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Reduction of fractures in the minimally invasive (MI) manner can avoid risks associated with open fracture surgery. The MI approach requires specialized tools called percutaneous fragment manipulation devices (PFMD) to enable surgeons to safely grasp and manipulate fragments. PFMDs developed for long-bone manipulation are not suitable for intra-articular fractures where small bone fragments are involved. With this study, we offer a solution to potentially move the current fracture management practice closer to the use of a MI approach. We investigate the design and testing of a new PFMD design for manual as well as robot-assisted manipulation of small bone fragments. This new PFMD design is simulated using FEA in three loading scenarios (force/torque: 0 N/2.6 Nm, 75.7 N/3.5 N, 147 N/6.8 Nm) assessing structural properties, breaking points, and maximum bending deformations. The PFMD is tested in a laboratory setting on Sawbones models (0 N/2.6 Nm), and on ex-vivo swine samples (F = 80 N ± 8 N, F = 150 ± 15 N). A commercial optical tracking system was used for measuring PFMD deformations under external loading and the results were verified with an electromagnetic tracking system. The average error difference between the tracking systems was 0.5 mm, being within their accuracy limits. Final results from reduction maneuvers performed both manually and with the robot assistance are obtained from 7 human cadavers with reduction forces in the range of (F = 80 N ± 8 N, F = 150 ± 15 N, respectively). The results show that structurally, the system performs as predicted by the simulation results. The PFMD did not break during ex-vivo and cadaveric trials. Simulation, laboratory, and cadaveric tests produced similar results regarding the PFMD bending. Specifically, for forces applied perpendicularly to the axis of the PFMD of 80 N ± 8 N deformations of 2.8, 2.97, and 3.06 mm are measured on the PFMD, while forces of 150 ± 15 N produced deformations of 5.8, 4.44, and 5.19 mm. This study has demonstrated that the Georgilas et al. Manipulation Device for MI Surgery proposed PFMD undergoes predictable deformations under typical bone manipulation loads. Testing of the device on human cadavers proved that these deformations do not affect the anatomic reduction quality. The PFMD is, therefore, suitable to reliably achieve and maintain fracture reductions, and to, consequently, allow external fracture fixation.

Evaluating the accessibility of web resources is usually done by checking the conformance of the resource against a standard or set of guidelines (e.g., the WCAG 2.1). The result of the evaluation will indicate what guidelines are respected (or not) by the resource. While it might hint at the accessibility level of web resources, often it will be complicated to compare the level of accessibility of different resources or of different versions of the same resource from evaluation reports. Web accessibility metrics synthesize the accessibility level of a web resource into a quantifiable value. The fact that there is a wide number of accessibility metrics, makes it challenging to choose which ones to use. In this paper, we explore the relationship between web accessibility metrics. For that purpose, we investigated eleven web accessibility metrics. The metrics were computed from automated accessibility evaluations obtained using QualWeb. A set of around three million web pages were evaluated. By computing the metrics over this sample of nearly three million web pages, it was possible to identify groups of metrics that offer similar results. Our analysis shows that there are metrics that behave similarly, which, when deciding what metrics to use, assists in picking the metric that is less resource intensive or for which it might be easier to collect the inputs.