Novel approach to dislocation reduction training with three-dimensional printed models

ABSTRACT

Intro/Background: The management of dislocation reductions is a crucial aspect of comprehensive training within emergency medicine. Due to the COVID-19 pandemic however, local governments have implemented policies restricting many activities, resulting in fewer orthopedic injuries and traumatic presentations. Similarly, volumes across national emergency departments have decreased by 42%, with some regions by 63.5%. As a result, there is a lower incidence of polytrauma, fractures, and joint dislocations. Purpose/Objective: Due to decreases in patient volume and fewer opportunities to perform dislocation reductions, we developed a series of models and orthopedic curriculum to supplement exposure to these procedures. Through the implementation of joint dislocation models, resident physicians may attain procedural competency, practice reduction techniques, and help to satisfy ACGME requirements despite the relative scarcity of dislocations. The aimed application is for resident physician learning as well as in-servicing for continuing medical education. Methods: Low cost, high fidelity, reusable, and wearable models have been created using open-access 3D printed bone models. Models developed include the elbow, shoulder, knee, ankle, and jaw. These were further assembled with additional materials into functional joints that allow for assessment of appropriate traction and tactile feedback for successful reduction. These have been supplemented with an orthopedic curriculum for comprehensive learning of joint reductions. Outcomes (if available) Assessment of the models and curriculum have been performed by board certified emergency and sports medicine trained faculty using a survey following model use. Based on a survey of faculty, the models teach reduction techniques with a reasonable level of fidelity. Attitudes reveal that it would be a valued tool in resident learning. We aim to further assess the curriculum through resident feedback. Future steps also involve examining resident assessment through surveying and feedback. Summary: Among other setbacks, the COVID-19 pandemic has introduced limitations in the emergency medicine resident training environment. A crucial aspect of which includes the volume of orthopedic dislocations managed in the emergency department. Herein, we developed a series of models and orthopedic curriculum to supplement exposure to these procedures. Models developed include the elbow, shoulder, knee, ankle, and jaw. Through the implementation of joint dislocation models, resident physicians may attain procedural competency, practice reduction techniques, and help to satisfy ACGME requirements despite the relative scarcity of dislocations. We leveraged low cost, high fidelity, reusable, and wearable models using open-access 3D printed bone models. These were further assembled using accessible tools, such as hospital tourniquet bands to act as ligaments and provide resistance, screws as tethering-points, and a 3D printer with open access bone models that can either be purchased or used publicly at a local library. These models allow for assessment of appropriate traction and tactile feedback for successful reduction. They can also be applied in an orthopedic curriculum for comprehensive learning of joint reductions. Currently, there are no similar task trainers to simulate this series of dislocations and reductions that are commercially available or described in literature. We anticipate these novel models and the paired curriculum will be advantageous to assist development of emergency medicine residents' confidence and competency in joint dislocation reductions. Due to the changes in resident education during the COVID-19 pandemic, these adaptable, flexible, and easily reproducible education strategies may be beneficial for supplemental training in other emergency residency programs. In assessment of the models through surveying board-certified emergency medicine faculty, the models teach reduction techniques with a reasonable level of fidelity and would be a valued tool in resident learning. uture steps also involve examining resident competence following the application of simulation models and orthopedic curriculum.