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Märdian S, Maleitzke T, Niemann M, Salmoukas K, Stöckle U. [Imaging examination procedures, navigation and minimally invasive procedures in acetabular surgery]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:89-99. [PMID: 36645450 DOI: 10.1007/s00113-022-01281-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/17/2023]
Abstract
Acetabular fractures still pose a special challenge even today. Considering the increasing case numbers, especially in the geriatric patient group, modern imaging examination procedures represent an essential pillar of the diagnostics. Especially in this vulnerable patient group, minimally invasive methods are necessary, which can be guaranteed by intraoperative navigation; however, the choice of surgical access and implants is also made based on the existing morphological characteristics of fractures, which highlights the importance of an imaging modality that is as detailed as possible. Last but not least, new developments concerning the surgical treatment of these injuries are also based on this. This article summarizes the current state of the techniques and the available literature.
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Affiliation(s)
- Sven Märdian
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - T Maleitzke
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Julius Wolff Institut, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - M Niemann
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Julius Wolff Institut, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - K Salmoukas
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - U Stöckle
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
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Xu D, Lou W, Li M, Xiao J, Wu H, Chen J. Current status of robot‐assisted surgery in the clinical application of trauma orthopedics in China: A systematic review. Health Sci Rep 2022; 5:e930. [DOI: 10.1002/hsr2.930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ding Xu
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
- Department of Surgery Ningbo University Medical College Ningbo China
| | - Weigang Lou
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
| | - Ming Li
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
| | - Jingwei Xiao
- Department of Surgery Ningbo University Medical College Ningbo China
| | - Hongbao Wu
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
| | - Jianming Chen
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
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Lu S, Yang K, Lu C, Wei P, Gan Z, Zhu Z, Tan H. O-arm navigation for sacroiliac screw placement in the treatment for posterior pelvic ring injury. INTERNATIONAL ORTHOPAEDICS 2021; 45:1803-1810. [PMID: 33594466 DOI: 10.1007/s00264-020-04832-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aims to investigate the application value of O-arm navigation system in sacroiliac screw placement for the treatment of unstable pelvic ring injury. METHODS A total of 40 patients (mean age = 30.75 ± 14.99 years, 25 males, 15 females) were included. From January 2016 to July 2018, 40 patients with posterior pelvic ring injury treated in our hospital were included. Of them, 19 patients underwent O-arm navigation for screw placement (O-arm group) while the other 21 received C-arm fluoroscopy guidance (C-arm group) for sacroiliac screw placement. Intraoperative outcomes and the outcome of screw placement were compared between groups. The quality of radiological images was assessed by Matta's radiological outcome grade. The outcome of complex pelvic fracture treatment was evaluated by Majeed Functional score. RESULTS All demographic and clinical characteristics were comparable between the two groups. Compared with the C-arm groups, the O-arm group had a shorter surgery time (33.19 ± 3.14 vs. 48.35 ± 4.38 min, P < 0.001), a higher overall good outcome "excellent + good" rate of screw placement (95.45% vs. 73.91%, P < 0.05), and a significantly higher Majeed Functional score better outcome of complex pelvic fracture treatment at 1 and 3 months postoperation (both P < 0.05). CONCLUSION Our results demonstrated that O-arm navigation system is feasible and safe for the treatment of posterior pelvic ring injury and can effectively improve the accuracy and safety of sacroiliac screw placement, shorten the operation time, and help rapid postoperative functional recovery.
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Affiliation(s)
- Shengyu Lu
- Department of Orthopedic Trauma, Guigang City People's Hospital, No. 1 Zhongshan Road, Gangbei District, Guigang, 537100, Guangxi Province, China
| | - Keqin Yang
- Department of Orthopedic Trauma, Guigang City People's Hospital, No. 1 Zhongshan Road, Gangbei District, Guigang, 537100, Guangxi Province, China
| | - Cailing Lu
- Department of Orthopedic Trauma, Guigang City People's Hospital, No. 1 Zhongshan Road, Gangbei District, Guigang, 537100, Guangxi Province, China
| | - Ping'ou Wei
- Department of Orthopedic Trauma, Guigang City People's Hospital, No. 1 Zhongshan Road, Gangbei District, Guigang, 537100, Guangxi Province, China
| | - Zhi Gan
- Department of Orthopedic Trauma, Guigang City People's Hospital, No. 1 Zhongshan Road, Gangbei District, Guigang, 537100, Guangxi Province, China
| | - Zhipeng Zhu
- Department of Orthopedic Trauma, Guigang City People's Hospital, No. 1 Zhongshan Road, Gangbei District, Guigang, 537100, Guangxi Province, China
| | - Haitao Tan
- Department of Orthopedic Trauma, Guigang City People's Hospital, No. 1 Zhongshan Road, Gangbei District, Guigang, 537100, Guangxi Province, China.
