Augmented reality enhanced physical simulation for femoral nailing training

Area of Science:

• Medical Simulation
• Surgical Training Technologies
• Augmented Reality in Medicine

Background:

• Current femoral nailing simulators struggle to balance procedural guidance with realistic haptic feedback.
• There is a need for advanced simulation tools to improve surgical training accessibility and effectiveness.

Purpose of the Study:

• To develop and evaluate an augmented reality (AR)-enhanced physical simulator for femoral nailing.
• To integrate real surgical instruments with AR visualization for improved spatial feedback and self-directed learning.

Main Methods:

• A hybrid simulator was created using a synthetic femur, real instruments, and an AR interface (Apple Vision Pro).
• Participants (25 trainees) underwent AR-guided training followed by unguided simulation runs and a retention session.
• Performance was assessed via task completion time, fluoroscopic image count, and implant placement accuracy.

Main Results:

• Task completion time significantly decreased across simulation runs for both insertion and alignment.
• The number of simulated fluoroscopic images used also declined significantly.
• Implant placement accuracy remained stable, and performance gaps between experts and non-experts narrowed over time.

Conclusions:

• The AR-enhanced simulator demonstrated clear learning effects, improving procedural efficiency and radiographic technique.
• AR technology enhances spatial learning and realism in simulation-based surgical training.
• This system represents a significant advancement in simulation-based surgical training.