gms | German Medical Science

German Congress of Orthopaedics and Traumatology (DKOU 2023)

24. - 27.10.2023, Berlin

Training with a novel Digitally Enhanced Hands-on Surgical Training (DEHST) enhances the performance during intramedullary nail distal interlocking

Meeting Abstract

  • presenting/speaker Torsten Pastor - Luzerner Kantonsspital, Luzern, Switzerland
  • Emanuele Cattaneo - Luzerner Kantonsspital, Luzern, Switzerland
  • Tatjana Pastor - Inselspital Bern, Bern, Switzerland
  • Boyko Gueorguiev-Rüegg - AO Research Institute Davos, Davos, Switzerland
  • Markus Windolf - AO Research Institute Davos, Davos, Switzerland
  • Jan Buschbaum - AO Research Institute Davos, Davos, Switzerland

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2023). Berlin, 24.-27.10.2023. Düsseldorf: German Medical Science GMS Publishing House; 2023. DocAB22-2698

doi: 10.3205/23dkou071, urn:nbn:de:0183-23dkou0713

Published: October 23, 2023

© 2023 Pastor et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objectives: Freehand distal interlocking of intramedullary nails remains a challenging task. If not performed correctly it can be a time consuming and radiation expensive procedure. Recently, the AO Research Institute developed a new training device for Digitally Enhanced Hands-on Surgical Training (DEHST) that features practical skills training augmented with digital technologies, potentially improving surgical skills needed for distal interlocking.

Aim of the study: To evaluate weather training with DEHST enhances the performance of novices without surgical experience in free-hand distal nail interlocking compared to a non-trained group of novices.

Methods: 20 novices were assigned in two groups and performed distal interlocking of a tibia nail in an artificial bone model. Group 1: DEHST trained novices (virtual locking of five nail holes during one hour of training). Group 2: untrained novices without DEHST training. Time, number of x-rays, nail hole roundness, critical events and success rates were compared between the groups.

Results: Time to complete the task (sec.) and x-ray exposure (µGcm2) were significantly lower in Group 1 414.7 (290–615) and 17.8 (9.8–26.4) compared to Group 2 623.4 (339–1215) and 32.6 (16.1–55.3); p=0.041 and 0.003. Perfect circle roundness (%) was 95.0 (91.1–98.0) in Group 1 and 80.8 (70.1–88.9) in Group 2; p<0.001. In Group 1 90% of the participants achieved successful completion of the task (hit the nail with the drill), whereas only 60% of the participants in group 2 achieved this; p=0.121.

Conclusions: Training with DEHST significantly enhances the performance of novices without surgical experience in distal interlocking of intramedullary nails. Besides radiation exposure and operation time the complication rate during the operation can be significantly reduced.