Medical equipment data
Page data
Part of Tibial Fracture Fixation
Type Medical equipment
Keywords orthopedic surgery, surgical training, tibial fracture, bicortical drilling, 3D printing, artificial bones
SDG Sustainable Development Goals SDG03 Good health and well-being
Authors Medical Makers
Published 2021
License CC-BY-SA-4.0
Impact Number of views to this page. Views by admins and bots are not counted. Multiple views during the same session are counted as one. 743

Tibial Shaft Simulator with Far Cortex Breakthrough Detection Augmented Feedback and Clay Backstop for Recording Plunge Depth

This data-driven, gender-specific, easy to print, environmentally friendly, hygienic, and cruelty-free simulator can be locally made to provide the highest fidelity orthopedic surgical simulation training at the lowest cost in resource-constrained settings.

Materials and Equipment[edit | edit source]

Arbutus Medical HEX Drill Kit and 3.2 mm Drill Bit[edit | edit source]

Each Arbutus Medical HEX Drill Kit contains aː

  • 3-Jaw Chuck Adapter
  • Modified DeWalt Drill
  • DrillCover Hex Linen
  • Chuck Key
  • Battery Charger
  • Rechargeable Lithium-Ion Battery
  • Storage Bag (not shown)

The Arbutus Medical HEX Drill Kit does not include drill bits so the learner must obtain a 3.2 mm drill bit separately.

3D Printed Tibial Bone Model #1 with Bicortical Anatomy and Cancellous Bone Microstructure[edit | edit source]

  • Fused Deposition Modelling 3D Printer (on-site access to a 3D printer and materials is not required)
  • White Polylactic Acid (PLA) Filament
  • STL Files for 3D Printed Adult Male or Female Tibial Bone Models #1

Periosteum Layer for Far Cortex Breakthrough Detection[edit | edit source]

  • Aluminum Foil
  • Ruler
  • Marker
  • Scissors
  • Tape
  • Wire Stripper (optional)
  • Buzzer
  • Alligator Clips (minimum of 4)
  • 9 V Battery
  • Small Gauge, Non-Insulated Wire

We will be conducting further user testing to determine if completing self-assessed bicortical drilling skills training without augmented feedback translates into similar or better plunge depth performance on long-term retention testing compared to simulators with augmented feedback. If augmented feedback for plunge detection does not confer long-term learning benefits (which is what the current research literature indicates[1]) or if we continue to observe that augmented feedback fosters anti-skills and distracts self-assessed learners from paying attention to intrinsic cues to minimize plunge, we will remove the augmented feedback feature from this simulator toː

  • increase simulator fidelity, reduce simulator costs by up to $51.47 USD, simplify the simulator build, and minimize simulator assembly time for the learner
  • increase learner safety with the removal of the live electric circuit
  • permit the learner to use any locally available powered surgical drill for bicortical drilling skills training
  • streamline the bicortical drilling skills training process of our self-assessed module
  • prevent the development of learner dependence on augmented feedback to minimize plunge ("anti-skills"), and
  • improve long-term learning and clinical outcomes for bicortical drilling.

We will still be including a clay backstop to permit the learner to measure plunge depth values which will provide targeted feedback to the learner during bicortical drilling skills training.

Soft Tissue Layer for Plunge Depth Measurement[edit | edit source]

  • Modelling Clay
  • Cellophane
  • Depth Gauge
  • Airtight Storage Container or Resealable Bag (to prevent clay from drying out to permit reuse)

Miscellaneous Supplies[edit | edit source]

  • Vise Clamp
  • Eye Protection
  • Gloves
  • Syringe
  • Water (to simulate sterile normal saline)
  • Shallow Container (to collect irrigation solution)
  • Training Logbook

Assembly Instructions[edit | edit source]

Set Up 3D Printed Tibial Bone Model #1[edit | edit source]

