Three-dimensional Printed Surgical Simulator for Kirschner Wire Placement in Hand Fractures

Closed reduction and percutaneous pinning (CRPP) of hand fractures can be a deceptively challenging procedure that requires significant hands-on time to teach and learn. We created a realistic three-dimensional simulator that can be used for teaching junior residents the CRPP. Computer-aided design and computer-aided manufacturing (CAD/CAM) software was used to create a three-dimensional hand model incorporating several common hand fractures: Bennett's fracture, transverse fifth metacarpal neck, and transverse second proximal phalanx. Three-dimensional printing was used to create molds in which the bones and soft tissue were poured. A polyurethane foam was utilized for the bones with iron incorporated to render them radiopaque, whereas silicone of varying viscosities was used for the soft tissues. Five plastic surgery residents and 5 consultants evaluated the model. Individuals then completed an anonymous 12-question survey evaluating the model based on realism, educational utility, and overall usefulness. Survey responses obtained from both residents and consultants were strongly in favor of the simulator. Average realism was graded as 4.48/5 by residents and 4.68/5 by consultants. Average educational utility was graded as 5/5 by residents and 4.95/5 by consultants. Average overall usefulness was graded as 5/5 by both groups. We created an anatomically accurate and realistic simulator for CRPP of hand fractures that was low cost and easily reproducible. Initial feedback was encouraging in regard to realism, educational utility, and overall usefulness.