Dataset Information

A simulation trainer for complex articular fracture surgery.

ABSTRACT:

Background

The purposes of this study were (1) to develop a physical model to improve articular fracture reduction skills, (2) to develop objective assessment methods to evaluate these skills, and (3) to assess the construct validity of the simulation.

Methods

A surgical simulation was staged utilizing surrogate tibial plafond fractures. Multiple three-segment radio-opacified polyurethane foam fracture models were produced from the same mold, ensuring uniform surgical complexity between trials. Using fluoroscopic guidance, five senior and seven junior orthopaedic residents reduced the fracture through a limited anterior window. The residents were assessed on the basis of time to completion, hand movements (tracked with use of a motion capture system), and quality of the obtained reduction.

Results

All but three of the residents successfully reduced and fixed the fracture fragments (one senior resident and two junior residents completed the reduction but were unsuccessful in fixating all fragments). Senior residents had an average time to completion of 13.43 minutes, an average gross articular step-off of 3.00 mm, discrete hand motions of 540 actions, and a cumulative hand motion distance of 79 m. Junior residents had an average time to completion of 14.75 minutes, an average gross articular step-off of 3.09 mm, discrete hand motions of 511 actions, and a cumulative hand motion distance of 390 m.

Conclusions

The large difference in cumulative hand motion distance, despite comparable numbers of discrete hand motion events, indicates that senior residents were more precise in their hand motions. The present experiment establishes the basic construct validity of the simulation trainer. Further studies are required to demonstrate that this laboratory-based model for articular fracture reduction training, along with an objective assessment of performance, can be used to improve resident surgical skills.

SUBMITTER: Yehyawi TM

PROVIDER: S-EPMC3689258 | biostudies-literature | 2013 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A simulation trainer for complex articular fracture surgery.

Yehyawi Tameem M TM Thomas Thaddeus P TP Ohrt Gary T GT Marsh J Lawrence JL Karam Matthew D MD Brown Thomas D TD Anderson Donald D DD

The Journal of bone and joint surgery. American volume 20130701 13

<h4>Background</h4>The purposes of this study were (1) to develop a physical model to improve articular fracture reduction skills, (2) to develop objective assessment methods to evaluate these skills, and (3) to assess the construct validity of the simulation.<h4>Methods</h4>A surgical simulation was staged utilizing surrogate tibial plafond fractures. Multiple three-segment radio-opacified polyurethane foam fracture models were produced from the same mold, ensuring uniform surgical complexity b ...[more]

PMID: 23824397

Similar Datasets

Project description:PURPOSE:In the surgical treatment for lower-leg intra-articular fractures, the fragments have to be positioned and aligned to reconstruct the fractured bone as precisely as possible, to allow the joint to function correctly again. Standard procedures use 2D radiographs to estimate the desired reduction position of bone fragments. However, optimal correction in a 3D space requires 3D imaging. This paper introduces a new navigation system that uses pre-operative planning based on 3D CT data and intra-operative 3D guidance to virtually reduce lower-limb intra-articular fractures. Physical reduction in the fractures is then performed by our robotic system based on the virtual reduction. METHODS:3D models of bone fragments are segmented from CT scan. Fragments are pre-operatively visualized on the screen and virtually manipulated by the surgeon through a dedicated GUI to achieve the virtual reduction in the fracture. Intra-operatively, the actual position of the bone fragments is provided by an optical tracker enabling real-time 3D guidance. The motion commands for the robot connected to the bone fragment are generated, and the fracture physically reduced based on the surgeon's virtual reduction. To test the system, four femur models were fractured to obtain four different distal femur fracture types. Each one of them was subsequently reduced 20 times by a surgeon using our system. RESULTS:The navigation system allowed an orthopaedic surgeon to virtually reduce the fracture with a maximum residual positioning error of [Formula: see text] (translational) and [Formula: see text] (rotational). Correspondent physical reductions resulted in an accuracy of 1.03 ± 0.2 mm and [Formula: see text], when the robot reduced the fracture. CONCLUSIONS:Experimental outcome demonstrates the accuracy and effectiveness of the proposed navigation system, presenting a fracture reduction accuracy of about 1 mm and [Formula: see text], and meeting the clinical requirements for distal femur fracture reduction procedures.

Project description:Background:Cognitive overload can impair learning, and different factors might affect cognitive load during simulation-based training. In this study, we investigate the role of failure in repeated practice of virtual reality (VR) simulation of hip fracture surgery on cognitive load (CL) estimated by secondary-task reaction time test and two questionnaires. Methods:The VR simulation training program consisted of three competency levels of increasing complexity starting with the placement of a Kirschner wire in a fractured hip of one patient, adding clinical variability at the intermediate level, and performing the entire dynamic hip screw procedure in 24 different patients at the highest level. Thirteen consecutive passed simulations were required to advance to the next level. Performance was measured as passing/failing a procedure and the number of failed procedures within the latest three and five simulations. CL was measured objectively using reaction time testing during simulation and subjectively using the NASA-TLX and PAAS questionnaires. The study was carried out at a simulation center from November 2016 to March 2019. Forty-two first-year orthopedic surgery residents from the Central Denmark Region and the North Denmark Region participated in the training program. Results:A failing performance in the simulated procedure was associated with a higher CL than passing a procedure. The subjective CL estimates were affected by the number of failures during last three and five procedures with a higher number of failures being associated with a higher CL. In contrast, relative reaction time estimates of CL were not affected by previous failures. Conclusions:Questionnaires for estimation of CL seem to be affected by participant frustration after failure-a meta-cognitive "carry-over" effect. This could be a general limitation of the subjective questionnaire approach to estimate CL. Reducing CL through instructional design and handling of participant frustration might improve the learning outcome of simulation training programs.

Dataset Information

A simulation trainer for complex articular fracture surgery.

Background

Methods

Results

Conclusions

Publications

A simulation trainer for complex articular fracture surgery.

Similar Datasets

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