Robot-assisted fracture reduction: A preliminary study in the femur shaft

Reduction in femoral shaft fractures can be difficult to achieve with minimally invasive techniques. Malalignment and high intra-operative radiation exposure can result. The hypothesis was that robot-assisted fracture reduction could improve the quality of reduction while reducing the amount of radiation exposure. A robot system was developed that allows fracture manipulation with a joystick as input device. The system provides the surgeon with haptic and metric feedback. Fifteen synthetic femurs were broken and reduced by simulated open (group A) and closed techniques (group B). These techniques were compared with the robot-assisted reduction with (group C) and without (group D) haptic and metric information. An image intensifier was simulated with two orthogonal cameras. All reduction techniques showed minor malalignment. In group C, the alignment was: procurvatum/recurvatum 0.6° (0–2.0°); varus/valgus 0.8° (0–3.0°); and axial rotation 0.8° (0–3.1°). A significant difference was seen between the groups (two-way ANOVA, p<0.001). Axial rotation was significantly lower in group C than in group B (1.9°; p<0.001). The residual varus and valgus deviation was higher in group C compared with group A (0.4°, p=0.03). The median number of simulated radiographs was significantly less in group C (35) compared with group D (72; p<0.001) and group B (49; p=0.01). Robot-assisted fracture reduction of the femur provides high precision in alignment while reducing the amount of intraoperative imaging. Further research in this field is worthwhile.

[1]  K Bouazza-Marouf,et al.  Robotic-Assisted Internal Fixation of Femoral Fractures , 1995, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[2]  A Burkart,et al.  Precision of ACL tunnel placement using traditional and robotic techniques. , 2001, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

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

[4]  Gibson Rj,et al.  Erectile dysfunction induced by orthopedic trauma managed with a fracture table. , 2000 .

[5]  Wolfgang Görtz,et al.  Robotically-milled bone cavities , 2002, Acta orthopaedica Scandinavica.

[6]  D. Seligson.  Length of Operative Procedures: Reamed Femoral Intramedullary Nailing Performed With and Without a Fracture Table , 1998 .

[7]  P. Hawley,et al.  Compartment syndrome , 2002, Anaesthesia.

[8]  C Krettek,et al.  Computer-assisted fluoroscopy-based reduction of femoral fractures and antetorsion correction. , 2000, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[9]  L. Dias,et al.  CT determination of femoral torsion. , 1981, AJR. American journal of roentgenology.

[10]  Maurice E. Muller,et al.  The Comprehensive Classification of Fractures of Long Bones , 1990 .

[11]  L Kinzl,et al.  [Local complications of intramedullary nailing]. , 1996, Der Orthopade.

[12]  M Evans,et al.  A method of examining the magnitude and origin of "soft" and "hard" tissue forces resisting limb lengthening. , 1997, Medical engineering & physics.

[13]  A Grosse,et al.  Closed locked intramedullary nailing. Its application to comminuted fractures of the femur. , 1985, The Journal of bone and joint surgery. American volume.

[14]  G M Georgiadis,et al.  Percutaneous skeletal joysticks for closed reduction of femoral shaft fractures during intramedullary nailing. , 2001, Journal of orthopaedic trauma.

[15]  J. Jahng,et al.  Prevention of malrotation deformity in femoral shaft fracture. , 1998, Journal of orthopaedic trauma.

[16]  N Prévot,et al.  Utilisation d'un clou non fendu de Russel-Taylor pour la stabilisation des fractures du fémur. A propos de 57 fractures avec 30 études tomodensitométriques de la rotation. , 1998 .

[17]  D Wolter,et al.  Fracture reduction and deformity correction with the hexapod Ilizarov fixator. , 1999, Clinical orthopaedics and related research.

[18]  D. Clawson,et al.  Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. , 2005, The Journal of bone and joint surgery. American volume.

[19]  J. Anglen,et al.  Compartment syndrome in the well leg resulting from fracture-table positioning. , 1994, Clinical orthopaedics and related research.

[20]  J. Kerdraon,et al.  Electrophysiological analysis of pudendal neuropathy following traction , 2001, Muscle & nerve.

[21]  E. McCarty,et al.  Reamed intramedullary nailing of the femur: 551 cases. , 1999, The Journal of trauma.

[22]  Russell Meldrum,et al.  Compartment syndrome of the leg after less than 4 hours of elevation on a fracture table. , 2002, Southern medical journal.

[23]  J. Grover,et al.  A prospective study of fractures of the femoral shaft treated with a static, intramedullary, interlocking nail comparing one versus two distal screws. , 1995, The Orthopedic clinics of North America.