1
Supplies to Set Up 3D Printed Tibial Bone Model #1: (i) 3D Printed Tibial Bone Model #1, (ii) Shallow Container, (iii) Vise Clamp, and (iv) Table.
Collect Supplies

You will need the following materials:

  • 3D Printed Tibial Bone Model #1
  • Shallow Container
  • Vise Clamp
  • Table
2
Blue Vise Clamp ̈Displaying Threaded Metal Screw That Connects the Black Jaws
Attach Vise Clamp to Table
  1. Secure one Vise Clamp to a flat, stable surface.
  2. Open the jaws of the Vise Clamp to permit insertion of 3D Printed Tibial Bone Model #1.
  3. Identify the threaded screw that connects the jaws of the Vise Clamp.
3
Orient 3D Printed Tibial Bone Model #1 in the Vise Clamp so the Drilling Direction Arrow is Pointing in a Right-to-Left Direction.
Use Drilling Direction Arrow To Orient Model #1
  1. Identify the semi-engraved drilling direction arrow on the base of 3D Printed Tibial Bone Model #1.
  2. Orient 3D Printed Tibial Bone Model #1 in the Vise Clamp so the drilling direction arrow is pointing in a right-to-left direction.
4
The Model Vise Attachment Should Be Centered and Rest On the Threaded Screw That Connects the Jaws of the Vise Clamp.
Secure Model Inside Vise Clamp
  1. Place Model #1 inside the Vise Clamp.
  2. To maximize stability, (i) the model vise attachment should be centered and rest on the threaded screw that connects the jaws of the vise clamp, and (ii) the model vise attachment should be well secured between the tightly closed jaws of the vise clamp.
  3. Place the shallow container on the floor to collect the irrigation solution during bicortical drilling skills training.
5
Check Stability of 3D Printed Tibial Bone Model #1 in Vise Clamp by Pushing Down on the Top of the Left and Right Ends of the Model.
Check Stability of Model in Vise Clamp
  1. Check the stability of the model by pushing down on the top of the left and right ends of the model.
  2. If the model drops down, check and reposition the vise attachment over the threaded screw inside the body of the vise clamp (if needed) and be sure to clamp the jaws together more tightly.
6
3D Printed Tibial Bone Model #1 is Properly Oriented When The Drilling Direction Arrow is Pointing in a Right-to-Left Direction.
Verify Proper Orientation of Model in Vise Clamp
  1. Check the orientation of the 3D Printed Tibial Bone Model #1 by identifying the semi-engraved drilling direction arrow on the base of Model #1.
  2. If the arrow is not pointing in a right-to-left direction, remove and re-orient the 3D Printed Tibial Bone Model #1 so the drilling direction arrow is pointing in a right-to-left direction.

Assemble the Powered Surgical Drill[edit | edit source]

1
Arbutus Medical HEX Drill Kit and 3.2 mm Drill Bit
Collect Supplies

You will need the following materials:

  • Arbutus Medical HEX Drill Kit
  • 3.2 mm Drill Bit
2
Arbutus Medical HEX Drill with Chuck Key and Instructions for Use
Assemble Arbutus Medical HEX Drill with 3.2 mm Drill Bit
  • Follow the video instructions to assemble the Arbutus Medical HEX Drill and insert a 3.2 mm drill bit.
  • NOTE: A sterile person is NOT required to assemble the Arbutus Medical HEX Drill for simulation training.

Construct the Far Cortex Breakthrough Detector for Augmented Feedback[edit | edit source]

We will be conducting further user testing to determine if completing self-assessed bicortical drilling skills training without augmented feedback translates into similar or better plunge depth performance on long-term retention testing compared to simulators with augmented feedback. If augmented feedback for plunge detection does not confer long-term learning benefits (which is what the current research literature indicates) or if we continue to observe that augmented feedback fosters anti-skills and distracts self-assessed learners from paying attention to intrinsic cues to minimize plunge, we will remove the augmented feedback feature from this simulator toː

  • increase simulator fidelity, reduce simulator costs by up to $51.47 USD, simplify the simulator build, and minimize simulator assembly time for the learner
  • increase learner safety with the removal of the live electric circuit
  • permit the learner to use any locally available powered surgical drill for bicortical drilling skills training
  • simplify the bicortical drilling skills training steps of our self-assessed module
  • prevent the development of learner dependence on augmented feedback to minimize plunge (“anti-skills”), and
  • improve long-term learning and clinical outcomes for bicortical drilling.[1]

We will still be including a clay backstop to permit the learner to measure plunge depth values which will provide targeted feedback to the learner.

