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Part of Uniplanar External Fixation
Parent Uniplanar External Fixation

Modular External Fixation for an Open Tibial Shaft Transverse Fracture

This module allows medical officers, junior orthopedic surgery residents, and surgeons who are not orthopedic specialists to become confident and competent in irrigation and debridement, powered and manual drilling, positioning and correctly inserting Schanz screws, and constructing the uniplanar external fixator frame as part of external fixation procedures for open tibial shaft fractures performed in regions without specialist coverage. To maximize patient safety, this module teaches learners to use a powered drill to insert self-drilling Schanz screws through the near cortex and then manually advance Schanz screws into the far cortex to avoid plunging.

It's highly recommended to: (i) print off this checklist and review it before simulation skills training, (ii) have an assistant read out and complete this checklist to verify that all the steps are properly performed during the simulation skills training, and (iii) file and save a back-up copy of the completed and signed checklist for your training records.

Training Logbook[edit | edit source]

Please print out the Training Logbook below and write your name, your assistant's name, procedure start and end times, and date of training at the bottom of the Training Logbook.

Training Logbook - Uniplanar External Fixation for an Open Tibial Shaft Transverse Fracture
# Self-Assessment Checklist Check the most appropriate response
1A Wore proper eye protection and gloves

Done Correctly

Done Incorrectly

Not Done

1B Loosened the right vise clamp securing the distal fragment to simulate a displaced fracture during simulation training

Done Correctly

Done Incorrectly

Not Done

1C Performed simulated irrigation using an average of 3L of irrigation solution for each successive Gustilo Type (i.e., 6L for Gustilo Type II open tibial fracture and 9L for Gustilo Type III open tibial fracture) to reduce the risk of infection

Done Correctly

Done Incorrectly

Not Done

1D Debrided all foreign material and non-viable tissue to reduce the risk of infection and minimize wound complications This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
2A Extended the open wound, if necessary, to directly visualize the fracture This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
2B While directly visualizing the fracture, applied manual longitudinal traction to the distal lower extremity to reduce the fracture This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
2C Used bone reduction forceps to manually reduce the fracture, compress the fragments together, and restore alignment:
  • Bone apposition > 50%
  • Rotation < 10 degrees
  • Angulation < 10 degrees in any plane
  • Length discrepancy < 2 cm shortening
  • No distraction (lengthening)

Done Correctly

Done Incorrectly

Not Done

2D Confirmed restoration of rotational alignment by visually checking the position of the big toe and the alignment of the middle of the second toe with the center of the patella
  • Rotation < 10 degrees
This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
2E Palpated the medial malleolus of both limbs under sterile conditions to estimate and compare the length of the reduced limb to the uninjured limb
  • Length discrepancy < 2 cm shortening
  • No distraction (lengthening)
This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
2F If required, adjust the fragments to achieve an alignment within acceptable parameters:
  • Bone apposition > 50%
  • Rotation < 10 degrees
  • Angulation < 10 degrees in any plane
  • Length discrepancy < 2 cm shortening
  • No distraction (lengthening)

Done Correctly

Done Incorrectly

Not Done

2G Applied bone holding forceps to maintain the reduced fracture

Done Correctly

Done Incorrectly

Not Done

2H Tightened right vise clamp and removed bone reduction forceps once fracture is stabilized during simulation training

Done Correctly

Done Incorrectly

Not Done

3A Positioned the “far” Schanz screw (furthest from the fracture line) in the proximal fragment in the anteromedial tibial wall medial or distal to the tibial tuberosity while avoiding traumatized soft tissues to avoid tethering of the patellar ligament and penetration into the knee joint

Done Correctly

Done Incorrectly

Not Done

3B Used a 22 blade scalpel to make a stab incision in the soft tissue (not shown) overlying the anteromedial tibial wall for insertion of the Schanz screw This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
3C Used dissecting scissors to spread the soft tissue (not shown) apart in the stab incision to expose the bone for drilling of the Schanz screw This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
3D Prepared the powered surgical drill for use by inserting the Schanz screw into the powered surgical drill, inserting the chuck key into the opening in the drill, turning the chuck key clockwise to tighten the drill over the Schanz screw, and then engaging the switch for forward drilling direction

