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      Using formalin embalmed cadavers to teach fracture identification with ultrasound

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          Abstract

          Background

          Ultrasound is being utilized more frequently to diagnose fractures in bone and track fracture reduction quickly, and without radiation exposure in the ED. Realistic and practical methods of teaching sonographic fracture identification to medical trainees are needed. The objective of this study is to determine the feasibility of using formalin-embalmed human cadavers in teaching medical trainees to use ultrasound to identify synthetic fractures in tibia, radius, and metacarpal bones.

          Methods

          First-year medical students attended an orientation presentation and a 15-min scanning workshop, to evaluate fractures in cadaver bones with an instructor. Next participants independently scanned bones to determine if a fracture was present. Questionnaires were given that assessed participant self-confidence and ability to evaluate still ultrasound images for fracture and differentiate between tissue layers before, after, and 5 months following training.

          Results

          Participants were collectively able to scan and differentiate between fractured and unfractured bone in 75% of 186 total bone scanning attempts (tibia: 81% correct, metacarpal: 68% correct, radius: 76% correct). When evaluating still ultrasound images for fracture, participants’ scores rose significantly following training from an average score of 77.4 to 91.1% ( p = 0.001). Five months post-training, scores fell slightly, to an average of 89.8% ( p = 0.325).

          Conclusions

          Ultrasound images of formalin-embalmed cadaveric fractures are of sufficient quality to use in teaching fracture identification to medical trainees. With only 15 minutes of scanning experience, medical trainees can learn to independently scan and significantly increase their ability to identify fractures in still ultrasound images.

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          Most cited references18

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          Comparison of fresh and Thiel's embalmed cadavers according to the suitability for ultrasound-guided regional anesthesia of the cervical region.

          Ultrasound-guided punctures are a new technique in anesthesia. However, training in these techniques requires conditions resembling real life as far as possible for learning purposes. Several models are available, but none associates realistic anatomy and lifelike sensations of the passage of fascias. The aim of our study was to compare fresh and Thiel's embalmed cadavers for ultrasound-guided punctures. Eight fresh cadavers and eight Thiel's embalmed cadavers were investigated. The cervical region was scanned with an ultrasound probe. Age, sex and body mass index (BMI) were recorded. Visibility of he structures, including sternocleidomastoid (SCM) muscle, anterior and middle scalene muscles, thyroid gland, nerve and the needle, was evaluated as 0 (not visible or bad visibility) or 1 (good visibility). The feeling ("pop") of passing the fascias was noted as 0 (not felt) or 1 (felt). The possibility of nerve displacement with the needle, the difficulty of intraneural injection and the possibility of nerve penetration and nerve swelling were all recorded as 0 (not possible) or 1 (possible). The two groups were comparable in terms of sex, age and BMI. Visibility of the SCM muscle and the needle was better in the Thiel group. Moreover, the "pop" feeling and nerve swelling were significantly more frequently present in the Thiel group. There was no significant difference in terms of the other results between the two groups. Cadavers embalmed according to Thiel's method should be recommended for ultrasound-guided punctures as a realistic and lifelike model.
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            American Academy of Emergency Medicine Position Statement: Ultrasound Should Be Integrated into Undergraduate Medical Education Curriculum.

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              Bedside ultrasound diagnosis of nonangulated distal forearm fractures in the pediatric emergency department.

              Ultrasound (US) may be a useful tool for rapidly diagnosing fractures. Our objective was to determine the accuracy of US as compared with radiographs in the detection of nonangulated distal forearm fractures.
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                Author and article information

                Contributors
                nenalundgreen@gmail.com
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                18 July 2020
                18 July 2020
                2020
                : 20
                : 227
                Affiliations
                GRID grid.461417.1, ISNI 0000 0004 0445 646X, Rocky Vista University College of Osteopathic Medicine - Southern Utah, ; 255 East Center Street, Ivins, UT 84738 USA
                Author information
                http://orcid.org/0000-0003-4638-5164
                Article
                2148
                10.1186/s12909-020-02148-8
                7368716
                32682422
                e2a16cff-842a-4bae-b999-7f032ff79824
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 20 March 2020
                : 10 July 2020
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Education
                ultrasound education,fracture identification,ultrasound in cadavers,medical education

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