Navigation system for robot-assisted intra-articular lower-limb fracture surgery

Abstract

PurposeIn the surgical treatment for lower-leg intra-articular fractures, the fragments have to be positioned and aligned to reconstruct the fractured bone as precisely as possible, to allow the joint to function correctly again. Standard procedures use 2D radiographs to estimate the desired reduction position of bone fragments. However, optimal correction in a 3D space requires 3D imaging. This paper introduces a new navigation system that uses pre-operative planning based on 3D CT data and intra-operative 3D guidance to virtually reduce lower-limb intra-articular fractures. Physical reduction in the fractures is then performed by our robotic system based on the virtual reduction.Methods3D models of bone fragments are segmented from CT scan. Fragments are pre-operatively visualized on the screen and virtually manipulated by the surgeon through a dedicated GUI to achieve the virtual reduction in the fracture. Intra-operatively, the actual position of the bone fragments is provided by an optical tracker enabling real-time 3D guidance. The motion commands for the robot connected to the bone fragment are generated, and the fracture physically reduced based on the surgeon’s virtual reduction. To test the system, four femur models were fractured to obtain four different distal femur fracture types. Each one of them was subsequently reduced 20 times by a surgeon using our system.ResultsThe navigation system allowed an orthopaedic surgeon to virtually reduce the fracture with a maximum residual positioning error of (translational) and (rotational). Correspondent physical reductions resulted in an accuracy of 1.03 ± 0.2 mm and , when the robot reduced the fracture.ConclusionsExperimental outcome demonstrates the accuracy and effectiveness of the proposed navigation system, presenting a fracture reduction accuracy of about 1 mm and , and meeting the clinical requirements for distal femur fracture reduction procedures.Electronic supplementary materialThe online version of this article (doi:10.1007/s11548-016-1418-z) contains supplementary material, which is available to authorized users.

Safe Human–Robot Interaction in Medical Robotics: A case study on Robotic Fracture Surgery System

“…The target controller (NI-compactRIO 9068, National Instruments) process users' commands and sends the motion commands to the low level motor controller (EPOS 2 24/3, Maxon Motor) that executes the movement of the robotic system. 3D Imaging System, introduced in [18,19], consists of a reduction software, an optical tracking system, and a user controller. The reduction software receives preoperative CT scan data of the fracture and generates corresponding 3D models of the bone fragments.…”

Research on the accuracy of three‐dimensional localization and navigation in robot‐assisted spine surgery

“…The preoperative virtual plan was accurately transferred to the intraoperative stage of orthodontic surgery. In 2016, Dagnino G et al used a robot system based on virtual reduction to complete physical reduction of fractures in the surgical treatment of intra‐articular fractures of lower limbs . Ultimately, the fracture can be accurately reset, and the joint function returned to normal.…”

“…In 2016, Dagnino G et al used a robot system based on virtual reduction to complete physical reduction of fractures in the surgical treatment of intra-articular fractures of lower limbs. 27 Ultimately, the fracture can be accurately reset, and the joint function returned to normal. Meanwhile, robotic navigation systems were also being used in soft tissues such as the liver.…”

Translational and Rotational Arrow Cues (TRAC) Navigation Method for Manual Alignment Tasks

“…However, providing guidance to accurately and rapidly navigate the object in 5-DOF or 6-DOF is challenging. Guidance is commonly accomplished using a triplanar display, which simultaneously shows three distinct orthogonal viewpoints of the workspace, and requires simultaneous alignment in all views [1,4,6,8,13,19]. Minor variations of this implementation are sometimes used [22].…”