Shifting to an app-based method of preoperative templating in orthopaedic surgery

Preoperative templating plays an important part in attaining successful surgical outcomes after fracture fixation. Traditionally, surgeons have performed this task with printed radiographs, tracing paper, and colored markers. Now that digital radiography is ubiquitous, and digital templating platforms are needed but are expensive and may not be available to all surgeons, especially those in low-income and middle-income countries. In this study, we evaluate an innovative and user-friendly method using a mobile app that may facilitate the use of digital templating for all surgeons worldwide.

A study involving 2 groups of residents (N = 12) was conducted. Group A (n = 6) was assigned to do conventional templating; Group B (n = 6) was assigned to perform digital templating. Each group then switched to the other templating method and the process was repeated. Conventional templates were evaluated using the Arbeitsgemeinschaft für Osteosynthesefragen-Association for the Study of Internal Fixation (AO-ASIF) guidelines of template completeness. Digital templates were assessed using Image-Based Surgery Planning. Each subject in both groups completed templates for 3 injury patterns: AO 2R2A3/2U2C2, 32B2, and 43C2. Wilcoxon signed-rank and binomial tests (5% level of significance) were used for statistical analysis.

Template processing, fracture classification, and plan elaboration were comparable between the traditional and digital template groups, with good interobserver and intraobserver reproducibility using the Wilcoxon signed-ranks test (all |z values| below 1.96, all P-values > 0.05). There was no significant difference in the evaluation scores for either exercise, whether doing a traditional standard template or the digital template (P value > 0.05).

This study shows that digital templating can achieve the same goals as conventional preoperative templating for fracture fixation. With the ubiquity of digital radiography, digital templating provides an opportunity to visualize fracture configurations and create an optimum preoperative plan for fracture reconstruction using an innovative and user-friendly platform.