1
Supplies Used to Build the Far Cortex Breakthrough Detector
Collect Supplies

You will need the following materials:

  • Aluminum Foil
  • Optionalː Wire Stripper
  • Buzzer
  • 9 V Battery
  • Scissors
  • Alligator Clips (minimum 4)
  • Non-Insulated, Small Gauge Wire
  • Marker
  • Ruler
  • Tape

Not shown in imageː

  • Arbutus Medical HEX Drill with 3.2 mm Drill Bit Installed
  • Tibial Shaft Simulator with 3D Printed Tibial Bone Model #1 Secured Inside Vise Clamp
  • Gloves
2
Tape Sides of a 17.0 cm by 3.0 cm Aluminum Foil Strip As Shown and Attach To the Far Cortex of the 3D Printed Tibial Bone Model #1.
Attach Aluminum Foil to Far Cortex
  1. Cut out a 17.0 cm by 3.0 cm strip of aluminum foil.
  2. Tape the sides of the aluminum foil while leaving a section of the aluminum foil untaped (as shown).
  3. Attach aluminum foil to the Far Cortex of the 3D Printed Tibial Bone Model #1.
3
Connect the First Alligator Clip from the Exposed Wire of the Black Insulated End of the Buzzer to the Negative Lead of the 9 V Battery.
Connect First Alligator Clip to Buzzer and Battery
  1. Form a loop of the exposed wire of the black insulated end of the buzzer. TIP: Use the optional wire stripper to remove the colored plastic insulation covering the wire.
  2. Clip an alligator clip on the exposed wire loop of the black insulated end of the buzzer. TIPː For a more secure connection, create a loop of the exposed wire of the insulated end of the buzzer and attach the alligator clip perpendicular to the long axis of the wire loop.
  3. Connect the alligator clip from the exposed wire on the black insulated end of the buzzer to the negative lead of a 9 V battery.
4
Verify First (Black) Alligator Clip is Connected To The Proper Battery Lead By Attaching a Second (Red) Alligator Clip to the Opposite (Unused) Lead of the 9V Battery.
Verify First Alligator Clip Is Connected To The Proper Battery Lead
  1. Attach a second alligator clip to the exposed wire of the red insulated end of the buzzer to the positive lead of the 9V battery. TIPː Use the optional wire stripper to remove the colored plastic insulation covering the wire. For a more secure connection, create a loop of the exposed wire of the insulated end of the buzzer and attach the alligator clip perpendicular to the long axis of the wire loop.
  2. If the buzzer makes a sound, then the alligator clips are connected to the proper battery lead.
  3. If the buzzer does not make a sound, then switch the alligator clips to the opposite battery leads. The buzzer should now make a sound. If the buzzer still does not make a sound, consider using a new battery or a different buzzer.
  4. Disconnect the second alligator clip (which is attached to the exposed wire of the red insulated end of the buzzer) from the lead of the 9V battery.
5
Connect Second (Red) Alligator Clip to Exposed Section of Aluminum Foil Attached to Far Cortex of Tibial Shaft Simulator.
Connect Second Alligator Clip to Tibial Shaft Simulator
Connect the second alligator clip (attached to exposed wire of the red insulated end of the buzzer) to the exposed (untaped) section of the aluminum foil (as shown) attached to the Far Cortex of the Tibial Shaft Simulator.
6
Attach a (White) Alligator Clip To An Exposed Wire Loosely Looped Around the 3-Jaw Chuck Adapter of the Arbutus Medical HEX Drill. Then Attach Another (White) Alligator Clip to This (White) Alligator Clip.
Attach Two Alligator Clips to Surgical Drill
  1. Cut a small length of small gauge wire.
  2. Wrap a loop of the non-insulated, small gauge wire around the proximal metal section of the 3-Jaw Chuck Adapter of the Arbutus Medical HEX Drill. Twist the two loop ends of the small gauge wire together. IMPORTANT: Ensure that the wire loop has slack and is loosely wrapped around the proximal metal section of the 3-Jaw Chuck Adapter to prevent the wire from wrapping around the drill when drilling.
  3. Attach one alligator clip to the wire loop around the proximal metal section of the 3-Jaw Chuck Adapter.
  4. Wrap this alligator clip around the handle of the Arbutus Medical HEX Drill.
  5. Attach a second alligator clip to the free end of the alligator clip attached to the wire loop around the proximal metal section of the 3-Jaw Chuck Adapter of the Arbutus Medical HEX Drill.
7
Connect (White) Alligator Clip from Arbutus Medical HEX Drill to Battery Lead of Far Cortex Breakthrough Detector
Connect Alligator Clip from Surgical Drill to Battery Lead
  1. Connect the alligator clip from the Arbutus Medical HEX Drill to the open (unused) lead of a 9 V battery of the augmented feedback circuit of the Far Cortex Breakthrough Detector.
  2. IMPORTANT: Please put on gloves to prevent you from directly touching any material which can conduct a live electrical circuit.
  3. Test the Far Cortex Breakthrough Detector by placing the Arbutus Medical HEX Drill drill bit on the aluminum foil overlying the Far Cortex of the Tibial Shaft Simulator. The buzzer should now make a soundǃ

