Forces and torques during fracture reduction: Intraoperative measurements in the femur

Gösling, Thomas; Westphal, Ralf; Faulstich, J.; Sommer, Katharina; Wahl, Friedrich M.; Krettek, Christian; Hüfner, T.

doi:10.1002/jor.20045

Cited by 55 publications

(44 citation statements)

References 26 publications

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“…Previous studies have reported on applied fracture reduction forces. G€ osling et al [5] used a six-DOF sensor, rigidly fixed to an external fixator tube connected to the distal fragment through two Schanz screws, to collect and transmit reduction forces and torques. The opposite surface of the sensor was attached to a bar with two handles, used for alignment of the fracture fragments.…”

Section: Discussion and Future Workmentioning

confidence: 99%

“…All reductions were performed under radiographic monitoring ( Figure 5). [5] Femoral shaft fractures were classified using the AO/ASIF system, with typical diaphyseal femoral fractures (type A1-spiral, A2-oblique and A3-transverse) included in our study. Standard aseptic procedures were performed prior to using the measurement instrument.…”

Section: Experimental Methodsmentioning

confidence: 99%

“…One of these studies [5] evaluated reduction forces for femoral shaft fractures in seven polytraumatized patients. They reported that additional injury is likely to be sustained with implantation of the Schanz screws in the distal fracture fragment for reduction.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Experimental Methodsmentioning

confidence: 99%

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Force–torque intraoperative measurements for femoral shaft fracture reduction

Zhu

Liang

Wang

et al. 2016

Computer Assisted Surgery

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“…This can be attributed in part to the reduction table which is limiting in the degrees of freedom (DoF) and obtainable accuracies combined with mental strain from reconstructing images in 3-D. The manual traction interface to carry out the operation requires the surgeon to exert forces to counteract reduction which have been reported between 201 and 411 Newtons (Maeda et al, 2005;Gösling et al, 2006) and can lead to physical fatigue. Radiation reduction is a contributing motivator for a number of medical robotic research projects (Loser & Navab, 2000;Stoianovici et al, 2003;Cleary et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Robotic Long Bone Fracture Reduction

Graham¹,

Xie²,

Aw³

et al. 2008

Medical Robotics

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“…Very recent studies concerned intra-operative measurement procedures (Jenkinson et al, 2005;Gosling et al, 2006), and this endeavoured to answer the need to better identify and quantify the clinical gesture. The clinical relevance of our approach has fallen in this framework relating to maxillofacial pathologies and more particularly proptosis reduction.…”

Section: Introductionmentioning

confidence: 99%

Intra-operative quantification of the surgical gesture in orbital surgery: Application to the proptosis reduction

Luboz

Swider

Ambard

et al. 2007

Clinical Biomechanics

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Abstract:Background. Proptosis is characterized by a protrusion of the eyeball due to an increase of the orbital tissue volume. To recover a normal eyeball positioning, the most frequent surgical technique consists in the osteotomy of orbital walls combined with a loading on the eyeball to initiate tissue decompression. The first biomechanical models dealing with proptosis reduction, validated in one patient, have been previously proposed by the authors. Methods. This paper proposed an experimental method to quantify the intra-operative clinical gesture in proptosis reduction, and the pilot study concerned one clinical case. The eyeball's backward displacement was measured by an optical 3D localizer and the load applied by the surgeon was simultaneously measured by a custom-made force gauge. Quasi-static stiffness of the intra-orbital content was evaluated. Findings. The average values for the whole experiment was 16 N (SD: 3 N) for the force exerted by the surgeon and 9 mm (SD: 4 mm) for the eyeball backward displacement. The averaged quasi-static stiffness of the orbital content was evaluated to 2.4 N/mm (SD: 1.2) and showed a global decrease of 45% post-operatively. Interpretation. The protocol and the associated custom-designed devices allowed loads, induced displacements and macroscopic stiffness of the orbital content to be measured intra-operatively. The clinical relevance has been demonstrated in a pilot study. To our knowledge, no study has been published allowing the clinical gesture in proptosis reduction to be quantified intra-operatively. Associating an enlarged database and validated patient-related predictive models will reinforce the surgical efficiency and patient comfort contributing to diagnosis and intra-operative guidance.

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Forces and torques during fracture reduction: Intraoperative measurements in the femur

Cited by 55 publications

References 26 publications

Force–torque intraoperative measurements for femoral shaft fracture reduction

Force–torque intraoperative measurements for femoral shaft fracture reduction

Robotic Long Bone Fracture Reduction

Intra-operative quantification of the surgical gesture in orbital surgery: Application to the proptosis reduction

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