Chetan Khatri, Kapil Sugand, Kashif Akhtar, Chinmay Gupte, Justin Cobb MSk Lab, Imperial College London, Charing Cross Hospital, London

1. Training safer surgeons of the future: The training effect on a
virtual-reality, haptics-enabled orthopaedic trauma simulator
Chetan Khatri, Kapil Sugand, Kashif Akhtar, Chinmay Gupte, Justin Cobb
MSk Lab, Imperial College London, Charing Cross Hospital, London
Introduction
Within orthopaedic practice, dynamic hip-screw (DHS) fixation of extra-capsular
fractures is one of the commonest operations in the trauma setting. It is one of the
first operations junior doctors are exposed to and are expected to master.
With a lack of dry-bone training modules, the first time a surgical trainee performs the
procedure is often on a patient, posing increased risk towards the patient. Within
general surgery, using virtual-reality (VR) simulation training increases technical
performance within the operating theatre. However, there is a scarce amount of
literature concerning orthopaedic trauma, with most simulators lacking a haptic-
interface, limiting transfer of skills.1,2
Within orthopaedic trauma, hip fractures are a significant worldwide problem with over
1.6 million occurring annually3. They carry a high risk of sequelae with a mortality of
13% in the 6-month post-operative period4. Hip fractures are both common and
potentially life-threatening with high financial costs involved.
Results
FIGURE 1: A participant carrying out the DHS procedure
REFERENCES
1. Blyth P, Stott NS, Anderson I a. Virtual reality assessment of technical skill using the Bonedoc DHS simulator. Injury. 2008 Oct;
39(10):1127–33.
2. Blyth P, Stott NS, Anderson I a. A simulation-based training system for hip fracture fixation for use within the hospital
environment. Injury. 2007 Oct;38(10):1197–203.
3. Hartholt KA, van Beeck EF, Polinder S et al. Societal consequences of falls in the older population: injuries, healthcare costs, and
long-term reduced quality of life. J Trauma 2011 71(3):748–753
4. Hannan, E.L., et al., Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital
outcomes. JAMA, 2001. 285(21): p. 2736-42.
Methods
This study tested TraumaVision, the first VR, haptics-enabled orthopaedic trauma
simulator. All data was collected between March and July 2013. The aim was to
assess whether the 10-step DHS application on TraumaVision system had a training
effect to improve objective performance metrics in naïve medical students.
52 medical students, (naïve to DHS procedures and VR simulation) were voluntarily
recruited and randomised to two groups: Group 1 (training) performed 5 attempts
whilst Group 2 (control) performed only once. After a one-week washout period, both
cohorts repeated the same number of attempts as the week before.
Participants were assessed by objective performance metrics including (i) total
procedural time, (ii) fluoroscopy time, (iii) number of radiographs, (iv) attempts of
guide wire insertions, (v) tip-apex distance (TAD), (vi) probability of cut-out and (vii)
global score.
Conclusions
This study demonstrated significant training effect on the VR haptic DHS simulator in
improving seven clinically relevant object performance metrics. Simulation in the
trauma setting plays an important role the acquisition of orthopaedic surgical skills
and compliments proctorship in achieving competency, if not proficiency, during an
austere period of surgical training without compromising patient safety as an utmost
priority.
FIGURE 2: Screen viewed by participant after completing procedure Key Messages
1) Currently, simulation is a rare facility for orthopaedic tramua
2) Virtual-Reality provides a safe, controllable enviroment to
safely acquire technical skills
3) This study shows repeated exposure to the TraumaVision
simulator can improve performence of technical skills.
FIGURE 3: Box & Whisker plots to show improvement in objective metrics
FIGURE 4: Linear regression analysis of objective metrics
Thursday, 26 September 13