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Yu T, Cheng XL, Qu Y, Dong RP, Kang MY, Zhao JW. Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures. World J Clin Cases 2020; 8:2464-2472. [PMID: 32607323 PMCID: PMC7322419 DOI: 10.12998/wjcc.v8.i12.2464] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 02/05/2023] Open
Abstract
Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability. Traditional open surgery has a large amount of bleeding, which is not suitable for patients with acute pelvic fracture. Navigation-guided, percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages, which include less trauma, faster recovery times, and less bleeding. However, due to the complexity of pelvic anatomy, doctors often encounter some problems when using navigation to treat pelvic fractures. This article reviews the indications, contraindications, surgical procedures, and related complications of this procedure for the treatment of sacral fractures, sacroiliac joint injuries, pelvic ring injuries, and acetabular fractures. We also analyze the causes of inaccurate screw placement. Percutaneous screw placement under navigational guidance has the advantages of high accuracy, low incidence of complications and small soft-tissue damage, minimal blood loss, short hospital stays, and quick recovery. There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones. However, computer navigation technology requires extensive training, and attention should be given to avoid complications such as screw misplacement, intestinal injury, and serious blood vessel and nerve injuries caused by navigational drift.
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Affiliation(s)
- Tong Yu
- Department of Orthopedics, the Second Hospital of Jilin University, Changchun 130014, Jilin Province, China
| | - Xue-Liang Cheng
- Department of Orthopedics, the Second Hospital of Jilin University, Changchun 130014, Jilin Province, China
| | - Yang Qu
- Department of Orthopedics, the Second Hospital of Jilin University, Changchun 130014, Jilin Province, China
| | - Rong-Peng Dong
- Department of Orthopedics, the Second Hospital of Jilin University, Changchun 130014, Jilin Province, China
| | - Ming-Yang Kang
- Department of Orthopedics, the Second Hospital of Jilin University, Changchun 130014, Jilin Province, China
| | - Jian-Wu Zhao
- Department of Orthopedics, the Second Hospital of Jilin University, Changchun 130014, Jilin Province, China
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Abstract
This article examines new imaging, diagnostic, and assessment techniques that may affect the care of patients with orthopedic trauma and/or infection. Three-dimensional imaging has assisted in fracture assessment preoperatively, whereas improvement in C-arm technology has allowed real-time evaluation of implant placement and periarticular reduction before leaving the operating room. Advances in imaging techniques have allowed earlier and more accurate diagnosis of nonunion and infection. Innovations in bacteriologic testing have improved the sensitivity and specificity of perioperative and peri-implant infections. It is critical that surgeons remain up to date on the options available for optimal patient care.
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Zhao JW, Yu T, Chu GY, Zhang XW, Wang Y, Zhu XJ, Jiang QY, Jiang ZD, Wang DS. Accuracy and safety of percutaneous periacetabular screw insertion using screw view model of navigation in acetabular fracture: A case report. Medicine (Baltimore) 2018; 97:e13316. [PMID: 30544391 PMCID: PMC6310583 DOI: 10.1097/md.0000000000013316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The purpose of this study was to estimate the efficacy and safety of percutaneous periacetabular screw (PPS) insertion assisted by screw view model of navigation (SVMN) to treat fracture of acetabulum. PATIENT CONCERNS A 61-year-old male patient was injured in a motorcycle accident, which caused pain, swelling, deformity and limited mobility on his right hip. DIAGNOSES He was diagnosed with fracture of acetabulum. INTERVENTIONS We used PPS insertion assisted by SVMN to treat fracture of acetabulum in this patient. OUTCOMES The follow up lasted 24 months. Totally 2 screws were inserted into anterior and posterior column of acetabulum respectively and both of them displayed grade 0. Compared with the preoperative gap and step of fracture displacement, the postoperative ones were significantly reduced. It took 11.7 minutes for designing the screws, 6.7 minutes for implanting the guide wire, and 45.5 minutes for placing the screws. Intraoperative blood loss was 29 mL and total fluoroscopic time was 4.1 minutes. No clinical complications such as nerve vascular injury, infection and screw loosening were found after the operation. LESSONS The study indicated that SVMN is favorable to the PPS insertion for acetabular fracture. Our lesson is that the relative position between the acetabular and the patient tracker must be static to ensure the accuracy of the entire system throughout the operation.
