1. A Novel Approach to Teaching Visual-spatial Skills in Wire Navigated Procedures Jenniefer Y. Kho, M.D. J. L. Marsh, MD, Geb Thomas, PhD, Brian Johns, MS, Don Anderson, PhD University of Iowa Hospitals and Clinics

2. Aided by a Grant from the Orthopaedic Research and Education Foundation

3. Introduction Surgical simulation in orthopaedic trauma is lacking

4. Benchtop models Leong et al. Validation of orthopaedic bench models for trauma surgery. JBJSBr 2008. Atesok. Surgcial Simulation in Orthopaedic Skills Training. JAAOS 2012;20:410-422.

5. Yehyawi et al. A simulation trainer for complex articular fracture surgery. JBJS 2013.

6. Blyth. A simulation-based training system for hip fracture fixation for use within the hospital environment. Injury 2007. Virtual Reality Simulator

7. Froelich et al. Surgical Simulators and Hip Fracture: A Role in Residency Training? Journal of Surgical Education 2011. Haptic-based simulator

8. Background Wire navigation, or the ability to target a wire to a precise location through an osseous trajectory, is a fundamental skill in orthopaedic surgery.

9. Aims Develop a radiation-free electromagnetic sensor-based wire navigation simulator in a proximal femur model Determine if simulator training improves performance in novice (PGY-1) surgeons Compare novice and expert (senior residents/staff) surgeons

10. TrakStar simulator development

12. Methods 6 PGY-1 residents Sawbones pretest Simulator training (3 trials) Sawbones posttest

13. Methods 6 PGY-1 residents Sawbones pretest Simulator training (3 trials) Sawbones posttest - Tip-apex-distance - Time - # fluoro shots - # of attempts

14. Methods 6 PGY-1 residents Sawbones pretest Simulator training (3 trials) Sawbones posttest

15. Methods TAD 20.9mm – 53 images TAD 17.8mm – 50 images TAD 12.05mm – 42 images Trial 1 Trial 2 Trial 3

16. Methods 6 PGY-1 residents Sawbones pretest Simulator training (3 trials) Sawbones posttest - Tip-apex-distance - Time - # fluoro shots - # of attempts

17. Methods 6 PGY-1 residents Sawbones pretest Simulator training (3 trials) Sawbones posttest PGY-4/Staff - Tip-apex-distance - Time - # fluoro shots - # of attempts

18. Results * Mean+SD Table 1. Pre vs posttest (PGY-1)

19. Results Table 2. Novice vs expert surgeons * Mean+SD

20. Results of simulator practice in all groups

22. Discussion TrakStar wire navigation simulator can distinguish novice and expert surgeons – Increased TAD in novice surgeons Practice on the simulator leads to decreased time and fluoroscopic shots, but no difference in TAD (actually increased)

23. Discussion Simulator needs to be affordable, user- friendly, demonstrate validity – Trakstar is expensive – Need further validation studies Currently testing the simulator in graduate students and more senior surgeons