Utilising a Novel Virtual Reality System for Orthopaedic Pre-operative Trauma Planning

With increasing trauma burden, there is a need to improve the efficiency of care while improving surgical accuracy to minimise complications. Common fracture operations have been shown to have high failure rates, often related to implant-related technical errors. Pre-operative surgical planning has been shown to enhance orthopaedic surgical accuracy, particularly with robotic systems in elective arthroplasty. Historically, orthopaedic surgical planning was performed using plain radiographs, although modern three-dimensional (3D) techniques have been shown to be superior for assessing complex fracture patterns and are now in more routine use. While virtual reality (VR) environments have demonstrated benefits in delivering surgical training, there is little in the literature to describe surgeons' use of VR to visualise both patient-specific computed tomographic (CT) anatomy and surgical implants in the same virtual space. It was the author's aim to source and build an affordable system that would allow visualisation of 3D patient-specific CT data with the additional ability to augment this model with surgical implants, facilitating a full 3D trauma visualisation and planning system for complex trauma for surgical planning. Patient CT images were obtained as part of routine clinical care and viewed on local hospital patient imaging systems. An existing computer was upgraded with a graphics card to run additional software from Medicalholodeck™ (MedicalImaging XR™, Zurich, Switzerland). A VR gaming headset was purchased to utilise the system. A non-disclosure agreement was signed with our trauma implant supplier to allow access to virtual trauma implant object files. Patient-specific images can be opened on local computer software and imported to the Medicalholodeck™ MedicalImaging XR™ VR environment. Patient-specific images can be manipulated in 3D to review fracture patterns. Implant-specific files can be opened and placed within the same VR environment to plan optimal fixation. Local information technology (IT) governance procedures were followed during procurement, and patients agreed to the use of images in publication and research. To our knowledge, we are the first to describe this relatively low-cost, high-fidelity VR system using Medicalholodeck™ software, allowing visualisation of stereoscopic 3D patient images with specific orthopaedic surgical implants loaded into the same virtual space for orthopaedic trauma. We have been able to demonstrate proof of functionality in what we believe is a very useful tool to aid trauma and orthopaedic pre-operative surgical planning and execution going forward. In the future, we will look to demonstrate perceived usefulness by the orthopaedic team for fracture understanding and trauma planning. It is plausible that a VR system allowing accurate templating for orthopaedic trauma surgery could be of great benefit to both surgeon and patient and may have an influence over such factors as operative time, failure of fixation, surgeon satisfaction, and patient outcomes.