Robot-assisted fracture fixation in orthopaedic trauma surgery: a systematic review

Abstract

Objective: To investigate the applications of robot-assisted surgery and its effect on surgical outcomes in orthopaedic trauma patients. Data Sources: A search was performed in PubMed and Embase for articles in English, Dutch, German, or French, without restrictions on follow-up times, study size, or year of publication. Study Selection: Studies were included if they investigated patients undergoing robot-assisted fracture fixation surgery for orthopaedic trauma. Data Extraction: Outcomes studied were operating time, fluoroscopy time/frequency, complications, functional outcomes, intraoperative blood loss, fracture healing, and screw placement accuracy. Critical appraisal was done by using the Methodological Index for Non-Randomized Studies. Data Synthesis: Narrative review. Conclusions: A total of 3832 hits were identified with the search and 8 studies were included with a combined total of 437 included patients, 3 retrospective cohort studies, 2 prospective cohort studies, 1 cohort study not otherwise specified, 1 case series, and 1 randomized controlled trial. Four studies investigated pelvic ring fractures, 3 studies investigated femur fractures, and 1 study investigated scaphoid fractures. Seven investigated percutaneous screw fixation and 1 studied intramedullary nail fixation. One robotic system was used across all studies, the TiRobot, and all procedures were performed in China. The limited evidence suggests that that robot-assisted orthopaedic trauma surgery may reduce operating time, use of fluoroscopy, intraoperative blood loss, and improve screw placement accuracy, but the overall quality of evidence was low with a high risk of bias. Robot-assisted fracture fixation does not appear to lead to better functional outcomes for the patient. Level of evidence: III

Current status of robot‐assisted surgery in the clinical application of trauma orthopedics in China: A systematic review

“…8 Surgical robot was reported to be applied to the precise positioning and nail placement in orthopedic trauma surgery to improve surgical accuracy and reduce surgical injury. 7 Especially in China, the application research of computer-assisted navigation surgery and medical robots in trauma orthopedics was funded by national scientific research projects in 2001. After that, research reports on the clinical application of robots in trauma orthopedics appeared one after another.…”

“…The robot systems such as Robodoc (Curexo Technology Company), SpineAssist (Mazor Robotic Company), Stryker‐Nav (Stryker Corporation), and Renaissance (Mazor Robotic Company) had developed rapidly and had been successfully used in hip and knee arthroplasty, pedicle screw placement, and other operations 5,6 . Compared with joint surgery and spine surgery, there were few surgical robots used in trauma orthopedics 7 . However, this situation had changed because of the rapid development of image processing technology and the improvement of navigation tracers in recent years 8 .…”

“…However, this situation had changed because of the rapid development of image processing technology and the improvement of navigation tracers in recent years 8 . Surgical robot was reported to be applied to the precise positioning and nail placement in orthopedic trauma surgery to improve surgical accuracy and reduce surgical injury 7 . Especially in China, the application research of computer‐assisted navigation surgery and medical robots in trauma orthopedics was funded by national scientific research projects in 2001.…”

“…5,6 Compared with joint surgery and spine surgery, there were few surgical robots used in trauma orthopedics. 7 However, this situation had changed because of the rapid development of image processing technology and the improvement of navigation tracers in recent years. 8 Surgical robot was reported to be applied to the precise positioning and nail placement in orthopedic trauma surgery to improve surgical accuracy and reduce surgical injury.…”

A new technology combined robotics and 3D printing facilitates closed reduction of tibia shaft fractures using a minimally invasive plate as a reduction template: A technical note.

“…However, there is no robot-assisted fracture reduction (RAFR) system which is currently available on the market, robotics in fracture reduction remains at laboratory stage and cannot solve the clinical problem of TSFs. (14)(15)(16)(17)The purpose of this paper is to present a new technologie combined robotics and 3D printing to achieve anatomic reduction of TSFs with MIPO.…”