Done Correctly

Done Incorrectly

Not Done

3E Confirmed that the drill is ready for use by pressing the on/off trigger and observing that the Schanz screw tip is rotating clockwise when the drill is pointing forward

Done Correctly

Done Incorrectly

Not Done

3F Used the properly sized drill sleeve for the Schanz screw and held the drill sleeve at least 3.0 mm above the near cortex during this simulation training to prevent plastic strands from getting stuck inside the drill sleeve

Done Correctly

Done Incorrectly

Not Done

3G Used the properly sized drill sleeve and placed the drill sleeve directly on the near cortex in the stab incision to protect the surrounding soft tissues when drilling in the real clinical procedure This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
3H Placed the Schanz screw tip directly on the near cortex of the anteromedial tibial wall and not on the anterior tibial crest to reduce the risk of thermal osteonecrosis and reduce the risk that the drill bit may slip and injure the soft tissues

Done Correctly

Done Incorrectly

Not Done

3I Inserted the "far" Schanz screw in the proximal fragment at a drill trajectory angle between 30°-60° relative to the tibial crest to avoid injury to neurovascular structures

Done Correctly

Done Incorrectly

Not Done

3J Directed an assistant to perform simulated irrigation while drilling to reduce the risk of thermal osteonecrosis

Done Correctly

Done Incorrectly

Not Done

3K Started drilling with the Schanz screw tip rotating in a clockwise direction, and ensured that the tip did not slip medially or laterally on the near cortex which could injure the soft tissues

Done Correctly

Done Incorrectly

Not Done

3L Power drilled the Schanz screw through the near cortex of the anteromedial tibial wall and used tactile feel and acoustic feedback to stop drilling after passing through the near cortex and before or when the inner surface of the far cortex is reached to avoid plunging through the far cortex and damaging underlying neurovascular structures and soft tissues

Done Correctly

Done Incorrectly

Not Done

3M Inserted the chuck key into the opening in the drill, turned the chuck key anticlockwise, detached the drill and removed the drill sleeve from the Schanz screw

Done Correctly

Done Incorrectly

Not Done

3N Slid the universal chuck with T-handle over the Schanz screw, and tightened the chuck over the Schanz screw by manually rotating the proximal part of the chuck clockwise or by inserting the chuck key into the opening in the universal chuck with T-handle and turning the chuck key clockwise

Done Correctly

Done Incorrectly

Not Done

3O Used the universal chuck with T-handle to turn the Schanz screw manually for one to two 360 degree rotations to anchor the screw tip into the far cortex without exiting the far cortex

Done Correctly

Done Incorrectly

Not Done

3P Detached the universal chuck with T-handle from the Schanz screw by manually rotating the proximal part of the chuck anticlockwise or inserting the chuck key into the small, circular opening in the chuck and turning the chuck key anticlockwise

Done Correctly

Done Incorrectly

Not Done

4A Placed the "far" Schanz screw (furthest from the fracture line) in the distal fragment in the anteromedial tibial wall at least two fingers’ breadth proximal to the medial malleolus (not shown) while avoiding traumatized soft tissues to avoid entry into the ankle joint This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
4B Positioned the two “far” Schanz screws as widely spaced as possible into each fragment while avoiding traumatized soft tissues and entry into knee and ankle joints to permit better control of displacing forces and optimize stabilization of the reduction

Done Correctly

Done Incorrectly

Not Done

4C Used a 22 blade scalpel to make a stab incision in the soft tissue (not shown) overlying the anteromedial tibial wall for insertion of the Schanz screw This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
4D Used dissecting scissors to spread the soft tissue (not shown) apart in the stab incision to expose the bone for drilling of the Schanz screw This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
4E Inserted the Schanz screw into the powered surgical drill, inserted the chuck key into the opening in the drill, turned the chuck key clockwise to tighten the drill over the Schanz screw, and then engaged the switch for forward drilling direction

Done Correctly

Done Incorrectly

Not Done

4F Confirmed that the drill is ready for use by pressing the on/off trigger and observing that the Schanz screw tip is rotating clockwise when the drill is pointing forward

