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Hestehave RA, Gundtoft PH, Nielsen CL, Brink O, Rölfing JD. Poor usability of computer-assisted navigation for hip fracture surgery. Arch Orthop Trauma Surg 2024; 144:251-257. [PMID: 37878075 PMCID: PMC10774189 DOI: 10.1007/s00402-023-05096-2] [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: 02/23/2023] [Accepted: 09/28/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION The STRYKER ADAPT computer-assisted navigation system provides intraoperative feedback to the surgeon regarding implant placement of the Gamma3 nail. The usability of the ADAPT system has not been evaluated. The aim of the study was to investigate the perceived usability of the ADAPT system. MATERIALS AND METHODS This was a descriptive study with prospectively collected data. ADAPT was introduced at Aarhus University Hospital in February 2021. Prior to introduction, surgeons at the department attended a general introduction to the system. ADAPT was introduced to the surgical nurses and was on display at the surgical ward at more than one occasion, where personal introduction to the system was possible. After introduction, it was mandatory to use ADAPT when using the Gamma3 nail to treat intertrochanteric femur fractures. After each procedure, primary and an eventual supervisor answered a questionnaire, which encompassed the System Usability Scale (SUS) questionnaire. The SUS is a ten-item questionnaire regarding the perceived usability of a system. SUS scores were translated to adjectives, describing user experience on a 7-point adjective scale (worst imaginable, awful, poor, ok, good, excellent, best imaginable). User acceptability, defined as "not acceptable", "marginal" or "acceptable", was also used to interpret the SUS scores. RESULTS ADAPT was used in 50 procedures by 29 different surgeons, with varying skill-level. Median SUS-score after first-time use of ADAPT for all 29 surgeons was 43 (range: 5-60), which translated to "poor" or "not acceptable". For surgeons who performed ≥ 3 ADAPT-assisted procedures, there were no statistically significant difference in their first to latest SUS-score (median difference: 4.3, p = 0.5). In free text comments ADAPT was positively described as helpful in placement of K-wire and providing educational opportunities for inexperienced surgeons and negatively as inconsistent, slow, time consuming, and causing excessive fluoroscopy. CONCLUSIONS Usability and acceptability of ADAPT was rated as "poor" or "not acceptable" by the majority of operating surgeons. ADAPT has not been used at our institution based on these findings. The System Usability Scale may be used in further research exploring usability and acceptability of novel computer-assisted navigation systems for orthopaedic surgery.
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Affiliation(s)
- Rasmus Abildtrup Hestehave
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J801, 8200, Aarhus, Denmark
| | - Per Hviid Gundtoft
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J801, 8200, Aarhus, Denmark
| | - Christian Lind Nielsen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J801, 8200, Aarhus, Denmark
| | - Ole Brink
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J801, 8200, Aarhus, Denmark
| | - Jan Duedal Rölfing
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J801, 8200, Aarhus, Denmark.
- Corporate HR, MidtSim, Central Denmark Region, Hedeager 5, 8200, Aarhus, Denmark.
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Li H, Wang D, Zhang W, Xu G, Xu C, Zhang H, Zhang L, Li J, Tang P. Does computer-assisted orthopaedics system (ADAPT system) improve outcomes of intertrochanteric hip fractures? Injury 2023; 54:1047-1054. [PMID: 36759309 DOI: 10.1016/j.injury.2023.02.011] [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: 07/03/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Intramedullary nailing (IMN) is a general treatment for intertrochanteric hip fractures. The computer-assisted orthopaedics system (CAOS), ADAPT system (Stryker, NJ), has been developed to facilitate lag screw insertion. When compared to the conventional freehand method, the efficacy of CAOS has not been clearly clarified. Therefore, we conducted this systematic review and meta-analysis to answer: does the CAOS performed better than freehand method in IMN. MATERIALS AND METHODS Studies published up to January 2023 were searched in the PubMed, Embase, Web of Science and Cochrane Library databases with predetermined key words. Comparative clinical studies between CAOS (ADAPT system) and freehand method were included. The primary outcomes of interest were the tip-apex-distance (TAD) and positions of lag screw. Fluoroscopy use, operation duration and intraoperative/postoperative complications were also extracted. A meta-analysis was performed for pooled analysis. RESULTS There were seven studies with 326 fractures in CAOS group and 325 fractures in Freehand group. All studies included presented high qualities. The CAOS group showed a statistically smaller TAD than Freehand group (weighted mean difference = -3.24 mm; 95% confidence interval [CI] -5.10 to -1.37 mm; p = 0.0007) and a better lag screw position (83/92 [90.2%] VS 64/92 [69.6%]; RR = 1.3; 95% CI 1.12 to 1.51; p = 0.0007). The operative time and radiation use revealed no difference between two groups. CONCLUSIONS The current evidence indicated that ADAPT system could help to perform a more accurate lag screw than freehand manipulation while the operative time and radiation time was not reduced as expectations on such new technique. Long-term follow-up studies are appealed.
