Elsevier

Journal of Surgical Education

Volume 74, Issue 5, September–October 2017, Pages 799-804
Journal of Surgical Education

Original Reports
Assessment of “YouTube” Content for Distal Radius Fracture Immobilization

https://doi.org/10.1016/j.jsurg.2017.03.002Get rights and content

Objective

Distal radius fractures (DRFs) are the most common orthopedic fractures, with >70% of cases treated by closed immobilization using a short arm cast or a sugar tong splint. However, inadequate immobilization is a risk factor for loss of reduction requiring repeat reduction or surgical treatment. Therefore, education of clinical skills for appropriate immobilization of DRFs is important. With the increasing use of web-based information by medical learners, our aim was to assess the quality and quantity of videos regarding closed immobilization of DRFs on YouTube.

Design

Retrospective review of YouTube videos on distal radius fracture immobilization using specific search terms.

Setting

Identified videos were analyzed for their educational value, quality of the technical skill demonstrated, and overall metrics. Educational value was scored on a 5-point scale, with “1” indicative of low quality and “5” of high quality.

Participants

Not applicable.

Results

Among the 68,366 videos identified, 16 met our inclusion criteria of being in English; performed by a health care professional or institution; and with casting being the major theme of the educational information provided. Of these 16 videos, 6 had an educational value score of 4 or 5, with the remaining 10 having a score ≤3. Although immobilization was demonstrated by cast technician specialized in orthopedics, skills were also performed by orthopedic attendants, urgent care physicians, orthopedic residents, and nurse practitioners. The credentials of the performer in 3 videos were not identified.

Conclusion

There is a need to promote high-quality educational videos produced by established medical school faculty members on open, web-based, portals.

Introduction

Distal radius fractures (DRFs) are the most common of all fractures1 and are typically treated with closed immobilization, using either a circumferential cast or a sugar tong splint. In the United States and Europe, more than 70% of DRFs were treated nonoperatively between 2005 and 2010.2 Inadequate immobilization of these fractures, due to improper molding of the cast or splint and loss of the 3-point fixation, leads to loosening of the cast. The resulting inadequate immobilization is a risk factor for the loss of reduction requiring either repeat reduction or surgical treatment. Therefore, acquisition of the clinical skill of closed immobilization of DRFs is evidently important. In their review of 68 cases of DRF redisplacements in children, Proctor et al.3 reported a redisplacement rate of 5% for DRFs with a perfect reduction, with the rate increasing to 43% for cases with imperfect reduction. This finding was confirmed by several studies reporting a rate of redisplacement of 1% following perfect reduction compared to 17% with an imperfect reduction of a DRF.4, 5, 6 The quality of reduction of a DRF entails both reducing the fracture to acceptable alignment parameters such as the volar tilt, radial height, radial inclination, and ulnar variance in addition to applying an adequate short arm cast that will maintain the fracture in that acceptable position. Evaluating a properly applied short arm cast is done mainly through evaluating the molding of the cast, in addition to the casting index, which measures the cast tightness. Information regarding the proper source of education of this skill as an example of orthopedic conservative procedures is lacking.

Use of the World Wide Web for medical education is a great tool to enhance the knowledge and skills of learners, and is an approach which has been used in different fields of medicine.2, 4, 7 In fact, Pretell Mazzini and Rodriguez-Martin5 reported that web-based continuous medical education was as effective as traditional learning methods. Web-based medical education, also commonly known as e-learning, is part of a learner-centered approach to curriculum delivery that has been adopted by most medical schools and one that offers several benefits. Web-based educational content can be shared across the globe, improving the quality of medical education in regions of the world and, therefore, having the potential to improve health care in these underprivileged regions. YouTube provides a video platform that has been extensively used for patient and public education on health issues as well as for teaching physical examination and clinical skills to health care professionals. However, the quality of the educational content in these videos is not verified in most instances, which creates a potential for delivering misleading information that could result in harm to patients. In the field of orthopedic surgery, no study has been previously published regarding the quality of YouTube videos specifically focused on teaching casting and splinting skills. Therefore, our aim was to identify videos available on the YouTube portal on the closed treatment of DRFs and to evaluate their quality and educational value. This assessment was undertaken with the goal of identifying high-quality videos that could be used as a reference for health care learners.

Section snippets

Search Methodology

The following terms were used to search the YouTube database: “Below Elbow Cast”, “Below Elbow Slab”, “Wrist Fracture Cast”, “Wrist Fracture Slab”, “Distal Radius Fracture Cast”, “Distal Radius Fracture Slab”, “Short Arm Cast” and “Sugar Tong Splint”. The search was performed independently by 2 investigators (residents at their second year of orthopedic residency) on March 3, 2016. The following inclusion criteria were defined a priori: English language only; clinical skills performed by a

Search Terms and Outcomes

Our search strategy identified 68,366 videos, of which only 16 met our inclusion/exclusion criteria. Of the 16 videos retained for analysis, skills for below elbow circumferential casting were identified in 10 videos and sugar tong splinting in 6 videos. Outcomes of our assessment of the educational and technical qualities of retained videos are summarized in Table 4.

Video Metrics

For videos on the application of short arm casts, the mean length of the videos was 545.6 seconds (range: 209-1020 s), with a mean

Discussion

The presence and quality of clinical skills videos on YouTube as a medical education resource has been studied in domains other than orthopedics. In their review of the educational and technical skill quality of videos on knee arthrocentesis, Fischer et al.8 identified only 8 videos that could be considered suitable as an educational resource. In their review of online education of cardiopulmonary resuscitation, Azer et al.9 identified only 24 videos that were compatible with the 2010 official

Limitations

A major limitation to this study was that certain videos of potential high-quality were excluded including those on the top of the YouTube search list due to the fact that they were published by another entity other than a health care professional or an institution, which was one of our exclusion criteria. An example of an excellent quality video published by a non–health care professional or institution is a video by ORTHOfilms titled “Closed Reduction of a Distal Radius Fracture”.

Our methods

Conclusions

The video content on YouTube concerning the closed treatment of DRFs is limited, with most available videos being unsuitable as educational material. An effort should be initiated to improve the current status, including the publication of guidelines for videos of high educational quality, and to provide appropriate support to medical faculty in universities to increase their trust factor in this form of education.

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