Pelvic ring fracture simulator to practice emergency interventions of unstable pelvic ring fractures

Introduction

The management of hemodynamically unstable pelvic ring injuries necessitates surgical intervention, often involving procedures such as external fixation and percutaneous screw placement for which regular training is imperative to ensure readiness for emergencies. Our study aimed to adapt and validate a realistic simulation model for stabilizing unstable pelvic ring injuries.

Material & Methods

A standardized simulator of an unstable pelvic ring utilizing synthetic pelvic bones featuring complete disruption of the symphysis and sacroiliac joint, with simulated soft tissue coverage, was developed. Trauma surgeons affiliated with a level one academic hospital were invited to perform external fixation and emergency sacroiliac screw application under C-arm guidance. Prior to and following the simulation session, participants completed a subjective questionnaire assessing their confidence in emergency interventions on a 10-point Likert scale (10-LS). Objective parameters, such as intraoperative imaging quality, reduction accuracy, and the positioning of screws, wires, and external fixators, were also evaluated.

Results

Fifteen trauma surgeons (10 residents, 5 consultants) participated in the simulation over the course of one day. The confidence for emergency SI-Screw placement increased significantly after the simulator (10-LS: Before=3.8±3.08 vs. After=5.67±2.35; p=0.002) as well as after external fixation (10-LS: Before=3.93±2.79 vs. After=6.07±2.52; p=0.002). In addition, confidence in (intraoperative) pelvic imaging increased significantly (10-LS: Before=4.60±3.0 vs. After=6.53±2.39; p=0.011). Overall, the model was rated as a realistic simulation of clinical practice (10-LS=7.87±1.13).

Conclusions

Our unstable pelvis fracture model is a tool to practice emergency interventions such as external fixation and percutaneous techniques. Participants benefitted from this in terms of technical instrumentation as well as intraoperative imaging.

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