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Affiliation(s)
- Hua Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wupeng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China; School of Medicine, Nankai University, No.94 Weijin Road, Tianjin, 300071, China
| | - Gaoxiang Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Hao Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Licheng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| | - Jiantao Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| | - Peifu Tang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
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Improving Cephalad Lag Screw Placement in the Femoral Head During Cephalomedullary Nailing Using a Novel Augmented Reality System. J Orthop Trauma 2023; 37:130-134. [PMID: 36219771 DOI: 10.1097/bot.0000000000002504] [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] [Accepted: 10/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To measure the effect of a novel augmented reality software designed to aid in lag screw placement into the femoral head for cephalomedullary nails. DESIGN Retrospective cohort study. SETTING Single Level I trauma center. PATIENTS Between November 2017 and December 2020, 114 consecutive patients with a hip fracture that underwent repair with a cephalomedullary nail by one of 2 orthopaedic trauma surgeons were reviewed. Fracture classifications included OTA/AO 31-A1, 31-A2, 31-A3, and 31-B3. INTERVENTION The first 57 patients underwent fracture repair without the software (control) and the subsequent 57 patients underwent repair with use of the augmented reality software (AR). MAIN OUTCOME MEASUREMENTS Tip apex distance (TAD) and femoral head zone (AP: superior, center, inferior; Lateral: anterior, center, posterior) were measured using standardized techniques. RESULTS The mean TAD was lower for the AR versus control cohort (10.7 ± 2.9 mm vs. 15.4 ± 3.8 mm; P < 0.001). TAD <10 mm for AR versus control: 25 (43.9%) versus 3 (5.3%), P < 0.001. TAD <15 mm for AR versus control: 50 (87.7%) versus 44 (77.2%), P < 0.001. On the AP view, center position was achieved in 50.9% versus 7.0% of cases for the AR versus control cohort, respectively. On the lateral view, center position was achieved in 68.4% versus 12.3% of cases for the AR versus control cohort, respectively. CONCLUSION This study suggests that use of the novel augmented reality software for assistance in lag screw positioning within the femoral head improves overall TAD and ability to achieve the center-center position. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Tang L, Yi X, Yuan T, Li H, Xu C. Navigated intramedullary nailing for patients with intertrochanteric hip fractures is cost-effective at high-volume hospitals in mainland China: A markov decision analysis. Front Surg 2023; 9:1048885. [PMID: 36726954 PMCID: PMC9885142 DOI: 10.3389/fsurg.2022.1048885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/23/2022] [Indexed: 01/17/2023] Open
Abstract
Objective Previous studies have reported that navigation systems can improve clinical outcomes of intramedullary nailing (IMN) for patients with intertrochanteric fractures. However, information is lacking regarding the relationship between the costs of navigated systems and clinical outcomes. The present research aimed to evaluate the cost-effectiveness of navigated IMN as compared with traditional freehand IMN for patients with intertrochanteric fractures. Methods A Markov decision model with a 5-year time horizon was constructed to investigate the costs, clinical outcomes and incremental cost-effectiveness ratio (ICER) of navigated IMN for a 70-year-old patient with an intertrochanteric fracture in mainland China. The costs [Chinese Yuan (¥)], health utilities (quality-adjusted life-years, QALYs) and transition probabilities were obtained from published studies. The willingness-to-pay threshold for ICER was set at ¥1,40,000/QALY following the Chinese gross domestic product in 2020. Three institutional surgical volumes were used to determine the average navigation-related costs per patient: low volume (100 cases), medium volume (200 cases) and high volume (300 cases). Results Institutes at which 300, 200 and 100 cases of navigated IMN were performed per year showed an ICER of ¥43,149/QALY, ¥76,132.5/QALY and ¥1,75,083/QALY, respectively. Navigated IMN would achieve cost-effectiveness at institutes with an annual volume of more than 125 cases. Conclusions Our analysis demonstrated that the navigated IMN could be cost-effective for patients with inter-trochanteric fracture as compared to traditional freehand IMN. However, the cost-effectiveness was more likely to be achieved at institutes with a higher surgical volume.
