Teaching basic trauma: validating FluoroSim, a digital fluoroscopic simulator for guide-wire insertion in hip surgery

Figures & data

Figure 1. Control screen of the FluoroSim software running with the calibration femur. The software locates the colored markers and finds their center. It marks the position of the guide-wire on the camera image and, using the ATM, overlays this onto the pre-loaded radiograph. Both AP and CTL images are produced.

Figure 2. A right phantom limb produced out of a mannequin leg with an interchangeable workshop femur. In the background of the image the simulated radiograph of this construct may be seen.

Figure 3. A surgeon using FluoroSim with the phantom limb, surgical equipment and the imaging system.

Table 1. Checklist used to standardize the participants’ instructions

Standardized instruction checklist

1. Explain the basic working of FluoroSim, highlighting the importance of not covering the tracking markers or bending the guide-wire.

2. Explain the 5 objective metrics recorded.

3. Explain the main goal of the task: To achieve optimal guide-wire placement as if they were completing a DHS procedure thus giving them an optimal TAD.

4. Highlight that time was being recorded but the focus was on achieving an optimal guide-wire placement.

5. Explain that they should indicate when they are happy with their final guide-wire placement.

Figure 4. A series of box plots for each objective metric. The central line represents the median, the boundaries of the box represents the upper and lower quartiles respectively, and the whiskers represent the range without outliers. A significance value is presented from the adjusted Mann–Whitney U comparison.

Table 2. Median performance of each cohort

Performance metrics	Novices	Inter-mediates	Experts	p-value^a
Tip–apex distance (mm)	47	28	24	0.006
Cut-out rate (%)	55	4.7	2.6	0.007
Procedural time (s)	190	206	222	0.6
No. of radiographs (n)	16	26	28	0.03
No. of guide-wire retries (n)	0	1	2	0.2

a Kruskal–Wallis

Table 3. Percentage difference and (p-value) between the 3 cohorts for each objective metric ^a

Performance metrics	Novices vs. inter- mediates	Novices vs. experts	Inter-mediates. vs. expert
Tip–apex distance (mm)	40 (0.03)	48 (0.01)	13 (0.9)
Cut-out rate (%)	92 (0.03)	95 (0.01)	44 (1.0)
Procedural time (s)	8 (1.0)	14 (1.0)	7 (1.0)
No. of radiographs (n)	39 (0.06)	43 (< 0.05)	7 (1.0)
No. of guide-wire retries (n)	100 (0.4)	200 (0.3)	100 (1.0)

a Adjusted p-value presented from Mann–Whitney U post-hoc testing.