Telemanipulated Long Bone Fracture Reduction

Westphal, Ralf; Winkelbach, Simon; Goesling, Thomas; Oszwald, Markus; Huefner, Tobias; Krettek, Christian; Wahl, Friedrich M.

doi:10.5772/5271

Cited by 16 publications

(12 citation statements)

References 33 publications

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“…Reduction of fractured bone can be achieved through direct manipulation of the injured bone, as in open reduction, or through ligamentotaxis in closed reduction. Gosling and Westphal et al proposed a telemanipulation system for femur shaft fracture using joystick control9–12 and Fu et al 13 described a novel robot‐assisted bone setting system which consisted of an autonomic operating table, a repositioning robot and a guiding robot; however, these systems are too sophisticated for an ordinary operating theatre. 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.…”

Section: Discussionmentioning

confidence: 99%

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

Hung

Lee

2010

Robotics Computer Surgery

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Section: Discussionmentioning

confidence: 99%

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

Hung

Lee

2010

Robotics Computer Surgery

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“…The sequence and mathematical basis of the telemanipulation process have been described in detail before. 26 Fracture reduction problems involve six degrees of freedom (DoF) (three translational and three rotational DoF). In order to solve a fracture reduction puzzle using an input device with only two DoF, the complexity of the 3D space is decomposed into simpler two-dimensional (2D) reductions using stan- A two-part survey instrument was administered to all subjects.…”

Section: Methodsmentioning

confidence: 99%

“…[21][22][23][24] The technique has the overall aim of improving reduction accuracy and of reducing the incidence of femoral malrotation. 21,25,26 Given that this system includes features of telemanipulated and hands-on robotic systems, 27 achieving a reliable and user-friendly human-robot interface is an important part of this project.…”

Section: Introductionmentioning

confidence: 99%

Improving the human–robot interface for telemanipulated robotic long bone fracture reduction: Joystick device vs. haptic manipulator

Suero

Hartung

Westphal

et al. 2017

Robotics Computer Surgery

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Objectives: Intramedullary nailing is the treatment of choice for femoral shaft fractures.However, there are several problems associated with the technique, e.g. high radiation exposure and rotational malalignment. Experimental robotic assistance has been introduced to improve the quality of the reduction and to reduce the incidence of rotational malalignment. In the current study, we compare two devices for control of the fracture fragments during telemanipulated reduction.Methods: Ten male and ten female subjects were asked to participate as examiners in this experiment. A computer program was developed to render and manipulate CT-based renderings of femur fracture bone fragments. The user could manipulate the fragments using either a simple joystick device or a haptic manipulator. Each examiner performed telemanipulated reduction of 10 virtual fracture models of varying difficulty with each device (five in a 'training phase' and five in a 'testing phase'). Mixed models were used to test whether using the haptic device improved alignment accuracy and improved reduction times compared to using a joystick.Results: Reduction accuracy was not significantly different between devices in either the training phase or the testing phase (P > 0.05). Reduction time was significantly higher for the Phantom device than for the Joystick in the training phase (P < 0.0001), but it was no different in the testing phase (P = 0.865). High spatial ability with electronics had a significant effect on the alignment of fracture reduction and time to reduction. Conclusions:The Joystick and the Phantom devices resulted in similarly accurate reductions, with the Joystick having an easier learning curve. The Phantom device offered no advantage over the Joystick for fracture telemanipulation. Considering the high cost of the Phantom device and the lack of a demonstrable advantage over the Joystick, its use is not justified for implementation in a fracture telemanipulation workflow. The Joystick remains as a low-cost and effective device for developing 3D fracture telemanipulation techniques.

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“…RELATED WORK Several methodologies that tackle the problem of the intra-operative pose estimation of anatomy appear in literature. The schemes developed by [3,4] track bone fragments in real-time by means of an optical tracking system via a set of infrared markers. Thus to track the position of the distal and proximal bone fragments, the surgeon implants fiduciary markers into the bone segments.…”

Section: Introductionmentioning

confidence: 99%

Intra-operative 3D pose estimation of fractured bone segments for image guided orthopedic surgery

Gamage

Xie

Delmas

et al. 2009

2008 IEEE International Conference on Robotics and Biomimetics

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The widespread adoption of minimally invasive surgical techniques have driven the need for 3D intra-operative image guidance. Hence the 3D pose estimation (position and orientation) performed through the registration of preoperatively prepared 3D anatomical data to intra-operative 2D fluoroscopy images is one of the main research areas of image guided orthopedic surgery. The goal of this 2D-3D registration is to fuse highly detailed 3D information with the 2D images acquired intra-operatively to provide a real-time 3D visualization of the patient's anatomy during surgery. Existing research work on fractured bone pose estimation focuses on tracking preoperatively obtained 3D CT data through fiduciary markers implanted intra-operatively. This expensive and invasive approach is not routinely available for diagnostics, and a majority of fracture reduction procedures solely relies on xray/fluoroscopic images.The proposed concept eliminates the need to have the preoperative CT scan of the patient's injured anatomy and presents a non-invasive anatomy-based method for intra-operative pose estimation. The concept pre-operatively reconstructs a patientspecific fractured bone model utilizing two conventional x-ray images orthogonally (in anterior and lateral views) and a generic healthy 3D anatomical model. This pre-operatively reconstructed 3D model will then be utilized intra-operatively in the novel 2D-3D registration process for pose estimation. It is this registration process that is the focus of this paper. The registration is performed solely utilizing bony anatomical features extracted from fluoroscopic images without invasiveness external fiducial markers.

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Telemanipulated Long Bone Fracture Reduction

Cited by 16 publications

References 33 publications

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

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

Improving the human–robot interface for telemanipulated robotic long bone fracture reduction: Joystick device vs. haptic manipulator

Intra-operative 3D pose estimation of fractured bone segments for image guided orthopedic surgery

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