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. (c) 2025 THE AUTHORS. Published by Elsevier Inc on behalf of Mayo Foundation for Medical Education and Research. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) <black square> Mayo Clin Proc Digital Health 2025;3(2):100221