3D-Printed Surgical Simulator for Kirschner Wire Placement in Hand Fractures
Michal Brichacek, MD, BSc; Julian Diaz-Abele, MD; Sarah Shiga, MD, FRCSC; Christian Petropolis, MD, FRCSC
University of Manitoba, Winnipeg, MB, Canada
Introduction Surgical simulation provides resident physicians the opportunity to improve their operative skills in a safe environment. Placement of Kirschner wires for hand fractures is a deceptively difficult technique which requires significant experience to master. A simulator to aid in visualizing the anatomy would help trainees more rapidly advance their skills. We describe the design, creation, and preliminary validation of a 3D-printed hand simulator for Kirschner wire placement.
Materials & Methods Computer aided design (CAD) software was used to create a hand model based on anatomic measurements. 3D-printing was used to manufacture the separate components. Simulated bones were created from polyurethane, with imbedded iron to render them radiopaque. The overlying soft tissues were made from silicone. A transparent soft tissue envelope was created. For advanced difficulty, a surgical glove can be placed on the model to simulate an opaque soft tissue envelope. Resident physicians and staff both evaluated the model, and then a semi-structured questionnaire was used to assess their experiences.
Results An anatomically correct model was manufactured with multiple metacarpal and phalangeal fractures. Articulations at the interphalangeal joints were mobile within normal limits. Two variations of the model were utilized: one with transparent skin allowing visualization of the underlying bones, and one with simulated opaque skin by covering the model with a surgical glove. This transparency allowed for a graded difficultly for novice surgeons, and correlation between tactile and visual feedback. Visualization under fluoroscopic C-arm demonstrated visible discernment of the bones in both cases.
Five residents and five staff evaluated the models. Experiences analyzed included: simulation realism, educational utility, and overall reaction. On a five-point scale, participants rated the model at 4.58/5 for realism, 4.98/5 for educational utility, and 5/5 for overall usefulness. Responses in all domains were favorable, suggesting the positive utility of this model.
Conclusions Using 3D-printing, we developed an anatomically correct and realistic simulator for Kirschner wire placement in hand fractures. Initial feedback has been favorable, suggesting its potential as an effective educational tool.
Figure 1. Visualization of the model with transparent soft tissue envelope
Figure 2. Visualization of the model under fluoroscopy
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