In vivo test of a radiography‐based navigation system for control of derotational osteotomies

Grünwald, Leonard; Schröter, Steffen; Windolf, Markus; Gueorguiev, Boyko; Richards, Geoff; Buschbaum, Jan

doi:10.1002/jor.24782

Cited by 3 publications

(1 citation statement)

References 16 publications

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“…In vitro performance of a first module for distal nail interlocking was described in [ 6 ]. The performance and clinical application of another module for controlling rotational osteotomies was outlined in [ 8 ], whereas this work focused on a prototype module for proximal humerus plating.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Testing and Clinical Handling of a Novel Implant Positioning Technology for Proximal Humeral Plating

et al. 2023

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Background and Objectives: Fractures of the proximal humerus are common, particularly in elderly populations. Anatomical locking plates target stabilization with a multitude of screws spanning into the humeral head. Sound implant placement and screw length determination are key for a successful clinical outcome but are difficult to obtain from planar X-rays. A novel implant positioning technology for proximal humerus plating (Xin1) outputs screw lengths suggestions and plate position based on hole projections in conventional X-ray images. This study investigated the performance of a prototype Xin1 system in a postmortem (in vitro) experiment as well as in a clinical handling test. Materials and Methods: For in vitro testing, twelve shoulders from six anatomical specimens were randomized into two groups to compare the Xin1 technique to the conventional operation in terms of surgical precision, procedure time and X-ray exposure. For the clinical trial, 11 patients undergoing plating of the proximal humerus were included. The aim was to investigate clinical handling of the Xin1 marker clip and to retrospectively evaluate the system performance in a real-life fracture situation. Image pairs before and after insertion of the proximal screws were retrospectively processed to investigate the influence of potential bone fragment shifts on the system output. Results: In the postmortem experiment, the use of the system significantly improved the surgical precision (52% error reduction), procedure time (38% shorter) and radiation exposure (64% less X-rays). Clinical handling demonstrated seamless embedding of the marker clip into existing clinical workflows without adverse events reported. Retrospective X-ray analysis on six eligible patients revealed differences in the calculated screw lengths of ≤2 mm before and after screw insertion for five patients. In one patient, the screw lengths differed up to 8 mm, which might indicate displacement of the head fragment. Conclusions: Results suggest a strong potential of the Xin1 assistance technology to enhance the surgical procedure and patient outcomes in the rising incidence of osteoporotic humeral fractures. Robust performance in a real-life fracture situation was observed. In-depth validation of the system is, however, needed before placing it into clinical practice.

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Section: Discussionmentioning

confidence: 99%

In Vitro Testing and Clinical Handling of a Novel Implant Positioning Technology for Proximal Humeral Plating

et al. 2023

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Management of rotational malalignment following operative treatment of fractures of the lower extremities. A scoping review

Cherkaoui,

Onsea,

Thielman

et al. 2024

Injury

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Generic Implant Positioning Technology Based on Hole Projections in X-Ray Images

Windolf

Richards

2021

Journal of Medical Devices

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Implant placement plays a key role in trauma and orthopedics. In this paper a generic technological concept for implant positioning assistance is outlined. The system utilizes conventional radiographic devices for imaging and tracking and embeds into surgical workflows without the need for complex navigation equipment. It is based on feature extraction from cylindrical hole-projections in X-ray images for determining spatial alignment of implant and anatomy. Basic performance of a prototype system was experimentally verified in terms of tracking accuracy and robustness under varying conditions. In a second step the system was developed into a set of application modules, each serving a pressing clinical need: Plating of the proximal humerus, cephalic nail and dynamic hip-screw placement, general anatomic plating, distal nail interlocking with adjustment of femoral anteversion and corrective osteotomies. Module prototypes were tested according to their degree of maturity from feasibility assessment in wet-labs to clinical handling tests. Orientation tracking of reference objects yielded an accuracy and precision of 0.1 ± 0.71° (mean ± standard deviation) with a maximum error of 4.68° at unfavorable conditions. This base-performance translated e.g. into a precision of ±1.2mm (standard deviation) screw-tip to joint distance at proximal humerus plating, or into a precision of lag screw positioning in the femoral head of ±0.6mm in craniocaudal and ±1.6mm in anterioposterior direction. The concept revealed strong potential to improve surgical outcomes in a broad range of orthopedic applications due to its generic and simplistic nature. Comprehensive validation activities must follow for clinical introduction.

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In vivo test of a radiography‐based navigation system for control of derotational osteotomies

Cited by 3 publications

References 16 publications

In Vitro Testing and Clinical Handling of a Novel Implant Positioning Technology for Proximal Humeral Plating

In Vitro Testing and Clinical Handling of a Novel Implant Positioning Technology for Proximal Humeral Plating

Management of rotational malalignment following operative treatment of fractures of the lower extremities. A scoping review

Generic Implant Positioning Technology Based on Hole Projections in X-Ray Images

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