Learning curves in simulator-based training for percutaneous pelvic fixation: comparison between surgeons with and without prior fluoroscopy-guided percutaneous experience.

BACKGROUND

Mastering pelvic radiographic views and percutaneous fixation techniques is a critical skill for young orthopedic surgeons, yet the learning curve remains steep due to the anatomical complexity of the pelvis and the limited exposure during training. Simulation-based training enhances technical proficiency within a safe and reproducible environment. By enabling risk-free practice, it accelerates the learning curve and optimizes surgical education.

OBJECTIVE

To compare learning curves between junior and senior surgeons and to assess performance progression over training sessions.

HYPOTHESIS: Simulator-based training improves accuracy, efficiency, and radiation exposure in percutaneous pelvic fixation, with a greater effect in junior trainees.

MATERIAL AND

METHODS

Eight participants, four junior residents and four senior trainees experienced in fluoroscopy-guided percutaneous techniques, were assessed over 6-8 simulation sessions between May 2024 and February 2025. Each session included: (1) S1 iliosacral screw fixation, (2) antegrade anterior column screw placement, and (3) supra-acetabular (LC2) screw fixation. Outcome measures included: screw progression in the bone corridor (%), cortical breach (yes/no), number of wire repositioning, operative time (sec), and radiation exposure (mGy). All participants completed the training protocol.

RESULTS

Juniors showed a marked reduction in operative time and radiation dose for sacroiliac screw placement (522 ± 100 s to 205 ± 87 s; and 19.8 ± 5.9 mGy to 9.8 ± 2.4 mGy, respectively; p < 0.01), and similar improvements were observed for LC2 fixation. Accuracy increased across all procedures in the junior group, particularly for anterior column screw placement (38%-94%). Seniors exhibited limited improvement, with a modest decrease in radiation exposure for S1 screw fixation only. Learning curves for all participants demonstrated rapid improvement during the first four sessions, followed by a plateau phase. Mean radiation exposure progressively decreased in juniors, whereas it remained stable in seniors. No statistically significant differences were observed between groups for final performance metrics.

DISCUSSION: Simulation-based training improved efficiency and accuracy across all screw placements. The progression was especially notable in less experienced participants, who achieved performance levels comparable to those of more experienced surgeons.

CONCLUSION

Percutaneous pelvic fixation can be effectively taught through simulator-based training. Junior residents benefit the most, showing rapid improvement in technical accuracy and procedural efficiency. These findings support the integration of simulation into early surgical training programs for pelvic trauma.

LEVEL OF EVIDENCE: III; Non-randomized prospective comparative study.