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Affiliation(s)
| | | | | | - Xi-Wen Zhang
- Department of Gynecology, The Second Hospital of Jilin University, Changchun, Jilin Province, China
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Intraoperative Cone Beam Tomography and Navigation for Displaced Acetabular Fractures: A Comparative Study. J Orthop Trauma 2018; 32:612-616. [PMID: 30299379 DOI: 10.1097/bot.0000000000001324] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the accuracy of reduction of the acetabular articular surface using an intraoperative computed tomography scanner (O-Arm) and screw navigation compared with a classical open technique. DESIGN Prospective matched cohort study. SETTING Tertiary referral center. PATIENTS/PARTICIPANTS Adult patients with acute acetabular fractures were included in the study. All patients were treated by 2 senior surgeons using intraoperative imaging and screw navigation. MAIN OUTCOME MEASUREMENTS The primary outcome measure was articular reduction. Secondary outcomes were radiation dosage, operative variables [operative time, time for image acquisition, intraoperative bleeding (cell saver), number of surgical plates, and number of screws], and postoperative variables (first postoperative day pain on the visual analog scale, postoperative transfusion, and hemoglobin change). P < 0.05 was considered statistically significant. RESULTS Thirty-five patients were treated in the inclusion period (2016-2017) and were matched to 35 cases in our database (2013-2016). Mean age was 43 years, and the most common fracture type was a both-column fracture (OTA/AO type C). Postoperative image analysis showed that reduction was achieved in 87.1% of the cases in the O-Arm group versus 64.7% in the control group (P < 0.05). Mean gap of the articular fragments was 3.6 mm in the O-Arm group compared with 5.6 mm (P = 0.01) in the control group. There was no significant difference between the 2 groups in regards to all other studied variables except a decrease in intraoperative blood loss and transfusions and an increase in surgical time with the O-Arm group. Finally, the total radiation dose was decreased using the intraoperative O-Arm compared with a routine postoperative computed tomography scan (dose length product in O-Arm: 498 mGy.cm; dose length product in historical group: 715 mGy.cm). CONCLUSIONS Using intraoperative imaging and screw navigation for displaced acetabular fractures allow screw navigation with increasing articular surface reduction accuracy. Operative and anesthesia times were not increased, whereas radiation exposure to the patient was significantly decreased. We recommend the use of intraoperative imaging for the treatment of displaced acetabular fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Takao M, Hamada H, Sakai T, Sugano N. Clinical Application of Navigation in the Surgical Treatment of a Pelvic Ring Injury and Acetabular Fracture. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1093:289-305. [DOI: 10.1007/978-981-13-1396-7_22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Sebaaly A, Riouallon G, Zaraa M, Jouffroy P. The added value of intraoperative CT scanner and screw navigation in displaced posterior wall acetabular fracture with articular impaction. Orthop Traumatol Surg Res 2016; 102:947-950. [PMID: 27527248 DOI: 10.1016/j.otsr.2016.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 02/02/2023]
Abstract
Posterior wall with transverse acetabular fractures represents the most common type of acetabular fractures and is generally associated with poorer outcomes. This is caused by improper visualization of the fragments leading to imperfect reductions. Navigation in pelvic and acetabular trauma is reserved nowadays to non-displaced or mildly displaced fractures. To add to that, perioperative control of reduction is difficult using the conventional X-ray. The described 3D imaging method allowed proper reduction control. On the other hand, screw navigation of acetabular screws enabled better control of screw position as well as screw placement in otherwise inaccessible zones. In conclusion, peroperative 3D imaging and screw navigation optimize fracture reduction promoting better radiological and functional results.
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Affiliation(s)
- A Sebaaly
- Service de chirurgie orthopédique et traumatologique, centre hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - G Riouallon
- Service de chirurgie orthopédique et traumatologique, centre hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - M Zaraa
- Service de chirurgie orthopédique et traumatologique, centre hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - P Jouffroy
- Service de chirurgie orthopédique et traumatologique, centre hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
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