Add the Clay Backstop for Recording Plunge Depth[edit | edit source]

1
Supplies for Clay Backstop: (i) cellophane, (ii) modelling clay, (iii) scissors, and (iv) depth gauge.
Collect Supplies

You will need the following materials:

  • Cellophane
  • Modelling Clay
  • Scissors
  • Depth Gauge

Not shown in imageː

  • Tibial Shaft Simulator With or Without the Far Cortex Breakthrough Detector
2
Wrap the Cellophane Around the Entire Clay Backstop.
Wrap Clay Backstop
  1. Cut cellophane into long strips that are about 6.0 cm wide.
  2. Wrap the cellophane around the entire clay backstop. This keeps the clay from covering the aluminum foil during drilling to prolong the auditory signal for far cortex breakthrough detection.
3
Wrap a Cellophane Strip to Secure Clay Backstop to Far Cortex of Tibial Shaft Simulator (Shown Without the Far Cortex Breakthrough Detector)
Secure Clay Backstop to Far Cortex
Wrap one layer of a 6.0 cm wide long cellophane strip tightly around the clay backstop and 3D Printed Tibial Bone Model #1 to secure the clay backstop up against the lateral side of the 3D Printed Tibial Bone Model #1 so the clay is well molded against the far cortex.[2]

Final Preparations for Skills Training[edit | edit source]

  1. Download and print the Training Logbook.

References[edit | edit source]

  1. 1.0 1.1 Khokhotva M, Backstein D, Dubrowski A. Outcome errors are not necessary for learning orthopedic bone drilling. Can J Surg. 2009 Apr;52(2):98-102. PMID: 19399203; PMCID: PMC2663499. URL: https://pubmed.ncbi.nlm.nih.gov/19399203/.
  2. John A. Ruder, Blake Turvey, Joseph R. Hsu, Brian P. Scannell, Effectiveness of a Low-Cost Drilling Module in Orthopaedic Surgical Simulation, Journal of Surgical Education, Volume 74, Issue 3, 2017, Pages 471-476, ISSN 1931-7204, https://doi.org/10.1016/j.jsurg.2016.10.010.