Fluoroscopic Bone Fragment Tracking for Surgical Navigation in Femur Fracture Reduction by Incorporating Optical Tracking of Hip Joint Rotation Center

Abstract

A new method for fluoroscopic tracking of a proximal bone fragment in femoral fracture reduction is presented. The proposed method combines 2-D and 3-D image registration from single-view fluoroscopy with tracking of the head center position of the proximal femoral fragment to improve the accuracy of fluoroscopic registration without the need for repeated manual adjustment of the C-arm as required in stereo-view registrations. Kinematic knowledge of the hip joint, which has a positional correspondence with the femoral head center and the pelvis acetabular center, allows the position of the femoral fragment to be determined from pelvis tracking. The stability of the proposed method with respect to fluoroscopic image noise and the desired continuity of the fracture reduction operation is demonstrated, and the accuracy of tracking is shown to be superior to that achievable by single-view image registration, particularly in depth translation.

Evaluation of automated statistical shape model based knee kinematics from biplane fluoroscopy

“…Skin marker-based kinematics on the other hand is prone to soft-tissue motion resulting in errors larger than 10 mm (Garling et al, 2007; Stagni et al, 2005). More accurate kinematics can be obtained with model-based tracking in fluoroscopy (Fregly et al, 2005; Kitagawa et al, 2010; Li et al, 2008; Muhit et al, 2010; Nakajima et al, 2007; Pickering et al, 2009; Scott and Barney Smith, 2006; Tsai et al, 2010; You et al, 2001). These methods align a 3D bone model, segmented from CT or MRI, with calibrated fluoroscopic sequences.…”

“…These methods align a 3D bone model, segmented from CT or MRI, with calibrated fluoroscopic sequences. Alignment is achieved by minimizing either an image intensity distance through calculation of digitally reconstructed radiographs (DRR) (Anderst et al, 2009; Bey et al, 2008; Dennis et al, 2005; Mahfouz et al, 2003; Muhit et al, 2010; Nakajima et al, 2007; Pickering et al, 2009; Scott and Barney Smith, 2006; You et al, 2001), or an image edge to bone model silhouette distance (Defrate et al, 2006; Fregly et al, 2005; Gollmer et al, 2007; Hanson et al, 2006; Hirokawa et al, 2008; Kitagawa et al, 2010; Li et al, 2008; Tersi et al, 2012; Torry et al, 2011; Tsai et al, 2010). Kinematic analysis not requiring the subject-specific 3D model would, however, be preferred, as it would lower analysis costs and eliminate the prior 3D acquisition resulting in lower radiation dose in the case of CT.…”

Functional assessment of a surgical robot for reduction of lower limb fractures

“…Currently, most medical facilities use fracture tables for assisting reduction by applying a longitudinal traction force from the foot of the patient, with an additional abduction/adduction of the hip joint and external rotation/internal rotation of the entire lower limb. Sugano and colleagues14–17 developed a robotic system to assist fracture reduction through a mechanism similar to the conventional fracture table. Computer‐assisted surgical planning and navigation systems have also been incorporated to facilitate reduction and to minimize medical staff exposure to radiation18, 19.…”

A Robot Assisted Hip Fracture Reduction with a Navigation System

“…In our experiments, we could not use a fluoroscope for 2D-3D registration of bone fragments. We are trying to integrate our system and the registration method, which is reported by Nakajima et al [6]. Though the radiation exposure, the registration error, and the reduction accuracy of a complete system should be evaluated, it can be expected to reduce the radiation exposure, because the system shortens the overall reduction time and the surgeon can monitor the reduction status via the navigation system, without the use of a fluoroscope, and moreover surgeons can work at a distance from radiation source.…”

“…Kinematic knowledge of the hip joint, which has a positional correspondence with the femoral head center and the pelvis acetabular center, allows the position of the femoral fragment to be determined from pelvis tracking [6]. The robot's reference marker is used not only for tracking the robot, but also for tracking the distal bone fragment.…”