A computer assisted orthopaedic surgical system for distal locking of intramedullary nails

Abstract This paper presents a prototype system for computer assisted surgery, the purpose of which is to assist orthopaedic surgeons when performing distal locking of intramedullary nails. This system comprises three components, namely: an Intelligent Image Intensifier, a Trajectory Tactician and an Intelligent Trajectory Guide. The Intelligent Image Intensifier is an X-ray vision system that provides accurate X-ray images. Such images enable the Trajectory Tactician software to analyse the operation site and calculate the trajectory required for a screw to lock an intramedullary nail. This involves the capture of two X-ray images from which are extracted the projections of the nail's edge boundaries and its distal locking holes. Using an analytical mathematical model of the nail, the position and orientation of the nail is determined. The trajectory is then implemented by the surgeon using the Intelligent Trajectory Guide. Evaluation in the laboratory suggests that the system is capable of reliably inserting a locking screw into an intramedullary nail. The rapidity with which this computer assisted method achieves locking should benefit both patient and surgeon by reducing radiation dosage and the length of time required to lock a nail.

[1]  T D Bunker,et al.  Radiation dosage during AO locking femoral nailing. , 1988, Injury.

[2]  E. A. Brav,et al.  Fractures of the femoral shaft; a clinical comparison of treatment by traction suspension and intramedullary nailing. , 1952, American journal of surgery.

[3]  R. Evans,et al.  Locked intramedullary nailing for recent lower limb fractures. , 1990, Injury.

[4]  B. Mahaisavariya,et al.  Simplified method for closed femoral nailing. , 1991, Injury.

[5]  G. Graham,et al.  Experience with the A.O. locking femoral nail. , 1988, Injury.

[6]  M. Peshkin.  A Computer-Assisted Total Knee Replacement Surgical System Using a Calibrated Robot , 1995 .

[7]  E. Brug,et al.  A new distal aiming device for locking nail fixation. , 1988, Orthopedics.

[8]  R. Adelaar,et al.  A comparison of the Brooker-Wills and Russell-Taylor nails for treatment of patients who have fractures of the femoral shaft. , 1990, The Journal of bone and joint surgery. American volume.

[9]  C. Court-Brown,et al.  EXPERIENCE IN EDINBURGH OVER A TWO-YEAR PERIOD , 1992 .

[10]  S. Rudin,et al.  Accurate characterization of image intensifier distortion. , 1991, Medical physics.

[11]  C. Court-Brown,et al.  Locked nailing of humeral shaft fractures. Experience in Edinburgh over a two-year period. , 1992, The Journal of bone and joint surgery. British volume.

[12]  E J van der Merwe,et al.  Exposure of surgeons-in-training to radiation during intramedullary fixation of femoral shaft fractures. , 1992, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[13]  B. Browner,et al.  Radiation exposure to the surgeon during closed interlocking intramedullary nailing. , 1987, The Journal of bone and joint surgery. American volume.

[14]  J M Boone,et al.  Analysis and correction of imperfections in the image intensifier-TV-digitizer imaging chain. , 1991, Medical physics.

[15]  I. Hudson.  Locking nailing: an aid to distal targetting. , 1989, Injury.

[16]  E. Brug,et al.  [Insertion of distal screws in interlocking nailing using a new free-hand control device]. , 1989, Der Unfallchirurg.

[17]  S Stenzler,et al.  Exposure of the orthopaedic surgeon to radiation. , 1993, The Journal of bone and joint surgery. American volume.

[18]  J. G. Griffiths,et al.  Steps towards computer assisted locking of intramedullary nails , 1993, Proceedings of the 15th Annual International Conference of the IEEE Engineering in Medicine and Biology Societ.