1
|
Wu Z, Dai Y, Zeng Y. Intelligent robot-assisted fracture reduction system for the treatment of unstable pelvic fractures. J Orthop Surg Res 2024; 19:271. [PMID: 38689343 PMCID: PMC11059586 DOI: 10.1186/s13018-024-04761-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Precise and minimally invasive closed reduction is the premise of minimally invasive internal fixation. This paper aims to explore the safety and efficacy of a robot-assisted fracture reduction system (RAFR) in the treatment of pelvic fractures and to analyze its clinical advantages and existing problems. METHODS The RAFR system intelligently designed the optimal reduction path and target position based on a preoperative three-dimensional(3D) CT scan of the patient. The reduction robotic arm automatically reduced the affected hemipelvis according to the pre-planned reduction path. RESULTS The average residual displacement was the 6.65 ± 3.59 mm. According to Matta's criteria, there were 7 excellent, 10 good, and 3 fair, and the excellent and good rate was 85%. No postoperative complications occurred. CONCLUSION In our study, the RAFR system could complete accurate and minimally invasive closed reduction for most patients with unstable pelvic fractures, which could achieve good fracture reduction quality and short-term efficacy.
Collapse
Affiliation(s)
- Zhengjie Wu
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China.
| | - Yonghong Dai
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Yanhui Zeng
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| |
Collapse
|
2
|
Kabir K, von Rundstedt FC, Roos J, Gathen M. Robotic-assisted plate fixation of the anterior acetabulum - clinical description of a new technique. J Orthop Surg Res 2024; 19:253. [PMID: 38644485 PMCID: PMC11034051 DOI: 10.1186/s13018-024-04731-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/11/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION We present a detailed procedure for the robotic-assisted plate osteosynthesis of an anterior acetabular fracture. The purpose of this work was to describe a robotic-assisted minimally invasive technique as a possible method for reducing complications, pain, and hospitalization. Another goal was to present technical recommendations and to assess potential pitfalls and problems of the new surgical approach. METHODS Surgery was performed in an interdisciplinary setting by an experienced orthopedic surgeon and a urologist. The DaVinci System with standard instruments was used. Reduction was achieved through indirect traction of a pin that was introduced into the femoral neck and direct manipulation via the plate. The plate position and fixation were achieved through 7 additional minimally invasive incisions. RESULTS The technique has multiple advantages, such as no detachment of the rectus abdominal muscle, a small skin incision, and minimal blood loss. Furthermore, this approach might lower the incidence of hernia formation, infection, and postoperative pain. DISCUSSION We see the presented technique as a demanding yet progressive and innovative surgical method for treating acetabular fractures with indications for anterior plate fixation. TRIAL REGISTRATION The study was approved by the local institutional review board (Nr. 248/18).
Collapse
Affiliation(s)
- Koroush Kabir
- Centre of Trauma and Orthopaedic Surgery, Helios University Clinic Wuppertal, Wuppertal, Germany
| | | | - Jonas Roos
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, Bonn, 53127, Germany.
| | - Martin Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, Bonn, 53127, Germany
| |
Collapse
|
3
|
Xing B, Shen X, Ma L, Qi X. TiRobot-Assisted Percutaneous Cannulated Screw Fixation for Elderly Patients with Fragility Fractures of the Pelvis: A Retrospective Study. Orthop Surg 2024; 16:662-674. [PMID: 38384135 PMCID: PMC10925510 DOI: 10.1111/os.14011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE The incidence of fragility fractures of the pelvis (FFPs) is increasing in the elderly population, and FFPs that require fixation are a challenge for orthopedic surgeons. The insertion of implants is not risk free due to the complex anatomical and osteoporotic bones and requires a steep learning curve. This study aimed to investigate the clinical efficacy of TiRobot-assisted percutaneous cannulated screw fixation in the treatment of elderly FFP patients. METHOD The clinical data of 46 elderly FFP patients who had been treated with percutaneous cannulated screw fixation from May 2020 to September 2022 were retrospectively analyzed. Twenty-four patients were treated with percutaneous cannulated screw fixation assisted by the TiRobot (TiRobot-assisted group) and 22 patients were treated with conventional freehand surgery (freehand group). Postoperative outcomes, including Matta value, excellent and good rate (EGR) of fracture reduction, and accuracy of screw placement (ASP), were compared. Changes in the Visual analog scale (VAS) pain score and the Majeed score were recorded and compared between groups before and after surgery and during the 24-week follow-up. Repeated-measures analysis of variance (ANOVA) and effect sizes were used as analysis methods. RESULTS A total of 90 screws were implanted, 51 screws in the TiRobot-assisted group and 39 screws in the freehand group. The operation time of the two groups was 34.1 ± 2.67 min versus 64.5 ± 4.19 min (p < 0.001). There were no screw-related complications or revision surgeries in any group. The