ACKNOWLEDGEMENTSThis work would not be possible without the help, knowledge, and mentoring of my advisors, Donald D. Anderson and Geb W. Thomas. I would also like to express my thanks to David G. Wilder for serving on my thesis committee and as my academic advisor throughout graduate school and to Dr. Matthew Karam and Dr. Larry Marsh for their valuable clinical insight throughout this process. Additionally, thank you to Steven Long for spending countless hours fine-tuning the simulator, Andrew Kern for providing me with his MATLAB code and tutorials, and Clarence Kreiter for his help with statistics. iii ABSTRACTThe purpose of this study was to define a more accurate way of assessing guide wire navigation performance, which is a crucial first step in fixing an intertrochanteric femoral fracture. This study introduces a new measurement technique called the trajectory accuracy metric (TAM) to quantify the placement of a guide wire with respect to an ideal trajectory. A total of seventy-two cases were collected in which a Post Graduate Year 1 (PGY1) resident was instructed to place a guide wire through the neck and head of a synthetic femur as close to a center-center position as possible. Each resident was guided by the use of fluoroscopic anteroposterior (AP) and lateral images. A simple geometrical model of a femur was used to define an ideal wire trajectory in which the wire was inserted at a neck-shaft angle (NSA) of 130° and placed centrally through the femoral neck. 3D models of the femur and wire were created for each case, and the wire trajectory was compared with respect to ideal by calculating TAM, which is the average distance between the two wires. The average TAM across all cases was 8.62mm, with a minimum value of 3.35mm and a maximum value of 24.17mm. Since this is a novel measurement, further studies should be done to evaluate its reliability and validity.Additionally, more wire trajectories should be incorporated into this measurement because successful placement of a guide wire is not restricted to one correct trajectory.Another application of assessing guide wire navigation performance can be applied to a surgical simulation study, in particular, if skills obtained during surgical simulation carry over to a setting that closely resembled the OR. A cross-over experimental design was used for two groups, and metrics used to determine improvement included tip-apex distance (TAD), procedural time, number of fluoroscopic
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