25th - 26th SEPTEMBER 2019  |  OLYMPIA

Blow Out Your Knee? Hope Your Surgeon's Got a VR Headset

Wired 09 Aug 2019 11:00

With all due respect to games, porn, and lion kings, virtual reality's killer app might just be saving lives.

At a Stanford-affiliated children's hospital, pediatric cardiologists use an interactive virtual heart to help young patients and their families better understand congenital defects. Researchers in Maryland put on headsets to study viruses in the pursuit of a universal flu vaccine. In Minnesota, surgeons stood inside a VR model of the circulatory systems of conjoined twins—which proved integral to the ensuing separation surgery.

Great uses, certainly, but all variations on The Fantastic Voyage (or Innerspace, if you prefer). Now, building on a pile of evidence stretching back more than a decade, VR is finally getting clinical validation for actual surgical training. In a pilot study conducted at UCLA and presented recently at a meeting of orthopedic surgeons, medical students who practiced a common procedure in VR significantly outperformed those who used conventional preparation methods.

All the experience, none of the marrow: A (real) surgical trainee puts the (virtual) finishing touches on a (virtual) tibia.

Osso VR

This wasn't a highly specialized procedure, but the bread and butter of orthopedic surgeons everywhere: fixing a bone fracture. Specifically, a break in the tibia, the larger of the two bones in your lower leg. The tibia isn't the most commonly broken bone, but it certainly figures prominently in Most Gruesome Sports Injuries lists. Joe Theisman? Tibia. Gordon Hayward? Tibia. Paul George? Sweet lord, tibia. (If you didn't see them when they happened, there's video, but you probably don't want to watch.) As with most long bones, the preferred method to fix a fractured tibia is by inserting a nail into the cavity—an intramedullary nail, or IMN, as it's known clinically.

It’s not exactly easy. You've got to make the incision, insert a guide wire at the correct angle, ream out the incision with a drill, build the nail assembly, insert the nail, then place a proximal interlocking screw to help keep the nail static. That's a lot of steps and a lot of tools—and not a lot of opportunity to practice. "It's complicated if you don't know the anatomy that well," says Kevin Varner, chair of orthopedics and sports medicine at Houston Methodist.


You could use bone models or cadavers, but with the power tools involved, those are expensive, single-use propositions. The best training typically comes during a medical residency: You watch senior residents, then you assist in a procedure, then maybe you perform some—but always under the direct supervision of your attending physician. As a result, says Michael P. Ast, an assistant professor of orthopedic surgery at the Hospital for Special Surgery in New York City, flying truly solo might not happen until you’re out of school entirely: "When you went into practice, your first intramedullary nail was probably the first one where you had your own hands doing every step of the procedure, with no one else watching."

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