Orthopedic screws insertion simulation with immediate feedback enhances surgical skill

Abstract Background Screw insertion to bones is a fundamental skill in orthopedic, spine and cranio-maxillofacial surgery. Applying the correct tightening torque is critical when compressing and fixating bone fragments. Overtightening yields in plastic deformation of the bone and destruction of the screw-bone interface, damaging the construct's stability. The surgeon is required to achieve sufficient hold and compression without stripping the bone. Several studies had investigated these skills, demonstrating much potential to enhance the future surgeons' capabilities. This study presents a novel training module combining direct tightening followed by deliberate striping with immediate feedback, suggested to enhance the surgeon's tactile perception and improve skill. Methods A prospective cohort study, single blinded. Twenty surgeons from various disciplines, excluding orthopedic and maxillo-facial surgeons were trained using an orthopedic screws insertion model, comprised of synthetic bones. Training sessions comprised of inserting 40 screws into normal and osteoporotic bone models, experiencing deliberate stripping of the screws and feedback for their performance on three different sessions. Findings Success rate had increased between sessions – 24% to 48% in normal bone, 37% to 52% in osteoporotic bone. Stripping rate had decreased between sessions – 37.5% to 18.5% in normal bone, 29% to 14% in osteoporotic bone. Average tightening torque/Tmax ratio had improved gradually and consistentlyfrom 67.3% to 81.6% in normal bone (p  Interpretation Immediate feedback with deliberate stripping and external feedback using a digital torque measuring screwdriver may improve cortical screw insertion technique in the surgeons' population.