Establishing Construct Validity of a Novel Simulator for Guide Wire Navigation in Antegrade Femoral Intramedullary Nailing

Jan D Rölfing; Lisa B Salling; Steven A Long; Bjoern Vogt; Donald D Anderson; Geb W Thomas; Rune D Jensen

Establishing Construct Validity of a Novel Simulator for Guide Wire Navigation in Antegrade Femoral Intramedullary Nailing

Iowa Orthop J. 2023;43(1):31-35.

Authors

Jan D Rölfing^{1

2}, Lisa B Salling¹, Steven A Long³, Bjoern Vogt⁴, Donald D Anderson^{3

5

6}, Geb W Thomas^{3

6}, Rune D Jensen¹

Affiliations

¹ Corporate HR, MidtSim, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus, Denmark.
² Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J801; DK-8200 Aarhus, Denmark.
³ Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
⁴ Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany.
⁵ Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA.
⁶ Department of Industrial and Systems Engineering, University of Iowa, Iowa City, Iowa, USA.

PMID: 37383869
PMCID: PMC10296486

Abstract

Background: Antegrade femoral intramedullary nailing (IMN) is a common orthopedic procedure that residents are exposed to early in their training. A key component to this procedure is placing the initial guide wire with fluoroscopic guidance. A simulator was developed to train residents on this key skill, building off an existing simulation platform originally developed for wire navigation during a compression hip screw placement. The objective of this study was to assess the construct validity of the IMN simulator.

Methods: Thirty orthopedic surgeons participated in the study: 12 had participated in fewer than 10 hip fracture or IMN related procedures and were categorized as novices; 18 were faculty, categorized as experts. Both cohorts were instructed on the goal of the task, placing a guide wire for an IM nail, and the ideal wire position reference that their wire placement would be graded against. Participants completed 2 assessments with the simulator. Performance was graded on the distance from the ideal starting point, distance from the ideal end point, wire trajectory, duration, fluoroscopy image count, and other elements of surgical decision making. A two-way ANOVA analysis was used to analyze the data looking at experience level and trial number.

Results: The expert cohort performed significantly better than the novice cohort on all metrics but one (overuse of fluoroscopy). The expert cohort had a more accurate starting point and completed the task while using fewer images and less overall time.

Conclusion: This initial study shows that the IMN application of a wire navigation simulator demonstrates good construct validity. With such a large cohort of expert participants, we can be confident that this study captures the performance of active surgeons today. Implementing a training curriculum on this simulator has the potential to increase the performance of the novice level residents prior to their operating on a vulnerable patient. Level of Evidence: III.

Keywords: guide wire navigation; medical education; simulation; trauma.

MeSH terms

Analysis of Variance
Bone Screws
Curriculum
Fracture Fixation, Intramedullary*
Hip Fractures*
Humans