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Affiliation(s)
- Liang Tang
- Department of Orthopaedics, Hengyang Central Hospital, The Affiliated Hengyang Hospital of Southern Medical University, Hengyang, China
| | - Xiaoke Yi
- Department of Orthopaedics, Hengyang Central Hospital, The Affiliated Hengyang Hospital of Southern Medical University, Hengyang, China
| | - Ting Yuan
- Department of Orthopaedics, Hengyang Central Hospital, The Affiliated Hengyang Hospital of Southern Medical University, Hengyang, China
| | - Hua Li
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Cheng Xu
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
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Murakami T, Yamazaki K, Ogasa H. ADAPT system is a dramatic advance in computer-assisted surgery for femoral trochanteric fractures. SICOT J 2021; 7:55. [PMID: 34738902 PMCID: PMC8570136 DOI: 10.1051/sicotj/2021056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: In recent years, computer-assisted surgery has made it possible to undergo surgery with a high degree of precision. This study aimed to investigate the usefulness of computer-assisted surgery for femoral trochanteric fractures using the ADAPT (ADAptive Positioning Technology) system. Methods: A total of forty patients with femoral trochanteric fracture underwent intramedullary nailing for fracture fixation: in twenty patients, the ADAPT system (ADAPT group), and in the other twenty, it was not used (control group). The operative time, intraoperative fluoroscopy time, tip apex distance (TAD), and tip to head surface distance (TSD) were measured and compared between the two groups to assess the efficiency and accuracy of the surgery. Results: The operative time was significantly shorter (P < 0.05), intraoperative fluoroscopy time was significantly reduced (P < 0.01), and implant placement was significantly better in the ADAPT group (P < 0.01). Conclusion: Navigation systems have been developed to improve the efficiency of surgery. The ADAPT system was considered a very useful device for intramedullary nailing of femoral trochanteric fractures, as it reduced the intraoperative fluoroscopy time and improved the accuracy of implant placement, also reducing the operative time.
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Affiliation(s)
- Tomotoshi Murakami
- Department of Orthopedic Surgery, Hagi Civil Hospital, 3460-3 Tubaki, Hagi City, Yamaguchi 758-0061, Japan
| | - Kazuhiro Yamazaki
- Department of Orthopedic Surgery, Hagi Civil Hospital, 3460-3 Tubaki, Hagi City, Yamaguchi 758-0061, Japan
| | - Hiroyoshi Ogasa
- Department of Orthopedic Surgery, Hagi Civil Hospital, 3460-3 Tubaki, Hagi City, Yamaguchi 758-0061, Japan
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Effect of a computer-assisted navigation system on the lag screw placement accuracy of less experienced surgeons. J Orthop Sci 2021; 26:823-826. [PMID: 32863102 DOI: 10.1016/j.jos.2020.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Femoral trochanteric fracture is treated by osteosynthesis using an angle-fixed implant. Lag screw cut-out is a postoperative complication, and a tip-apex distance (TAD) of 20 mm or shorter is recommended to prevent it. The use of a navigation system for lag screw placement has been reported, but the use and non-use of navigation systems by less experienced surgeons has not been assessed. The objective of this study was to retrospectively investigate the usefulness of a navigation system for short femoral nailing. METHODS The subjects were 101 patients with femoral trochanteric fracture treated by osteosynthesis at our hospital between May 2017 and December 2018 (male, 14; female, 87; mean age, 84.7 years; navigation use group, 55; non-navigation use group, 46). The patients were divided into four groups: groups treated by less experienced surgeons with (Navigation-Young surgeon [NY] group, n = 35) and without (Manual-Young surgeon [MY] group, n = 23) the use of a navigation system; and groups treated by experienced surgeons with (Navigation-Aged surgeon [NA] group, n = 20) and without (Manual-Aged surgeon [MA] group, n = 23) the use of a navigation system. TAD (mm) and operative time (min) were compared. RESULTS The TAD was significantly longer in the MY group than in the NY group. The percentages of patients with 10-20 mm TAD were as follows: NY group, 94.3%; MY group, 65.2%; NA group, 100%; MA group, 100%. The mean operative time was significantly longer in the NY group than in the MA group, but no significant difference in mean operative time was noted between the NY and MY groups or between the NA and MA groups. CONCLUSIONS A computer-assisted navigation system improves the accuracy of lag screw placement performed by less experienced operators without increasing the operative time.
