Tibial Fracture Fixation

We aim to teach fracture reduction, intramedullary canal reaming, intramedullary nail insertion, plating techniques, and bicortical drilling skills to medical officers and surgeons performing open reduction and internal fixation (ORIF) procedures of closed tibial fractures in rural regions.

The key feature of our module is the open-source digital library of downloadable, 3D printable models of cylinders and bones of representative thicknesses, diameters, and porosities for common tibial fracture sites to provide high-fidelity, low-cost orthopedic skills training.

Our self-assessment framework includes visually checking that the fracture ends are well aligned with no rotation, angulation or length deformities, and measuring the drill depth of plunge in millimeters.

After completion, the 3D printed models are inspected by the learner, reviewed using a checklist and can be photographed and saved by the learner on any cellphone with a camera for remote evaluation and feedback by an orthopedic surgeon (if required).

Our module uses 3D printed cylinders for bicortical drilling skills training and 3D printed patient-based bone models for fracture reduction, intramedullary canal reaming, intramedullary nail insertion, plating techniques, and bicortical drilling skills training. 

We have started reviewing the scientific literature to identify representative cortical thicknesses, cancellous bone diameters, and trabecular bone porosities at common repair sites of closed tibial fractures.

We have used open-source software to design 3D printable cylinders of representative thicknesses, diameters, and porosities of common fracture sites of tibial bones.

We have used open-source 3D printing software to select settings (i.e. perimeters, shell thickness, infill percentage, and pattern) to simulate the compact bone thickness and cancellous bone microarchitecture at common closed tibial fracture sites for high fidelity, low-cost, ORIF training. 

We will use software to segment representative tibial fractures from open-source, de-identified radiology imaging databases and create 3D printable high-fidelity, patient-based bone models for advanced orthopedic skills training.  

All 3D printed models are designed to be made on affordable, open-source, open filament, and offline 3D printers that print recyclable plastic that costs pennies a gram.

We will teach the psychomotor skills outlined below for the operative management of closed tibial fractures.  

Intramedullary Nail Fixation:

• Fracture reduction
• Intramedullary canal reaming
• Intramedullary nail insertion
• Intramedullary nail locking (including bicortical drilling)

Dynamic Compression Plate Fixation:

• Fracture reduction
• Plate placement/alignment
• Dynamic compression plate fixation (including bicortical drilling)

Nigeria has 350 orthopaedic surgeons to serve the needs of 170 million patients and an estimated 75% of Nigerian orthopedic surgeons are located in 4 major cities. This shortage of orthopedic surgeons leaves patients vulnerable to traditional bone setters whose unsafe practices frequently lead to gangrene, amputation, and death. 

Closed tibial shaft fractures are the most common long-bone fractures sustained in children and adults, affecting approximately 1.3 million patients globally every year. In low to middle income countries (LMICs), tibial fractures typically occur in young adults and often leads to reduced quality-of-life, loss of employment, and financial hardship for patients and their young families.

Access to high-quality orthopedic care in LMICs is limited by a lack of providers, resources, and training programs. Training medical officers and surgeons to become confident and competent in performing intramedullary nail insertion, and plating techniques as part of tibial fracture fixation procedures would save limbs and lives. 

Medical Officers are fully trained, non-specialist physicians who have not received any exposure to orthopedic surgery outside of their undergraduate medical education.  Surgeons (who are not orthopedic specialists) have received formal advanced training in their surgical specialty but have not been trained to perform tibial fracture ORIF procedures on patients.  

We have recruited a Medical Officer to our team and will be engaging other Medical Officers and Surgeons in LMICs to better understand their needs. We have a signed partnership with the African Biomedical Engineering Consortium (ABEC) to host Make-A-Thons at community-based Makerspaces in LMICs and invite Medical Officers and Surgeons to help us develop the project and ensure we are addressing their needs.

Team Lead/Clinician/Educator: Habila Umaru, MBBS, FWACS, MDM, MHPM

Clinician/Educator: Paul Ssempebwa, MBchB

Educator/Technical Expert: Julielynn Y. Wong, MD, MPH, FACPM

Educator: Bob Dolan, PhD

Technical Experts: June Madete, PhD (Medical Engineering), Jason Tumusiime, BSc (Telecommunications Engineering), Jude Barnabas Kibwota, Ester Carrasco, MEng (Bioengineering and Biomedical Engineering), Owen Botelho, BEng (Mechanical Engineering), Dean Jin, PhD (Computer Science)

Technical Expert/Videographer: Filip Vukcevic

Technical Team Member: Saif Ali 

Biostatistician: William Fraser, MSc

Artists/UX Designers: Kseniia Shikhova, Laurissa Barnes-Roberts