Optimization of Surgical Outcomes Through Prospective Analysis of Failures and Redesign of Technical Teaching: A Single-Center Prospective Study of 400 Cases
Seance of wednesday 21 january 2026 (La prothèse trapézo-métacarpienne : de la France aux Etats Unis, un exemple emblématique de la portée internationale de l’Ecole Française)
DOI number : 10.26299/4btq-1e83/emem.2026.04.04
Abstract
Introduction
The quality of the surgical procedure and the accuracy of implant positioning directly determine functional outcomes and implant survival. Despite increasing standardization of surgical techniques, some failures persist, suggesting the need for in-depth analysis and adaptation of surgical teaching strategies.
Materials and Methods
We report a prospective series of 400 consecutive procedures performed in a university hospital department. Medical records of patients who experienced clinical or radiological failure were systematically analyzed to identify technical and organizational causes. Based on these findings, our teaching strategy was modified, shifting from simple operative scheduling to mandatory expert review of complex cases, combined with step-by-step instruction focusing on key technical points. Particular attention was paid to pin positioning at the trapezium, with the systematic use of specific anteroposterior and lateral radiographic views.
Results
Failure analysis revealed a significant correlation between suboptimal implant positioning—particularly at the trapezial level—and the occurrence of complications or the need for revision surgery. The implementation of a structured, progressive, and key-step–focused teaching approach improved procedural accuracy, optimized implant positioning, and increased implant survival. In parallel, this pedagogical strategy enhanced the acquisition of technical skills among junior surgeons.
Conclusion
Prospective analysis of failures represents a major lever for improving surgical practice. Redesigning surgical education to include mandatory expert review, step-by-step pedagogy, and targeted imaging optimizes clinical outcomes, implant survival, and junior surgeon training. This reproducible quality-improvement approach highlights the central role of structured teaching in achieving excellence in academic surgery.
The quality of the surgical procedure and the accuracy of implant positioning directly determine functional outcomes and implant survival. Despite increasing standardization of surgical techniques, some failures persist, suggesting the need for in-depth analysis and adaptation of surgical teaching strategies.
Materials and Methods
We report a prospective series of 400 consecutive procedures performed in a university hospital department. Medical records of patients who experienced clinical or radiological failure were systematically analyzed to identify technical and organizational causes. Based on these findings, our teaching strategy was modified, shifting from simple operative scheduling to mandatory expert review of complex cases, combined with step-by-step instruction focusing on key technical points. Particular attention was paid to pin positioning at the trapezium, with the systematic use of specific anteroposterior and lateral radiographic views.
Results
Failure analysis revealed a significant correlation between suboptimal implant positioning—particularly at the trapezial level—and the occurrence of complications or the need for revision surgery. The implementation of a structured, progressive, and key-step–focused teaching approach improved procedural accuracy, optimized implant positioning, and increased implant survival. In parallel, this pedagogical strategy enhanced the acquisition of technical skills among junior surgeons.
Conclusion
Prospective analysis of failures represents a major lever for improving surgical practice. Redesigning surgical education to include mandatory expert review, step-by-step pedagogy, and targeted imaging optimizes clinical outcomes, implant survival, and junior surgeon training. This reproducible quality-improvement approach highlights the central role of structured teaching in achieving excellence in academic surgery.