3-D Printed Fracture Models Improve Resident Performance and Clinical Outcomes in Operative Fracture Management

Elsevier

Available online 15 May 2023

Journal of Surgical EducationAuthor links open overlay panel, , , , Objective

To determine if preoperative examination of patient additive manufactured (AM) fracture models can be used to improve resident operative competency and patient outcomes.

Design

Prospective cohort study. Seventeen matched pairs of fracture fixation surgeries (for a total of 34 surgeries) were performed. Residents first performed a set of baseline surgeries (n = 17) without AM fracture models. The residents then performed a second set of surgeries randomly assigned to include an AM model (n = 11) or to omit it (n = 6). Following each surgery, the attending surgeon evaluated the resident using an Ottawa Surgical Competency Operating Room Evaluation (O-Score). The authors also recorded clinical outcomes including operative time, blood loss, fluoroscopy duration, and patient reported outcome measurement information system (PROMIS) scores of pain and function at 6 months.

Setting

Single-center academic level one trauma center.

Participants

Twelve orthopaedic residents, between postgraduate year (PGY) 2 and 5, participated in this study.

Results

Residents significantly improved their O-Scores between the first and second surgery when they trained with AM models for the second surgery (p = 0.004, 2.43 ± 0.79 versus 3.73 ± 0.64). Similar improvements were not observed in the control group (p = 0.916, 2.69 ± 0.69 versus 2.77 ± 0.36). AM model training also significantly improved clinical outcomes, including surgery time (p = 0.006), fluoroscopy exposure time (p = 0.002), and patient reported functional outcomes (p = 0.0006).

Conclusions

Conclusions: Training with AM fracture models improves the performance of orthopaedic surgery residents during fracture surgery.

Section snippetsINTRODUCTION

The advent of additive manufacturing (AM), known colloquially as 3-D printing, has begun to transform the world of medicine. AM models of patient anatomy can be rapidly and inexpensively produced for use in various surgical areas, including cardiovascular, neurological, craniomaxillofacial, and orthopedic surgery.1 Some applications include preoperative planning; intraoperative referencing; trialing new or difficult techniques; implant selection; and patient-specific instrumentation, implants,

METHODS

We conducted this Institutional Review Board-approved prospective study in 2019. It involved 12 orthopedic residents who performed 17 matched pairs of fracture fixation surgeries (Fig. 1). The participating residents had experience levels ranging between postgraduate year (PGY) 2 and 5, with 3 residents in each class. These participants were rotating through the Trauma service, a 6-week rotation, during the time course of the study. PGY 1 residents were excluded from the study because they do

RESULTS

We observed a significant improvement in O-Score between the first and second surgery for residents who trained with AM models in preparation for the second surgery (p = 0.004) (Table 2). Specifically, the mean O-score was 2.43 (0.79) for the first surgery and 3.73 (0.64) for the second surgery. There were significant increases in subscores for 7 of 8 categories for the AM model group. Visuospatial skills showed the greatest improvement, with mean scores increasing from 1.82 (0.75) to 4.18

DISCUSSION

This study confirmed that training with AM fracture models improved the performance of orthopedic residents during fracture surgery. The AM models significantly increased O-Score by 53.5% in comparison to the control group, which saw a nonsignificant increase of 3%. The improvement of over one full point on the 5-point O-Score scale for the AM model group means that the involvement of the attending surgeon improved from having to “prompt them from time-to-time” during the first surgery to only

Ethical Approval

Ethical approval was granted by the Institutional Review Board for study protocol number 818986 on August 22, 2019.

Previous Presentations

This work was previously presented as both a poster and podium presentation at the Orthopedic Research Society 2020 annual meeting in Phoenix, AZ on February 9, 2020.

Acknowledgments

None.

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© 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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