Robot‐assisted fracture reduction using three‐dimensional intraoperative fracture visualization: An experimental study on human cadaver femora

Oszwald, Markus; Westphal, Ralf; Bredow, Jan; Calafi, Afshin; Hüfner, T.; Wahl, Friedrich M.; Krettek, Christian; Gösling, Thomas

doi:10.1002/jor.21118

Cited by 39 publications

(13 citation statements)

References 35 publications

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“…These systems are being developed on an ongoing basis, with a need to develop a unified standard for fracture repositioning. Extensive research and development in the area of robot-assisted systems for fracture reduction has been carried out by Westphal et al [16][17][18] These researchers developed a surgical manipulator for femoral fractures based on an industrial robot St€ aubli (model RX 90). However, the endeffector of their robot-assisted system is rigidly fixed to the distal fracture fragment via Schanz screws, which causes additional injury to patients and increases the difficulty of IM nail implantation.…”

Section: Discussion and Future Workmentioning

confidence: 99%

Force–torque intraoperative measurements for femoral shaft fracture reduction

Zhu

Liang

Wang

et al. 2016

Computer Assisted Surgery

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Background: The minimally invasive technique of closed intramedullary (IM) nailing fixation is currently considered the standard of treatment for the operative management of displaced traumatic fractures of the femur, with fracture reduction and repositioning being the first and most important step of the procedure. Skeletal-muscle traction and alignment of the fracture fragments are always performed as individual components of the reduction and repositioning phase of the procedure. Methods: As use of high traction force and repositioning forces and torques can cause additional soft tissue injury, we developed a sensor-based system to monitor these forces and torques during the treatment of diaphyseal fractures of the femur, including the monitoring of traction forces during the entire procedure, from reduction to IM nail implantation and fixation. Results: Based on a local coordinate system localized at the center of the fracture, maximum forces of 203 N along the medial-lateral (X) axis, 517 N along the anterior-posterior (Y) axis and 505 N along the shaft of the femur (Z-axis) were identified, with maximum torques of 16.4 Nm calculated around Y-axis and 38.3 Nm around X-axis. The pressure between the counteraction post and the perineum was also recorded, with magnitudes as high as 523 N being recorded. Excessive forces were identified and the difference in force-torque magnitudes during different stages of the reduction and fixation procedure were calculated. Conclusion: The measurement system provides surgeons with real-time information which can assist them in performing effective repositioning of fracture fragments within safe margins of applied forces and torques.

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Section: Discussion and Future Workmentioning

confidence: 99%

Force–torque intraoperative measurements for femoral shaft fracture reduction

Zhu

Liang

Wang

et al. 2016

Computer Assisted Surgery

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“…In an effort to improve outcomes after intramedullary nailing of femur fractures, we have worked on developing a comprehensive roboticassisted operative technique. [6][7][8][9][10]13,14,[17][18][19][20][21][22][23] We have previously shown that surgeon-performed telemanipulated fracture reduction is effective and accurate for simple fracture types. To further improve the accuracy of more complex fractures, we have worked on automated fracture reduction algorithms that are able to rearrange the fracture fragments into their optimal position and plan an efficient and minimally traumatic fracture reduction path.…”

Section: Discussionmentioning

confidence: 99%

Comparison of algorithms for automated femur fracture reduction

Suero

Westphal

Citak

et al. 2017

Robotics Computer Surgery

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Purpose: We designed an experiment to determine the comparative effectiveness of computer algorithms for performing automated long bone fracture reduction.Methods: Automated reduction of 10 3D fracture models was performed using two computer algorithms, random sample matching (RANSAM) and Z-buffering (Z-Buffer), and one of five options of post-processing: none; iterative closest point algorithm (ICP); ICP-X1; ICP-X2;and ICP-X3. We measured the final alignment between the two fragments for each algorithm and post-processing option.

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“…distal interlocking) is not very practical, because of the higher financial, logistical, and educational demands. Considering economical and logistical aspects, this application should be integrated with robot-guided fracture reduction [9,10].…”

Section: Discussionmentioning

confidence: 99%

Hands-on robotic distal interlocking in intramedullary nail fixation of femoral shaft fractures

Oszwald

Westphal

Klepzig

et al. 2010

THC

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Introduction: Intramedullary nailing has become the gold standard in the treatment of femoral shaft fractures. This procedure involves the placement of distal interlocking bolts using the freehand technique. Accurate placement of distal interlocks can be a challenging task, especially in inexperienced hands. Misplacement of distal interlocking bolts can lead to iatrogenic fracture, instability of the bone-implant construct, or even malalignment of the extremity. Repeated drilling attempts increase radiation exposure and can cause additional bony and soft tissue trauma. We hypothesize that robot-guided placement of distal interlocks is more accurate, precise, and efficient than the freehand technique.Methods: A custom-designed drill guide was mounted onto the arm of an industrial robot. We developed a special device to secure a generic block (Synbone, Malans, Switzerland) into which an intramedullary nail could be inserted in a standardized way. A metric scale allowed later measurements of the drillings. Digital images were taken from each side of the block for analysis of the drilling trajectories. The fluoroscope was adjusted to obtain perfect circles of the distal interlocking holes. The number of images necessary to achieve this was recorded. The axis was recognized automatically by using the differences in contrast between the matrix of the generic bone and the implant (intramedullary nail). The drill trajectories were then computed. The robot with the mounted drill-guide automatically moved onto the calculated trajectory. The surgeon then executed the drilling. We performed 40 robot assisted drillings in generic blocks. Freehand drilling served as our control group.Results: Analysis of the digital images revealed a mean deviation of 0.94 mm and 2.7 • off the ideal trajectory using robotic assistance. In 100% of the cases (n = 40), the distal locking hole was hit. A mean of 8.8 images was acquired. After manual drilling, 92.5% of the distal interlocks were hit. A mean deviation of 3.66 mm and 10.36 • was measured. A mean of 23.4 fluoroscopic images were needed. The differences between the two methods were statistically significant.Conclusion: Robot-guided drilling increases the accuracy and precision of distal interlocking while reducing irradiation. Considering economical and logistical aspects, this application should be integrated with robot-guided fracture reduction.

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Robot‐assisted fracture reduction using three‐dimensional intraoperative fracture visualization: An experimental study on human cadaver femora

Cited by 39 publications

References 35 publications

Force–torque intraoperative measurements for femoral shaft fracture reduction

Force–torque intraoperative measurements for femoral shaft fracture reduction

Comparison of algorithms for automated femur fracture reduction

Hands-on robotic distal interlocking in intramedullary nail fixation of femoral shaft fractures

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