Matta value of the TiRobot-assisted group was 5.13 ± 3.52, which was significantly lower than that of the freehand group (9.00 ± 3.68, p < 0.001), while the EGR was 91.67% versus 72.73%, with statistical significance (p < 0.001). The ASP was 100% in the TiRobot-assisted group, better than that in the freehand group, where it was 85.7% (p = 0.043). At each timepoint in the early postoperative period, the VAS score of the TiRobot-assisted group was significantly lower than that of the freehand group and was close to consistent by the last follow-up; the Majeed score of the former was significantly higher than that of the latter at each timepoint of follow-up, with statistical significance (p < 0.001). CONCLUSION TiRobot-assisted percutaneous cannulated screw fixation of elderly FFP patients is advantageous over conventional freehand surgery, with less invasion, more accurate screw placement, better fracture reduction, early pain relief, and rapid recovery, suggesting that Freehand method to stabilize FFP in the elderly population.
Collapse
Affiliation(s)
- Baorui Xing
- Department of Orthopedic SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Department of Orthopaedic SurgeryHebei Cangzhou Hospital of Integrated Traditional Chinese and Western MedicineCangzhouChina
| | - Xiaoyu Shen
- Department of Orthopedic SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Lijie Ma
- Department of Orthopedic SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Xiangbei Qi
- Department of Orthopedic SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| |
Collapse
|
4
|
Hoskins T, Begley B, Giacalone JD, De Wilde K, Maguire F, Wittig J. Mako TM robotic-arm-assisted total hip and total knee arthroplasty outcomes in an orthopedic oncology setting: A case series. J Orthop 2023; 46:70-77. [PMID: 37942217 PMCID: PMC10630756 DOI: 10.1016/j.jor.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023] Open
Abstract
Background The MAKO Robotic-Arm system is a cutting-edge technology which combines both computed tomography (CT) scanning and three-dimensional planning to determine the ideal size and orientation of implants prior to bone resection. It is typically utilized within a general orthopedic setting for joint replacement procedures, such as total joint arthroplasties. However, its use within orthopedic oncology, which contains a much more compromised patient population and more complex surgical treatment, is not well documented within the literature. Question/purposes To determine the patient outcomes of those who underwent a total hip arthroplasty (THA) or total knee arthroplasty (TKA) at Morristown Medical Center using the MAKO Robotic-Arm System. Particularly, we aspired to delve into the use of the MAKO in an orthopedic oncology setting for patients with a degenerative hip or knee and a history of cancer or other orthopedic tumor, impending pathological fracture, PVNS, chondromatosis, radiation therapy, or other oncological related conditions. Patients and methods Our institution monitored twenty-five individuals with unique orthopedic oncology conditions that underwent MAKO robotic-assisted total hip and knee arthroplasty. This was performed between 2020 and 2022 at Morristown Medical Center in New Jersey. During this time period, 52% (13/25) of the operations were performed on knees and 48% (12/25) were performed on hips. Data regarding patient demographics, body mass index (BMI), medications, hemoglobin, hematocrit, comorbidities, American Society of Anesthesiologists (ASA) Class, operative data, the length of stay (LOS), readmission rates due to infection or periprosthetic fractures, and complications were collected retrospectively. All confidence intervals were calculated at the 95% confidence level. Results Postoperatively, the average LOS was 3.2 days, and there were no complications after any of the MAKO-assisted joint arthroplasty procedures. Additionally, there were no readmissions at any of our recorded intervals - 1-30, 1-60, 1-90, and 1 year - however one patient presented to the emergency department after falling 4 days post-operatively. X-ray imaging ultimately revealed no periprosthetic fracture or malalignment of the prosthesis. Conclusions The utilization of the MAKO Robotic-Arm System for joint arthroplasty procedures (THAs and TKAs) on orthopedic oncology patients yielded exceptional outcomes, with no complications or readmissions directly attributed to the use of this innovative robotic technology. Thus, this newly emerging surgical system holds great promise, potentially revolutionizing the approach for selected orthopedic oncology patients undergoing total joint arthroplasty compared to the traditional manual techniques. It further demonstrates that its use in an orthopedic oncology setting - where the cohort of patients are often compromised, leading to more intricate surgeries with heightened risks - elicits safety and provides optimal outcomes for patients. Nevertheless, its role within the field is evolving, and in the coming years, as it gains further popularity and sees broader application by orthopedic oncology surgeons, its potential will become clearer. To solidify its position, future clinical investigations and prospective research should be conducted to support the preference of the MAKO system over traditional manual techniques. This will help provide the necessary evidence to advocate for its widespread adoption and continued advancements in orthopedic oncology procedures.
