Validity of a Novel Digitally Enhanced Skills Training Station for Freehand Distal Interlocking

Abstract

Background and Objectives: Freehand distal interlocking of intramedullary nails is technically demanding and prone to handling issues. It requires precise placement of a screw through the nail under fluoroscopy guidance and can result in a time consuming and radiation expensive procedure. Dedicated training could help overcome these problems. The aim of this study was to assess construct and face validity of new Digitally Enhanced Hands-On Surgical Training (DEHST) concept and device for training of distal interlocking of intramedullary nails. Materials and Methods: Twenty-nine novices and twenty-four expert surgeons performed interlocking on a DEHST device. Construct validity was evaluated by comparing captured performance metrics—number of X-rays, nail hole roundness, drill tip position and drill hole accuracy—between experts and novices. Face validity was evaluated with a questionnaire concerning training potential and quality of simulated reality using a 7-point Likert scale. Results: Face validity: mean realism of the training device was rated 6.3 (range 4–7). Training potential and need for distal interlocking training were both rated with a mean of 6.5 (range 5–7), with no significant differences between experts and novices, p ≥ 0.234. All participants (100%) stated that the device is useful for procedural training of distal nail interlocking, 96% wanted to have it at their institution and 98% would recommend it to colleagues. Construct validity: total number of X-rays was significantly higher for novices (20.9 ± 6.4 versus 15.5 ± 5.3, p = 0.003). Success rate (ratio of hit and miss attempts) was significantly higher for experts (novices hit: n = 15; 55.6%; experts hit: n = 19; 83%, p = 0.040). Conclusion: The evaluated training device for distal interlocking of intramedullary nails yielded high scores in terms of training capability and realism. Furthermore, construct validity was proven by reliably discriminating between experts and novices. Participants indicate high further training potential as the device may be easily adapted to other surgical tasks.

Windshield Wiper Effect in Human Bone-Peri-Implant Benign Diaphyseal Expansile Lesion with Humerus Shaft Fracture Non-Union with Implant in situ – Case Report

“…Mastering the free hand distal interlocking screw is mandatory to avoid such complications. Digitally Enhanced Hands-on Surgical Training for practicing this technique will be very valuable [ 13 ].…”

Application of Virtual Reality Systems in Bone Trauma Procedures

“…For training in the distal interlocking of intramedullary nails, the Digitally Enhanced Hands-On Surgical Training (DEHST) concept and technology scored highly in terms of training capability and realism and reliably differentiated between experts and novices [ 95 ]. DEHST is a novel modular surgical skills training and evaluation system incorporating digital tools with haptic stations for hands-on learning.…”

Drill Bone with Both Hands: Plunge Depth and Accuracy with 4 Bracing Positions

“…The Accreditation Council for Graduate Medical Education considers bone drilling a "critical step" of core orthopaedic procedures and a Level 3 competency milestone required for graduation from an orthopaedic surgery residency 12 . Contemporary orthopaedic surgical education prioritizes instruction in bone drilling in a laboratory workshop environment using synthetic bone models or cadaveric tissue before actual performance on living patients [13][14][15][16][17][18][19][20] . Bone drilling accuracy and depth of plunge while drilling are associated with years of experience and both improve as trainees advance through residency 16,19,[21][22][23] .…”

“…Contemporary orthopaedic surgical education prioritizes instruction in bone drilling in a laboratory workshop environment using synthetic bone models or cadaveric tissue before actual performance on living patients [13][14][15][16][17][18][19][20] . Bone drilling accuracy and depth of plunge while drilling are associated with years of experience and both improve as trainees advance through residency 16,19,[21][22][23] . Equipment factors 1,[21][22][23][24] and surgical technique [13][14][15]17,20,21 also influence performance.…”