Immersiven Technologien wie Virtual Reality (VR) wird aktuell in allen Bildungsbereichen ein grosses Potenzial als Bildungstechnologien und Lernmedien zugeschrieben, obwohl derzeit noch viele Fragen bzgl. Lernwirksamkeit, pädagogischer und didaktischer Gestaltung sowie medizinischer und ethischer Einsatzrisiken nicht ausreichend beantwortet werden können. Diese haben jedoch insbesondere für den Schulunterricht eine besondere Relevanz, da Kinder immer auch Schutzbefohlene darstellen. Dieser Artikel gibt im metaphorischen Sinne eines «Beipackzettels» einen Überblick über die Bedenken und Risiken des schulischen VR-Einsatzes aus medizinischer, pädagogischer, didaktischer, technischer und ethischer Perspektive mit dem Ziel, eine sensibilisierte und reflektierte Nutzung dieser vielversprechenden Technologie zu ermöglichen. Daher werden weiterhin konkrete Gestaltungsempfehlungen für Lehrende, Lernende, Eltern, Bildungsinstitutionen, Personen in der Entwicklung sowie politische Akteur:innen formuliert. Dieser Artikel möchte des Weiteren mit diesen Empfehlungen einen Grundstein für den interdisziplinären Diskurs im Bereich der schulischen Nutzung von VR als Lernmedium legen. Er ist daher mit einem Beteiligungsaufruf zur Mitwirkung aller am Schulunterricht beteiligten Akteur:innen verbunden.

(1) Background: Diaphyseal forearm fractures are a common injury in children and adolescents. When operative treatment is needed, elastic stable intramedullary nailing (ESIN) is the most common surgical procedure. Although there is no clear evidence, hardware removal after fracture healing is performed in many patients. Often, the primary minimal invasive incision needs to be widened during implant removal. In order to decrease the burden of care of pediatric fractures, significant efforts were made to develop biodegradable implants, which make hardware removal unnecessary. Our study will conduct an observational trial on the clinical use of the Activa IM-Nail™ in forearm fractures in children between 3 and 13 years of age. The objective of this trial is to evaluate the risks and benefits of the Activa IM-Nail™. Among other objectives, the rate of refracture will be determined. (2) Methods: An international Europe-based, multicenter, prospective, single-arm, open-label study will be performed to ascertain the rate of refracture and to determine the subjective benefits of Activa IM-Nail™ for patients, parents and other caregivers. The study will include clinical follow-up including early post-operative complication, radiographs until bony healing and an additional follow-up after 1 year. At this stage, preliminary results and early complications on 76 patients are analyzed in this study and presented. (3) Results: As of April 2022, 76 patients were enrolled as per study protocol. There were 31 girls (40.8%) and 45 boys (59.2%). The mean age at the time of inclusion was 8.9 years (±2.4 years). The mean operation time was 58.9 ± 22.9 min (range, 15–119 min). The mean follow-up time was 8.9 ± 5.1 months (range, 0.2–18.6). Up to now, one refracture has occurred in one child falling from a height of about one meter 7 months after index surgery (1/76; 1.3%). (4) Conclusion: The research project assesses the safety and effectiveness of Activa IM-Nails™ as part of the surgical treatment of dislocated forearm fractures in children in the context of a PMCF study. The use of Activa IM-Nails™ with regard to various objectives, including postoperative complications and refracture rate, seems to be equal to the standard titan ESIN procedure compared to the literature. Preliminary results are encouraging and are made available.

Background: Removal of Kirschner wires (K-wires) after fracture treatment in the upper limb is unpleasant for children. The aim of this study was to evaluate whether virtual reality (VR) distraction could improve pain and the overall experience for children. Methods: An RCT was performed in a single outpatient fracture clinic, where children (aged 6–15 years) were randomized 1 : 1, in three age strata, to additional VR or standard of care. Pain perception was assessed using the Wong–Baker Faces Pain Rating Scale by neutral observers and later by the patients and their guardians. Further measures included the Face/Legs/Activity/Cry/Consolability (FLACC) Pain Scale, the modified Yale Pain Anxiety Scale (mYPAS), and questionnaires, as well as objective data, such as heart rate variability and blood pressure. Results: A total of 146 patients were recruited into the trial. The VR group showed significantly less pain on the Wong–Baker Faces Pain Rating Scale (OR 0.23 (95% c.i. 0.12 to 0.43)) compared with the control group. Observers rated the pain >2 for 43% of patients in the VR group and 74% of patients in the control group. Observer scales (the FLACC Pain Scale and the mYPAS) during K-wire removal also indicated less pain (OR 0.36 (95% c.i. 0.19 to 0.24) and 0.29 (95% c.i. 0.16 to 0.52) respectively). The difference in pain rated >2 between the VR and control group was smaller directly after (59% versus 69% respectively) and 2 weeks after (58% versus 70% respectively) K-wire removal. Children in the VR group were less aware of the painful stimulus directly after and 2 weeks after wire extraction. Conclusion: VR distraction effectively reduces pain during K-wire removal in children. VR positively impacts the procedural memory of children. Registration number: DRKS00020229 (Deutsches Register Klinischer Studien (DRKS; that is the German Clinical Trials Register); date of registration 10 December 2019).

Twenty years after the first robotic pediatric surgery, robotic surgery still plays a limited role in pediatric surgery. A better understanding of the current application of robotic pediatric surgery, could be valuable for the further development and implementation of minimally invasive and robotic pediatric surgery. The aim of this study was to analyze the nationwide distribution of robotic surgery in children and its acceptance among pediatric surgeons. The national database of administrative claims data from the Institute for the Remuneration System in Hospitals (InEK) and the quality reports in Germany were analyzed to determine the number of pediatric patients who underwent surgery using a robotic system and the number of pediatric surgical departments having access to this system. Additionally, an electronic questionnaire was developed for a nationwide cross-sectional survey within the DGKCH. From 2019 to 2024, the number of robot-assisted surgeries in children increased from 105 cases in 2019 to 376 cases in 2024. The majority of procedures are urological surgeries. The online survey was completed by 39 pediatric surgeons between December 2022 and March 2023. The survey identified and mapped differences in the use of robotic systems, the patient population treated, and the assessment of outcomes, complication rates, and patient satisfaction. This study is the first to document the varying views on pediatric robotic surgery in Germany.