Veterinary Surgery April 2026 – Ortho: Double Plating Mechanics & Surgical Skills Training

In this Simini Small Animal Surgery Podcast episode, we continue our orthopedic coverage from the April 2026 issue of Veterinary Surgery by focusing on two themes that shape every surgeon’s career: building stronger repairs and building stronger surgeons. 

From double plate fixation in complex scapular fractures to structured cadaver-based resident training, these papers explore how biomechanics and deliberate practice influence both surgical outcomes and long-term competency.

In this episode:

✅ Barrett et al. — An ex vivo biomechanical study evaluating single versus double plating constructs for comminuted canine scapular fractures. Adding a second plate along the caudolateral border nearly halved fracture displacement during cyclic loading (0.81 mm → 0.48 mm) and increased construct stiffness from 392.8 to 563.7 N/mm without increasing strain on the primary implant. The findings suggest that load-sharing double plating may support immediate postoperative weight bearing while potentially reducing reliance on restrictive external coaptation. 

✅ Leu et al. — A prospective pilot study evaluating a three-month cadaveric orthopedic skills curriculum for small animal surgery residents and interns. Using OSATS global rating scores, the study demonstrated significant improvement in technical performance, with median expert scores increasing from 17/35 to 23/35 after training. Interestingly, trainee self-assessment showed poor agreement with expert evaluation, highlighting the importance of objective feedback and structured mentorship during surgical development. 

Together, these studies reinforce an important principle in orthopedic surgery: better outcomes depend not only on stronger implants, but also on stronger surgical preparation and training systems.

🎓 Journal Articles Discussed

• Barrett et al. — Double plate fixation improves stiffness in a comminuted canine scapula fracture gap model compared to single plate fixation
• Leu et al. — Structured assessment of a cadaveric orthopedic surgical training program of small animal surgeons in training: A prospective observational pilot study

📚 From the April 2026 issue of Veterinary Surgery

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Transcript

SPEAKER_01 0:04

Hi, I'm Carl Damiani, and this is the Simene Small Animal Surgery Podcast, your fast focused update on what matters most from the latest small animal surgical literature. In each episode, we break down key articles from the veterinary journals and translate them into surgical insight you can use today, not someday. This episode continues our orthopedic coverage from the April 2026 issue of veterinary surgery, and we're focusing on two themes that shape every surgeon's career: how we build stronger repairs and how we build stronger surgeons. First, we'll look at a biomechanical study by Barrett et al. evaluating double plate fixation for cuminuted canine scapular fractures. Using a fracture gap model, the authors compared single versus dual plating constructs and found that adding a cautilateral plate significantly increased stiffness and reduced displacement during cyclic loading. It's a study that raises important questions about implant strategy, postoperative weight bearing, and how we manage these challenging fractures in clinical practice. Then we turned to Loivet al, who investigated a structured cadaveric orthopedic training program for surgical residents and interns. Using OSATS scoring and both expert and self-assessment, the study explored whether deliberate supervised cadaver training actually improves technical performance. Beyond the educational angle, this paper taps into a bigger discussion around surgical competency, feedback, and the future of residency training and veterinary surgery. Two studies, one shared idea. Advancing orthopedic surgery doesn't just depend on better implants, it also depends on better training, better assessment, and better preparation in and out of the operating room. Let's dive in.

SPEAKER_02 1:57

So if you try like fixing a broken shelf by only bracketing one side, um, a single heavy book is just gonna rip it right out of the wall.

SPEAKER_00 2:06

Right. Right. Yeah, it just tears right out.

SPEAKER_02 2:07

Exactly. And you know, tomorrow in the OR, you might face that exact same mechanical nightmare with uh a committed canine scapula fracture.

SPEAKER_00 2:16

Yeah, those are honestly brutal to deal with.

SPEAKER_02 2:18

They really are. So in today's deep dive, we're unpacking a 2026 paper by Barrett et al. And the mission here is to extract, you know, actionable intelligence for these complex fractures where conservative management just completely fails you.

