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J Wrist Surg
DOI: 10.1055/a-2803-5848
Scientific Article

Osteotomy of Three-Dimensional-Printed Distal Radius Malunions: A Performance Comparison of Naïve and Deliberate Practice Training

Authors

  • Ines Lefki

    1   Department of Hand Surgery, Strasbourg University Hospitals, FMTS, Strasbourg, France

  • Kyros Ipaktchi

    2   Department of Hand, Upper Extremity and Microvascular Surgery, Department of Orthopaedic Surgery, Denver Health Medical Center, Denver, Colorado, United States

  • Philippe Liverneaux 

    1   Department of Hand Surgery, Strasbourg University Hospitals, FMTS, Strasbourg, France
    3   ICube CNRS UMR7357, Strasbourg University, Strasbourg, France
    4   Gepromed, Bâtiment d'Anesthésiologie, Strasbourg Cedex, France
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Abstract

Background

Surgical education has traditionally relied on apprenticeship, which is limited by the availability of operations and case variability. Deliberate practice (DP) is a structured, goal-directed training method that emphasizes targeted objectives and individualized feedback. This study compared trainee performance in distal radius malunion osteotomy on three-dimensional-printed bone models using naïve practice (NP) versus video-assisted DP.

Case Description

Twelve participants were stratified by expertise level (levels 1 and 2), assigned to either the NP or DP group, and tasked to complete five consecutive trials (E1–E5). Performance was assessed using the Objective Structured Assessment of Technical Skill (score range: 15–75) and analyzed with appropriate statistical methods.

Literature Review

Baseline scores (E1) were similar between NP (57.7 ± 7.4) and DP (60.2 ± 9.1; p = 0.87). By E5, DP participants achieved higher scores (72.0 ± 2.8) than NP (67.0 ± 4.5; p = 0.038). Improvement was greatest in level 1 trainees, who demonstrated larger relative gains, despite lower absolute scores compared with level 2 participants

Clinical Relevance

These results are consistent with the literature demonstrating the effectiveness of DP in orthopaedics and highlight the complementarity between DP and mental practice. The systematic integration of active, feedback-guided methods—such as video-assisted DP—may shorten the learning curve and raise the performance level of surgical trainees.

Keywords

deliberate practice - learning curve - performance - OSATS - distal radius - osteotomy - malunion

Contributors' Statement

I.L.: Methodology; writing—original draft; validation. P.L.: Conceptualization; methodology; supervision; writing—original draft; writing—review and editing; project administration; validation. K.I.: Writing—review and editing (including reference refinement); validation.


Ethical Approval

Institutional review board approval was obtained: CE-2022-33.


Note

Skylab supplied plates and 3D models, Caresyntax provided the video storage platform, Gepromed provided the research facilities




Publication History

Received: 02 November 2025

Accepted: 03 February 2026

Article published online:
20 February 2026

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