How accurately can surgeons perform angle manipulation? Quantitative assessment of the accuracy of manual angle manipulation of orthopedic surgery: a cadaver study

Park, Young Hwan; Choi, Jung Woo; Choi, Gi Won; Kim, Soo Hyun

doi:10.1007/s00402-020-03702-1

Cited by 3 publications

(12 citation statements)

References 27 publications

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“…To determine accuracy in terms of three-dimensionality and independency of positioning, we performed repeated scanning in different bone positions up to 45° oblique inclination. Additional errors and variations due to manual goniometer measurements used for the oblique positioning of the bones in our experiment can be assumed, probably in a similar range as in other studies using goniometer measurements ( 76 ). Comparing the measurements of parallel and oblique scans by subtracting their results showed differences that tended to zero and did not exceed 1.3°.…”

Section: Discussionsupporting

confidence: 58%

“…Considering an oblique inclined position up to 45°, if the measurements were not 3D, erroneous, or biased, greater differences than 1.3° should be expected. Furthermore, 1.3° is less than the current manually achievable surgical accuracy ( 76 ).…”

Section: Discussionmentioning

confidence: 87%

“…To be able to propose a benchmark and apply an evaluation standard in terms of precision for a measurement technique, it could be compared to the precision of an orthopedic procedure, such as a corrective osteotomy. Quantitative assessment of the inaccuracy of angular manipulation in a human cadaver study revealed a mean error of 8.8° for Kirschner wire placement using a manual goniometer technique, which could be reduced to 2.1° mean error when a mounted digital goniometer device was used ( 76 ). In our study, to determine precision (intra- and inter-observer agreement), we performed repeated measurements.…”

Section: Discussionmentioning

confidence: 99%

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Introduction of a bone-centered three-dimensional coordinate system enables computed tomographic canine femoral angle measurements independent of positioning

et al. 2022

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IntroductionMeasurement of torsional deformities and varus alignment in the canine femur is clinically and surgically important but difficult. Computed tomography (CT) generates true three-dimensional (3D) information and is used to overcome the limitations of radiography. The 3D CT images can be rotated freely, but the final view for angle measurements remains a subjective variable decision, especially in severe and complex angular and torsional deformities. The aim of this study was the development of a technique to measure femoral angles in a truly three-dimensional way, independent of femoral positioning.MethodsTo be able to set reference points in any image and at arbitrary positions of the CT series, the 3D coordinates of the reference points were used for mathematical calculation of the angle measurements using the 3D medical imaging Software VoXim®. Anatomical reference points were described in multiplanar reconstructions and volume rendering CT. A 3D bone-centered coordinate system was introduced and aligned with the anatomical planes of the femur. For torsion angle measurements, the transverse projection plane was mathematically defined by orthogonality to the longitudinal diaphyseal axis. For varus angle measurements, the dorsal plane was defined by a femoral retrocondylar axis. Independence positioning was tested by comparison of angle measurement results in repeated scans of 13 femur bones in different parallel and two double oblique (15/45°) positions in the gantry. Femoralvarus (or valgus), neck version (torsion), and inclination angles were measured, each in two variations.ResultsResulting mean differences ranged between –0.9° and 1.3° for all six determined types of angles and in a difference of <1° for 17 out of 18 comparisons by subtraction of the mean angles between different positions, with one outlier of 1.3°. Intra- and inter-observer agreements determined by repeated measurements resulted in coefficients of variation for repeated measurements between 0.2 and 13.5%.DiscussionThe introduction of a bone-centered 3D coordinate system and mathematical definition of projection planes enabled 3D CT measurements of canine femoral varus and neck version and inclination angles. Agreement between angular measurements results of bones scanned in different positions on the CT table demonstrated that the technique is independent of femoral positioning.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Introduction of a bone-centered three-dimensional coordinate system enables computed tomographic canine femoral angle measurements independent of positioning

et al. 2022

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“…To the best of our knowledge, minimum requirements for an orthopedic angle measurement technique with regard to accuracy and precision are not known to us. A quantitative assessment of the inaccuracy of surgical angle manipulation in a human cadaver study revealed a mean error of 8.8° for Kirschner wire placement using a manual goniometer technique, which could be reduced to 2.1° mean error when a mounted digital goniometer device was used ( 64 ). Based on this surgical precision and error size, and as long as no better method is available, we considered the inaccuracy and imprecision of our 3D method acceptable for current clinical application.…”

Section: Discussionmentioning

confidence: 99%

Computed tomographic angular measurements using a bone-centered three-dimensional coordinate system are accurate in a femoral torsional deformity model and precise in clinical canine patients

Brühschwein¹,

Schmitz²,

Zöllner³

et al. 2023

Front. Vet. Sci.

