Is actual surgical experience reflected in virtual reality simulation surgery for a femoral neck fracture?

  • Yasuhiro HommaEmail author
  • Atsuhiko Mogami
  • Tomonori Baba
  • Kiyohito Naito
  • Taiji Watari
  • Osamu Obayashi
  • Kazuo Kaneko
Original Article • HIP - FRACTURES



A virtual reality simulator developed for orthopaedic and trauma surgical training has been introduced. However, it is unclear whether the experiences of actual surgery are reflected in virtual reality simulation surgery (VRSS) using a simulator. The aim of this study is to investigate whether the results in VRSS differ between a trauma expert and a trauma novice.


In Group A (expert), there are ten orthopaedic trauma surgeons and in Group B (novice) ten residents within 2 years after medical school graduation. VRSS for a femoral neck fracture using Hansson hook-pins (Test 1) and Hansson twin hook plate (Test 2) was performed. The parameters evaluated were total procedure time (s), fluoroscopy time (s), number of times X-ray was used (defined by the number of times the foot pedal was used), number of retries in guide placement, and final implant position.


In Test 1, the averages of four parameters (distance to posterior cortex (p = 0.009), distal pin distance above lesser trochanter (p = 0.015), distal pin hook angular error (p = 0.004), and distal pin tip distance to centre (lateral) (p = 0.015)) were significantly different between Groups A and B. In Test 2, no parameters in a mean were significantly different between groups, but seven parameters in a variance (guide wire distance to joint surface (p = 0.0191), twin hook length outside barrel (p = 0.011), twin hook tip distance to centre (lateral) (p = 0.042), twin hook distance to centre of lateral cortex (lateral) (p = 0.016), plate end alignment error (lateral) (p = 0.027), guide wire angle with lateral cortex (front) (p = 0.024), and 3.2-mm drill outside cortex (p = 0.000)) were significantly different between groups. In Test 1, Group B showed significantly longer fluoroscopy time than Group A (p = 0.044). In Test 2, Group B showed significantly fewer instances of X-ray use than Group A (p = 0.046).


Our study showed that the experiences of actual surgery are reflected in the result of VRSS using the simulator.


Virtual reality Simulation surgery Femoral neck fracture 



Virtual reality simulation surgery


Authors’ contributions

YH involved in analysis and interpretation, and writing the article, AM contributed to conception, design, data collection, TB took part in analysis and interpretation, and writing the article, KN involved in analysis and interpretation, and writing the article, TW involved in analysis and interpretation, and writing the article, OO contributed to design, analysis, interpretation, and KK took part in design, analysis, interpretation. All authors read and approved the final manuscript.


No funds were received in support of this study. No benefits in any form have been received or will be received from a commercial party related.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

Ethical approval was not required for this simulation-based intervention.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryJuntendo UniversityTokyoJapan
  2. 2.Department of Orthopaedic SurgeryJuntendo University Shizuoka HospitalIzunokuniJapan

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