Done Correctly

Done Incorrectly

Not Done

4G Used the properly sized drill sleeve for the Schanz screw and held the drill sleeve at least 3.0 mm above the near cortex during this simulation training to prevent plastic strands from getting stuck inside the drill sleeve

Done Correctly

Done Incorrectly

Not Done

4H Used the properly sized drill sleeve and placed the drill sleeve directly on the near cortex in the stab incision to protect the surrounding soft tissues when drilling in the real clinical procedure This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
4I Placed the Schanz screw tip directly on the near cortex of the anteromedial tibial wall and not on the anterior tibial crest

Done Correctly

Done Incorrectly

Not Done

4J Inserted the "far" Schanz screw in the distal fragment at an identical drill trajectory angle between 30°-60° relative to the tibial crest to the "far" Schanz screw in the proximal fragment to avoid injury to neurovascular structures

Done Correctly

Done Incorrectly

Not Done

4K Directed an assistant to perform simulated irrigation while drilling to reduce the risk of thermal osteonecrosis

Done Correctly

Done Incorrectly

Not Done

4L Started drilling with the Schanz screw tip rotating in a clockwise direction, and ensured that the tip did not slip medially or laterally on the near cortex which could injure the soft tissues

Done Correctly

Done Incorrectly

Not Done

4M Power drilled the Schanz screw through the near cortex of the anteromedial tibial wall and used tactile feel and acoustic feedback to stop drilling after passing through the near cortex and before or when the inner surface of the far cortex is reached to avoid plunging through the far cortex and damaging underlying neurovascular structures and soft tissues

Done Correctly

Done Incorrectly

Not Done

4N Inserted the chuck key into the opening in the drill, turned the chuck key anticlockwise, detached the drill and removed the drill sleeve from the Schanz screw

Done Correctly

Done Incorrectly

Not Done

4O Slid the universal chuck with T-handle over the Schanz screw, and tightened the chuck over the Schanz screw by manually rotating the proximal part of the chuck clockwise or by inserting the chuck key into the opening in the universal chuck with T-handle and turning the chuck key clockwise

Done Correctly

Done Incorrectly

Not Done

4P Used the universal chuck with T-handle to turn the Schanz screw manually for one to two 360 degree rotations to anchor the screw tip into the far cortex without exiting the far cortex

Done Correctly

Done Incorrectly

Not Done

4Q Detached the universal chuck with T-handle from the Schanz screw by manually rotating the proximal part of the chuck anticlockwise or inserting the chuck key into the small, circular opening in the chuck and turning the chuck key anticlockwise

Done Correctly

Done Incorrectly

Not Done

5A Inserted 4 pin-to-rod clamps on a 300 mm uniplanar rod and applied the two outer pin-to-rod clamps to connect the two "far" Schanz screws in each fragment to the 300 mm rod

Done Correctly

Done Incorrectly

Not Done

5B Tightened the two outer pin-to-rod clamps initially by hand and left the two inner pin-to-rod clamps loosened

Done Correctly

Done Incorrectly

Not Done

6A Placed the “near” Schanz screw (closest to the fracture line) at least 2.0 cm (a finger breadth) from the fracture line while avoiding traumatized soft tissues to help prevent the placement of the Schanz screw within the fracture hematoma and risk having a pin site infection spread within the fracture and positioned the “near and far” Schanz screws as widely spaced as possible in the fragment to permit better control of displacing forces and optimize stabilization of the reduction

Done Correctly

Done Incorrectly

Not Done

6B Used a 22 blade scalpel to make a stab incision in the soft tissue (not shown) overlying the anteromedial tibial wall for insertion of the Schanz screw This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
6C Used dissecting scissors to spread the soft tissue (not shown) apart in the stab incision to expose the bone for drilling of the Schanz screw This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
6D Inserted the Schanz screw into the powered surgical drill, inserted the chuck key into the opening in the drill, turned the chuck key clockwise to tighten the drill over the Schanz screw, and then engaged the switch for forward drilling direction

Done Correctly

Done Incorrectly

Not Done

6E Confirmed that the drill is ready for use by pressing the on/off trigger and observing that the Schanz screw tip is rotating clockwise when the drill is pointing forward

Done Correctly

Done Incorrectly

Not Done

6F Inserted the "near" Schanz screw into the loosened pin opening in the rod-to-pin clamp attached to the 300 mm rod

