Influence of Surgeon's Expertise on the Duration of Approach and Closure during Osteosynthesis of Distal Radius Fractures.

 The aim of this study was to determine whether the duration of the approach (PII) and closure (PV) phases for minimally invasive plate osteosynthesis (MIPO) of distal radius fractures varied according to the surgeon's level of expertise. The main hypothesis was that the PII or PV duration was inversely proportional to the level of expertise.  The method measured the duration of PII and PV for 50 videos of MIPO operated by one surgeon with level 3 expertise, three with level 4 , and one with level 5 . The videos were viewed to identify any technical errors.  The average PII duration was 3 minutes 8 seconds for level 5 , 4 minutes 7 seconds for 4 , and 6 minutes 19 seconds for 3 . Average PV duration was 2 minutes 12 seconds for level 5 , 2 minutes 36 seconds for 4 , and 2 minutes 41 seconds for 3 . The average duration of PII + PV was 5 minutes 20 seconds for level 5 , 6 minutes 37 seconds for 4 , and 9 minutes for 3 . These findings indicate that both PII and PV duration was the longest in the level 3 surgeons' practice. Six technical errors were identified for levels 3 and 4 during PII (hemostasis control, multiple incisions, instrument handling, improper use of the fluoroscope, time-outs) and PV (intradermal reattachment).  The main hypothesis was verified since the duration of PII or PV was inversely proportional to the surgeon's level of expertise. This study identified technical errors in hand surgery practices of new surgeons. By early identification and correcting these minor errors, it would be possible to speed up the learning curve. We recommend surgical videos to be systematically recorded and analyzed to improve hand surgery practices.  Therapeutic/Level IIIa.