DISCOVERING PATTERNS IN ORTHOPEDIC SURGICAL RESIDENT BEHAVIOR DURING A CEPHALOMEDULLARY NAIL PROCEDURE WITH A WIRE NAVIGATION SIMULATOR

Each year there are hundreds of thousands of emergency department visits for hip fractures. Hip fracture repair is a common surgical procedure that residents learn early in their careers. Efficient fluoroscopy use and the precision of fixation can have an important influence on patient outcomes. This study used a wire navigation simulator to assess patterns in behavior between less experienced and experienced surgeons. The hypothesis was that experienced surgeons would have more controlled hand motions, higher accuracy in obtaining an entry point, and use less fluoroscopy than less experienced surgeons. A new simulation module for the cephalomedullary nail wire navigation task was developed, including a solid Sawbones model and visually and haptically realistic soft tissue. Second- and fifth-year residents found an appropriate entry point and drive their k-wire into the femoral shaft. Each participant repeated this task twice. Experienced surgeons had a starting point on average 1.77 mm more accurate than less experienced surgeons (p = 0.045), and experienced surgeons were more consistent in their starting point. Neither group used significantly more images or time (p = 0.097 and p = 0.061, respectively). Surgeons who consistently used larger corrections typically required more images to find their entry point. Each corrective movement with a swept area larger than 1329.7 mm2 was estimated to add between 1.53-2.25 images to the total needed.