Preoperative virtual reduction reduces femoral malrotation in the treatment of bilateral femoral shaft fractures

Omar, Mohamed; Suero, Eduardo M.; Hawi, Nael; Decker, Sebastian; Krettek, Christian; Citak, Musa

doi:10.1007/s00402-015-2285-8

Cited by 15 publications

(12 citation statements)

References 18 publications

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“…Our results show that improved visual presentation of the patient's anatomy may help surgeons achieve better technical outcomes during the procedure. This is in line with previous studies showing that virtual reality methods aimed at improving anatomic visualization help surgeons perform better, particularly during complex tasks such as fracture reduction and fixation . Furthermore, recent studies have shown that augmented reality in combination with opto‐electromagnetic tracking can improve drill hole targeting in distal interlocking procedures …”

Section: Discussionsupporting

confidence: 90%

Video‐augmented fluoroscopy for distal interlocking of intramedullary nails decreased radiation exposure and surgical time in a bovine cadaveric setting

Weidert

Wang

Landes³

et al. 2019

Robotics Computer Surgery

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Background We aimed to assess the feasibility of a video‐augmented fluoroscopy (VAF) technique using a camera‐augmented mobile C‐arm (CamC) for distal interlocking of intramedullary nails. Methods Three surgeons performed distal interlocking on seven pairs of cadaveric bovine carpal bones using the VAF system and conventional fluoroscopy. We compared radiation exposure, procedure time, and drilling quality between the VAF system and conventional fluoroscopic guidance. Results Distal interlocking using VAF significantly reduced the number of fluoroscopic images compared with conventional fluoroscopy (P < 0.05). No significant difference in overall procedure time (P = 0.96) or drilling quality (P = 0.12) was detected. VAF demonstrated improvement in radiation exposure when used by a less experienced surgeon (P < 0.05). Conclusion VAF is a feasible technique for distal interlocking. Overlaid visualization of the osseous anatomy in relation to the surgical field of view appears to improve surgeons' perception of relevant structures and their spatial orientation for the use of surgical instruments.

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Section: Discussionsupporting

confidence: 90%

Video‐augmented fluoroscopy for distal interlocking of intramedullary nails decreased radiation exposure and surgical time in a bovine cadaveric setting

Weidert

Wang

Landes³

et al. 2019

Robotics Computer Surgery

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“…The annual incidence of femur fractures has been estimated at [10][11][12][13][14][15][16][17] cases per 100 000 persons. 1,2 Closed reduction and intramedullary (IM) nailing is the technique of choice in these cases.…”

Section: Introductionmentioning

confidence: 99%

“…Computer navigation has been available for over 10 years and it has proven to be a useful tool in the treatment of femoral fractures. [10][11][12][13][14] Preoperative computer assistance has also been described as a tool for improving the understanding of complex fractures and for planning complex procedures. [15][16][17] Robotic procedures have also been designed in an attempt to improve some of the most difficult portions of the intramedullary nailing technique.…”

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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“…Rotational malalignment remains one of the most relevant but oftentimes neglected complications after intramedullary nailing for fractures of long bones, such as the femur . The incidence of clinically relevant malrotation (>15°) ranges from 17 to 35% of unilateral femoral shaft fracture cases and up to 41% of bilateral cases . Due to the soft tissue envelope, minimally invasive stabilization after reduction is challenging for the surgeon.…”

mentioning

confidence: 99%

“…[1][2][3][4][5] The incidence of clinically relevant malrotation (>15˚) ranges from 17 to 35% of unilateral femoral shaft fracture cases and up to 41% of bilateral cases. 1,3,[6][7][8][9] Due to the soft tissue envelope, minimally invasive stabilization after reduction is challenging for the surgeon. Beside reduction and subsequent stabilization and fixation of the fracture, reduction control is crucial in treating long bone fractures.…”

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confidence: 99%

Radiographic cortical thickness parameters as predictors of rotational alignment in proximal femur fractures: A cadaveric study

Zeckey

Bogusch

Borkovec

et al. 2018

Journal Orthopaedic Research

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Radiographic assessment tools such as the cortical step sign (CSS) or the diameter difference sign (DDS) aim to identify clinically relevant rotational malalignment after long bone fracture fixation. We aimed to analyze the effect of rotational malalignment on CSS and DDS parameters in a subtrochanteric fracture model and to construct a prognostic model to identify clinically relevant rotational malalignment. A subtrochanteric transverse osteotomy was set in human femora. Rotation was set stepwise from 0° to 30° in internal and external rotation. Images were obtained using a C‐arm and transferred for measuring the medial cortical thickness (MCT), lateral cortical thickness (LCT), femoral diameter (FD) in AP and the anterior cortical thickness (ACT) as well as the posterior cortical thickness (PCT) and the FD of the proximal and the distal main fragment. There were significant differences between the various levels of rotation for each of the absolute values of the evaluated variables. MCT, PCT and FD (AP & lat.) were the most affected parameters. In internal rotation, the MCT, PCT and the FD were the most affected variables. The parameters with the highest correlation with femoral rotation were ACT, PCT and FD. A model combining ACT, LCT, PCT and FD AP was most suitable model in identifying rotational malalignment. The best prediction of clinically relevant rotational malalignment was obtained with the FD and the PCT. The CSS and the DDS are promising tools for detecting rotational deformities of the proximal femur and should be used intra‐ and postoperatively. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Preoperative virtual reduction reduces femoral malrotation in the treatment of bilateral femoral shaft fractures

Cited by 15 publications

References 18 publications

Video‐augmented fluoroscopy for distal interlocking of intramedullary nails decreased radiation exposure and surgical time in a bovine cadaveric setting

Video‐augmented fluoroscopy for distal interlocking of intramedullary nails decreased radiation exposure and surgical time in a bovine cadaveric setting

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

Radiographic cortical thickness parameters as predictors of rotational alignment in proximal femur fractures: A cadaveric study

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