Fluoroscopy-Based Surgical Navigation versus Fluoroscopic Guidance to Control Guide Wire Insertion for Osteosynthesis of Femoral Neck Fractures

Abstract

Background and Purpose: Long fluoroscopic times and related radiation exposure are a universal concern when C-arm fluoroscopy is used to guide percutaneous procedures. Fluoroscopy-based surgical navigation has been proposed as an alternative guidance method requiring limited fluoroscopic times to achieve precision. The purpose of this experimental study was to compare fluoroscopy-based surgical navigation with C-arm fluoroscopy for guidance with respect to the precision achieved, the fluoroscopic time, and the resources needed. Material and Methods: 114 guide wires were placed in 38 synthetic bone models using either C-arm fluoroscopy (group A) or fluoroscopy-based surgical navigation (group B) for guidance. Precision of guide wire placement was rated on the basis of an individual CT scan on all fracture models of both groups. The fluoroscopic time, the procedure time, and the number of attempts required to place the guide wires were documented as well. Results: An average fluoroscopic time of 26 s was needed with C-arm fluoroscopy to place three guide wires compared with an average fluoroscopic time of 2 s that was needed when fluoroscopy-based surgical navigation was used for guidance (p < 0.0001). Precision of guide wire placement and procedure times required to place the guide wires did not differ significantly between both groups. The number of attempts required for correct placement was found significantly reduced with fluoroscopy-based surgical navigation when compared with fluoroscopic guidance (p = 0.04). Conclusion: Fluoroscopic times to achieve precision are reduced with fluoroscopy-based surgical navigation compared with C-arm fluoroscopy. The impact of this new technique on minimally invasive, percutaneous procedures has to be evaluated in controlled prospective clinical studies.

Evaluation of a fluoroscopy-based navigation system enabling a virtual radiation-free preview of X-ray images for placement of cannulated hip screws. A cadaver study

“…In clinical use, this approach may serve to minimize the need for revision surgery as a result of early failure of implant fixation in a femoral neck weakened by multiple incorrect guide wire pathways. The results are similar to those of other researchers who also performed computer-assisted guide wire placement in the femoral neck [10,11,19]. In one of those studies [11], one of 15 computer-assisted trials required a second pass because the surgeon did not follow the computer plan.…”

Evaluation of a new computer-assisted surgical planning and navigation system based on two-dimensional fluoroscopy for insertion of a proximal femoral nail

“…The surgeon could trust the navigation system. The results obtained in this paper are similar to those reported in Mayman et al [20] (conventional technique: 2.4 ¡ 1.1 drilling attempts; computer-assisted technique: 1.1 ¡ 0.3 drilling attempts) and Suhm et al [27] (conventional technique: 1.4 ¡ 0.6 drilling attempts; computer-assisted technique: 1.1 ¡ 0.2 drilling attempts) who also performed computer-assisted guide wire placement in the femoral neck. One of the 15 computer-assisted trials performed in [20] required a second pass because the surgeon did not follow the computer-generated path.…”

Three-dimensional computer-assisted navigation for the placement of cannulated hip screws. A pilot study

“…In clinical use, this may minimise revision surgery caused by early failure of implant fixation in a weakened femoral neck or early osteoarthritis caused by penetration of the femoral head. In comparison to authors who performed biplanar computer-assisted guide wire placement in the femoral neck, the results are similar [13][14][15][16]. In these studies, one of 15 computer-assisted trials required a second pass because the surgeon did not follow the computer plan [14].…”