Virtual reality players suffer from real broken bones, other injuries

The house shook so much when he fell that his wife and children came running. They found Mingione lying on the floor in pain, parts of the remote controls and batteries scattered around him.

“I told them I was fine, but my knee was killing me,” Mingione said. “… When I fell, what stopped me was the floor, not my hands or anything.”

His knee and elbow swelled up painfully and continued to ache for about four weeks. He hasn’t touched the headset or any other game since: “I’m retired,” he said.

Mingione was luckier than a friend who wore a VR headset in a virtual boxing match as his family watched. A family member said, “You know you can kick, too,” and so his friend kicked the air as hard as he could — and broke his toe on a coffee table.

“You definitely have to be careful, because you can’t see anything while you’re playing,” Mingione said.

As the number of people using VR headsets increases, so do the number of people injured when the virtual world crashes – literally – into the real one.

Sales of virtual reality headsets rose from USD 4.42 million in 2018 to USD 21.76 million last year and is expected to reach USD 27.26 million in 2028, according to Statista Market Insights, which also reported that more than 5.4 million units were sold in 2019 and more than expected 14 million for this year. Headsets cost from several hundred to several thousand dollars.

A study published last year found that just 125 incidents of VR-related injuries were reported to emergency rooms in 2017. By 2021, that number was estimated to be 1,336, the study found, using data from the National Electronic Injury Surveillance System, known as NEISS.

According to Melissa Kovacs, an associate professor of trauma research at Dignity Health Medical Group in Chandler, Arizona, and the study’s co-author, unofficial numbers from 2022 show she has seen a 100 percent increase since 2021 in VR-related emergency room visits. reflecting the increased sales and usage of the headsets.

She added that the number of injuries is probably much higher than the NEISS numbers because they only reflect people who went to the emergency room, not those who went to doctors’ offices or urgent care or who dealt with injuries at home.

“These injury numbers are small, but they are increasing, quite alarmingly quickly,” Kovacs said.

Daniel Cucher, a trauma surgeon who works with Kovacs at Dignity Health and co-authored the study published last year, said that after trying one of the VR headsets himself, he understands how people get hurt. “It’s quite a physical engagement,” he said, and “they’re typically used in people’s living rooms or their basements or enclosed spaces, where they’re prone to injury if they’re flailing around wildly with the headset on” and can’t see, or feel , the real world of walls, ottomans and chairs around them.

According to the study, the most common VR-related injury, which accounted for 30 percent of emergency room visits, was a fracture, followed by lacerations, at 18.6 percent, contusion at about 14 percent, and strains or sprains, accounting for 10 percent, according to the data .

Young children, up to age 5, were most likely to injure their face, while those 6 to 18, were most likely to injure their hands or face. Adults, up to age 54, primarily injure their knees, fingers and wrists, while the majority of people over 55 injure their upper body and upper arm.

Among the NEISS cases were: a 60-year-old man who ran into an object, hit his chest on the wall, and suffered a rib contusion and toothache; a 13-year-old boy who ran into a table and cut his face; a 9-year-old who dove and hit his face on a TV stand, gave himself a tooth injury and cut his upper lip; and a 12-year-old who was evaluated for a head injury after leaning on a virtual shelf that caused him to fall into a real shelf.

Many of the VR-related injuries are from a direct hit or blow against a hard object, like a wall or a table or a door stop, said Hilton Phillip Gottschalk, an orthopedic hand surgeon in Austin, who has treated a number of people with such injuries.

When his son plays a VR game called “Gorilla Tag,” Gottschalk said, he has no idea where the walls or tables or couches are. When swinging at something in the virtual game, he could easily hit a real object in the room with a lot of force without knowing it was there.

“There are a few percent [of injuries] which will be a case of maybe dizziness or tripping or something. But most of these are really a direct hit, a direct contact. The hand hits the wall, the hand hits the couch, the hand hits the table, Gottschalk said.

Bryce Gillespie, an orthopedic surgeon in Atlanta who specializes in hands and upper extremities, wrote in an email that the most common VR injuries he sees are finger fractures. Fortunately, most simply require casts and not surgery, he wrote in an email.

“The injuries I’ve seen are usually teenage boys using VR headsets while playing games” at home, Gillespie wrote. “They lose track of what objects are around them. Some have tripped over a table and landed on their hands. Others have simply turned around quickly and slammed a door with their hands.”

Recently, he treated a 12-year-old boy who was playing a VR game and slammed his hand into a door that got stuck while swinging his arms in defense, breaking several fingers. And a 14-year-old boy came to see him after he tripped over a coffee table, fell and broke his hand while playing a VR sports game.

Jennifer Weiss, chief of staff at Shriners Children’s Hospital in Honolulu, recently treated a 13-year-old boy who sprained his ankle and ended up in air casts even though he had adjusted his play to make sure there were no objects to hit or trip over. “It wasn’t even that there was anything there to trip over. It was just that his proprioception was funky,” she said, referring to the ability to know where your body is in relation to the space around you. “He misjudged where the floor was.”

She recognizes that feeling, Weiss said. She recently did a virtual reality mock-up of an operating room, and she said wearing the headset was disorienting.

“When I’ve played along [the VR glasses] … it’s kind of like walking in the dark,” she said. “Even though there’s nothing to trip over, it’s just a different sense of where your body is.”

Brian A. Janz, a plastic and reconstructive surgeon in Catonsville, Md., who specializes in hands and upper extremities, said the increase in VR-related injuries is similar to what happened a few years ago when people started buying hoverboards, two-wheeled self- balancing scooters that people control by leaning forward, backward, right or left.

A child would get one for Christmas, and then the adults would try it and hurt themselves. “I’ve seen injuries similar to hoverboards, where parents and grandparents [are] to test VR and then become unstable or not feel good balance and fall and end up with wrist sprains or wrist fractures, he said. With hoverboards, people eventually got used to riding them and the flow of injuries ebbed. The same thing will likely happen with VR, he said.

Manufacturers of VR devices provide rules for the safe use of their products, including using them in a free space and setting up play limits in the headset, so that play does not venture into areas that are encumbered by real objects. If the user goes over the limits, the device warns them.

Kate McLaughlin, a spokeswoman for Meta, which makes a line of Quest VR headsets, answered questions about injuries by pointing to the company’s safety instructions. “Here is our Meta Quest Safety Center, where we help educate people about how to stay safe when using Meta Quest products,” she wrote in an email.

Apple, which makes the Apple Vision Pro, also pointed to its security guidelines, noting that its product “uses the most natural and intuitive inputs possible — a user’s eyes, hands and voice,” wrote Andrea Schubert, an Apple public relations executive, in an email. “Apple Vision Pro is a spatial computer that blends digital content with the physical world while allowing users to be present and connected to others (users can see the world around them from the moment they put on the device).”

In the ideal world, that might be true. “But let’s be honest,” Gottschalk said. “When you make a quick move, it’s not like you have time to react, right? If you’re close to that limit, and you make a quick maneuver, a quick flick of your hand, when you get that warning, it’s over. You’ve already done the damage.”