Training with a Novel Digitally Enhanced Hands-On Surgical Training (DEHST) Enhances the Performance During Intramedullary Nail Distal Interlocking

Abstract

Abstract Background Freehand distal interlocking of intramedullary nails remains a challenging task. This surgical step is the most difficult part performed at the end of the operation and may have a catastrophic influence on patients’ outcome of not performed precisely. Recently, the AO Research Institute developed a new training device for Digitally Enhanced Hands-on Surgical Training (DEHST), potentially improving surgical skills needed for this surgical step. The device already yielded high scores in terms of face and construct validity in the first step of the validation cascade. Aims To evaluate weather training with DEHST enhances the performance of novices without surgical experience in free-hand distal nail interlocking compared to a non-trained group of novices. Methods 20 novices were assigned in two groups and performed distal interlocking of a tibia nail in an artificial bone model under a real C-arm. Group 1: DEHST trained novices (virtual locking of five nail holes during one hour of training). Group 2: untrained novices without DEHST training. Time, number of x-rays, nail hole roundness, critical events and success rates were compared between the groups. Results Time to complete the task (sec) and x-ray exposure (µGcm2) were significantly lower in Group1 414.7 (290–615) and 17.8 (9.8–26.4) compared to Group2 623.4 (339–1215) and 32.6 (16.1–55.3); p=0.041 and 0.003. Perfect circle roundness (%) was 95.0 (91.1–98.0) in Group 1 and 80.8 (70.1–88.9) in Group 2; p<0.001. In Group 1 90% of the participants achieved successful completion of the task (hit the nail with the drill), whereas only 60% of the participants in group 2 achieved this; p=0.121. Conclusions Training with DEHST significantly enhances the performance of novices without surgical experience in distal interlocking of intramedullary nails. Besides radiation exposure and operation time the complication rate during the operation can be significantly reduced.