## 4 Discussion  
Extended reality technologies are beginning to assume a central role in health care, assisting and improving the practice of both trainees and experienced surgeons. Nonetheless, these advancements come with inherent limitations. These technologies are active participants in reducing the learning curve for trainees. However, better and more cost-efficient ways of utilizing them still have to be theorized and employed. VR reproduces the patient's anatomy and surgical conditions in a virtual environment, in which the user is immersed through a wearable headset [42]. Furthermore, it can be enhanced by sounds and other inputs [1], providing a fully immersive and detailed experience for simulated surgical procedures. To reinforce its training capability, this technology also offers the possibility to implement features for recording and performance analysis. Simulators, devised to promote and upgrade learning prospects, are indeed being validated for both training and surgical practice. Contextually, it has been shown that VR-trained residents execute surgical tasks faster than those who were trained traditionally. Nonetheless, simulators are still not available in equal numbers in the different subfields of orthopaedics. As per [PERSON] et al. [40], while numerous advanced simulators are available for being employed in hip trauma and drilling practices, other procedures seem neglected in comparison [40]. Observing how spinal and hip replacement surgery simulators are still at an embryological state, it is possible to assume that not enough research has been carried out regarding reality technology application in orthopaedic surgery during the last decades [40]. Nowadays, the possibility that orthopaedics will become one of the central focuses of reality technology-related research is feasible. This would, of course, be represented by a uniform development of VR, AR and AI in their applications to different subfields and procedures. Specifically, while VR is already widely accredited to create simulators for surgical training and preoperative planning, AR is more promising for intraoperative purposes [25]. This technology could aid the surgeon in understanding and visualizing the surgical site, including the topographical relationship between anatomical landmarks, orthopaedic implants and operating tools [43]. While offering a limited user-machine interaction potential, AR can create virtual images, project them onto real-life surroundings and superimpose them on data obtained by imaging, thereby providing a guided, minimally invasive approach [2; 3; 4]. However, in orthopedic trauma surgery, AR use was not already validated [9]. As shown in numerous experimental studies [24; 44; 45; 46; 47; 48; 49; 50], such as the one conducted by [PERSON] et al. [51], AR's potential practical applications appear countless. Some of these are still under development, while others have been proven successful in animals and still need to be redesigned for human application. [PERSON] et al. [25] described several types of surgeries performed using AR. Indeed, it has been shown that combining iCT imaging with AR can greatly facilitate spine surgery by ensuring meticulous navigational accuracy and a deep understanding of the surrounding anatomy. In the study conducted by [PERSON] et al. [34], forty-six patients underwent acetabular cup placement during total hip arthroplasty. In one group, AR navigation was used, while the other group received traditional surgery. No differences were found between the groups in the end, meaning that surgery was just as successful in the AR group as it was in the traditional one. Even though this result shows that AR does not yield benefits in all cases, it also shows that it does not have adverse effects. Moreover, minimally invasive procedures represent an increasingly popular trend in the orthopedic field, delineating the value of augmented reality technologies even more clearly [52].