Done Correctly

Done Incorrectly

Not Done

6G Placed the Schanz screw tip directly on the near cortex of the anteromedial tibial wall and not on the anterior tibial crest to reduce the risk of thermal osteonecrosis and reduce the risk that the drill bit may slip and injure the soft tissues

Done Correctly

Done Incorrectly

Not Done

6H Inserted the "near" Schanz screw at an identical drill trajectory angle between 30°-60° relative to the tibial crest to all the other Schanz screws to avoid injury to neurovascular structures

Done Correctly

Done Incorrectly

Not Done

6I Directed an assistant to perform simulated irrigation while drilling to reduce the risk of thermal osteonecrosis

Done Correctly

Done Incorrectly

Not Done

6J Started drilling with the Schanz screw tip rotating in a clockwise direction, and ensured that the tip did not slip medially or laterally on the near cortex which could injure the soft tissues

Done Correctly

Done Incorrectly

Not Done

6K Power drilled the Schanz screw through the near cortex of the anteromedial tibial wall and used tactile feel and acoustic feedback to stop drilling after passing through the near cortex and before or when the inner surface of the far cortex is reached to avoid plunging through the far cortex and damaging underlying neurovascular structures and soft tissues

Done Correctly

Done Incorrectly

Not Done

6L Inserted the chuck key into the opening in the drill, turned the chuck key anticlockwise, detached the drill and removed the drill sleeve from the Schanz screw

Done Correctly

Done Incorrectly

Not Done

6M Slid the universal chuck with T-handle over the Schanz screw, and tightened the chuck over the Schanz screw by manually rotating the proximal part of the chuck clockwise or by inserting the chuck key into the opening in the universal chuck with T-handle and turning the chuck key clockwise

Done Correctly

Done Incorrectly

Not Done

6N Used the universal chuck with T-handle to turn the Schanz screw manually for one to two 360 degree rotations to anchor the screw tip into the far cortex without exiting the far cortex

Done Correctly

Done Incorrectly

Not Done

6O Detached the universal chuck with T-handle from the Schanz screw by manually rotating the proximal part of the chuck anticlockwise or inserting the chuck key into the small, circular opening in the chuck and turning the chuck key anticlockwise

Done Correctly

Done Incorrectly

Not Done

7A Placed the “near” Schanz screw (closest to the fracture line) at least 2.0 cm (a finger breadth) from the fracture line while avoiding traumatized soft tissues to help prevent the placement of the Schanz screw within the fracture hematoma and risk having a pin site infection spread within the fracture and positioned the “near and far” Schanz screws as widely spaced as possible in the fragment to permit better control of displacing forces and optimize stabilization of the reduction

Done Correctly

Done Incorrectly

Not Done

7B Used a 22 blade scalpel to make a stab incision in the soft tissue (not shown) overlying the anteromedial tibial wall for insertion of the Schanz screw This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
7C Used dissecting scissors to spread the soft tissue (not shown) apart in the stab incision to expose the bone for drilling of the Schanz screw This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
7D Inserted the Schanz screw into the powered surgical drill, inserted the chuck key into the opening in the drill, turned the chuck key clockwise to tighten the drill over the Schanz screw, and then engaged the switch for forward drilling direction

Done Correctly

Done Incorrectly

Not Done

7E Confirmed that the drill is ready for use by pressing the on/off trigger and observing that the Schanz screw tip is rotating clockwise when the drill is pointing forward

Done Correctly

Done Incorrectly

Not Done

7F Inserted the "near" Schanz screw into the loosened pin opening in the rod-to-pin clamp attached to the 300 mm rod

Done Correctly

Done Incorrectly

Not Done

7G Placed the Schanz screw tip directly on the near cortex of the anteromedial tibial wall and not on the anterior tibial crest to reduce the risk of thermal osteonecrosis and reduce the risk that the drill bit may slip and injure the soft tissues

Done Correctly

Done Incorrectly

Not Done

7H Inserted the "near" Schanz screw at an identical drill trajectory angle between 30°-60° relative to the tibial crest to all the other Schanz screws to avoid injury to neurovascular structures

Done Correctly

Done Incorrectly

Not Done

7I Directed an assistant to perform simulated irrigation while drilling to reduce the risk of thermal osteonecrosis