Collapse
Affiliation(s)
| | - Brian Begley
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Joseph D. Giacalone
- Department of Orthopedic Surgery Morristown Medical Center, Morristown, NJ, USA
| | - Kristen De Wilde
- Department of Orthopedic Surgery Morristown Medical Center, Morristown, NJ, USA
| | - Francis Maguire
- Department of Orthopedic Surgery Morristown Medical Center, Morristown, NJ, USA
| | - James Wittig
- Department of Orthopedic Surgery Morristown Medical Center, Morristown, NJ, USA
| |
Collapse
|
5
|
Liu F, Lei Q, Cai L, Jiang M, Yang H, Wang K, Ding Z, Liu W. Efficacy comparison between iliosacral screw fixation of the posterior pelvic ring fracture with the assistance of modified percutaneous three-dimensional printing guide template and conventional fluoroscopy. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:1703-1710. [PMID: 38432861 PMCID: PMC10929951 DOI: 10.11817/j.issn.1672-7347.2023.230122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVES The effect of three-dimensional (3D) printed bone-attached guide plate assisted cannulated screw fixation of pelvic fracture is reliable, but extensive soft tissue dissection is still required when installing the guide plate. This study aims to compare the efficacy of posterior pelvic ring fracture fixation with iliosacral screw insertion between the assistance of modified percutaneous patient specific 3D printed guide template and conventional fluoroscopy. METHODS From May, 2019 and September 2021, 28 patients sustained posterior pelvic ring fractures were randomized into 2 groups: A guide template group, in which the iliosacral screw was inserted for fixation of the posterior pelvic ring fracture with the assistance of modified percutaneous patient specific 3D printed guide template, and a fluoroscopy group, in which the iliosacral screw was inserted under the guidance of conventional fluoroscopy. The operation time, fluoroscopic frequency, intraoperative blood loss, and incision length were recorded for each screw insertion. Fracture reduction was evaluated according to the Matta criteria. The screw position was evaluated according to the modified Gras classification, and the functional outcome was evaluated according to Majeed score. The parameters of both groups were compared, and statistical analysis was performed. RESULTS All the 28 patients were followed up for 12-24 months. Of them, 15 iliosacral screws were inserted in 14 patients in the guide template group, and 14 iliosacral screws were inserted in 14 patients in the fluoroscopy group. The operation time, fluoroscopic frequency, screw deviation, incision length, and blood loss in the guide template group were 20-30(25.8±2.8) min, 9-15(12.2±1.9), 2-4(2.6±0.7) mm, 4-5(4.6±0.5) cm, and 5-10 (7.8±1.7) mL, respectively, whereas those in the fluoroscopy group were 30-60(48.1±7.5) min, 40-96(64.7±16.3), 3-6(4.2±0.9) mm, 0.8-1.2(1.0±0.1) cm, and 2-5(3.1±1.3) mL, respectively, and there were statistical significance (all P<0.001). Fracture reduction was evaluated according to the Matta criteria, and all the patients reached excellence and good (P=0.584) in the 2 groups. According to modified Gras classification, there were 12 Grade I screws, 3 Grade II screws, and 0 Grade III screws in the guide template group, and 10 Grade I screws, 3 Grade II screws, and 1 Grade III screw in the fluoroscopy group, with no statistical significance (P=0.334). The functional outcome was evaluated according to Majeed score at the last follow-up, without significant difference between the guide template group and the fluoroscopy group (P=0.908). CONCLUSIONS Compared with the conventional fluoroscopy, it would cost less operation time, less fluoroscopic frequency and increase more accurate screw insertion to fixate the posterior pelvic ring fracture with the assistance of modified percutaneous patient specific 3D printed guide template.
