05 Dec 2022

JTO - December 2022

Volume 10 Issue 4

From the Executive Editor

As ever it is a pleasure to welcome you all to the December edition of the JTO. In my first editorial Flaming June was a damp squib but three months later we were begging for rain! Now we have it in biblical proportions! Let’s hope we are not emulating Siberia for the next edition.

It been a tumultuous last few months politically, financially and of course in the Health Service with ever increasing winter pressures, elective waiting lists and trauma numbers.

In this edition of the Journal, we open with an article on virtual reality (VR) in surgical training by Thomas Lewis et al. (page 22). Not a new subject by any means but a subject of increasing importance as our young colleague’s grapple with the effects of the pandemic and the loss of over a year’s worth of elective practice. The article covers the considerable advantages of such training but also the current constraints in increased use. We have some way to go in emulating Mr Zuckerberg’s recent TV advert!

The next article introduces a new and very important society in the world of T&O, ‘BOMSA’ the British Orthopaedic Medical Student’s Association (page 26). This new association is the culmination of some very hard work by enlightened young colleagues who have succeeded in bringing together many separate medical school associations under the umbrella of a national body. Medical students are a vital group to T&O as the grass roots of the future work force and the BOA has for a while been focusing on this group primarily to support students with an interest in T&O and to dismiss some of the more archaic impressions students have of the profession. We have a way to go but BOMSA is a great start.

We have our second article this year from the NJR (page 30), highlighting the importance of high quality data in the Registry and as we look to the introduction of an implant registry this article is undoubtedly timely.

Ad Gandhe’s article from Rwanda (page 34) records his latest chapter in his continued passion for, as he puts it, ‘democratising medical education’. A thought provoking article all the way from rusty nails to high tech drone delivery of blood products.

Sameer Singh writes on how to get started as a medico-legal expert continuing the series of articles from the Medico-legal Committee (page 38).

Finally, our subspeciality section looks at hand surgery. Jonathan Hobby, BSSH President, introduces the specialist section (page 42) and is co-author on the first of three articles covering the management of extensor injuries (page 44). This is followed by the management of high pressure injection injuries to the hand (page 48) and then a different perspective on the subject when Jonathan Jones and colleagues discuss the development of hand partnerships around the world (page 52).

Hopefully something for everyone and may I take this opportunity to wish all readers in these difficult times, a happy and at least at some stage, a restful festive season.

 Simon Hodkinson, Vice President Elect


Subspecialty Section



Immersive Virtual Reality for Surgical Training in Trauma and Orthopaedic Surgery