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Windolf M, Richards RG. Generic Implant Positioning Technology Based on Hole Projections in X-Ray Images. J Med Device 2021; 15:025002. [PMID: 33995756 DOI: 10.1115/1.4049979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 01/13/2021] [Indexed: 11/08/2022] Open
Abstract
Implant placement plays a key role in trauma and orthopedics. In this paper, a generic technological concept for implant positioning assistance is outlined. The system utilizes conventional radiographic devices for imaging and tracking and embeds into surgical workflows without the need for complex navigation equipment. It is based on feature extraction from cylindrical hole-projections in X-ray images for determining spatial alignment of implant and anatomy. Basic performance of a prototype system was experimentally verified in terms of tracking accuracy and robustness under varying conditions. In a second step, the system was developed into a set of application modules, each serving a pressing clinical need: Plating of the proximal humerus, cephalic nail and dynamic hip-screw placement, general anatomic plating, distal nail interlocking with adjustment of femoral anteversion and corrective osteotomies. Module prototypes were tested according to their degree of maturity from feasibility assessment in wet-labs to clinical handling tests. Orientation tracking of reference objects yielded an accuracy and precision of 0.1±0.71 deg (mean±standard deviation) with a maximum error of 4.68 deg at unfavorable conditions. This base-performance translated, e.g., into a precision of ±1.2 mm (standard deviation) screw-tip to joint distance at proximal humerus plating, or into a precision of lag screw positioning in the femoral head of ±0.6 mm in craniocaudal and ±1.6 mm in anterioposterior direction. The concept revealed strong potential to improve surgical outcomes in a broad range of orthopedic applications due to its generic and simplistic nature. Comprehensive validation activities must follow for clinical introduction.
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Affiliation(s)
- Markus Windolf
- AO Research Institute Davos, Concept Development Focus Area, Clavadelerstrasse 8, Davos 7270, Switzerland
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Takai H, Kitajima M, Takahashi T. Response to 'Letter to the editor about "Comparing the usefulness of a fluoroscopic navigation system in femoral trochanteric fracture for orthopaedic residents with the conventional method". Injury 2020; 51:2723-2724. [PMID: 32868070 DOI: 10.1016/j.injury.2020.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/22/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Hirokazu Takai
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kitaku, Kumamoto 860-8518, Japan.
| | - Masato Kitajima
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kitaku, Kumamoto 860-8518, Japan
| | - Tomoki Takahashi
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kitaku, Kumamoto 860-8518, Japan
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Does Computer-assisted Surgery Improve Lag Screw Placement During Cephalomedullary Nailing of Intertrochanteric Hip Fractures? Clin Orthop Relat Res 2020; 478:2132-2144. [PMID: 32496321 PMCID: PMC7431259 DOI: 10.1097/corr.0000000000001306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Computer-assisted surgery (CAS) techniques have been shown to improve implant placement and reduce the radiation time during cephalomedullary nailing in cadaveric and pilot clinical studies of intertrochanteric hip fractures. However, clinical comparisons of CAS and conventional techniques are lacking. It is unclear whether CAS offers clear advantages in terms of radiation time, operative time, and accuracy of lag-screw placement in patients undergoing surgery for intertrochanteric hip fractures and whether any potential difference in accuracy is associated with a change in the risk of lag-screw cut-out postoperatively. QUESTIONS/PURPOSES In patients undergoing cephalomedullary nailing for intertrochanteric hip fractures compared with the conventional technique, we asked: (1) Is the CAS technique associated with a decrease in tip-apex distance (TAD), with less variation and fewer outliers at the standard (25 mm) and lower (15 mm) TAD thresholds? (2) Is the CAS technique associated with a decrease in radiation and operative time? (3) If the CAS technique results in a decrease in TAD, is this decrease associated with a decrease in lag screw cut-out postoperatively? METHODS Between Oct 2007 and June 2015, 964 stable and unstable intertrochanteric hip fractures were treated surgically at our