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IntroductionIn small animal orthopedics, angular measurements in the canine femur are often applied in clinical patients with bone deformities and especially in complex and severe cases. Computed tomography (CT) has been shown to be more precise and accurate than two-dimensional radiography, and several methods are described. Measurement techniques evaluated in normal bones must prove accuracy in deformed bones in clinical settings.ObjectivesThe goals of our study were to evaluate the accuracy of canine femoral torsion angle measurements in a femoral torsional deformity model and to test repeatability and reproducibility of canine femoral neck inclination, torsion, and varus angle measurements in CT datasets of dogs applying a CT-based technique using a three-dimensional (3D) bone-centered coordinate system.Materials and methodsFor precision testing, femoral torsion, femoral neck inclination, and femoral varus angles were measured in CT data of 68 canine hind limbs by two operators, and their results were compared. For accuracy testing, a femoral torsional deformity model was preset from 0° to +/−90° with a goniometer and scanned. Torsion angles were measured in the CT data and compared to the preset value.ResultsIn the femoral torsion model, the Bland–Altman plots demonstrated a mean difference of 2.11°, and the Passing–Bablok analysis demonstrated a correlation between goniometer and CT-based measurements. In the clinical CT scans, intra- and interobserver agreement resulted in coefficients of variation for repeated measurements (%) between 1.99 and 8.26 for the femoral torsion, between 0.59 and 4.47 for the femoral neck inclination, and between 1.06 and 5.15 for the femoral varus angles.DiscussionEvaluation of femoral malformations with torsional deformities is the target area of this technique. Further studies are required to assess its value in different types, degrees, and combinations of osseous deformities and to establish normal reference values and guidelines for corrective osteotomies.ConclusionBased on the results of this study, the accuracy of the torsion angle measurements and the precision of inclination, torsion, and the varus angle measurements were considered acceptable for clinical application.

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“…Another example are hip arthroplasty procedures, where precise angle estimates are crucial for optimal patient outcomes. Multiple studies have shown that the estimation of angles using just visual estimates is very inaccurate [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Nevertheless, reports on the use of digital tools for angle estimation are scarce and mostly focus on estimating angles restricted to a single plane [ 25 , 26 , 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

Smart Drill for a Streamlined Estimation of the Drilling Angle and Channel Length in Orthopedic Surgical Procedures

Ivanišević,

Boban,

Jurić

et al. 2024

Bioengineering

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The estimation of distances and angles is a routine part of an orthopedic surgical procedure. However, despite their prevalence, these steps are most often performed manually, heavily relying on the surgeon’s skill and experience. To address these issues, this study presents a sensor-equipped drill system which enables automatic estimation of the drilling angle and channel length. The angular accuracy and precision of the system were tested over a range of inclination angles and proved to be superior to the manual approach, with mean absolute errors ranging from 1.9 to 4.5 degrees for the manual approach, and from 0.6 to 1.3 degrees with the guided approach. When sensors were used for simultaneous estimation of both the inclination and anteversion angles, the obtained mean absolute errors were 0.35 ± 0.25 and 2 ± 1.33 degrees for the inclination and anteversion angles, respectively. Regarding channel length estimation, using measurements obtained with a Vernier caliper as a reference, the mean absolute error was 0.33 mm and the standard deviation of errors was 0.41 mm. The obtained results indicate a high potential of smart drill systems for improvement of accuracy and precision in orthopedic surgical procedures, enabling better patient clinical outcomes.

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How accurately can surgeons perform angle manipulation? Quantitative assessment of the accuracy of manual angle manipulation of orthopedic surgery: a cadaver study

Cited by 3 publications

References 27 publications

Introduction of a bone-centered three-dimensional coordinate system enables computed tomographic canine femoral angle measurements independent of positioning

Introduction of a bone-centered three-dimensional coordinate system enables computed tomographic canine femoral angle measurements independent of positioning

Computed tomographic angular measurements using a bone-centered three-dimensional coordinate system are accurate in a femoral torsional deformity model and precise in clinical canine patients

Smart Drill for a Streamlined Estimation of the Drilling Angle and Channel Length in Orthopedic Surgical Procedures

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