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Objectives and questions: During plate-osteosynthesis, screw length is measured manually with a depth gauge (DG). Although this method is standard in daily operative care, it can be inaccurate, time consuming, and cumbersome to use for surgeons. To increase accuracy and to save time, the ADEPTH sensor system has been developed. The ADEPTH is an add-on on the drill machine, which automatically determines the needed screw implant length. A previous study showed a 96.0% accuracy rate for the ADEPTH, but its usability and time efficiency in clinical setting remain unknown. Therefore, the primary objective of this randomized study is to assess the usability of the ADEPTH. The secondary objective is to compare the duration of the fixation process per screw between the ADEPTH and the DG.

Material and methods: Adult fracture patients scheduled for an open reduction and small fragment plate osteosynthesis in an academic level 1 teaching hospital were approached for inclusion. Nine trauma surgeons performed six procedures each; three with and three without the ADEPTH. For the procedures without the ADEPTH, the surgeon performed the measurements with the DG only. The duration of the fixation process was assessed through recordings of the operative field with the OR-integrated video system. After completion of three procedures with the ADEPTH and three procedures with the DG, the surgeon and OR assistant filled out a System Usability Scale (SUS) survey (scale 0–100), a validated outcome scale to measure usability, to assess the usability of both the ADEPTH and the DG. The study setup was approved by the medical ethics committee of the hospital.

Results: Nine surgeons gave the ADEPTH and DG an average SUS score of 81.67 (± 7.29) and 77.78 (± 15.93) respectively. Seven OR assistants gave an average score of 88.93 (± 8.76) to the ADEPTH and 80.63 (± 11.59) to DG. The total average SUS score for the ADEPTH system and DG was 84.84 (± 8.54) and 78.91 (± 13.81) respectively. The average fixation duration in seconds per screw for the ADEPTH was 22.11 s (± 10.16). For the DG, it was 43.91 s per screw (± 24.65). The average difference in fixation duration was 21.8 s (p<0.05).

Discussion and conclusions: The ADEPTH obtained a higher mean SUS score compared to the DG and achieved a significantly shorter screw fixation time. The results of this study indicate that the ADEPTH could be a usable and time-efficient technique during plate osteosynthesis.