Computer-Assisted Preoperative Planning for Reduction of Proximal Femoral Fracture Using 3-D-CT Data

Abstract

This paper describes procedures for repositioning calculations of fractured bone fragments using 3-D-computed tomography (CT), aimed at preoperative planning for computer-guided fracture reduction of the proximal femur. Fracture boundaries of the bone fragments, as "fracture lines (FLs)," and the mirror-transformed contralateral femur shape extracted from 3-D-CT were used for repositioning of the fragments. We first describe a method for extracting FLs based on 3-D curvature analysis and then formulate repositioning methods based on registration of bone fragments using the following three constraints: 1) contralateral (CL) femur shape; 2) FLs; and 3) both CL femur shape and fracture lines, as "both constraints". We performed experiments using CT datasets from five simulated and four real patients with proximal femoral fracture. We evaluated the rotation error in reposition calculations and the contact ratio between repositioned fragment boundaries, which are crucial for the recovery of proper functional axes and bone adhesion of fragments, respectively. Experimental results showed that good accuracy and stability were attainable when registration using both constraints was performed after registration using the fracture-line constraint. On average, 6.0 degrees +/-0.8 degrees in rotation error and 89%+/-3 % in contact ratio were obtained without providing precise initial values.

A scale-space curvature matching algorithm for the reconstruction of complex proximal humeral fractures

“…However, the literature regarding computer-assisted reconstruction of bone fractures is relatively sparse, compared to the very large body of research on the topics of bone segmentation and medical image registration ( Thomas et al, 2011 ). Jiménez-Delgado et al (2016) recently published a comprehensive review article, summarizing current approaches for bone fracture reduction planning ( Albrecht and Vetter, 2012;Chowdhury et al, 2009;Fürnstahl et al, 2012;Moghari and Abolmaesumi, 2008;Okada et al, 2009;Thomas et al, 2011;Willis et al, 2007;Winkelbach and Wahl, 2008;Zhou et al, 2009 ).…”

“…Some of these approaches rely on a reconstruction template, i.e. the contralateral bone model Fürnstahl et al, 2012;Okada et al, 2009 ) or a statistical shape model ( Albrecht and Vetter, 2012;Moghari and Abolmaesumi, 2008 ) is required to calculate the reduction. DeLude et al (2007) and Vlachopoulos et al (2016a) verified that the contralateral humeral anatomy might be a reliable template for some geometric characteristics (i.e., the humeral head size and the humeral length).…”

Computer-assisted preoperative planning improves the learning curve of PFNA-II in the treatment of intertrochanteric femoral fractures

“…However, this technology is available for only a few patients because it is expensive and time consuming, which limited its clinical applications. Okada et al [22] described a method that extract fracture lines based on 3D curvature analysis. It was used for the repositioning and registration of bone fragments in proximal femoral fractures.…”

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“…Studies have been conducted on the use of computer-aided surgery simulation for individual modeling of long bone fractures [8][9][10], proximal femur fractures [11,12], proximal humerus fractures [13,14], and acetabular fractures [15][16][17]. Most of these studies deal with 3D modeling, visualization, segmentation, fracture reduction, and topics related to preoperative planning.…”