Surgeons Experience with Head-Mounted Augmented Reality for Intra-articular Fractures in Orthopedic Trauma Surgery

Abstract Conventional 2D imaging in orthopedic trauma surgery lacks depth and requires attention shifts away from the operative field. Head-mounted augmented reality (AR HMDs) may improve intra-operative visualization by overlaying 3D holograms in the field of view. However, clinical evaluations focusing on surgeon experience remain limited. This study aimed to evaluate the usability and surgeon experience with AR HMD during intra-articular fracture surgery. A prospective single-center case series was conducted with ten orthopedic trauma surgeons who each completed a preclinical simulator session and then used a Microsoft HoloLens 2 to visualize patient-specific 3D models during 20 open reduction and internal fixation procedures. Outcomes: Simulator Sickness Questionnaire (SSQ; primary), Borg CR10 physical exertion, NASA-TLX mental workload, System Usability Scale (SUS), and a feasibility questionnaire. Across 20 procedures, SSQ indicated symptoms ranging from minimal to significant (preclinical mean 12.7, SD 16.2; intra-operative/postoperative mean 22.0, SD 20.7). Physical exertion was very low (Borg CR10 median 1.0, P 25 – P 75 0–1). Mental demand was medium (NASA-TLX mean 23.0, SD 21.9). Usability was rated good (SUS mean 69.3, SD 14.0). Surgeons judged potential utility highest for complex trauma, revision cases, and osteotomies (feasibility means 73.0, 73.0, and 68.0, respectively). Overall satisfaction averaged 62.0 (SD 27.5), and willingness to reuse was high (median 80, P 25 – P 75 55–87). Common challenges were gesture control and hologram positioning. Intra-operative AR use was feasible, with low physical exertion, medium mental demand, and good perceived usability, although simulator sickness symptoms were reported. Surgeons expressed willingness to reuse the system and identified greatest value in complex articular reconstructions. Findings reflect a small, single-center prospective case study using one AR HMD model and did not assess patient outcomes. Results support further multicenter evaluations focused on ergonomics, interaction design, workflow integration, and clinical impact.