Medical Training Phantoms to Teach Distal Radius Fracture Management in Orthopaedic Residency Students by Utilizing 3D-printed Components

 After medical school, aspiring surgeons require additional multi-year training to develop highly specialized skills required in certain disciplines. These residency programs focus on targeted areas of the body to create experts who will excel at performing the specific medical duties tailored for and given to them in their careers. To develop these abilities before operating on patients, we can create simulated environments for residents to engage in hands-on activities to test their educational knowledge and ability to actualize prescribed results.

In upper extremity orthopaedic surgery, one of the most commonly seen injuries is a distal radius fracture (DRF), the result of a fall on an outstretched hand. To manage this injury, surgeons must tactilely identify the fracture pattern, manipulate surrounding tissue to stabilize the bone, and verify the positioning via medical imaging. This thesis discusses our development of a surgical phantom simulator (DRF MedPhantom) to assess and train surgical residents in performing DRF reduction and management. Previous work in this area has several limitations, including: high-cost production methods that limited the volume of trainees, limited anatomical feature expression required for palpation and imaging, and minimal clinical validation to support the given design. 

Therefore, we propose a development process for medical phantoms by utilizing low-cost materials augmented with additive manufacturing to convey anatomical features derived from patient medical scans. First, we discuss the advancement of a phantom hand, developed by a former lab member, into a phantom arm and the additional complications of doing such. Second, we cover the requirements of a simulated DRF and show residents successfully demonstrating those skills with our DRF MedPhantom. Third, we go into greater detail on the design and production of our phantoms, and demonstrate their continued use in a larger clinical study than previously shown. Fourth, we discuss the full results of our multi-year clinical testing where we demonstrate statistically significantly discrimination between resident year performances in addition to improved technical skills in repeat trainees. 

To continue this work, we have developed higher-fidelity bone phantom components to facilitate additional resident training exercises involving percutaneous pinning, open reduction, and internal fixation. The first and second steps of this process have been completed: investigating physical feedback of topological infill patterns to match cancellous bone properties in our 3D-printed components and implementing these new phantom bones in our pre-existing DRF MedPhantom model. Step three is currently underway: residents performing Kirschner wire pinning tests with our clinical partners.