Repairing articular fractures is a complex and challenging task that demands competency in both physical and cognitive skills. Currently, there are few methods for novice surgeons to hone the skills necessary for articular fracture reduction outside of the operating room. The need for a standalone training platform has become more urgent to meet new mandates requiring dedicated skills training during the first year of orthopaedic residency. To address this, this research team has created a set of novel fracture reduction simulators.

Much of this work describes the development of these fracture reduction simulators. These simulators combine physical fracture models and surgical tools with virtually generated, radiation free imaging to recreate fracture reduction surgeries in a safe and repeatable environment, conducive to learner advancement.

As a validation study, performances between novice (n=6) and experienced (n=4) surgeons were assessed to determine whether the simulators can accurately differentiate skill levels. This assessment involved using a tenaculum to reduce a simulated partial articular fracture of the distal tibia. This results of this study showed that expert surgeons significantly outperformed the novice cohort in the time it took to complete the reduction (average 61.4 seconds vs. 151.2 seconds, p = 0.012), the number of images they used (average 6.6 vs. 16.3, p = 0.012), the cumulative distance the fracture fragment was manipulated (average 36.6 mm vs. 132.4 mm, p = 0.3), the amount of contact points between the surgical tools and the fragments (average 8.25 vs. 23.7, p = 0.03), and the number of discrete attempts to achieve the final reduction (average 1.25 vs. 6.5, p = 0.03). The results of this study show that these simulators can successfully differentiate skill levels between novice and advanced users and indicates the potential for further development of the systems into full training platforms to compliment the traditional education system.