping is performed during the actual clinical procedure versus this simulation-based skills training.

3 What are the differences between how irrigation and debridement is performed during the actual clinical procedure versus this simulation-based skills training? Select all correct answers.

Normally, an average of 3L of irrigation solution (distilled water or isotonic saline) is used for each successive Gustilo Type (i.e., 6L for Gustilo Type II and 9L for Gustilo Type III) for wound lavage of an open tibial fracture to reduce the risk of infection. However, an empty syringe can be used to simulate wound lavage during this simulation-based skills training.
Normally, all foreign material and non-viable tissue is debrided to prevent infection and minimize wound complications. However, the simulator does not display foreign material or non-viable tissue so this step is skipped during this simulation-based skills training.
There are no differences between how irrigation and debridement is performed during the actual clinical procedure versus this simulation-based skills training.

4 What is the difference between how the practitioner avoids inserting a Schanz Screw into the ankle joint during the actual clinical procedure versus this simulation-based skills training?

Normally, the "far" Schanz screw in the distal fragment should be placed at least two fingers’ breadth proximal to the medial malleolus while avoiding traumatized soft tissues to avoid entry into the ankle joint. However, the simulator does not display the medial malleolus so this step is skipped during this simulation-based skills training.
There is no difference between how the practitioner avoids inserting a Schanz Screw into the ankle joint cavity during the actual clinical procedure versus this simulation-based skills training.

5 What are the differences between how each pin insertion site is accessed during the actual clinical procedure versus this simulation-based skills training? Select all correct answers.

Normally, a 22 blade scalpel is used to make a stab incision in the soft tissue overlying the anteromedial tibial wall for each Schanz screw. However, the simulator does not have simulated soft tissue so this step is skipped during this simulation-based skills training.
Normally, dissecting scissors are used to spread the soft tissue apart in each stab incision to expose the bone for drilling of each Schanz screw. However, the simulator does not have simulated soft tissue so this step is skipped during this simulation-based skills training.
There are no differences between how each pin insertion site is accessed during the actual clinical procedure versus this simulation-based skills training.

6 What is the difference between how the drill sleeve is used during the actual clinical procedure versus this simulation-based skills training?

Normally, the drill sleeve is positioned directly on the near cortex in the stab incision to protect the surrounding soft tissues when drilling. However, the drill sleeve should be pulled back and kept at least 3.0 mm above the near cortex only during this simulation-based skills training to prevent plastic strands from getting stuck inside the drill sleeve while drilling.
There is no difference between how the drill sleeve is used during the actual clinical procedure versus this simulation-based skills training.

7 What is the difference between how irrigation is provided while drilling during the actual clinical procedure versus this simulation-based skills training?

Normally, irrigation should be provided when drilling is performed to reduce the risk of thermal osteonecrosis. However, an assistant can simulate irrigation with an empty syringe while drilling is performed during this simulation-based skills training.
There is no difference between how irrigation is provided while drilling during the actual clinical procedure versus this simulation-based skills training.

8 What is the difference between how the clinical verification of adequate restoration of rotational alignment is performed during the actual clinical procedure versus this simulation-based skills training?

Normally, restoration of rotational alignment is confirmed by visually checking the position of the big toe and the alignment of the middle of the second toe with the center of patella. However, the simulator does not include a foot or patella so the tibial crest will be visually inspected and palpated to verify restoration of rotational alignment during this simulation-based skills training.
There is no difference between how the clinical verification of adequate restoration of rotational alignment is performed during the actual clinical procedure versus this simulation-based skills training.

9 What is the difference between how to verify the post-reduction restoration of limb length during the actual clinical procedure versus this simulation-based skills training?

Normally, the medial malleolus of both limbs is palpated under sterile conditions to estimate and compare the length of the reduced limb to the uninjured limb. Then a measuring tape is used to measure and compare the limb length (from the anterior superior iliac spine to the medial malleolus) of both legs to confirm acceptable length discrepancy in the injured leg after dressings have been applied. However, the simulator does not display the contralateral limb, anterior superior iliac spine, or medial malleolus so the fracture line will be visually inspected for shortening or distraction to confirm that the fracture has been adequately reduced during this simulation-based skills training.
There is no difference between how to verify the post-reduction restoration of limb length during the actual clinical procedure versus this simulation-based skills training.

10 What is the difference between how the post-fixation inspection of the skin around the Schanz screws is performed during the actual clinical procedure versus this simulation-based skills training?

Normally, the pin sites are inspected for skin tenting. If skin tenting is present, the stab incision should be widened to release any soft tissue tension around the pin site to reduce the risk of inflammation and pin site infection. However, the simulator does not have simulated soft tissue so this step is skipped during this simulation-based skills training.
There is no difference between how the post-fixation inspection of the skin around the Schanz screws is performed during the actual clinical procedure versus this simulation-based skills training.

11 What are the differences between the final steps of the actual clinical procedure versus this simulation-based skills training? Select all correct answers.

Normally, the extremity should be cleaned and sterile gauze dressings applied to all 4 pin sites at the end of the procedure. However, this step is skipped during this simulation-based skills training.
Normally, a measuring tape should be used to measure and compare the limb length (from the anterior superior iliac spine to the medial malleolus) of both legs to confirm acceptable length discrepancy in the injured leg after dressings have been applied. However, the simulator does not display the contralateral limb, anterior superior iliac spine, or medial malleolus so this step is skipped during this simulation-based skills training.
Normally, the Gustilo open-fracture classification for the injury should be re-evaluated after debridement in the operating room, and the antibiotic regimen and surgical treatment plan updated accordingly. If the injury is re-classified to a Gustilo Type IIIB or IIIC, then referral to a tertiary center with specialist care is warranted. However, the simulator does not have simulated soft tissue so this step is skipped during this simulation-based skills training.
There are no differences between the final steps of the actual clinical procedure versus this simulation-based skills training.

PDF Creation for Training Records

Here's how to create a PDF document of this clinical readiness evaluation that can be saved on the learner's mobile device or computer for their training records.

You will still need to fill out relevant blank sections (ː____________________________________) manually on a paper document or electronically on a digital document.

Android System

  1. On your Android device, open the Chrome app.[1][2]
  2. Open this page and click to check the appropriate checkboxes.
  3. At the top right, tap "More" (the three-dot button) and then "Share."
  4. Select "Print."
  5. At the top right, tap the Down arrow and choose "Save as PDF" from the options menu.
  6. At right, tap the blue PDF button to save your PDF to an appropriate folder (i.e., Downloads).

iOS System

  1. On your iPhone or iPad, open the Chrome app.[3]
  2. Open this page and click to check the appropriate checkboxes.
  3. At the top right, tap "Share" (box with an upward arrow).
  4. Select "Print."
  5. On the Options page, tap "Share" (box with an upward arrow) at the top right.
  6. Select "Save to Files" and "Save" PDF to an appropriate folder (i.e., Downloads).

Laptop or Desktop Computer

  1. On your computer, open the Chrome app.[4]
  2. Open this page and click to check the appropriate checkboxes.
  3. Click "File" and then "Print." Or, use a keyboard shortcut (Windows & Linux: "Ctrl + p"; Mac: "⌘ + p"). Or, click on the 3 vertical dots at the top right and select "Print."
  4. For "Destination," select "Save as PDF" and "Save" PDF to an appropriate folder (i.e., Downloads).

References

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