Percutaneous antegrade scaphoid screw placement: a feasibility and accuracy analysis of a novel electromagnetic navigation technique versus a standard fluoroscopic method

Hoffmann, Michael; Reinsch, Oliver; Petersen, J.; Schröder, Matthias; Priemel, Matthias; Spiro, A. G.; Rueger, Johannes M.; Yarar, S.

doi:10.1002/rcs.1572

Cited by 9 publications

(9 citation statements)

References 23 publications

(31 reference statements)

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“…Regarding nancial resources in trauma care, introducing a new navigation system is always associated with acquisition costs. Bene ts for all stakeholders have to be clear and visible [32]. However, length of surgery is an expense factor and a signi cant reduction leads to an increased cost-effectiveness overall as well as to lower infection rates.…”

Section: Discussionmentioning

confidence: 99%

Electromagnetic Navigation Reduces Radiation Exposure and Provides Excellent Accuracy for Retrograde Drilling in Osteochondrosis Dissecans of the Talus

Berger-Groch

Jungesblut

Hoffmann

et al. 2020

Preprint

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Background: Retrograde drilling in osteochondrosis dissecans (OCD) is a widely used surgical intervention. A radiation-free electromagnetic navigation system (ENS)-based method was compared with the standard freehand fluoroscopic (SFF) method regarding clinical applicability.Methods: We performed a clinical cohort study at a department of Orthopaedics in a Level 1 children’s hospital with 40 patients (20 SFF and 20 ENS). Retrograde drilling of the talar dome was used in patients with unstable medial OCD (MRI stage 2 according to Hepple’s revised classification; stage 2 according to the International Cartilage Repair Society). The outcome measurements were: a) Intraoperative fluoroscopy exposure and length of surgery and b) Postoperative serial follow-up MRIs every 6 months.Results: 22 female and 18 male patients aged 13.8 ± 1.6 years (range: 11-17 years) were included. Using the ENS technique, length of surgery was significantly reduced to 20.2 ± 6.4 min compared to 36.1 ± 11.8 min (p<0.01) for the SFF technique. The average x-ray radiation time for the SFF technique was 23.5 ± 13.5 sec and 1.9 ± 1.7 sec for the ENS technique (p<0.01). Radiation exposure was significantly reduced from 44.6 ± 19.7 mSv (SFF technique) to 5.6± 2.8 mSv (ENS technique) (p<0.01). Intraoperative perforation of cartilage occurred once in the SFF group. Correct placement of the drilling channel was verified in all patients on follow-up MRI after six months and a timely healing was seen after two years. No differences were detected on follow-up MRI between the two methods.Conclusions: The ENS method provides for a significant reduction in length of surgery and radiation exposure. ENS was without intraoperative cartilage perforation. The clinical and radiological follow-up parameters are comparable for SFF- and ENS-guided retrograde drilling.Trial registration: WF – 085/20, 05/2020 “retrospectively registered”

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Section: Discussionmentioning

confidence: 99%

Electromagnetic Navigation Reduces Radiation Exposure and Provides Excellent Accuracy for Retrograde Drilling in Osteochondrosis Dissecans of the Talus

Berger-Groch

Jungesblut

Hoffmann

et al. 2020

Preprint

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“…Previous clinical and experimental studies have shown that electromagnetic navigation represents a reliable technique for interventional procedures like radiofrequency ablations of tumors, liver biopsies or punctures of the lumbar facet joints [ 19 , 21 – 23 ] [ 24 ]. However, different factors avoided the widespread use of this technique in trauma surgery [ 25 – 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ricci et al found in his experimental setup comparable results regarding the accuracy of electromagnetic and optical navigated guidewires [ 14 ]. Hoffmann et al postulates that the use of electromagnetic guidance in scaphoid fractures is superior to the standard fluoroscopic technique [ 24 ]. Other studies confirm these results and show a high accuracy of EM-tracking particularly during long distance interventional setups [ 13 , 15 , 16 , 18 , 19 , 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

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Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques

Pishnamaz¹,

Wilkmann²,

Na³

et al. 2016

PLoS ONE

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BackgroundElectromagnetic tracking is a relatively new technique that allows real time navigation in the absence of radiation. The aim of this study was to prove the feasibility of this technique for the treatment of posterior pelvic ring fractures and to compare the results with established image guided procedures.MethodsTests were performed in pelvic specimens (Sawbones®) with standardized sacral fractures (Type Denis I or II). A gel matrix simulated the operative approach and a cover was used to disable visual control. The electromagnetic setup was performed by using a custom made carbon reference plate and a prototype stainless steel K-wire with an integrated sensor coil. Four different test series were performed: Group OCT: Optical navigation using preoperative CT-scans; group O3D: Optical navigation using intraoperative 3-D-fluoroscopy; group Fluoro: Conventional 2-D-fluoroscopy; group EMT: Electromagnetic navigation combined with a preoperative Dyna-CT. Accuracy of screw placement was analyzed by standardized postoperative CT-scan for each specimen. Operation time and intraoperative radiation exposure for the surgeon was documented. All data was analyzed using SPSS (Version 20, 76 Chicago, IL, USA). Statistical significance was defined as p< 0.05.Results160 iliosacral screws were placed (40 per group). EMT resulted in a significantly higher incidence of optimal screw placement (EMT: 36/40) compared to the groups Fluoro (30/40; p< 0.05) and OCT (31/40; p< 0.05). Results between EMT and O3D were comparable (O3D: 37/40; n.s.). Also, the operation time was comparable between groups EMT and O3D (EMT 7.62 min vs. O3D 7.98 min; n.s.), while the surgical time was significantly shorter compared to the Fluoro group (10.69 min; p< 0.001) and the OCT group (13.3 min; p< 0.001).ConclusionElectromagnetic guided iliosacral screw placement is a feasible procedure. In our experimental setup, this method was associated with improved accuracy of screw placement and shorter operation time when compared with the conventional fluoroscopy guided technique and compared to the optical navigation using preoperative CT-scans. Further studies are necessary to rule out drawbacks of this technique regarding ferromagnetic objects.

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“…Several surgical teams have recently sought to develop new techniques to improve guide wire positioning, such as two-dimensional (2-D) navigation (Liverneaux et al., 2008), three-dimensional (3-D) navigation (Catala-Lehnen et al., 2011), or electromagnetic navigation (Hoffmann et al., 2015). These techniques have proven to be reliable and to result in proper screw placement.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional-printed patient-specific Kirschner-wire guide for percutaneous fixation of undisplaced scaphoid fractures: a cadaveric study

Salabi

Rigoulot²,

Sautet

2019

J Hand Surg Eur Vol

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Undisplaced scaphoid waist fractures can be managed by percutaneous fixation. The purpose of this study is to compare percutaneous fixation using a three-dimensional (3-D)-printed guide with the conventional method in a cadaveric study. Twelve wrists were divided into two groups: standard fluroscopic technique group, and a patient-specific 3-D-printed guide group. In the patient-specific group, using high resolution CT scans, we manufactured a mould-guide including a wire guide sleeve aligned with the planned ideal path, and 3-D printed it. On postoperative CT scans we measured the angular deviation of the screw axis from the ideal axis, and compared the two groups. The angular deviation was significantly lower in the patient-specific guide group. We concluded that a 3-D-printed guide for scaphoid percutaneous fixation allows a more accurate placement of the screw than a fluoroscopy guide in our cadaveric model.

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Percutaneous antegrade scaphoid screw placement: a feasibility and accuracy analysis of a novel electromagnetic navigation technique versus a standard fluoroscopic method

Abstract: Compared with the standard fluoroscopic technique, the ENS method used in this study showed higher accuracy, less complications, required less operation and radiation exposure time.

Cited by 9 publications

References 23 publications

Electromagnetic Navigation Reduces Radiation Exposure and Provides Excellent Accuracy for Retrograde Drilling in Osteochondrosis Dissecans of the Talus

Electromagnetic Navigation Reduces Radiation Exposure and Provides Excellent Accuracy for Retrograde Drilling in Osteochondrosis Dissecans of the Talus

Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques

Three-dimensional-printed patient-specific Kirschner-wire guide for percutaneous fixation of undisplaced scaphoid fractures: a cadaveric study

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