Orthopedic screws insertion simulation with immediate feedback enhances surgical skill.

Area of Science:

• Surgical Skill Development
• Orthopedic Biomechanics
• Medical Education Technology

Background:

• Accurate screw insertion torque is crucial in orthopedic and cranio-maxillofacial surgery for stable bone fixation.
• Overtightening screws can lead to bone deformation and damage the screw-bone interface, compromising construct stability.
• Developing surgical skills for optimal screw insertion without stripping bone is essential.

Purpose of the Study:

• To evaluate a novel training module designed to enhance surgeons' tactile perception and skill in cortical screw insertion.
• To assess the effectiveness of immediate feedback and deliberate stripping in improving screw insertion technique.

Main Methods:

• A prospective single-blinded cohort study involving 20 surgeons from various disciplines (excluding orthopedic/maxillo-facial).
• Surgeons trained using a synthetic bone model, performing 40 screw insertions in normal and osteoporotic bone models.
• Training included deliberate screw stripping and immediate performance feedback over three sessions.

Main Results:

• Success rates significantly increased: 24%-48% in normal bone, 37%-52% in osteoporotic bone.
• Screw stripping rates decreased: 37.5%-18.5% in normal bone, 29%-14% in osteoporotic bone.
• The ratio of tightening torque to maximum torque before stripping improved from 67.3% to 81.6% (normal bone) and 76.4% to 77.5% (osteoporotic bone).

Conclusions:

• Immediate feedback and deliberate stripping, combined with digital torque measurement, can enhance cortical screw insertion techniques.
• This training approach shows potential for improving surgical proficiency in bone fixation procedures.
• The module effectively improved tactile perception and skill in managing screw insertion torque.