Orthopaedic Hand Surgical Simulation Training: A Review

Abstract

In recent years, new orthopaedic surgical simulation and virtual reality (VR) training models have emerged to provide unlimited education medium to an unlimited number of trainees with no time limit, especially in response to trainee work-hour restrictions. Surgical simulators range from simple wooden boxes to animal and cadaver models to three-dimensional-printed and VR simulators. The coronavirus disease 2019 pandemic further highlighted the need for at-home learning tools for orthopaedic surgical trainees. Advancement in simulating shoulder and knee arthroscopies using VR simulators surpasses the other fields in orthopaedic surgery. Despite the high degree of precision needed to operate at a microscopic level involving vessels, nerves, and the small bones of the hand, the simulation tools have limited advancement in the field of orthopaedic hand surgery. This narrative review summarizes the status of surgical simulation and training techniques available to orthopaedic hand surgical trainees, factors affecting their application, and areas in hand surgery that still lag behind their surgical subspecialty counterparts.

Keywords: education; hand surgery; medical student; orthopaedics; resident; surgical simulation; surgical training.

Fig. 1

(A) Plunge depth simulator using a hand drill and wood piece (Olson et al⁷). (B) Dental rolls being used for anastomosis suture practice (Tare, Copyright 2004 by The British Society for Surgery of the Hand, reproduced with permission of SAGE Publications). (C) Silicone model used for nerve repair practice, showing (a) removal of fascia, (b) cut of epineurium and fascicle exposure, (c) microsuturing of fascicles, and (d) microsuturing of epineurium (Gul et al, Copyright 2019, with permission from Elsevier). (D) Japanese noodles as a model for anastomosis repair, with suturing steps shown (a–c) (Prunières et al, Copyright 2014, published by Elsevier). (E) (a) Z-plasty model, (b) metacarpal fracture fixation model, (c) tendon repair model, and (d) model for end-to-end anastomosis (Qassemyar and Boulart, Copyright 2015, published by Elsevier).

Fig. 2

(A) High tactile hand simulator for percutaneous pinning practice using three-dimensional (3D)-printed bones with skin covering (left) and without skin covering to check fracture fixation (right) (Wu et al¹⁸). (B) 3D-printed hand model used for K-wire placement (top) with different fracture patterns (bottom) (Prsic et al, Copyright 2020, with permission from Elsevier).

Fig. 3

(A) Comparison of a chicken femur to the human metacarpal bone (Malic et al, Copyright 2007, reproduced with permission of SAGE Publications). (B) Porcine flexor tendon with corresponding pulleys (Smith et al, Copyright 2005, reproduced with permission of SAGE Publications).

Fig. 4

Synthetically perfused cadaveric model showing dissection of the radial forearm flap (Chouari et al³¹).

Fig. 5

(A) Images from the Visible Body anatomy dissection application (Human Anatomy Atlas [Version 2022] [Computer software] [2021], retrieved May 13, 2022, from www.visiblebody.com). (B) Interactive steps of the carpal tunnel release module on the Touch Surgery app, showing decision-making via multiple choice questions (left) and interactive procedural interactions (right) (Copyright 2022 Medtronic, reproduced with permission of Medtronic). (C) Endoscopic simulator of carpal tunnel release with on-screen feedback (Kempton et al, Copyright 2018, published by Elsevier).