A surgical telemanipulator for femur shaft fracture reduction

Westphal, Ralf; Winkelbach, Simon; Gösling, Thomas; Hüfner, T.; Faulstich, J.; Martin, Paul; Krettek, Christian; Wahl, Friedrich M.

doi:10.1002/rcs.81

Cited by 35 publications

(26 citation statements)

References 14 publications

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“…These systems are being developed on an ongoing basis, with a need to develop a unified standard for fracture repositioning. Extensive research and development in the area of robot-assisted systems for fracture reduction has been carried out by Westphal et al [16][17][18] These researchers developed a surgical manipulator for femoral fractures based on an industrial robot St€ aubli (model RX 90). However, the endeffector of their robot-assisted system is rigidly fixed to the distal fracture fragment via Schanz screws, which causes additional injury to patients and increases the difficulty of IM nail implantation.…”

Section: Discussion and Future Workmentioning

confidence: 99%

Force–torque intraoperative measurements for femoral shaft fracture reduction

Zhu

Liang

Wang

et al. 2016

Computer Assisted Surgery

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Background: The minimally invasive technique of closed intramedullary (IM) nailing fixation is currently considered the standard of treatment for the operative management of displaced traumatic fractures of the femur, with fracture reduction and repositioning being the first and most important step of the procedure. Skeletal-muscle traction and alignment of the fracture fragments are always performed as individual components of the reduction and repositioning phase of the procedure. Methods: As use of high traction force and repositioning forces and torques can cause additional soft tissue injury, we developed a sensor-based system to monitor these forces and torques during the treatment of diaphyseal fractures of the femur, including the monitoring of traction forces during the entire procedure, from reduction to IM nail implantation and fixation. Results: Based on a local coordinate system localized at the center of the fracture, maximum forces of 203 N along the medial-lateral (X) axis, 517 N along the anterior-posterior (Y) axis and 505 N along the shaft of the femur (Z-axis) were identified, with maximum torques of 16.4 Nm calculated around Y-axis and 38.3 Nm around X-axis. The pressure between the counteraction post and the perineum was also recorded, with magnitudes as high as 523 N being recorded. Excessive forces were identified and the difference in force-torque magnitudes during different stages of the reduction and fixation procedure were calculated. Conclusion: The measurement system provides surgeons with real-time information which can assist them in performing effective repositioning of fracture fragments within safe margins of applied forces and torques.

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Section: Discussion and Future Workmentioning

confidence: 99%

Force–torque intraoperative measurements for femoral shaft fracture reduction

Zhu

Liang

Wang

et al. 2016

Computer Assisted Surgery

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“…The minimum sample size was calculated based on previous studies. 23,24 We expected the highest differences for malrotation. The mean rotation malalignment with a similar manual reduction technique was 5.18, 24 whereas the mean difference for the robot-assisted reduction with surface visualization was 0.88.…”

Section: Specimen Preparationmentioning

confidence: 99%

“…We used the same technical set-up for the robot that was described before with the following modifications: 24 The 2D image intensifier was changed for a 3D image intensifier (Siremobil Iso-C-3D, Siemens AG, Medical Solns, Erlangen, Germany). This image intensifier was equipped with the localization crown for navigated applications.…”

Section: Robot Set-upmentioning

confidence: 99%

“…The description and validation of this model was previously established. 24 The femur was then fractured by 3-point bending; fractures where classified according to the AO classification system. 27 …”

Section: Specimen Preparationmentioning

confidence: 99%

“…Nevertheless the reduction accuracy could not be improved significantly compared to the manual reduction. 24 Reduction control in the first study was facilitated by two orthogonal cameras, whereas in the second study a 2D image intensifier was used. These findings demonstrated that visualization is a crucial factor in achieving accurate results.…”

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confidence: 99%

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Robot‐assisted fracture reduction using three‐dimensional intraoperative fracture visualization: An experimental study on human cadaver femora

Oszwald

Westphal

Bredow

et al. 2010

Journal Orthopaedic Research

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Closed fracture reduction can be a challenging task. Robot-assisted reduction of the femur is a newly developed technique that could minimize potential complications and pitfalls associated with fracture reduction and fixation. We conducted an experimental study using 11 human cadaver femora with intact soft tissues. We compared robot-assisted fracture reduction using 3D visualization with manual reduction, using 2D fluoroscopy. The main outcome measure was the accuracy of reduction. The manual reductions were done by an experienced orthopedic trauma surgeon, whereas the robot-assisted reductions were done by surgeons of different experience. The robotassisted group showed significantly less postreduction malalignment (p < 0.05) for internal/external rotation (2.98 vs. 8.48) and for varus/ valgus alignment (1.18 vs. 2.58). However, the reduction time was significantly (p < 0.01) longer (6:14 min vs. 2:16 min). The higher precision associated with robot-assisted fracture reduction makes this technique attractive and further research and development worthwhile. In particular, less experienced surgeons may benefit from this new technique. ß

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