A Standardized Hand Fracture Fixation Training Framework using Novel 3D Printed Ex Vivo Hand Models: Our Experience as a Unit

Abstract

Surgery for hand trauma accounts for a significant proportion of the plastic surgery training curriculum. The aim of this study was to create a standardized simulation training module for hand fracture fixation with Kirschner wire (K-wire) techniques for residents to create a standardized hand training framework that universally hones their skill and prepares them for their first encounter in a clinical setting.

Methods: A step-ladder approach training with 6 levels of difficulty on 3-dimensional (3D) printed ex vivo hand biomimetics was employed on a cohort of 20 plastic surgery residents (n = 20). Assessment of skills using a score system (global rating scale) was performed in the beginning and at the end of the module by hand experts of our unit.

Results: The overall average scores of the cohort before and after assessment were 23.75/40 (59.4%) and 34.7/40 (86.8%), respectively. Significant (P < 0.01) difference of improvement of skills was noted on all trainees. All trainees confirmed that the simulated models provided in this module were akin to the patient scenario and noted that it helped them improve their skills with regard to K-wire fixation techniques, including improvement of their understanding of the 3D bone topography.

Conclusions: We demonstrate a standardized simulation training framework that employs 3D printed ex vivo hand biomimetics proved to improve the skills of residents and that paves the way to more universal, standardized and validated training across hand surgery. This is, to our knowledge, the first standardized method of simulated training on such hand surgical cases.

Fig. 1.

All the models used: A, The MC on the stand device, fracture short oblique through the shaft. B, The silicone-embedded 3D printed biomimetic model.

Fig. 2.

A, The single finger bone construct for dynamic frame fixation. Orange arrows indicate the elastic bands that mimic the collateral ligaments. B, External fixator. The red arrow indicates the ability to increase the joint space.

Fig. 3.

A, X-ray radiograph using a mini C-arm as obtained for 3 different infill settings of a single MC model. From left to right: infills of 10%, 20%, and 30%. B, Image analysis suggested the relative radio-opacities calculated from 3 different regions of interest to be (100 ± 1.7)%, (99 ± 2.0)%, and (97 ± 1.9)%, respectively, suggesting no significant difference with regard to the 3 different infill settings.

Fig. 4.

A, The silicone embedded 3D printed biomimetic model with the fracture patterns. B, The radiograph taken with mini C-arm provides evidence of significant contrast to mimic a normal hand radiograph. C, The 3D printed bone parts with the fracture patterns.

Fig. 5.

Bar plot showing the average score on each task before (orange bars) and after (blue bars) the completion of the module.