Virtual Simulation for Interactive Visualization of 3D Fracture Fixation Biomechanics

Abstract

Introduction: In the surgical fixation of fractures, proper biomechanical stability is key in preventing clinical complications including poor fracture healing, residual deformity, loss of fixation, or implant failure. Stability is largely influenced by treatment decisions made by the surgeon. The interplay of surgeon-controlled variables and their effect on the three-dimensional (3D) biomechanics of a fracture fixation construct are often not intuitive, and current training methods do not facilitate a deep understanding of these interactions.Methods: A simulation software interface, FracSim, was developed. FracSim is built on a large precomputed library of finite element simulations. The software allows a surgeon to make adjustments to a virtual fracture fixation construct/weight-bearing plan and immediately visualize how these changes affect 3D biomechanics, including implant stress and fracture gap strain, important for clinical success. Twenty-one orthopaedic residents completed an instructor-led educational session with FracSim focused on bridge plating. Subjects completed pretests and posttests of knowledge of biomechanical concepts and a questionnaire.Results: Subjects scored a mean of 5.6/10 on the pretest of biomechanical knowledge. Senior residents scored better than junior residents (P = 0.04). After the educational session with FracSim, residents improved their test scores to a mean of 8.0/10, with a significant improvement (P , 0.001). Questionnaire scores indicated that subjects believed that FracSim had realistic implants, constructs, and motions and that training with FracSim was purposeful, desirable, efficient, fun, and useful for enhancing the understanding of fracture fixation biomechanics.Discussion: This new type of simulation software enables interactive visualization of 3D fracture fixation biomechanics. Limitations of this study include lack of a control group undergoing traditional education and lack of a delayed posttest to assess retention. FracSim may provide an effective and engaging way to promote a deeper understanding of biomechanical concepts in the orthopaedic learner.

Finite element modeling of fracture compression by compression plates

“…[3][4][5][6]11,34 These simplified generic models are suitable for investigation and demonstration of fundamental principles. 35 We caution against direct extrapolation of results here to specific clinical settings. Although we believe the findings of this investigation would generalize well to many specific bone geometries (e.g., curvature and cortical thickness), bone properties, and fracture types/geometries, further work is warranted in this area.…”

“…Transverse planar fractures were modeled for simplicity, as was the case for most previous experimental studies of dynamic compression plates 3–6,11,34 . These simplified generic models are suitable for investigation and demonstration of fundamental principles 35 . We caution against direct extrapolation of results here to specific clinical settings.…”

Biomechanics of fracture healing: how best to optimize your construct in the OR

“…In a previous study, we demonstrated improvements in biomechanical knowledge after a session with FractSim. 25 The aim of this study was to add visualization of the effects of fracture healing to FractSim (Fig. 3 ).…”