With the advancement of the virtual technologies, three-dimensional surgical simulators are now possible. In this article, we describe an immersive simulation platform, allowing students in orthopaedic surgery to learn how to deal with a sample diaphyseal fracture of the femur using LC-DCP plate hole, cortical screw and verbrugge forceps. To reach certain realism, weight of the objects and force feedback are used in addition to the visual scene and the 3D sound. The students feel the weight, the strength of the bone when they pierce the holes, and the vibration of the drill. The simulation is implemented by using CAVE, the CyberGlove, CyberGrasp, and 3D sound system.

Purpose

To describe the implication of Family Physicians (FPs) in the management of osteoporosis revealed by a fragility fracture.

Purpose: Until now no experimental study has evaluated the effect of orthopedic immobilizations of the lower right limb on driving performances. Clinicians and legislators therefore cannot appropriately advise patients with this type of treatment on their driving capabilities and put forth recommendations for road safety.

Method: An experimental study of the effect of orthopedic immobilizations of the lower right limb on driving performances has been conducted at the Research Center on Aging of the Sherbrooke Geriatric University Institute. The breaking capabilities of forty-eight healthy volunteers were tested in three conditions: wearing their usual running shoes and two types of immobilization, namely the walking cast (Delta-Cast Conformable, BSN Medical, Leuven, Belgium) and the foam pneumatic walker (Aircast, Vista, CA). The order in which each condition was tested was randomly determined for each volunteer. A custom driving simulator was used to measure the force applied on the break pedal and the breaking time using the software LabVIEW (National Instruments, Austin, TX). In addition, each volunteer completed a socio-demographic survey, a brief physical exam and two clinical tests (stepping and standing).

Results: The average maximum breaking forces exerted by the volunteers with the walking cast, the foam walker and the shoes are 275,4 lb, 287,2 lb and 293,8 lb respectively. The two significant differences are between the walking cast and the shoes (18,4 lb, p< 0,001) and between the walking cast and the foam walker (11,8 lb, p< 0,001). The measured average breaking reaction times are (from the slowest to the fastest) 619 ms, 609 ms, and 580 ms with the foam walker, the walking cast and the shoes respectively. The two significant differences are between the shoes and the foam walker (39 ms, p< 0,001) and between the shoes and the walking cast (29 ms, p< 0,001). The results of this study also confirm the correlation between the measured breaking reaction times and the stepping and standing clinical test (p< 0,05).

Conclusion: Although this study observed statistically significant changes in breaking force and reaction time in volunteers wearing two common

Purpose: Only 20% of women presenting with fragility fracture are subsequently investigated for Osteoporosis (OP). Blurred lines of responsibility between the orthopedic surgeons (OS) and the general practitioners may partly explain this situation. OPTIMUS is a 3 year health management program, lead by an OS and a rheumatologist, whose objective is to improve the rate of initiation of and persistence on treatment of OP in patients sustaining a fragility fracture visiting an OS at the Centre hospitalier universitaire de Sherbrooke.

Method: All outpatients aged 50 years and older in which a fragility fracture is suspected by the OS are informed by a nurse practitioner about the OPTIMUS program. The first 200 patients seen at the Hôtel-Dieu site of the CHUS represent the control group. Inpatients with hip fragility fracture are evaluated by a rheumatologist. After signed consent, outpatient participants are randomized to one out of two intervention groups: The Minimal Intervention group includes nurse counseling and written general information transmitted to both patient and treating physician. Same information is given in the Intensive Intervention group. Blood tests and osteodensitometry are also performed and results transmitted to the treating physician along with personalized guidelines for treatment of the patient’s OP. In both interventions, patients are reached by phone at fixed intervals. Additional rounds of intervention are repeated as needed to increase the rates and persistence of appropriate treatment.

Results: Over the first 6 months, the OS team identified 300 patients, 30% of which suffered from hip fracture. Acceptance rates to OPTIMUS management program were close to 95% with direct contact as compared to 50% with delayed phone contact. 5% of outpatients could not name a treating physician and thus had to be seen in rheumatology. The results during the first 18 months of the project will assess the feasibility of OPTIMUS’ interventions.

Conclusion: There is a substantial care gap in the management of OP, despite the availability of diagnostic modalities and effective treatment. Involving orthopedic surgeons as key leaders of a multidisciplinary team implementing a systematic approach to identify patient with OP should help to close this care gap.