Course review

Wrightington cadaveric hand and wrist trauma course

Authors: Arpit Jariwala

Publication date: 03 Nov 2012

The one and a half day Wrightington cadaveric hand and wrist trauma course is organised by the Upper Limb Unit at Wrightington Hospital, Wigan. Covering the soft tissue and bony tissues in hand and wrist trauma, it is recognised by the British Society for Surgery of the Hand as one of the key courses for training in hand surgery.

Who is it for?

The course is aimed at trainees in trauma and orthopaedics and plastic surgery who wish to specialise or gain further experience in hand and wrist surgery. It is also suitable for established surgeons who want to revisit the upper limb region and get up to date with the newer implants and techniques.

Why did you do it?

In this age of the European Working Time Directive I prefer cadaveric courses with an emphasis on practical training rather than “death by PowerPoint” courses. This course achieved a balance of both types of teaching. When I began work in a hand trauma unit in February 2012 I was advised to attend this course to gain further experience. Although there are several hand and wrist fracture courses around the country, both taught and using sawbones, few offer cadaveric training.

When did you do it?

I did the course in March 2012. The course runs each year at the conference centre at Wrightington Hospital, Wigan. The well equipped surgical skills laboratory is in the basement of the conference centre. My course colleagues included junior consultants, senior trainees from orthopaedic and plastics backgrounds, and core surgical trainees starting jobs in related specialties. I even met my previous plastics consultant (from my senior house officer days), who was finding out “what’s new” in hand and wrist trauma.

How was it structured?

The course started on Thursday afternoon (with a quick bite to eat) and covered mainly soft tissue injuries on the first day. The second day, which began at 9 am, covered management of fractures in the hand and wrist.

The faculty comprised consultants from Wrightington Upper Limb Unit and various other specialist upper limb and hand units across the country, such as Derby, Manchester, Bristol, and Edinburgh. All tutors were experienced in their field and keen to teach and to share their experiences.

The course emphasised hands-on training. There were few didactic lectures, and most teaching was at the laboratory’s dissection table. After a brief tutorial on the principles of management of a particular injury, candidates worked through the problem with their designated tutor, who gave guidance and positive feedback and also helpful tips and tricks to tackle the problem. A trainer to trainee ratio of around 1:2 allowed an excellent level of interaction and supervision, in an informal setting. The time allocated for each exercise was enough to complete the task, have a discussion, and practise additional tasks.

The surgical skills laboratory was well equipped, with the entire inventory needed for dissection and bony fixation. It even had a mini C-arm, allowing us to check our fixations. The implant company sponsoring the course had representatives on hand to inform candidates of the design and utility of the various implants, and they helped throughout with the workshops, even acting as assistants at times.

The course finished at around 5 pm on Friday after a quick round-up and feedback session.

What was covered?

The course aimed to cover common soft tissue and bony injuries presenting at a hand unit. The first day covered flexor and extensor tendon injuries and their management. We were then shown surgical techniques for covering soft tissue defects in the hand and wrist and practised some commonly used flaps (Z-plasty, thenar flap, cross finger flap). One of the tutors even demonstrated the Cadbury technique for managing first web space contracture.

The second day concentrated on workshops for management of phalangeal and metacarpal fractures, including base of thumb fractures. The fractures were created in the cadavers, and candidates fixed them with the implants provided. The afternoon session covered fixation of scaphoid fractures (open and percutaneous techniques) and distal radius fractures.

How much did it cost?

The course cost £400, which covered all materials, refreshments, and meals. An additional evening dinner at a local restaurant was optional but was well attended by tutors and candidates and was an excellent opportunity to interact further with the tutors in a relaxed environment.

Was it worth it?

The course was well worth it. The option of being able to operate and undertake procedures and fracture fixations on cadavers simulated real life situations. Having experts to guide us helped us to understand the principles of surgery and fracture fixation. We also learnt numerous useful tricks throughout the course. The course is recognised by the British Society for Surgery of the Hand as one of the educational events for specialist hand training and can be used as credits towards the postgraduate diploma in hand surgery.

Finally, we had the opportunity to meet the president of the British Society for Surgery of the Hand, Ian Trail, one of the tutors on the course.

Further information

Contact Adam Watts or Sumedh Talwalkar, consultant hand and upper limb surgeons, or Mavis Luya, course administrator, Hand and Upper Limb Research Unit, Wrightington Hospital, Old Synexus Building, Hall Lane, Appley Bridge, Wigan WN6 9EP. Tel +44 (0)1257 256248, www.wrightington.com.

Competing interests: None declared.

Arpit Jariwala clinical lecturer and specialist registrar Department of Orthopaedics and Trauma Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK

ajariwala@dundee.ac.uk

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