Done Correctly

Done Incorrectly

Not Done

7J Started drilling with the Schanz screw tip rotating in a clockwise direction, and ensured that the tip did not slip medially or laterally on the near cortex which could injure the soft tissues

Done Correctly

Done Incorrectly

Not Done

7K Power drilled the Schanz screw through the near cortex of the anteromedial tibial wall and used tactile feel and acoustic feedback to stop drilling after passing through the near cortex and before or when the inner surface of the far cortex is reached to avoid plunging through the far cortex and damaging underlying neurovascular structures and soft tissues

Done Correctly

Done Incorrectly

Not Done

7L Inserted the chuck key into the opening in the drill, turned the chuck key anticlockwise, detached the drill and removed the drill sleeve from the Schanz screw

Done Correctly

Done Incorrectly

Not Done

7M Slid the universal chuck with T-handle over the Schanz screw, and tightened the chuck over the Schanz screw by manually rotating the proximal part of the chuck clockwise or by inserting the chuck key into the opening in the universal chuck with T-handle and turning the chuck key clockwise

Done Correctly

Done Incorrectly

Not Done

7N Used the universal chuck with T-handle to turn the Schanz screw manually for one to two 360 degree rotations to anchor the screw tip into the far cortex without exiting the far cortex

Done Correctly

Done Incorrectly

Not Done

7O Detached the universal chuck with T-handle from the Schanz screw by manually rotating the proximal part of the chuck anticlockwise or inserting the chuck key into the small, circular opening in the chuck and turning the chuck key anticlockwise

Done Correctly

Done Incorrectly

Not Done

8A Applied and turned the 11 mm spanner with T-handle wrench clockwise for final tightening of the pin-to-rod clamps.

Done Correctly

Done Incorrectly

Not Done

8B Verified the reduction visually, and with gentle palpation of the tibial crest at the fracture line to confirm that the alignment is still within acceptable parameters:
  • Bone apposition > 50%
  • Rotation < 10 degrees
  • Angulation < 10 degrees in the coronal (frontal) and sagittal planes

Done Correctly

Done Incorrectly

Not Done

8C Visually inspected the fracture line to confirm that the reduction is adequate during this simulation training
  • Length discrepancy < 2 cm shortening
  • No distraction (lengthening)

Done Correctly

Done Incorrectly

Not Done

8D Visually checked the position of the big toe and the alignment of the middle of the second toe with the center of patella to confirm whether rotational alignment is still adequately restored
  • Rotation < 10 degrees (at 0 degrees of rotation, the big toe is pointing straight up towards the ceiling and the middle of the second toe is aligned with the center of the patella)
This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
8E Palpated the medial malleolus of both limbs under sterile conditions to estimate and compare the length of the reduced limb to the uninjured contralateral limb
  • Length discrepancy < 2 cm shortening
  • No distraction (lengthening)
This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
8F Removed the bone holding forceps once fracture is stabilized with external fixator frame and acceptable alignment is confirmed This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
8G Checked for skin tenting around Schanz screws and if present, widened the stab incision to release soft tissue tension around the pin site to reduce the risk of inflammation and pin infection This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
8H Cleaned the extremity and apply sterile gauze dressings to all four pin sites at the end of the procedure This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
8I Used a measuring tape to measure and compare the limb length (from anterior superior iliac spine to the medial malleolus) of both legs after dressings have been applied
  • Length discrepancy < 2 cm shortening (compared to uninjured, contralateral leg)
  • No distraction (lengthening)
This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
8J Re-evaluated the Gustilo open-fracture classification for the open tibial fracture in the operating room, and updated the antibiotic regimen and surgical treatment plan accordingly This Step Cannot Be Performed During Simulation Training But Must Be Performed During the Actual Clinical Procedure
9A Took an anterior view photo of the simulator with a ruler in the image to provide scale

Done Correctly

Done Incorrectly

Not Done

9B Visually inspected the tibial shaft in the anterior photo and confirmed that alignment is within acceptable parameters:
  • Bone apposition > 50%
  • Rotation < 10 degrees
  • Angulation < 10 degrees in the coronal plane