SPEAKER_00 2:33

Aaron Powell Yeah. So I mean a single locking plate on the cranial spine, it might hold a simple fracture fine. But uh, under the really complex stresses of a combinated one, you strongly risk cantilever failure.

SPEAKER_02 2:44

Because of all that wobble, right.

SPEAKER_00 2:45

Exactly. So to test a structural upgrade, Barrett et al. 2026 designed this ex vivo mechanical study. They took 14 paired beagle scapulae, um, and half of them got the standard single walking plate.

SPEAKER_02 2:58

Aaron Powell Okay, and the other half?

SPEAKER_00 2:59

Aaron Powell The other half got this load-sharing double plate construct. So they added a second plate right on the cautilateral border, and then they basically simulated uh 7,200 cycles of walking.

SPEAKER_02 3:11

Aaron Powell Wait, so slapping a second plate onto a shattered bone, I mean that seems a little counterintuitive to me. Doesn't adding more hardware just, you know, create new stress points or maybe risk stress yielding that primary plate?

SPEAKER_00 3:22

Aaron Powell You'd think so, right. But the data actually points firmly to load sharing rather than like dangerous stress concentration. The double plate construct nearly halved the displacement of the bone fragments.

SPEAKER_02 3:34

Well, half. Wow, that's significant.

SPEAKER_00 3:35

Yeah. It dropped from 0.81 millimeters down to 0.48 millimeters.

SPEAKER_02 3:39

Aaron Powell Oh man, cutting displacement in half, I mean, that's the difference between a bone that actually heals and a plate that just bends, that completely changes the torsional stability of the whole repair.

SPEAKER_00 3:48

Absolutely, it does. And it also increased the overall stiffness from, let's see, 392.8 newtons per millimeter to 563.7.

SPEAKER_02 3:57

That is a massive jump in stiffness.

SPEAKER_00 3:59

Aaron Powell It really is. By placing that second plate specifically on the cautilateral edge, the whole construct directly resists those massive tensile forces, you know, from the triceps and rhomboid muscles during a normal stride.

SPEAKER_02 4:12

Aaron Ross Powell Right, because those muscles pull so hard on that specific area.

SPEAKER_00 4:15

Aaron Powell Exactly. And addressing your earlier concern about new stress points, uh adding that extra plate actually did not significantly alter the surface strain on the primary plate at all.

SPEAKER_02 4:25

Trevor Burrus So it's a win-win. And that 563.7 newtons of stiffness gives you, the surgeon, a huge clinical advantage, right? Because it means the construct is strong enough to allow for immediate postoperative weight bearing.

SPEAKER_00 4:40

Yes, exactly.

SPEAKER_02 4:41

You can just completely eliminate the need for um a Velpo sling or a spike of splint.

SPEAKER_00 4:46

Which is huge, right? Because then you bypass the muscle atrophy and the jaint stiffness that well, you know, they basically always accompany limb immobilization.

SPEAKER_02 4:54

Right. But okay, so the double plates solves the mechanical side. But introducing all that extra hardware into a commutative fracture, I mean you're leaving significantly more metal behind in the patient.

SPEAKER_00 5:04

Aaron Powell Yeah, which elevates a massive biological risk, right? Infection. Securing that surgical site before you close becomes incredibly critical here.

SPEAKER_02 5:13

Aaron Powell Because saline is the standard for clearing the field, but um head-to-head studies show standard saline leaves like 42% of bacteria behind. And if we're leaving extra hardware in the patient, a 42% retention rate is just, well, it's an unacceptable, invisible risk.

SPEAKER_00 5:29

Well, yeah, it really is.

SPEAKER_02 5:30

So how do we actually drop that number?

SPEAKER_00 5:31

Aaron Powell Well, substituting standard saline with Semini Protect Livage provides a really crucial workflow upgrade here. In those exact same head-to-head studies, Semini actually left zero percent of bacteria behind.

