Abstract. In this paper, we present study to integrate virtual fracture bone reduction simulation tool with a novel hybrid 3-DOF-RPS external fixator to relocate back bone fragments into their anatomically original position. A 3D model of fractured bone was reconstructed and manipulated using 3D design and modeling software, PhysiGuide. The virtual reduction system was applied to reduce a bilateral femoral shaft fracture type 32-A3. Measurement data from fracture reduction and fixation stages were implemented to manipulate the manipulator pose in patient's clinical case. The experimental result presents that by merging both of those techniques will give more possibilities to reduce virtual bone reduction time, improve facial and shortest healing treatment. IntroductionUtilization the computer-assisted or robotic surgery technology for enhancing orthopedic procedure is still not mature yet. It needs more evident for patients and surgeons to improve the uncertainty and make them sure that those of assisted-technology can provide accurate, predictable and safe treatment. At least two decades research in Computer-Aided Orthopaedic Surgery (CAOS) and Orthopaedic Robotics (CAOR) have happened in design and development level but only a few of them are presently being allowed for clinical trials. In orthopedic clinical practice, complicated bone deformities treatment and unreduced fractures are always problematic issues. In this study, the combination of virtual fracture reduction with a robotic-assisted reduction is proposed to solve those problems. Currently, we have built an integrated preoperative simulation system for orthopedic surgery and have been used as preoperative planning tool for a surgeon to solve clinical cases of bone fracture reduction and implant placement. The system is operated in a PC based environment that integrates the virtual surgery tools in single computer program package, making it easy to implement in clinical applications [1][2]. The aims of our research to study integration of computer-assisted fracture reduction and robotic system. Even though computerassisted fracture reduction have been developed by several researchers with different level of accuracies, we explore beneficity merging both of cutting-edge-technology. A 3D model of fractured bone is generate directly from a stacks of CT images, segmented in multi region, and virtually reduce and stabilize. A computer-integrated orthopedic system, called FRACAS, was develop for deal with long bone fractures. It replace to use fluoroscopic images to virtual reality display of 3D bone models [3]. A 3D visualization tool was developed to generate a realistic model of the bone-fixator system. The visualization tool has improved the current software to provide a realistic depiction of the treatment procedure [4]. Integrating surgeon instructed, image-guided and robot-assisted applied to reposition long bone fracture. A robotic solution exists to solve the problems of manipulating and reducing long bone
In the most severe cases of longitudinal bone fractures such as femur, tibias, humerus etc., the bone can be completely separated into two fragments. In order to guarantee the re-ossification of the bone, it is required to reposition the bone fragments together. This process requires a delicate surgery called “bone reduction surgery”. The most advanced technique relies on the use of a robotic manipulator to reposition the bone fragments with higher precision and stability than manual surgeries. The present work introduces the kinematic design of a new hybrid mechanical architecture to perform this task. It is composed of a 3-PRP planar mechanism attached with a 3-RPS tripod mechanism. The kinematic analysis of this mechanism is provided while taking account the tripod parasitic motion. Kinematic simulations using Matlab and Adams are performed to validate the kinematic and velocity models and the parasitic motion compensation provided by the planar mechanism. The workspace of this hybrid mechanism is then compared to the standard hexapod mechanism that is widely used in bone reduction surgery. It reveals that the proposed mechanism can generate a larger workspace with the same linkage dimensions.
In severe fracture cases, a bone can be separated into two fragments and it is mandatory to reposition the bone fragments together. This type of surgery is called "bone reduction surgery". Originally, the operation consisted in manipulating the bones fragments by hand in open surgery. The most advanced technique relies on robotic manipulators providing higher precision and stability. A new mechanical architecture is proposed based on a 3-RPS tripod parallel mechanism combined with a Double Triangular Planar parallel mechanism. Its kinematic and velocity models are calculated and the parasitic motion generated by the tripod mechanism is considered in the final result. The workspace it can generate is compared to the Stewart manipulator, which is a classical mechanism for the targeted application. The use of a robotic manipulator is due to be part of an entire surgical procedure involving a pre-operative simulation software dedicated to pre-planning reduction surgery, namely PhysiGuide. It is used to measure the kinematic associated with bone fragments manipulation and transfer it to the robot during the intra-operative phase. Simulations are then performed based on a real patient's fracture images showing the suitability of the present mechanism with bone reduction surgery.S. Nguyen Phu et al.: A hybrid mechanism for bone reduction surgery
Robot-assisted bone reduction surgery consists in using robots to reposition the bone fragments into their right place prior to fracture healing. This study presents an application of a 3-RRPS augmented tripod mechanism with six degrees of freedom for longitudinal bone reduction surgery. First, the inverse and forward kinematic models of the mechanism are investigated. Particularly, the forward kinematic solution is solved by applying Sylvester's dialytic method. Secondly, the velocity model is studied and its singular configurations are identified. The workspace of the 3-RRPS mechanism is then outlined and compared with the Stewart platform, which is a classical mechanism for the targeted application. The results show that this mechanism provides a larger workspace, especially its rotation angle about the vertical axis which is an important aspect in the bone reduction. A series of simulations on the numerical and graphic software is performed to verify the entire analysis of the parallel mechanism. A Physiguide and Msc Adams software are used to carry out a simulation of a real case of femur fracture reduction using the proposed mechanism to validate its suitability. Finally, a robotic prototype based on the mechanism is manufactured and experimented using an artificial bone model to evaluate the feasibility of the mechanism.
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