Low-Cost, Reusable Fracture Reduction Task Trainer for Distal Radius Fractures

Audience: This task trainer is designed to instruct emergency medicine (EM) resident physicians, senior medical students, and advanced practice providers. Introduction: While orthopedic emergencies are common, exposure to fracture management may vary depending on one's training environment. Given that extremity bony trauma and fracture reduction techniques are listed as core content topics in the American Board of Emergency Medicine's (ABEM) 2022 Model of the Clinical Practice of Emergency Medicine,1 it is beneficial to practice their management in a simulated environment. Fracture reduction is particularly difficult to practice without any task trainers. Commercial fracture models are available and cost thousands of dollars which limits universal availability. This wrist fracture task trainer was developed to be a low-cost, reusable, transportable, and storable model with similar haptics to human bone and soft tissue. Educational Objectives: Utilizing this task trainer, learners will be able to 1) identify key anatomic structures, 2) distinguish a Colles from a Smith fracture of the radius, 3) understand fracture reduction technique using traction, translation and angulation, 4) appreciate the amount of force required for manipulation of the distal fracture fragment, and 5) gain hands-on practice using a model with similar haptics to bone and soft tissue. Educational Methods: This task trainer is designed for practicing fracture reduction techniques in a simulated environment. Using materials that mimic similar haptics to bone and soft tissue, such as taut rubber bands for tendons and layers of socks for soft tissue, learners will need to use force to apply traction and reduce the distal fracture fragment through translation and angulation. This task trainer can be used for procedural education at the bedside or as part of small group sessions. Research Methods: This task trainer was used during a small group session at a training institution's medical simulation conference. Using a Likert scale, an anonymous survey assessed learner's confidence in the ability to reduce a fracture pre- and post-session. Free-text boxes were also provided to obtain feedback. This task trainer was also presented as a table-top innovation in an EM national conference where attendees provided verbal feedback. Results: This task trainer was utilized by 32 participants during a medical simulation conference (10 PGY-1 (Post Graduate Year-1), 7 PGY-2, 5 PGY-3, 3 PGY-4, 5 medical students, 1 fellow, 1 attending physician). Of these individuals, 23 participated in the anonymous survey (8 PGY-1, 6 PGY-2, 4 PGY-3, 3 PGY-4, 2 medical students). Using a Likert scale of 1 to 5 assessing learner's confidence in fracture reduction technique before and after using this task trainer, the total mean score of the pre-session survey was 2.6 and the total mean score of the post-session survey results was 3.9. Attendees of an EM national conference who used the task trainer for hands-on practice provided verbal feedback. It was stated that its design was simple enough to replicate, it could be used for bedside teaching during a shift, and that the feel of the fracture line and technique required to reduce the fragment was realistic. It was noted that although the amount of force required was less for this model than in human practice, it was conceptually accurate. Discussion: The utilization of this task trainer allows learners to understand and practice the maneuvers and force needed for successful fracture reduction. The materials used in its design require the learner to manipulate the distal fracture fragment in a realistic manner. This model is a low cost, reusable, transportable, and easily storable alternative to commercial trainers and can be used in a simulated environment to improve procedural competency and confidence. Topics: Fracture reduction, orthopedic emergencies, distal wrist fracture, distal radius fracture, Colles fracture, Smith fracture, radius, ulna.