institution. Of these, 23% (225 of 964) were isolated, acute intertrochanteric hip fractures managed by a single surgeon. Ninety-five percent (213 of 225) of hip fractures were surgically treated with the same cephalomedullary nail based on the general indications of displaced fractures, poor bone quality, and medical complexity. This same surgeon used a sliding hip screw device in the remaining 5% (12 of 225) of hip fractures for the treatment of nondisplaced and minimally displaced fractures in younger patients with fewer medical comorbidities and good bone quality. Between October 2007 and August 2011, all procedures were performed with conventional lag screw placement (n = 110), and between September 2011 and June 2015, all procedures were performed with CAS (n = 103) for lag screw placement. Postoperative radiographs were missing or unavailable for TAD analysis for 3% (3 of 110) of the conventional technique group and 6% (6 of 103) of the CAS group, so these patients were excluded. The remaining 97% (107 of 110) of conventional procedures and 94% (97 of 103) of CAS procedures were included in the TAD, radiation time, and operative time analysis. For the evaluation of cut-out postoperatively, 24% (26 of 107) of conventional patients and 25% (24 of 97) of CAS patients were excluded due to mortality and/or loss to follow-up at a minimum of 1 year. The remaining 76% (81 of 107) of conventional patients and 75% (73 of 97) of CAS patients were included in the cut-out analysis. A retrospective chart review was performed to obtain the data and then compare TAD, radiation time, operative time, and cut-out between the two cohorts. RESULTS The median TAD for the CAS procedures was lower than the median TAD for the conventional procedures (median 13 mm versus median 16 mm, median difference 3 mm; p < 0.001 power for difference = 85%). In addition, the TAD variation was also less for the CAS procedures compared with the conventional procedures (interquartile range [IQR] 4 mm versus IQR 9 mm, IQR difference 5 mm; p < 0.001, power for difference = 98%). A TAD greater than 25 mm was found in 1% (1 of 97) of the CAS procedures and 12% (13 of 107) of the conventional procedures. A difference between the proportions could be detected indicating a lesser chance of a TAD > 25 mm in the CAS cohort (odds ratio = 0.075 [95% confidence interval 0.010 to 0.587]; p = 0.002, power for difference 90%). A TAD > 15 mm was found in 23% (22 of 97) of the CAS procedures and 56% (60 of 107) of the conventional procedures, also indicating a lesser chance of a TAD > 15 mm in the CAS cohort (OR = 0.230 [95% CI 0.125 to 0.423], relative risk for TAD > 15 mm = 0.404 [95% CI 0.270 to 0.606]; p < 0.001, power for difference > 99%). The median radiation time for the CAS cohort was lower than the median radiation time for the conventional cohort (median 1.4 minutes versus median 1.7 minutes, median difference 0.3 minutes; p = 0.002, power for difference = 81%). No difference in median total operating time was found for the CAS procedures compared with the conventional procedures (median 36 minutes versus median 38 minutes, median difference 2 minutes; p = 0.227, power for difference = 18%, power for equivalency = 93%). There was no difference in cut-out noted with the use of the CAS compared with the conventional technique with the numbers available. Based on the current results, the upper 95% probability for a cutout complication ranges from 0% to 5% in the CAS cohort versus 0% to 9% in the conventional cohort (difference of upper 95% CI = 4%). CONCLUSION CAS use is associated with a decrease in median TAD with less variation and fewer outliers during cephalomedullary nailing. Compared with the conventional technique, fewer outliers were noted with the CAS at the standard TAD threshold of 25 mm and a lower TAD threshold of 15 mm. Additional research is needed to determine the association of TAD variation and outliers on cut-out and to determine if there is any clinical value to the decrease in TAD variation and outliers noted here. The patient and surgical team are exposed to less radiation with the CAS compared with the conventional technique, but this difference is small and it is unclear if this benefit justifies CAS use. Incorporating CAS into the cephalomedullary nailing procedure is not associated with a change in operative time, so there are no costs or risks associated with increased operative time. More procedures would be needed to provide adequate power to better analyze the risk of lag screw cut-out, allowing a more complete understanding of the value of this technology compared with its cost. LEVEL OF EVIDENCE Level III, therapeutic study.
