Astronaut‘s fast learning to treat a tibial shaft fracture: A mars analogue simulation

Abstract text (incl. references and figure legends)

INTRODUCTION
As long-duration exploration missions (LDEM) delve deeper into outer space, the likelihood of adverse effects on skeletal system increases with mission duration [1]. Astronauts are prone to long bone fracture during/after LDEM and their autonomy has to be improved [2]. This study shows how easily astronauts can address a single fracture without surgical skills or extensive training.

MATERIAL & METHODS
A newly developed external fixation (ExFix) [3] was employed to repair artificial tibial shaft fractures during a two weeks inhabited mission at the Mars Desert Research Station (USA). Six analogue astronauts carried out this ExFix in spatial conditions (Fig. 1). To assess the efficacy of the procedure, patient safety, steps respected during the surgery, reduction accuracy and time taken were evaluated.

Fig 1. ExFix material (A). ExFix mounted on a broken artificial leg (B), after removing soft tissues to measure analysis parameters on a frontal, sagittal and upper view (C).

RESULTS
Patient safety was almost always respected (23/24 surgeries). 79.2% of fractures were treated correctly when only the main criteria (skin compression and stability) are considered. The average time for each completed surgery was 52 minutes. Steps 2 (ExFix positioning) and 4 (fracture reduction and stabilization) were the most time-consuming steps, though the most relevant for a successful surgery. The most important reduction defects were recurvatum and internal rotation. Educational background and learning conditions did not affect the outcome (p>0.05).

CONCLUSION
Astronauts achieve nearly 80% of success at repairing tibial fractures by using the ExFix. Just 2 weeks training was sufficient to become autonomous without extensive surgical education. This technique should be considered for LDEM to increase astronauts" self-sufficiency.

REFERENCES
1 L. Vico et al, The Lancet (2000)
2 T.P. Swaffield et al, AMHP (2018)
3 K.J.-E. Kouassi et al, International Orthopaedics (2022)

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