Introduction: Surgical training is being greatly affected by the challenges of reduced training opportunities, shortened working hours, and financial pressures. There is thus an increased need for training systems to aid development of psychomotor skills of the surgical trainee. Furthermore, simulation environments can provide a friendlier and less hazardous environment for learning surgical skills. Such simulations may be used to augment training in the operating room (OR) so that trainees acquire key skills in a non-threatening and unhurried environment.

Trajectory planning and implementation forms a substantial part of current and future orthopaedic practice. This type of surgery is governed by a basic orthopaedic principle where the placement of a surgical tool at a specific site within a region via a trajectory that is planned from X-ray based 2D images and is governed by 3D anatomical constraints. The accuracy and safety of procedures utilising the basic orthopaedic principle depends on the surgeon’s judgement, experience, ability to integrate images, utilisation of intra-operative X-ray, knowledge of anatomical-biomechanical constraints and eye hand dexterity.

With the decrease in training opportunities in OR for the surgical trainee, these skills are developing at a much later stage in training. Several studies have shown a reduction in the number of operations undertaken and a reduction in the level of competence achieved by surgical trainees.

Purpose of the study: This study develops our existing surgical CAOSS (Computer Assisted Orthopaedic Surgical System) [4, 5] for fracture fixation into a training tool for skill acquisition of the basic orthopaedic principle, namely, 3D navigation using 2D X-ray images.

Material and Methods: Orthopaedic trainees who are presently working in Hull and East Yorkshire NHS Trust are recruited in this study.

The study is divided into two parts. The initial part of the study involves the use of the conventional CAOSS to train the orthopaedic trainees with no prior exposure of distal locking of femoral nails and the dynamic hip screw. The second part of the study involves the use of modified CAOSS to assess whether the initial training has helped in developing mental navigation skills of using a 2-D image and navigating the drill bit in 3-D space.

The scoring system is based on a combination of parameters which include the time taken for centring of the interlocking screw, total exposures taken and the improvement in the position of the tip of the drill bit with each exposure.

Results: The presentation will discuss the theories, methodology and scoring criteria to produce a training tool for training of the basic orthopaedic principle and how the training tool was validated.

Discussion: The ability to quantify precisely three-dimensional navigation and processing of virtual information to help in hand eye co-ordination has not previously been used as a formal orthopaedic training tool. Clearly the assessment of such skills demands a scoring system that is both reproducible as well as being able to validate it that it predicts skill acquisition correctly. Currently, there is no known scoring system which can accurately assess the ability to navigate instruments in 3-D space using a C-arm image. We therefore propose that using CAOSS as a training tool for the surgical trainees in a relaxing less hurried environment is beneficial to training and we also propose for this tool a reproducible scoring system.