A High-fidelity Tactile Hand Simulator as a Training Tool to Develop Competency in Percutaneous Pinning in Residents

Abstract

Introduction:We developed an economical three-dimensional printed and casted simulator of the hand for the training of percutaneous pinning. This simulator augments the traditional “See one, do one, teach one” training model.Methods:To evaluate the simulator, five expert orthopaedic surgeons were recruited to perform percutaneous pinning on the simulator and then to complete a questionnaire on its realism and expected usefulness. Evaluation was based on responses to multiple-choice questions and a Likert-type scale.Results:All subjects expressed that the tactile hand simulator is useful for residency training. They would recommend the simulator to their colleagues and indicated interest in testing future iterations. Subjects rated highly the realism of the material, the purchase of the pin, and the cortical–cancellous bone interface.Conclusion:The learning of tactile skills in addition to visual cues on a tactile simulator is expected to benefit residents. It provides a low-cost and low-risk environment outside the operating room for residents to hone their skills.

3D Printing of Customizable Phantoms to Replace Cadaveric Models in Upper Extremity Surgical Residency Training

“…For our models to exhibit the same sensory feedback surgeons expect from true fractures, we captured and translated the mechanical requirements of DRF reduction into phantom components: (1) a periosteum-like sheath on the bones to improve cartilaginous joint behavior [1], (2) better replicate the behavior and difficulty of manipulating a real patient by creating an entire arm from the phalanges to the proximal humerus [1,15], (3) incorporate the use of radiopaque elements to allow for medical imaging of surgical accuracy [1], and (4) an opaque covering to mimic skin and restrict visual cues from the phantom's internal structure. Below we describe the required materials and manufacturing methods used to create these phantom components.…”

“…Small pins are added between adjacent bones to maintain their relative positioning during printing, coating, and casting. These pins break, still contained within the periosteum layer and ballistic gelatin, when first manipulating the phantom and do not interfere with further use [1,15].…”

“…The DRF phantom described in this paper was an expansion on previous work developing a carpal fracture pinning model [15]. This phantom included all carpals and metacarpals but was truncated mid-forearm, removing the interaction of the radius and ulna at the elbow.…”

“…Human bones are not solid, and the mesh lattice created by FDM printing closely replicates the cancellous geometry of bone [18]. This bone composition was chosen during our previous work on a percutaneous pinning model to give cortical (outer shell) and cancellous (inner lattice) feedback to surgeons [15]. This not only makes our models splinter and deform like bones, but also drastically reduces infill material and speeds up printing time.…”

A 3-Dimensional-Printed Hand Model for Home-Based Acquisition of Fracture Fixation Skills Without Fluoroscopy

“…While previous reports have cited costs over $100 per hand, we have achieved this under $50 per hand. 4 With 3D printers becoming more affordable and ubiquitous at academic centers, it is our goal to share our knowledge and increase access to easy production of 3D-printed models for resident training. At the same time, it is our goal to make simulation available at home and outside of the hospital.…”