Collapse
Affiliation(s)
- Feng Liu
- Department of Orthopedics, Third Hospital of Changsha, Changsha 410015.
| | - Qing Lei
- Department of Orthopedics, Third Hospital of Changsha, Changsha 410015.
- 3D Printing Technology Medical Application Research Institute of Changsha, Changsha 410015.
| | - Lihong Cai
- 3D Printing Technology Medical Application Research Institute of Changsha, Changsha 410015
- Department of Radiology, Third Hospital of Changsha, Changsha 410015, China
| | - Minghui Jiang
- Department of Orthopedics, Third Hospital of Changsha, Changsha 410015
| | - Hongqi Yang
- Department of Orthopedics, Third Hospital of Changsha, Changsha 410015
| | - Kang Wang
- Department of Orthopedics, Third Hospital of Changsha, Changsha 410015
| | - Zhou Ding
- Department of Orthopedics, Third Hospital of Changsha, Changsha 410015
| | - Wenqian Liu
- Department of Orthopedics, Third Hospital of Changsha, Changsha 410015
| |
Collapse
|
6
|
Jun XH, Yi L. Percutaneous Fixation of Levine-Edwards Type II Hangman's Fractures Under the Guidance of an Orthopedic Robot. Orthopedics 2023; 46:59-63. [PMID: 36343643 DOI: 10.3928/01477447-20221031-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There is no consensus regarding the optimal treatment for unstable hangman's fractures. Conservative treatment, although time-consuming and associated with complications such as nonunion, neck stiffness, and pseudarthrosis formation, is still preferred by many surgeons. With the development of minimally invasive techniques, surgical treatment is trending in recent years. We have proposed a minimally invasive, robot-assisted technique for the treatment of Levine-Edwards (L-E) type II hangman's fractures; this could improve the patients' quality of life. Five patients with L-E type II hangman's fractures were treated operatively initially. After closed reduction, the C2 pedicle screws were inserted percutaneously with the guidance of the orthopedic surgical robot. The positions of pedicle screws were verified by intraoperative 3-dimensional C-arm fluoroscopy. Regular follow-ups were performed to evaluate the radiological and functional outcomes. Postoperatively, all the fractures have healed with an average healing time of 3.5 months, the functional outcomes were satisfactory at last follow-up, and there was no neurovascular injury associated with this technique. The 3D-fluoroscopy-based, robot-assisted C2 pedicle screw fixation is a safe, precise, and feasible method for the initial treatment of L-E type II hangman's fractures. [Orthopedics. 2023;46(1):59-63.].
Collapse
|
7
|
Alsheikh KA, Alzahrani AM, Alshehri AS, Alzahrani FA, Alqahtani YS, Alhumaidan MI, Alangari HS. Clinical outcomes of percutaneous screw fixation of acetabular fracture: A minimally invasive procedure. J Taibah Univ Med Sci 2022; 18:279-286. [PMID: 36817219 PMCID: PMC9926199 DOI: 10.1016/j.jtumed.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/24/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Objective Open reduction with internal fixation is the surgical intervention of choice for acetabular fractures (AFs). Percutaneous screw fixation for AFs is a new procedure that is desirable because of the complex anatomy of the pelvis. In this study, we aimed to assess the functional outcomes, mobility, healing, and distal neurovascular abnormalities in patients who underwent percutaneous retrograde screw fixation. Methods Our study included 36 patients with AFs treated with percutaneous screw fixation between January 2016 and June 2021. There were 18 cases with anterior column AF, 7 cases with transverse AF, and 11 cases with associated AF, 6 of which had a T-shaped AF. Frequencies and percentages were used to describe characteristics and clinical outcomes. Mean and standard deviation were used for continuous variables. SPSS version 23 (IBM Corporation, Armonk, NY, USA) was used for statistical analysis. Results The average time to regain full mobility with full weight bearing was 12.9 ± 5.4 weeks, and approximately 11.1 ± 2.8 weeks was required for patients to be pain-free with satisfactory fracture healing. Only a minority (8.3%) of patients had abnormalities affecting the distal neurovascular system, and 11.1% experienced sexual dysfunction. Pain severity was assessed with a visual analogue scale. The average pain severity on the first and third post-operative days was 4 ± 2.4 and 3.8 ± 2.6, respectively. However, the average pain intensity before discharge was 1.7 ± 2.6. Conclusion Percutaneous screw fixation is the most efficient surgical choice for most pelvic/AFs.