SPEAKER_02 5:44

Wow, zero percent. But wait, if Semine is a non-antibiotic lavage, how is it achieving total clearance? Is it like mechanically disrupting the bacterial adhesion?

SPEAKER_00 5:53

Yeah, it acts physically, so it clears the microscopic contaminants and the biofilm that standard saline basically just washes right over.

SPEAKER_02 5:59

Right, right. It misses the sticky stuff.

SPEAKER_00 6:01

Exactly. And taking, you know, just 60 seconds right at the point of closure removes the bacteria that saline misses entirely without disrupting your existing surgical protocol.

SPEAKER_02 6:10

Aaron Powell That is such a simple swap. So to sort of summarize these workflow upgrades for you, first, utilize a caudilateral double plating technique to achieve load sharing stability in commonated scapula. Yes. And second, close securely by upgrading your lavage to completely eliminate the biological risk of that extra hardware.

SPEAKER_00 6:31

Spot on. And you know, looking at this data, it leaves you with an interesting thought. If double plating allows us to confidently ditch the sling for the scapula, uh, what other traditional restrictive post-op splinting protocols in veterinary orthopedics might actually be hindering patient recovery rather than helping it?

SPEAKER_01 6:51

Here's the next article.

SPEAKER_02 6:56

What if the biggest threat to your surgical residence training uh isn't actually a lack of talent? Right. What if it's just your clinic's relentless drive for operating room efficiency?

SPEAKER_00 7:08

It's I mean, it's a massive clinical bottleneck right now.

SPEAKER_02 7:11

Yeah. So today's deep dive looks at a 2026 prospective observational pilot study by Lou et al. We are exploring whether, you know, we can solve this surgical exposure crisis with structured out-of-OR cadaver training.

SPEAKER_00 7:25

Aaron Powell Because we demand these really fast turnaround times for patient safety and you know caseload flow, which inherently means trainees just get fewer real-world reps.

SPEAKER_02 7:34

I mean, it makes sense when you think about it like learning to fly in a simulator rather than uh mid-air.

SPEAKER_00 7:39

Exactly.

SPEAKER_02 7:39

In a live OR, a resident's cognitive load is just maxed out monitoring the patient and trying not to slow down the attending.

SPEAKER_00 7:45

Aaron Powell Right. They can't focus on the actual mechanics. So to fix this, Lou et al. 2026 designed a three-month training program.

SPEAKER_01 7:52

Okay.

SPEAKER_00 7:52

And it focused on basic orthopedic skills for seven small animal ECVS residents and interns using feline cadavers.

SPEAKER_02 8:00

Aaron Powell, so out of the OR, they can isolate specific things, like holding a drill at the perfect angle or managing a bone plate.

SPEAKER_00 8:07

Yeah, without the background alarms going off. The study setup gave them the space to actually build that muscle memory.

SPEAKER_02 8:14

How was it structured exactly?

SPEAKER_00 8:15

Aaron Powell Well, it included six supervised practical sessions, plus weekly self-directed training, and then a really critical one-to-one session with direct instructor feedback. Right. And to measure the impact, they actually recorded the trainees performing specific orthopedic procedures before the training began and then again after the three months concluded.

SPEAKER_02 8:37

Okay, wait. I have to push back here though.

SPEAKER_00 8:39

Okay.

SPEAKER_02 8:39

Grading surgery is notoriously subjective. I mean, it's not exactly a multiple choice test. No, it's aren't one attending might love a residence technique, while another thinks they're way too aggressive with the drill. So how did the study strip out that bias to prove the training actually worked?

SPEAKER_00 8:55

Well, they relied on a tool called the OSE's GRS.

SPEAKER_02 8:58

The OFH GRS.

SPEAKER_00 9:00

Yeah, the Objective Structured Assessment of Technical Skills Global Rating Scale.

SPEAKER_02 9:03

That is a mouthful.

