Training femoral neck screw insertion skills to surgical trainees:  computer-assisted surgery versus conventional fluoroscopic technique.
BACKGROUND
: Femoral neck fractures are among the most common orthopaedic injuries impacting the health care system. Surgical management of such fractures with cannulated screws is a commonly performed procedure. The acquisition of surgical skills necessary to perform this procedure typically involves learning on real patients with fluoroscopic guidance. This study attempts to determine if a novel computer-navigated training model improves the learning of this basic surgical skill.


METHODS
A multicenter, prospective, randomized, and controlled study was conducted using surgical trainees with no prior experience in surgically managing femoral neck fractures. After a training session, participants underwent a pretest by performing the surgical task (screw placement) on a simulated hip fracture using fluoroscopic guidance. Immediately after, participants were randomized into either undergoing a training session using conventional fluoroscopy or computer-based navigation. Immediate posttest, retention (4 weeks later), and transfer tests were performed. Performance during the tests was determined by radiographic analysis of hardware placement.


RESULTS
Screw placement by trainees was ultimately equal to the level of an expert surgeon with either training technique. Participants who trained with computer navigation took fewer attempts to position hardware and used less fluoroscopy time than those trained with fluoroscopy. When those trained with fluoroscopy used computer navigation at the transfer test, less fluoroscopy time and dosage was used. The concurrent augmented feedback provided by computer navigation did not affect the learning of this basic surgical skill in surgical novices. No compromise in learning occurred if the surgical novice trained with one type of technology and transferred to using the other.


CONCLUSIONS
The findings of this study suggest that computer navigation may be safely used to train surgical novices in a basic procedure. This model avoids using both live patients and harmful radiation without a compromise in the acquisition of a 3-dimensional technical skill.
Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. markku.nousiainen@sunnybrook.ca
Markku T
MT
Nousiainen
Daniel M
DM
Omoto
Patrick O
PO
Zingg
Yoram A
YA
Weil
Sami W
SW
Mardam-Bey
William C
WC
Eward
D001863:Bone Screws; D002983:Clinical Competence; D004521:Educational Measurement; D005265:Femoral Neck Fractures / Q000601:surgery*; D005272:Femur Neck / Q000601:surgery; D005471:Fluoroscopy; D006801:Humans; D007396:Internship and Residency; D008953:Models, Anatomic; D019637:Orthopedic Procedures / Q000193:education*; D011446:Prospective Studies; D013337:Students, Medical; D025321:Surgery, Computer-Assisted / Q000193:education*