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

Development of a robot-assisted reduction and rehabilitation system for distal radius fractures

Background: Closed reduction is the preferred treatment for distal radius fractures. However, it requires a multiple experienced medical staff and manually maintaining stable traction is difficult. Additionally, doctors cannot assess the reduction status of a fracture in real-time through radiographic images, which may lead to improper reduction. Furthermore, post-fracture complications such as joint adhesion, stiffness, and impaired mobility pose a challenge for the doctors. So it is necessary to optimize the treatment process of the distal radius fracture through technological means. Methods: A robot-assisted closed reduction and rehabilitation system, which could assist doctors throughout the entire process of reduction, fixation, and rehabilitation of distal radius fractures, was developed. A mechanical system, composed of two grippers and a cooperative robotic arm, was used to grasp and tract the affected limb. A doctor controlled the robot through a joystick console and Windows application program. A biplane radiographic device was integrated into the system, which is not only convenient for doctors to view radiographic images of the fracture at any time but also for them to select the rotation axis of the wrist on the images before reduction and rehabilitation. Important information including the anteroposterior and lateral radiographic data and force and position parameters during the reduction and rehabilitation process were displayed on a graphic user interface. Results: Experimental results showed that the proposed robotic system can meet the technical requirements for the reduction and rehabilitation of distal radius fractures, all the rotation angles could be achieved, a maximum force of more than 50 N could be achieved in all traction directions, and the error in selecting the wrist joint rotation axis line using radiographic images was less than 5 mm. Conclusion: The developed robot-assisted system was shown to be suitable for closed reduction and rehabilitation of distal radius fractures, contributing a potential improvement in the quality of the procedures.

A review of advances in image-guided orthopedic surgery

Orthopedic surgery remains technically demanding due to the complex anatomical structures and cumbersome surgical procedures. The introduction of image-guided orthopedic surgery (IGOS) has significantly decreased the surgical risk and improved the operation results. This review focuses on the application of recent advances in artificial intelligence (AI), deep learning (DL), augmented reality (AR) and robotics in image-guided spine surgery, joint arthroplasty, fracture reduction and bone tumor resection. For the pre-operative stage, key technologies of AI and DL based medical image segmentation, 3D visualization and surgical planning procedures are systematically reviewed. For the intra-operative stage, the development of novel image registration, surgical tool calibration and real-time navigation are reviewed. Furthermore, the combination of the surgical navigation system with AR and robotic technology is also discussed. Finally, the current issues and prospects of the IGOS system are discussed, with the goal of establishing a reference and providing guidance for surgeons, engineers, and researchers involved in the research and development of this area.

Hill-based musculoskeletal model for a fracture reduction robot

BACKGROUND

The introduction of fracture reduction robot can solve the problem of large reduction forces during fracture reduction surgeries and the need to collect multiple medical images. However, because its safety has not been certified, there are few academic achievements on this type of robot. To calculate the safety factor during its operation, a musculoskeletal model needs to be established to study the constraints of muscles on the robot. The existing academic achievements of musculoskeletal modelling are mainly for application such as rehabilitation treatment and collision in car accidents.

METHODS

A musculoskeletal model applied to the fracture reduction robot is proposed in this paper. First, by comparing the characteristics of mainstream muscle models and combining the biological characteristics of the anesthetised muscles, the Hill model was selected as the muscle model for this study. Second, based on the motion composition of six spatial degrees of freedom, five basic fractural malposition situations are proposed. Then, a 170-cm tall male musculoskeletal model was built in Opensim. Based on this model, the muscle force curves of the above malposition situations are calculated. Finally, a similar musculoskeletal model was established in Adams, and the accuracy of its muscle force data was tested. The study is approved by the ethics committee of the Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, China.

RESULTS

The muscle force curve of Opensim and Adams model under situations of five basic malposition are compared. Most of the correlation coefficients are in the range of 0.98-0.99. The overall correlation coefficient is greater than 0.95.

CONCLUSIONS

The simulation results prove that this model can be used for the safety assessment of the fracture reduction robots. This model will be served as an environmental constraint to study the control of fracture reduction robot.

Haptics in Teleoperated Medical Interventions: Force Measurement, Haptic Interfaces and Their Influence on User's Performance

OBJECTIVES

Haptics in teleoperated medical interventions enables measurement and transfer of force information to the operator during robot-environment interaction. This paper provides an overview of the current research in this domain and guidelines for future investigations.

METHODS

We review current technologies in force measurement and haptic devices as well as their experimental evaluation and influence on user's performance.

RESULTS

Force sensing is moving away from the conventional proximal measurement methods to distal sensing and contact-less methods. Wearable devices that deliver haptic feedback on different body parts are increasingly playing an important role. Performance and accuracy improvement are the widely reported benefits of haptic feedback, while there is a debate on its effect on task completion time and exerted force.

CONCLUSION

With the surge of new ideas, there is a need for better and more systematic validation of the new sensing and feedback technology, through better user studies and novel methods like validated benchmarks and new taxonomies.

SIGNIFICANCE

This review investigates haptics from sensing to interfaces within the context of user's performance and the validation procedures to highlight salient advances. It provides guidelines to future developments and highlights the shortcomings in the field.

Medical Robotics in Bone Fracture Reduction Surgery: A Review

Since the advantages of precise operation and effective reduction of radiation, robots have become one of the best choices for solving the defects of traditional fracture reduction surgery. This paper focuses on the application of robots in fracture reduction surgery, design of the mechanism, navigation technology, robotic control, interaction technology, and the bone-robot connection technology. Through literature review, the problems in current fracture reduction robot and its future development are discussed.