Done Correctly

Done Incorrectly

Not Done

9C Used the ruler to measure the distance of the two near Schanz screws from the fracture line

Done Correctly

Done Incorrectly

Not Done

9D The two near Schanz screws were placed at least 2.0 cm (a finger breadth) from the fracture line to help prevent the placement of the Schanz screw within the fracture hematoma and risk having a pin site infection spread within the fracture

Done Correctly

Done Incorrectly

Not Done

9E Visually inspected the fracture line to confirm that the reduction is adequate:
  • Length discrepancy < 2 cm shortening
  • No distraction (lengthening)

Done Correctly

Done Incorrectly

Not Done

9F Took a medial view photo of the simulator

Done Correctly

Done Incorrectly

Not Done

9G The far Schanz screw in the proximal fragment was inserted medial or distal to the tibial tuberosity to avoid tethering of the patellar ligament and penetration into the knee joint

Done Correctly

Done Incorrectly

Not Done

9H All four Schanz screws were inserted medial to the anterior tibial crest in the medial photo to reduce the risk of thermal osteonecrosis and reduce the risk that the drill bit may slip and injure the soft tissues

Done Correctly

Done Incorrectly

Not Done

9I Took a lateral view photo of the simulator

Done Correctly

Done Incorrectly

Not Done

9J All four Schanz screws did not perforate the far cortex in the lateral photo

Done Correctly

Done Incorrectly

Not Done

9K Visually inspected the tibial crest in the lateral photo and confirmed that alignment is within acceptable parameters:
  • Bone apposition > 50%
  • Rotation < 10 degrees
  • Angulation < 10 degrees in the sagittal plane

Done Correctly

Done Incorrectly

Not Done

9L Removed the rods and clamps but left the four Schanz screws in the distal and proximal fragments, used scissors to cut the cellophane wrap overlying the fracture site to separate the two fragments, removed each fragment from the vise clamp, and placed each fragment on a flat surface for inspection of the drill trajectory angles

Done Correctly

Done Incorrectly

Not Done

9M Placed a protractor on the cross-section of the proximal fragment and lined up the center vertical black line of the protractor with the center of the vise attachment

Done Correctly

Done Incorrectly

Not Done

9N Took an overhead ("bird's eye view") photo of the cross-section of the proximal fragment to record the drill trajectory angles relative to the tibial crest and checked that the center vertical black line of the protractor was lined up with the center of the vise

Done Correctly

Done Incorrectly

Not Done

9O For the proximal fragment, the drill trajectory angles of both Schanz screws are identical and between 30°-60° relative to the tibial crest to avoid injury to neurovascular structures

Done Correctly

Done Incorrectly

Not Done

9P Placed a protractor on the cross-section of the distal fragment and lined up the center vertical black line of the protractor with the center of the vise attachment

Done Correctly

Done Incorrectly

Not Done

9Q Took an overhead ("bird's eye view") photo of the cross-section of the distal fragment to record the drill trajectory angles relative to the tibial crest and checked that the center vertical black line of the protractor was lined up with the center of the vise

Done Correctly

Done Incorrectly

Not Done

9R For the distal fragment, the drill trajectory angles of both Schanz screws are identical and between 30°-60° relative to the tibial crest to avoid injury to neurovascular structures

Done Correctly

Done Incorrectly

Not Done

9S The drill trajectory angles of the proximal and distal fragments are identical

Done Correctly

Done Incorrectly

Not Done

9T Provided specific, clear, and concise directions to the assistant during the simulated procedure

Done Correctly

Done Incorrectly

Not Done

9U Photographed this completed training logbook on a cellphone as a backup and filed this original completed training logbook in your training records.

Done Correctly

Done Incorrectly

Not Done

10 All the checklist items (except for the steps that cannot be performed during simulation training) must be rated as "Done Correctly" to pass this module.

Passed Module

Did Not Pass Module

Learner's Nameː

Learner's Signature:

Assistant's Nameː

Assistant's Signature:

Procedure Start Time:

Procedure End Time:

Date of Trainingː

Acknowledgements[edit | edit source]

This work is funded by a grant from the Intuitive Foundation. Any research, findings, conclusions, or recommendations expressed in this work are those of the author(s), and not of the Intuitive Foundation.