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Takai H, Mizuta K, Murayama M, Nakayama D, Kii S, Hayai C, Takahashi T. Comparing the usefulness of a fluoroscopic navigation system in femoral trochanteric fracture for orthopaedic residents with the conventional method. Injury 2020; 51:1840-1845. [PMID: 32540179 DOI: 10.1016/j.injury.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/29/2020] [Accepted: 06/01/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Lag screw insertion into the ideal position is essential to obtain good results in open reduction and internal fixation for femoral trochanteric fracture. Tip-apex distance (TAD) is a widely adopted method for evaluating the risk of lag screw cut-out. Adaptive positioning technology (ADAPT) is a fluoroscopic computer-assisted surgery system that enables orthopaedic surgeons to guide the screw into a proper position intraoperatively. A randomized control study concluded that ADAPT resulted in excellent TAD. However, it was not significantly better than conventional methods when performed by fellowship-trained traumatologists. Therefore, we hypothesised that ADAPT would be useful to orthopaedic residents and evaluated this usefulness. METHODS We reviewed 102 patients who underwent open reduction and internal fixation for femoral trochanteric fracture from May 2017 to March 2019 using Gamma-3 intertrochanteric nails. Two residents performed all procedures; 51 patients underwent surgery using ADAPT and the others underwent surgery without navigation. The number of attempts to drill guide-wire, operation time, lag screw insertion time, radiation exposure time, TAD, and lag screw position were evaluated for each surgeon. RESULTS In one resident, when using the ADAPT system, the number of attempts to drill guide-wire (p=0.001), lag screw insertion time (p=0.000), radiational exposure time (p=0.009) and TAD (p=0.007) were lower, and the percentage of ideal lag screw position (p=0.035) were better than that in the conventional method. However, there was no significant difference in the performance of another resident with respect to the aforementioned factors, whether using ADAPT or not. CONCLUSION One resident showed better results with the ADAPT system than with conventional osteosynthesis. However, another resident received no benefit from ADAPT. The efficiency may not apply to everyone as individual competence can influence efficiency when using ADAPT system. Therefore, as a new device, it must be used cautiously because skill or experience may influence its use, especially by orthopaedic residents.
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Affiliation(s)
- Hirokazu Takai
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan.
| | - Kazutaka Mizuta
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan
| | - Masatoshi Murayama
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan
| | - Daisuke Nakayama
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan
| | - Sakumo Kii
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan
| | - Chihiro Hayai
- Imaging Diagnostic Center, Kumamoto Kinoh Hospital, Kumamoto, Japan
| | - Tomoki Takahashi
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan
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Wang Z, Liu Y, Li S, Wang X, Liu C, Tang X. How to get better TAD? Relationship between anteversion angle of nail and position of femoral neck guide pin during nailing of intertrochanteric fractures. BMC Musculoskelet Disord 2020; 21:512. [PMID: 32738886 PMCID: PMC7395984 DOI: 10.1186/s12891-020-03518-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/20/2020] [Indexed: 11/28/2022] Open
Abstract
Background To demonstrate the correlation between guide pin-shaft angle (PSA) at the anteroposterior film and anteversion angle of guide pin at the lateral film and investigate whether excellent tip–apex distance (TAD) can be obtained by changing the entry point via axial rotation of the main intramedullary nail. Methods Fifty patients with intertrochanteric femoral fractures (IFFs) undergoing internal fixation with intramedullary nails under 2D fluoroscopy were retrospectively enrolled. Both of the PSA at the anteroposterior film and anteversion angle at the lateral film before and after adjustment of the guide pin were collected. Pearson correlation analysis was performed to investigate their correlation. Intraoperative and postoperative outcomes were recorded. Furthermore, the software of Mimics 10.0 and Pro/E were used to establish the 3D models of the proximal femur and main intramedullary nail/guide pin, respectively. Surgery was simulated on the Pro/E software platform and solid geometry analysis was conducted to calculate the correlation between the PSA and the anteversion angle. Results Pearson correlation analysis indicated there was a positive correlation between PSA and anteversion angle, with the correlation coefficient of 0.902 (p < 0.01). By altering the PSA and anteversion angle, TAD was adjusted to be less than 25 mm in all patients. The mean operative time, fluoroscopy time and length of hospital stay were 65.82 ± 11.16 min, 2.03 ± 0.79 min and 6.66 ± 2.49 d. Thirty-one patients received blood transfusions (3.55 ± 1.95 U). Fracture reduction was considered to be good or acceptable in all patients. Complications occurred only in 6 patients (12.00%). At a 3-month follow-up, the mean Timed Up and Go was 31.54 ± 20.95 s and Harris Hip Score was 72.88 ± 8.79. The 3D surgery model also showed when the main intramedullary nail was externally rotated or internally rotated of 20° at the standard location, the PSA of guide pin at the anteroposterior position and anteversion angle of the guide pin at the lateral position were simultaneously increased or decreased. Conclusion Our findings suggest altering the PSA and anteversion angle may be beneficial for obtaining excellent TAD and achieving superior outcomes.
