Browsing by Author "Orrego, Mario"
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- ItemAn assessment of the Chilean National Examination of Orthopaedic Surgery(2016) Urrutia Escobar, Julio Octavio; Orrego, Mario; Wright Navarrete, Ana Cecilia; Amenábar Velasco, Diego José.Abstract Background The Chilean National Examination of Orthopaedic Surgery (EMNOT) has been administered since 2009. It was developed to determine whether individual residents are meeting minimal knowledge standards at the end of their training programs. Methods We performed a retrospective evaluation of the EMNOT for all years it has been administered (2009–2015). The test was analyzed for content, taxonomy of questions asked (1: direct recall; 2: diagnosis; 3: evaluation/decision-making), residents’ performance, difficulty index and discrimination index. Results During the years of EMNOT administration, the most frequently tested areas have been pediatric orthopaedics (22.9 %), spine (13.8 %), general orthopaedics (13.8 %) and musculoskeletal trauma (9.9 %). A significant increase in questions with images was observed, as well as a significant decrease in the percentage of Type 1 and an increase in Type 3 questions. The Difficulty Index showed a medium level of difficulty for all years the examination has been administered. The Discrimination Index showed good discrimination in 2009, fair discrimination from 2010 through 2012, and excellent discrimination from 2013 through 2015. Conclusion The EMNOT has evolved over several years to include better quality questions, better discrimination, and a more representative distribution of questions covering the different orthopaedic sub-specialties. This examination represents an effective instrument for quality assurance of orthopaedic residency programs in Chile.
- ItemAnterior and distal tunnel orientation for anatomic reconstruction of the medial patellofemoral ligament is safer in patients with open growth plates(SPRINGER, 2020) Irarrazaval, Sebastian; Besa, Pablo; Fernandez, Francisco; Fernandez, Tomas; Tuca, Maria; Lira, Maria J.; Orrego, MarioPurpose In patients with open growth plates, the direction of tunneling that avoids distal femoral physis (DFP) damage in anatomic reconstructions of the medial patellofemoral ligament (MPFL) has been a topic of discussion. The objective of this study was to determine the ideal orientation for anatomic reconstructions of MPFL tunneling that minimized DFP damage while avoiding breaching the intercondylar notch. Methods Eighty magnetic resonance images of patients aged 10 through 17 were obtained, randomly sampled from the institutional database. A de novo software was developed to obtain 3D models of the distal femur and DFP. In each model, the anatomical insertion point of the MPFL was determined as defined by Stephen. A 20-mm-depth drilling was simulated, starting from the insertion point at every possible angle within a 90 degrees cone using 5-, 6- and 7-mm drills. Physeal damage for each pair of angles and each drill size was determined. Damage was expressed as a percentage of total physis volume. Statistical analysis was conducted using Student'sttest and one-way ANOVA. Results Maximum physeal damage (5.35% [4.47-6.24]) was obtained with the 7-mm drill when drilling 3 degrees cephalic and 15 degrees posterior from insertion without differences between sexes (n.s.). Minimal physeal damage (0.22% [0.07-0.37]) was obtained using the 5-mm drill aimed 45 degrees distal and 0 degrees anteroposterior, not affected by sex (n.s.). Considering intra-articular drilling avoidance, the safest zone was obtained when aiming 30 degrees-40 degrees distal and 5 degrees-35 degrees anterior, regardless of sex. Conclusion Ideal femoral tunnel orientation, avoiding physeal damage and breaching of the intercondylar notch, was obtained when aiming 30 degrees-40 degrees distal and 5 degrees-35 degrees anterior, regardless of sex. This area is a safe zone that allows anatomic MPFL reconstruction of patients with an open physis.