Collapse
Affiliation(s)
- Khalid A. Alsheikh
- Department of Surgery, Ministry of National Guard-Health Affairs, Riyadh, KSA
- King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, Riyadh, KSA
- King Saud bin Abdulaziz University for Health Science, College of Medicine, Riyadh, KSA
| | - Abdullah M. Alzahrani
- Department of Surgery, Ministry of National Guard-Health Affairs, Riyadh, KSA
- King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, Riyadh, KSA
- King Saud bin Abdulaziz University for Health Science, College of Medicine, Riyadh, KSA
| | - Ali S. Alshehri
- Department of Surgery, Ministry of National Guard-Health Affairs, Riyadh, KSA
- King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, Riyadh, KSA
| | - Faisal A. Alzahrani
- Department of Surgery, Ministry of National Guard-Health Affairs, Riyadh, KSA
- King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, Riyadh, KSA
| | - Yousef S. Alqahtani
- Department of Surgery, Ministry of National Guard-Health Affairs, Riyadh, KSA
- King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, Riyadh, KSA
| | - Mohammed I. Alhumaidan
- King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, Riyadh, KSA
- King Saud bin Abdulaziz University for Health Science, College of Medicine, Riyadh, KSA
| | - Hussam S. Alangari
- Department of Surgery, Ministry of National Guard-Health Affairs, Riyadh, KSA
- King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, Riyadh, KSA
- King Saud bin Abdulaziz University for Health Science, College of Medicine, Riyadh, KSA
- Corresponding address: King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, King Saud bin Abdelaziz University for Health Science, College of Medicine, Department of Surgery, Ministry of National Guard-Health Affairs Riyadh, 11564, KSA.
| |
Collapse
|
8
|
Zhao B, Li J, Zhao C, Su Y, Han W, Wu X, Jiang X, Wang J. [Orthopedic robot based on 5G technology for remote navigation of percutaneous screw fixation in pelvic and acetabular fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:923-928. [PMID: 35979780 DOI: 10.7507/1002-1892.202204073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the accuracy and safety of percutaneous screw fixation for pelvic and acetabular fractures with remote navigation of orthopedic robot based on 5G technology. Methods Between January 2021 and December 2021, 15 patients with pelvic and/or acetabular fractures were treated with percutaneous screws fixation which were placed by remote navigation of orthopedic robot based on 5G technology. There were 8 males and 7 females. The age ranged from 20 to 98 years, with an average of 52.1 years. The causes of trauma included traffic accident injury in 6 cases, falling from height injury in 6 cases, fall injury in 2 cases, and heavy object smashing injury in 1 case. The time from injury to operation ranged from 3 to 32 days, with an average of 10.9 days. There were 8 cases of simple pelvic fractures, 2 simple acetabular fractures, and 5 both pelvic and acetabular fractures. There were 7 cases of pelvic fractures of Tile type B2, 2 type B3, 1 type C1, and 3 type C2; 4 cases of unilateral anterior column fracture of the acetabulum, 2 bilateral anterior column fractures, and 1 anterior wall fracture. CT images within 5 days after operation were collected for screw position assessment. The screw planning time and guidewire placement time were recorded, as well as the presence of intraoperative adverse events and complications within 5 days after operation. Results All patients achieved satisfactory surgical results. A total of 36 percutaneous screws were inserted (20 sacroiliac screws, 6 LC Ⅱ screws, 9 anterior column screws, and 1 acetabular apical screw). In terms of screw position evaluation, 32 screws (88.89%) were excellent and 4 screws (11.11%) were good; there was no screw penetrating cortical bone. The screw planning time ranged from 4 to 15 minutes, with an average of 8.7 minutes. The guidewire placement time ranged from 3 to 10 minutes, with an average of 6.8 minutes. The communication delayed in 2 cases, but the operation progress was not affected, and no serious intraoperative adverse events occurred. No delayed vascular or nerve injury, infection, or other complications occurred within 5 days after operation. No cases need surgical revision. Conclusion The fixation of pelvic and acetabular fractures by percutaneous screw with remote navigation of orthopedic robot based on 5G technology is accurate, safe, and reliable.
