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Percutaneous pelvic fixation model: an affordable and realistic simulator for pelvic trauma training

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

To describe the construction and use of a percutaneous pelvic fixation model, evaluate its translational validity among fellowship-trained orthopedic trauma surgeons, and investigate the importance of specific criteria for effective competency-based assessment of pelvic fixation techniques.

Methods

Five orthopedic trauma surgeons were asked to place percutaneous wires on a pelvic fixation model, including anterior column (antegrade/retrograde), posterior column (antegrade/retrograde), supra-acetabular, transsacral, and iliosacral. Evaluation criteria included successful wire placement, redirections, cortical breaches, procedure duration, radiation exposure, and quality of fluoroscopic views. Following completion, participants were provided a survey to rate the model.

Results

There were no differences between approaches on successful screw placement, wire redirections, or fluoroscopic quality. Antegrade approaches to the anterior and posterior columns took longer (p = 0.008) and used more radiation (p = 0.02). There was also a trend toward more cortical breaches with the antegrade anterior column approach (p = 0.07). Median ratings among surgeons were 4 out of 5 for their overall impression and its accuracy in tactile response, positioning constraints, and fluoroscopic projections. Learning parameters considered most important to the progression of trainees (most to least important) were successful screw placement, corridor breaches, wire redirections, quality of fluoroscopic views, radiation exposure, and procedure duration.

Conclusion

In being affordable, accessible, and realistic, this percutaneous pelvic fixation model represents an opportunity to advance orthopedic surgery education globally. Future research is needed to validate the findings of this pilot study and to expand upon how trainees should be evaluated within simulations and the operating room to optimize skill progression.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Orthopedics, Denver Health Medical Center, 777 Bannock St, MC 0188, Denver, CO, 80204, USA

    Nicholas J. Tucker, Austin Heare, Stephen C. Stacey, Joshua A. Parry & Cyril Mauffrey

  2. Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA

    Nicholas J. Tucker, Austin Heare, Stephen C. Stacey, Joshua A. Parry & Cyril Mauffrey

  3. Orthopedics and Traumatology Unit, Azienda Ospedaliero-Universitaria Cittá della Salute e della Scienza di Torino, Turin, Italy

    Michele Nardi

  4. Department of Orthopedic Surgery, Unit of Trauma and Reconstruction, Hospital Universitario Austral, Buenos Aires, Argentina

    Roberto F. Herrera

  5. Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA

    Bryan L. Scott

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  1. Nicholas J. Tucker
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All authors made substantial contributions to this work and give explicit consent for submission. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Cyril Mauffrey.

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Supplementary Information

Below is the link to the electronic supplementary material.

Video, Supplemental Digital Content 1. Building the Model. Video demonstrating and describing how to build the percutaneous pelvic fixation model. (WMV 48352 kb)

Video, Supplemental Digital Content 2. Anterior Column Wires. Educational video demonstrating placement of anterior column wires (antegrade and retrograde) with the associated fluoroscopic views. (WMV 107608 kb)

Video, Supplemental Digital Content 3. Posterior Column Wires. Educational video demonstrating placement of posterior column wires (antegrade and retrograde) with the associated fluoroscopic views. (WMV 126458 kb)

Video, Supplemental Digital Content 4. Supra-Acetabular Wires. Educational video demonstrating placement of a supra-acetabular wire with the associated fluoroscopic views. (WMV 44873 kb)

Video, Supplemental Digital Content 5. Posterior Ring Wires. Educational video demonstrating placement of posterior ring wires (transsacral and iliosacral) with the associated fluoroscopic views. (WMV 107027 kb)

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Tucker, N.J., Nardi, M., Herrera, R.F. et al. Percutaneous pelvic fixation model: an affordable and realistic simulator for pelvic trauma training. Eur J Orthop Surg Traumatol (2023). https://doi.org/10.1007/s00590-023-03649-0

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