Validation Study on Iatrogenic Nerve Damage Reduction Using Augmented Reality on Elbow Phantom

Objective: To compare augmented reality (AR) and classical intraoperative C-arm surgical navigation and evaluate whether head-mounted display improves surgical accuracy in the placement of a rod-like object, such as K-wire, using an anatomically accurate elbow phantom. Participants and Methods: Data were collected between January 10, 2024, and March 15, 2024. We developed an AR system, X-ray simulation system and surgical phantom to test K-wire placement in 3 locations of the distal humerus and proximal ulnar bones. An initial phase with only X-ray as guidance was performed as case control; in later phases, the candidates were allowed to also use the head-mounted display. The evaluation parameters were time, placement angle, number of X-ray images taken, number of attempts, and distance from anatomical structures. Results: In total, 19 physicians participated in the study. We analyzed 193 K-wire placements attempts that resulted in 150 estimated correct positions. This reflects a real-world scenario where multiple placements might be attempted to correctly place a K-wire. Compared with standard procedure, the use of AR resulted in 53.8 seconds in K-wire placement time, 47% of angular error from the K-wire target, 80% X-ray images taken to reach the estimate correct position, and decrease in distance variability of 81%, of the K-wire from anatomical structures of interest. Conclusions: Compared with C-arm, AR navigation improved time, and angle of placement, requiring less X-ray images.