Anti-Plunge Medical Educational Device: University of Southern California Senior Design

Sophie Emma Herant; Alexander William Clark Kuncz

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Conference: 2025 ASEE PSW Conference
Location: California Polytechnic University, California
Publication Date: April 10, 2025
Start Date: April 10, 2025
End Date: April 12, 2025
Page Count: 8
DOI: 10.18260/1-2--55163
Permanent URL: https://peer.asee.org/55163
Download Count: 2

Abstract

As part of the USC biomedical engineering program, seniors take a capstone senior design course in which they design and build a prototype of a medical device or testing system. Our project seeks to address a common issue during orthopedic surgery, plunging, through a device that improves the training regimens of resident orthopedic surgeons. We hope our work contributes to reducing surgical error and provides residents with tools to enhance training feedback and performance metrics. Orthopedic surgery often requires drilling through bone to create holes where screws are placed to secure a titanium plate to the bone to reduce fractures. During internal fracture reduction, the most effective plating technique is called bicortical fixation, where a screw spans both the proximal and distal cortex of the drilling plane. This requires a hole to be drilled through the bone marrow and across both cortices of the bone. A common drilling error is “plunging” where the surgeon drills past the desired endpoint of the far cortex of the bone. The drill bit may damage structures behind the cortex, such as arteries and/or nerves. Significant damage to these structures may result in hemorrhage or other serious complications. Proper drilling technique takes novice orthopedic surgeons years to master, and any mistakes while using the drill may result in serious patient injury. In interviews with orthopedic surgeons, we learned that drilling skills are developed mostly by feel. Studies on the incidence of plunging reveal that while plunging occurs at all levels of training, experienced orthopedic surgeons plunge at a rate below that of novice orthopedic surgeons. Based on this background research, we concluded that a training device where surgeons can practice and receive feedback on their drilling may reduce the high incidence of plunging in novice orthopedic surgeons. Information like the depth of the plunge and acceleration data can provide insight into the quality of drilling. Playing on a surgery resident’s competitive attitude, this training can be developed into a game, where the lowest depth of plunge corresponds to the highest score, and therefore the least risk to the patient. This training device– developed as an attachment to an orthopedic drill– is called the Anti-Plunge Medical Educational Device, or APMED. It comes as an attachment containing the necessary circuitry to measure relevant information during a drilling event, and an accompanying software for post-processing and display. The user, a resident orthopedic surgeon, could attach the training device to their preferred drill to practice their technique and observe improvement with time. APMED uses the Adafruit feather platform with Arduino and Python code integration. Two sensors, a time of flight (ToF) sensor and an absolute orientation sensor, generate data for each run. The ToF sensor is an infrared sensor which measures the distance to the object directly in front of the drill. The absolute orientation sensor outputs triaxial acceleration data, and the Z axis data is displayed to the user. Both sensors communicate with the Adafruit feather using Inter-Integrated Circuit, or I2C, communication. Additional elements help the user interface with the system, such as an LED and buzzer to alert the user to the beginning of data collection, and a button that allows the user to end data collection once drilling has been completed. The accompanying software to APMED analyzes the data generated by the ToF and orientation sensors using a change-point detection algorithm to determine when plunging occurs. The algorithm finds the time of plunge, which enables the analysis of time, distance and acceleration values of each drilling event. The user interacts with APMED using a graphical user interface (GUI). The GUI allows the user to input test information such as the test number, test name and data for easier file organization. Upon test completion, the GUI confirms the successful run and displays and saves the resulting plot of the data for evaluation. With our device, we hope to improve the quality of orthopedic resident training and reduce plunging events and ultimately enhance patient safety at all levels of orthopedic care.

Citation
Format

Herant, S. E., & Kuncz, A. W. C. (2025, April), Anti-Plunge Medical Educational Device: University of Southern California Senior Design Paper presented at 2025 ASEE PSW Conference, California Polytechnic University, California. 10.18260/1-2--55163

TY - CPAPER
AB - As part of the USC biomedical engineering program, seniors take a capstone senior design course in which they design and build a prototype of a medical device or testing system. Our project seeks to address a common issue during orthopedic surgery, plunging, through a device that improves the training regimens of resident orthopedic surgeons. We hope our work contributes to reducing surgical error and provides residents with tools to enhance training feedback and performance metrics.
Orthopedic surgery often requires drilling through bone to create holes where screws are placed to secure a titanium plate to the bone to reduce fractures. During internal fracture reduction, the most effective plating technique is called bicortical fixation, where a screw spans both the proximal and distal cortex of the drilling plane. This requires a hole to be drilled through the bone marrow and across both cortices of the bone. A common drilling error is “plunging” where the surgeon drills past the desired endpoint of the far cortex of the bone. The drill bit may damage structures behind the cortex, such as arteries and/or nerves. Significant damage to these structures may result in hemorrhage or other serious complications. Proper drilling technique takes novice orthopedic surgeons years to master, and any mistakes while using the drill may result in serious patient injury.
In interviews with orthopedic surgeons, we learned that drilling skills are developed mostly by feel. Studies on the incidence of plunging reveal that while plunging occurs at all levels of training, experienced orthopedic surgeons plunge at a rate below that of novice orthopedic surgeons. Based on this background research, we concluded that a training device where surgeons can practice and receive feedback on their drilling may reduce the high incidence of plunging in novice orthopedic surgeons. Information like the depth of the plunge and acceleration data can provide insight into the quality of drilling. Playing on a surgery resident’s competitive attitude, this training can be developed into a game, where the lowest depth of plunge corresponds to the highest score, and therefore the least risk to the patient.
This training device– developed as an attachment to an orthopedic drill– is called the Anti-Plunge Medical Educational Device, or APMED. It comes as an attachment containing the necessary circuitry to measure relevant information during a drilling event, and an accompanying software for post-processing and display. The user, a resident orthopedic surgeon, could attach the training device to their preferred drill to practice their technique and observe improvement with time.
APMED uses the Adafruit feather platform with Arduino and Python code integration. Two sensors, a time of flight (ToF) sensor and an absolute orientation sensor, generate data for each run. The ToF sensor is an infrared sensor which measures the distance to the object directly in front of the drill. The absolute orientation sensor outputs triaxial acceleration data, and the Z axis data is displayed to the user. Both sensors communicate with the Adafruit feather using Inter-Integrated Circuit, or I2C, communication. Additional elements help the user interface with the system, such as an LED and buzzer to alert the user to the beginning of data collection, and a button that allows the user to end data collection once drilling has been completed.
The accompanying software to APMED analyzes the data generated by the ToF and orientation sensors using a change-point detection algorithm to determine when plunging occurs. The algorithm finds the time of plunge, which enables the analysis of time, distance and acceleration values of each drilling event. The user interacts with APMED using a graphical user interface (GUI). The GUI allows the user to input test information such as the test number, test name and data for easier file organization. Upon test completion, the GUI confirms the successful run and displays and saves the resulting plot of the data for evaluation.
With our device, we hope to improve the quality of orthopedic resident training and reduce plunging events and ultimately enhance patient safety at all levels of orthopedic care.

AU - Sophie Emma Herant
AU - Alexander William Clark Kuncz
CY - California Polytechnic University, California
DA - 2025/04/10
PB - ASEE Conferences
TI - Anti-Plunge Medical Educational Device: University of Southern California Senior Design
UR - https://peer.asee.org/55163
DO - 10.18260/1-2--55163
ER -

Anti-Plunge Medical Educational Device: University of Southern California Senior Design

Paper Authors

Sophie Emma Herant University of Southern California

Alexander William Clark Kuncz University of Southern California

Abstract

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