Jenniefer Y. Kho, Brian D. Johns, Geb W. Thomas, Matthew D. Karam, John L. Marsh, Donald D. Anderson

Surgical simulation is an increasingly important method to facilitate the acquiring of surgical skills. Simulation can be helpful in developing hip fracture fixation skills because it is a common procedure for which performance can be objectively assessed (i.e., the tip-apex distance). The procedure requires fluoroscopic guidance to drill a wire along an osseous trajectory to a precise position within bone. The objective of this study was to assess the construct validity for a novel radiation-free simulator designed to teach wire navigation skills in hip fracture fixation. Novices (N=30) with limited to no surgical experience in hip fracture fixation and experienced surgeons (N=10) participated. Participants drilled a guide wire in the center-center position of a synthetic femoral head in a hip fracture simulator, using electromagnetic sensors to track the guide wire position. Sensor data were gathered to generate fluoroscopic-like images of the hip and guide wire. Simulator performance of novice and experienced participants was compared to measure construct validity. The simulator was able to discriminate the accuracy in guide wire position between novices and experienced surgeons. Experienced surgeons achieved a more accurate tip-apex distance than novices (13 vs 23 mm, respectively, p=0.009). The magnitude of improvement on successive simulator attempts was dependent on level of expertise; tip-apex distance improved significantly in the novice group, while it was unchanged in the experienced group. This hybrid reality, radiation-free hip fracture simulator, which combines real-world objects with computer-generated imagery demonstrates construct validity by distinguishing the performance of novices and experienced surgeons. There is a differential effect depending on level of experience, and it could be used as an effective training tool in novice surgeons.