An Extensible Orthopaedic Wire Navigation Simulation Platform.

The demand for simulation-based skills training in orthopaedics is steadily growing. Wire navigation, or the ability to use 2D images to place an implant through a specified path in bone, is an area of training that has been difficult to simulate given its reliance on radiation based fluoroscopy. Our group previously presented on the development of a wire navigation simulator for a hip fracture module. In this paper, we present a new methodology for extending the simulator to other surgical applications of wire navigation. As an example, this paper focuses on the development of an iliosacral wire navigation simulator. We define three criteria that must be met to adapt the underlying technology to new areas of wire navigation; surgical working volume, system precision, and tactile feedback. The hypothesis being that techniques which fall within the surgical working volume of the simulator, demand a precision less than or equal to what the simulator can provide, and that require the tactile feedback offered through simulated bone can be adopted into the wire navigation module and accepted as a valid simulator for the surgeons using it. Using these design parameters, the simulator was successfully configured to simulate the task of drilling a wire for an iliosacral screw. Residents at the University of Iowa successfully used this new module with minimal technical errors during use.