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Affiliation(s)
- Zhe Wang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yadong Liu
- Department of Orthopedic Trauma, the First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning Province, China
| | - Shenglong Li
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University Liaoning Cancer Hospital & Institute, Shenyang, 110042, Liaoning Province, China
| | - Xiuhui Wang
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated to Zhoupu Hospital, Shanghai, 201318, China
| | - Changjian Liu
- Department of Orthopedic Trauma, the First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning Province, China.
| | - Xin Tang
- Department of Orthopedic Trauma, the First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning Province, China.
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von Rüden C, Trapp O, Augat P, Stuby FM, Friederichs J. Evolution of imaging in surgical fracture management. Injury 2020; 51 Suppl 2:S51-S56. [PMID: 31706585 DOI: 10.1016/j.injury.2019.10.080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/20/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
Intraoperative imaging has been advanced substantially over the last decades. It supports localization of the region of interest, verification of the preoperatively classified fracture pattern, identification of correct insertion point of the implant, placement of instruments and fixation material, and verification of correct fracture reduction and implant positioning. While conventional fluoroscopic 2D imaging remains the gold standard in intraoperative imaging, critical anatomical regions are predestined for intraoperative 3D imaging. Additional options such as perioperative virtual planning, simulation, and surgical training, 3D printing techniques and 3D augmented reality visualization may potentially open new windows to improve surgical results in fracture care. This manuscript presents an update on current and upcoming imaging techniques in orthopaedic and trauma surgery focusing on technical advances for decreasing malreduction, malalignment, and malposition, as well as tips and tricks for daily surgical practice in order to improve clinical outcomes and patients' and surgeons' safety.
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Affiliation(s)
- Christian von Rüden
- Department of Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany; Institute for Biomechanics, BG Trauma Center Murnau, Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria.
| | - Oliver Trapp
- Department of Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Peter Augat
- Institute for Biomechanics, BG Trauma Center Murnau, Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Fabian M Stuby
- Department of Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Jan Friederichs
- Department of Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany
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Fluoroscopic Marker-Based Guidance System Improves Gamma Lag Screw Placement During Nailing of Intertrochanteric Fractures: A Randomized Controlled Trial. J Orthop Trauma 2020; 34:145-150. [PMID: 31725087 DOI: 10.1097/bot.0000000000001662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine whether a fluoroscopy-based navigation system would improve tip-apex distance (TAD) compared with the conventional technique. DESIGN Randomized controlled trial. SETTING Level 1 trauma center. PATIENTS A total of 161 patients were screened for inclusion in the study. After meeting inclusion and exclusion criteria, 31 patients were randomized (n = 18 navigated vs. n = 13 control group), with the patient blinded to the result. INTERVENTION Fluoroscopy-based navigated guidance of lag screw length and position. MAIN OUTCOME MEASURES Average TAD and the proportion of TAD over 25 mm. RESULTS TAD was lower in the navigated group compared with the control group (mean = 17.5 vs. 24.2 mm; P = 0.0018). No navigated cases exceeded the 25 mm TAD threshold, compared with 39% of conventional cases (P = 0.0076). Navigation resulted in fewer drilling attempts compared with the conventional technique (median = 1 vs. 4 attempts; P < 0.0001). We detected no significant differences in operation time or total number of fluoroscopic images (P > 0.05). CONCLUSIONS Fluoroscopy-based computer navigated Gamma nailing for intertrochanteric fractures improved TAD and reduced the number of drilling attempts without increasing operation time compared with the conventional fluoroscopy-guided technique in a teaching hospital setting. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Hierholzer C, Friederichs J, Augat P, Woltmann A, Trapp O, Bühren V, von Rüden C. [Evolution and principles of intramedullary locked nailing]. Unfallchirurg 2019; 121:239-255. [PMID: 29464295 DOI: 10.1007/s00113-018-0461-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Key factors for successful osteosynthetic fracture stabilization are anatomical fracture reduction, restoration of axis and torsion alignment as well as tissue-preserving operative techniques. In long bone fractures, the use of intramedullary long bridging nailing offers ideal conditions for bone healing, as axial and rotational stability is provided by canal-filling nails and locking screws. In addition, the tissue in the fracture region is protected as the intramedullary nail insertion is distant from the fracture. The indication spectrum for modern intramedullary locked nailing includes diaphyseal fractures of long bones, metaphyseal fractures and reconstructions, as well as treatment of nonunion, osteotomy and arthrodesis of the lower extremities. Continuous improvements in nail design and instrumentation as well as the introduction of anatomical reconstruction nails will optimize the spectrum and effectiveness of intramedullary osteosynthesis even further.