  1. Hope C, Reilly JJ, Griffiths G, Lund J, Humes D. The impact of COVID-19 on surgical training: a systematic review. Tech Coloproctol. 2021 May;25(5):505–20.
  2. Lund J, Sadler P, McLarty E. The effect of COVID-19 on surgical training. Surgery. 2021 Dec;39(12):829–33.
  3. Chick RC, Clifton GT, Peace KM, Propper BW, Hale DF, Alseidi AA, et al. Using Technology to Maintain the Education of Residents During the COVID-19 Pandemic. J Surg Educ. 2020 Jul;77(4):729–32.
  4. Aïm F, Lonjon G, Hannouche D, Nizard R. Effectiveness of Virtual Reality Training in Orthopaedic Surgery. Arthroscopy. 2016 Jan;32(1):224–32.
  5. Clarke E. Virtual reality simulation-the future of orthopaedic training? A systematic review and narrative analysis. Adv Simul (Lond). 2021 Jan 13;6(1):2.
  6. Hasan LK, Haratian A, Kim M, Bolia IK, Weber AE, Petrigliano FA. Virtual Reality in Orthopedic Surgery Training. Adv Med Educ Pract. 2021 Nov 10;12:1295–301.
  7. Mao RQ, Lan L, Kay J, Lohre R, Ayeni OR, Goel DP, et al. Immersive Virtual Reality for Surgical Training: A Systematic Review. J Surg Res. 2021 Dec;268:40–58.
  8. Bartlett JD, Lawrence JE, Stewart ME, Nakano N, Khanduja V. Does virtual reality simulation have a role in training trauma and orthopaedic surgeons? Bone Joint J. 2018 May 1;100-B(5):559–65.
  9. Stirling ERB, Lewis TL, Ferran NA. Surgical skills simulation in trauma and orthopaedic training. J Orthop Surg Res. 2014 Dec 19;9:126.
  10. Pedowitz RA, Marsh JL. Motor skills training in orthopaedic surgery: a paradigm shift toward a simulation-based educational curriculum. J Am Acad Orthop Surg. 2012 Jul;20(7):407–9.
  11. Cannon WD, Nicandri GT, Reinig K, Mevis H, Wittstein J. Evaluation of skill level between trainees and community orthopaedic surgeons using a virtual reality arthroscopic knee simulator. J Bone Joint Surg Am. 2014 Apr 2;96(7):e57.
  12. Lohre R, Wang JC, Lewandrowski KU, Goel DP. Virtual reality in spinal endoscopy: a paradigm shift in education to support spine surgeons. J Spine Surg. 2020 Jan;6(Suppl 1):S208–23.
  13. Lohre R, Bois AJ, Athwal GS, Goel DP, Canadian Shoulder and Elbow Society (CSES). Improved Complex Skill Acquisition by Immersive Virtual Reality Training: A Randomized Controlled Trial. J Bone Joint Surg Am. 2020 Mar 18;102(6):e26.
  14. Capitani P, Zampogna B, Monaco E, Frizziero A, Moretti L, Losco M, et al. The role of virtual reality in knee arthroscopic simulation: a systematic review. Musculoskelet Surg [Internet]. 2021 Oct 15;
  15. Lohre R, Bois AJ, Pollock JW, Lapner P, McIlquham K, Athwal GS, et al. Effectiveness of Immersive Virtual Reality on Orthopedic Surgical Skills and Knowledge Acquisition Among Senior Surgical Residents: A Randomized Clinical Trial. JAMA Netw Open. 2020 Dec 1;3(12):e2031217.
  16. Lohre R, Warner JJP, Morrey BR, Athwal GS, Morrey ME, Mazzocca AD, et al. Mitigating Surgical Skill Decay in Orthopaedics Using Virtual Simulation Learning. JAAOS Global Research & Reviews. 2021 Oct;5(10):e21.00193.
  17. Baniasadi T, Ayyoubzadeh SM, Mohammadzadeh N. Challenges and Practical Considerations in Applying Virtual Reality in Medical Education and Treatment. Oman Med J. 2020 May;35(3):e125.
  18. Cumin D, Boyd MJ, Webster CS, Weller JM. A systematic review of simulation for multidisciplinary team training in operating rooms. Simul Healthc. 2013 Jun;8(3):171–9.

Management of closed extensor tendon injuries

  1. Manley WG, Wormald JCR and Furniss D. The changing shape of hand trauma: an analysis of Hospital Episode Statistics in England. J Hand Surgery E. 2019; 44(5): 532-536
  2. Trickett RW. Injuries at the Distal Interphalangeal Joint. In: Boyce D, Giddins G, Shewring D. Eds. Tendon Disorders of the Hand and Wrist. IFSSH/FESSH Instructional Course Book. Thieme; 2022.
  3. Brush M, Dick NR, Rohman EM, Bohn DC. Comparison of orthosis management failure rates for mallet injuries. J Hand Surgery Global Online. 2022; 4: 220-225
  4. Capon A, Watson, A and England, H. Therapeutic management of closed central slip injuries: outcome of a service evaluation. Hand Therapy. 2019; 24:3-12.
  5. Walsh MT, Rinehimer W, Muntzer E, et al. Early controlled motion with dynamic splinting versus static splinting for zones III and IV extensor tendon lacerations: A preliminary report, J Hand Ther. 1994:7:232–236.
  6. Evans RB. Early active short arc motion for the closed central slip injury. J Hand Ther. 2010; 23(4): E15-16
  7. Merritt W, Howell J.W., Relative Motion Orthoses: The Concepts and Application to Hand Therapy Management of Finger Extensor Tendon Zone lll and lV Repairs, Acute and Chronic Boutonniere Deformity, and Sagittal Band Injury in Rehabilitation of the Hand and Upper Extremity 7th ed. 1496-1510
  8. Rayan GM, Murray D. Classification and treatment of closed sagittal band injuries. J Hand Surg Am. 1994;19 (4):590-594
  9. Roh YH, Hong SW, Gong HS, Baek GH.  Prognostic Factors for Nonsurgically Treated Sagittal Band Injuries of the Metacarpophalangeal Joint. J Hand Surg Am. 2019 Oct;44(10):897.
  10. Nina Suh. Injuries to the sagittal bands. In: Boyce D, Giddins G, Shewring D. Eds. Tendon Disorders of the Hand and Wrist. IFSSH/FESSH Instructional Course Book. Thieme; 2022.