Collapse
Affiliation(s)
- Bin Zhao
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China
| | - Jinqi Li
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China
| | - Chunpeng Zhao
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China
| | - Yonggang Su
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China
| | - Wei Han
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China
| | - Xinbao Wu
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China
| | - Xieyuan Jiang
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China
| | - Junqiang Wang
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China
| |
Collapse
|
9
|
Robot-Assisted Autonomous Reduction of a Displaced Pelvic Fracture: A Case Report and Brief Literature Review. J Clin Med 2022; 11:jcm11061598. [PMID: 35329924 PMCID: PMC8950953 DOI: 10.3390/jcm11061598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 12/04/2022] Open
Abstract
Displaced pelvic fracture is among the most complicated fractures in traumatic orthopedics, with high mortality and morbidity. Reduction is considered a complex procedure as well as a key part in surgical treatment. However, few robotic techniques have been employed in the reduction of pelvic fracture, despite the rapid advancement of technologies. Recently, we designed a robot surgery system specialized in the autonomous reduction of displaced pelvic fracture and applied it in the true patient for the first time. In this paper, we report its successful clinical debut in the surgery of a displaced pelvic fracture. Total surgery time was 110 min and an anatomic reduction was achieved. We then present a brief overview of the literature about reduction techniques in pelvic fracture and introduce related principles involved in our robot-assisted reduction system.
Collapse
|
10
|
Li C, Wang L, Perka C, Trampuz A. Clinical application of robotic orthopedic surgery: a bibliometric study. BMC Musculoskelet Disord 2021; 22:968. [PMID: 34809652 PMCID: PMC8609816 DOI: 10.1186/s12891-021-04714-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/09/2021] [Indexed: 01/14/2023] Open
Abstract
Objectives The present study aimed to evaluate the status and trends of robotic orthopedic surgery in a clinical setting using bibliometrics. Methods All relevant publications on the clinical use of robotic surgery in orthopedics were searched from the Web of Science database. Subsequently, data were analyzed using bibliometrics. Visualizing data of bibliographic coupling, co-citation, and co-occurrence analysis were performed using VOSviewer. Results In total, 224 clinical studies met the included standards between 2000 to 2019. Global publications presented an increasing annual trend, with the United States found to have the largest number of publications and robotic companies active in the field (n = 99), followed by China (n = 38), and the United Kingdom (n = 27). The institution with the most contributions was the Beijing Jishuitan Hospital in China (n = 15). The most productive scholars were Tian Wei and Mont Michael A, with 14 publications each. The top 30 most cited papers list showed 29 publications to be cited on more than 40 occassions. The journal with the most related and influential publications on robotic orthopedic surgery was the Journal of Arthroplasty. Fourteen types of robots were used, with the majority applied in knee and spinal surgery. MAKO was the most widely used robot in hip and knee surgery and Mazor in spinal surgery. Most studies were small sample populations of low-quality in this field. The top 20 most frequently used keywords were identified from 950 author keywords. Research on orthopedic robots were classified into two clusters by co-occurrence networks: spinal-related robotic surgery and joint-related robotic surgery. Conclusions The present bibliometric study summarizes the clinical research of orthopedic robots on study type, sample size, type of surgery, robot information, surgical site, most popular keywords, most cited papers, journals, authors, institutions, and countries. These findings may assist the scholars better understand the current status and research trends to guide future practice and directions. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04714-7.
Collapse
Affiliation(s)
- Cheng Li
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, P.R. China. .,Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Lei Wang
- Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| |
Collapse
|
11
|
Vijayan RC, Han R, Wu P, Sheth NM, Ketcha MD, Vagdargi P, Vogt S, Kleinszig G, Osgood GM, Siewerdsen JH, Uneri A. Development of a fluoroscopically guided robotic assistant for instrument placement in pelvic trauma surgery. J Med Imaging (Bellingham) 2021; 8:035001. [PMID: 34124283 PMCID: PMC8189698 DOI: 10.1117/1.jmi.8.3.035001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/21/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: A method for fluoroscopic guidance of a robotic assistant is presented for instrument placement in pelvic trauma surgery. The solution uses fluoroscopic images acquired in standard clinical workflow and helps avoid repeat fluoroscopy commonly performed during implant guidance. Approach: Images acquired from a mobile C-arm are used to perform 3D-2D registration of both the patient (via patient CT) and the robot (via CAD model of a surgical instrument attached to its end effector, e.g; a drill guide), guiding the robot to target trajectories defined in the patient CT. The proposed approach avoids C-arm gantry motion, instead manipulating the robot to acquire disparate views of the instrument. Phantom and cadaver studies were performed to determine operating parameters and assess the accuracy of the proposed approach in aligning a standard drill guide instrument. Results: The proposed approach achieved average drill guide tip placement accuracy of 1.57 ± 0.47 mm and angular alignment of 0.35 ± 0.32 deg in phantom studies. The errors remained within 2 mm and 1 deg in cadaver experiments, comparable to the margins of errors provided by surgical trackers (but operating without the need for external tracking). Conclusions: By operating at a fixed fluoroscopic perspective and eliminating the need for encoded C-arm gantry movement, the proposed approach simplifies and expedites the registration of image-guided robotic assistants and can be used with simple, non-calibrated, non-encoded, and non-isocentric C-arm systems to accurately guide a robotic device in a manner that is compatible with the surgical workflow.
