A virtual reality simulator for training the surgical reduction of patient-specific supracondylar humerus fractures

Abstract

Purpose Virtual reality has been used as a training platform in medicine, allowing the repetition of a situation/scenario as many times as needed and making it patient-specific prior to an operation. Of special interest is the minimally invasive plate osteosynthesis (MIPO). It represents a novel technique for orthopedic trauma surgery, but requires intensive training to acquire the required skills. In this paper, we propose a virtual reality platform for training the surgical reduction of supracondylar fractures of the humerus using MIPO. The system presents a detailed surgical theater where the surgeon has to place the bone fragments properly. Methods Seven experienced users were selected to perform a surgical reduction using our proposal. Two paired humeri were scanned from a dataset obtained from the Complejo Hospitalario de Jaén. A virtual fracture was performed in one side of the pair, using the other as contralateral part. Users have to simulate a reduction for each case and fill out a survey about usability, using a five-option Likert scale. Results The subjects have obtained excellent scores in both simulations. The users have notably reduced the time employed in the second experiment, being 60% less in average. Subjects have valued the usability (5.0), the intuitiveness (4.6), comfort (4.5), and realism (4.9) in a 1–5 Likert scale. The mean score of the usability survey was 4.66. Conclusion The system has shown a high learning rate, and it is expected that the trainees will reach an expert level after additional runs. By focusing on the movement of bone fragments, specialists acquire motor skills to avoid the malrotation of MIPO-treated fractures. A future study can fulfill the requirements needed to include this training system into the protocol of real surgeries. Therefore, we expect the system to increase the confidence of the trainees as well as to improve their decision making.

The effectiveness of virtual reality, augmented reality, and mixed reality training in total hip arthroplasty: a systematic review and meta-analysis

“…At present, VR and AR simulators can help students to perform better [ 38 – 40 ]. But the data collection capabilities of them are limited.…”

Evaluation of Gartland Classification, Baumann Angle and Anterior Humeral Line in Paediatrics Supracondylar Fractures: An Inter and Intra-Observer Reliability Study

“…For complex articular fracture patterns, a computed tomography (CT) with 3D reconstruction could be helpful in preoperative evaluation and accurate reduction planning [ 36 , 37 ]. Some authors presented good results after using a virtual reality-based simulator for training the reduction of the fracture [ 38 ]. Also, the use of artificial intelligence (AI) has been used for fracture detection, but its algorithms must be better tested [ 39 ].…”

Application of Virtual Reality Systems in Bone Trauma Procedures

“…The innovative minimally invasive plate osteosynthesis (MIPO) approach in orthopaedic trauma surgery requires substantial training for adequate skill acquisition. A VR platform was developed by Negrillo-Cárdenas et al for training in the MIPO technique for surgical reduction of humeral supracondylar fractures [ 64 ]. It was shown that the common malrotation of MIPO-treated fractures might be avoided by enhancing the motor skills and expertise of surgeons via an emphasis on the mobility of bone fragments.…”