SPEAKER_00 9:04

It really is. But instead of a vague good job, OSATS forces graders to look at very specific mechanics. Like what? Like are they demonstrating economy of movement? Are they respecting the soft tissue? You know, how safely are they handling the instruments?

SPEAKER_02 9:21

Oh, I see. So it quantifies the subjective art of surgery into this strict rubric.

SPEAKER_00 9:25

Aaron Powell Yes, exactly. And they were rigorous about the blinding too.

SPEAKER_02 9:28

Right, because of the videos.

SPEAKER_00 9:29

Yeah, the videos had no sound and no faces. So the three board-certified surgeons grading them couldn't, you know, play favorites.

SPEAKER_01 9:36

That's smart.

SPEAKER_00 9:37

They scored the procedures out of a total of 35 points. And crucially, the trainees also had to score themselves using that exact same scale.

SPEAKER_02 9:45

Aaron Powell Okay, so let's look at those numbers. Did three months on the simulator actually translate to better hands?

SPEAKER_00 9:51

The objective data says absolutely. Really? Yeah. Median expert scores jumped significantly. They went from 17 out of 35 before the training up to 23 out of 35 after.

SPEAKER_02 10:02

Wow, that's a solid jump.

SPEAKER_00 10:03

And the trainees felt that improvement too. Their self-assessments jumped from a median of 17 to 25.

SPEAKER_02 10:09

Okay, so their hands got better and they knew they got better. Well. But wait, a median jump across a group doesn't really tell us if an individual resident's self-grade actually matched the expert's grade.

SPEAKER_00 10:19

And that is the most fascinating clinical nuance of the data. There was zero agreement between the expert assessments and the trainees' self-assessments.

SPEAKER_02 10:29

Wait, zero.

SPEAKER_00 10:30

Literally zero. The statistical measure for this, Cohen's Kappa, was zero. Oh wow. Trainees were just wildly overrating or underrating their own performance on those specific orthopedic tasks.

SPEAKER_02 10:42

But why the massive disconnect? If their hands are objectively moving better, why can't they gauge their own skill?

SPEAKER_00 10:49

Because beginners often lack the proprioceptive awareness to know when they are, say, mishandling tissue or wasting motion.

SPEAKER_02 10:56

Ah, right.

SPEAKER_00 10:56

They're so focused on getting a screw into the bone that they just miss the subtleties of their own technique.

SPEAKER_02 11:01

That makes total sense.

SPEAKER_00 11:02

Interestingly, though, the residents who had more years of real-world surgical experience, they aligned slightly better with the experts than the first year interns did.

SPEAKER_02 11:12

Because true surgical experience breeds realistic self-assessment.

SPEAKER_00 11:17

Exactly.

SPEAKER_02 11:18

It takes time and real-world reps to actually know what good feels like.

SPEAKER_00 11:22

Right. So the clinical punchline from Lew et al. 2026 is that integrating a three-month structured cadaver training program into a residency isn't just feasible, it objectively improves basic ultopedic skills.

SPEAKER_02 11:34

Yeah. And if you are mentoring trainees, out-of-order training paired with an objective evaluation tool like OSATS is just a necessary evolution.

SPEAKER_00 11:43

It really is. It allows clinics to maintain efficiency and safety in the OR while still developing top-tier surgeons.

SPEAKER_02 11:49

It isolates the mechanics so the OR can be about execution.

SPEAKER_00 11:52

Yeah, absolutely.

SPEAKER_02 11:53

Which leaves us with a final thought to mull over. If surgical trainees' self-perception is this skewed early in their careers, how often might you be confusing your own growing confidence with objective clinical confidence?

SPEAKER_01 12:09

That's it for this episode of the Simony Small Animal Surgery Podcast. This show is brought to you by Semini Protect Livage, our interoperative lavage developed to target resistant bacteria and biofilms where traditional solutions of saline and post op antibiotics fall short. If you're interested in learning more or trying out your own procedures, you'll find information and links in the show notes. For listening, and we'll see you in the next episode.