Collapse
Affiliation(s)
- Rohan C. Vijayan
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Runze Han
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Pengwei Wu
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Niral M. Sheth
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Michael D. Ketcha
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Prasad Vagdargi
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States
| | | | | | - Greg M. Osgood
- Johns Hopkins Medicine, Department of Orthopaedic Surgery, Baltimore, Maryland, United States
| | - Jeffrey H. Siewerdsen
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States
| | - Ali Uneri
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| |
Collapse
|
12
|
Yao S, Chen K, Zhu F, Liu J, Wang Y, Zeng L, Wan Y, Qu Y, Yang L, Guo X, Yang X. Internal fixation of anterior acetabular fractures with a limited pararectus approach and the anatomical plates: preliminary results. BMC Musculoskelet Disord 2021; 22:203. [PMID: 33602187 PMCID: PMC7891165 DOI: 10.1186/s12891-021-04034-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/31/2021] [Indexed: 01/17/2023] Open
Abstract
Background The surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the anatomical plates. Methods A consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with a limited approach and the anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted. Results All of the patients were operated using the limited pararectus approach and the anatomical plates successfully. The mean operative time and blood loss were 90.9 min and 334.1 ml, respectively. The average postoperative residual gap and step displacement on CT were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively. Conclusions The limited pararectus approach with the advantages of less trauma, direct exposure to the anterior column and quadrilateral plate. The anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction. The combination approach can be a good choice for limited surgery of displaced anterior acetabular fractures especially involving the quadrilateral plate. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04034-w.
Collapse
Affiliation(s)
- Sheng Yao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaifang Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fengzhao Zhu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yulong Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lian Zeng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yizhou Wan
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanzhen Qu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xu Yang
- Department of Orthopaedics, Suizhou Hospital, Hubei university of medicine, Suizhou, China.
| |
Collapse
|
13
|
Maintaining education, research and innovation in orthopaedic surgery during the COVID-19 pandemic. The role of virtual platforms. From presential to virtual, front and side effects of the pandemic. INTERNATIONAL ORTHOPAEDICS 2020; 44:2197-2202. [PMID: 33064172 PMCID: PMC7561700 DOI: 10.1007/s00264-020-04848-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
14
|
Braun BJ, Grimm B, Hanflik AM, Marmor MT, Richter PH, Sands AK, Sivananthan S. Finding NEEMO: towards organizing smart digital solutions in orthopaedic trauma surgery. EFORT Open Rev 2020; 5:408-420. [PMID: 32818068 PMCID: PMC7407868 DOI: 10.1302/2058-5241.5.200021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
There are many digital solutions which assist the orthopaedic trauma surgeon. This already broad field is rapidly expanding, making a complete overview of the existing solutions difficult.The AO Foundation has established a task force to address the need for an overview of digital solutions in the field of orthopaedic trauma surgery.Areas of new technology which will help the surgeon gain a greater understanding of these possible solutions are reviewed.We propose a categorization of the current needs in orthopaedic trauma surgery matched with available or potential digital solutions, and provide a narrative overview of this broad topic, including the needs, solutions and basic rules to ensure adequate use in orthopaedic trauma surgery. We seek to make this field more accessible, allowing for technological solutions to be clearly matched to trauma surgeons' needs. Cite this article: EFORT Open Rev 2020;5:408-420. DOI: 10.1302/2058-5241.5.200021.
Collapse
Affiliation(s)
- Benedikt J Braun
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | | | | | - Meir T Marmor
- Department of Orthopaedic Surgery, University of California, San Francisco, California, USA
| | - Peter H Richter
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | - Andrew K Sands
- Weill Cornell Medical College, Foot and Ankle Surgery, Downtown Orthopedic Associates, New York Presbyterian Lower Manhattan Hospital, New York, USA
| | | |
Collapse
|