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Affiliation(s)
- C Hierholzer
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
- Klinik für Traumatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - J Friederichs
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - P Augat
- Universitätsinstitut für Biomechanik, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
- Institut für Biomechanik, BG Unfallklinik Murnau, Murnau, Deutschland
| | - A Woltmann
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - O Trapp
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - V Bühren
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - C von Rüden
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland.
- Universitätsinstitut für Biomechanik, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
- Institut für Biomechanik, BG Unfallklinik Murnau, Murnau, Deutschland.
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Herzog J, Wendlandt R, Hillbricht S, Burgkart R, Schulz AP. Optimising the tip-apex-distance in trochanteric femoral fracture fixation using the ADAPT-navigated technique, a longitudinal matched cohort study. Injury 2019; 50:744-751. [PMID: 30782395 DOI: 10.1016/j.injury.2019.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 01/14/2019] [Accepted: 02/12/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The annual incidence of proximal femoral fractures is 100-150/100,000 and continues to increase with an aging population. Cut-out of hip screws after fracture fixation has been quoted as 8% in the literature. The tip-apex distance (TAD) is the strongest predictor for cut-out after operative fracture stabilisation. The aim of this study was to evaluate the novel ADAPT system (Adaptive Positioning Technology, Stryker, USA), a navigation device for intramedullary nailing of trochanteric fractures and its effect on optimising the TAD. This is the first clinical study to evaluate this new technology. METHODS The study group of 36 consecutive patients with a pertrochanteric fracture underwent intramedullary nailing for fracture fixation using ADAPT technology, while the matched control group underwent conventional Gamma-3-nailing. Matching criteria included fracture classification, gender and age. We measured the operative time and the postoperative TAD in anteroposterior (AP) and lateral radiographs of the 72 patients. RESULTS The mean TAD using ADAPT was 16.9 mm (range 8.4-33.7 mm) compared with 24.9 mm (range 14.6-40.2 mm) in the reference group treated without ADAPT. Using the ADAPT system significantly improved (p < 0.0005) the accuracy of lag screw placement but had no effect on operating time in fixation of femoral pertrochanteric fractures. CONCLUSION Working with the novel ADAPT system for positioning the lag screw using the Gamma-3-nail led to a statistically highly significant reduction of the TAD compared to the reference group (p < 0.001). The ADAPT system proved to be a very useful device in achieving higher surgical standards for the treatment of trochanteric fractures with intramedullary nailing. It enables higher accuracy in screw positioning and therefore better placement of the implant.
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Affiliation(s)
- Jan Herzog
- Royal National Orthopaedic Hospital, Stanmore, United Kingdom, Department of Orthopaedics, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom.
| | - Robert Wendlandt
- Biomechanics Laboratory, University Medical Centre Lübeck, Germany
| | | | - Rainer Burgkart
- Dept. for Orthopaedics and Sportorthopaedics, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Arndt-Peter Schulz
- Dept. for Trauma, Orthopaedics and Sportsmedicine, BG Clinic Hamburg and Dept. for Trauma and Orthopaedics, University Medical Centre Lübeck, Germany
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Takai H, Murayama M, Kii S, Mito D, Hayai C, Motohashi S, Takahashi T. Accuracy analysis of computer-assisted surgery for femoral trochanteric fracture using a fluoroscopic navigation system: Stryker ADAPT ® system. Injury 2018; 49:1149-1154. [PMID: 29605293 DOI: 10.1016/j.injury.2018.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/14/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE ADAPT is a fluoroscopic computer-assisted surgery system which intraoperatively shows the distance from the tip of the screw to the surface of the femoral head, tip-to-head-surface distance (TSD), and the tip-apex distance (TAD) advocated by Baumgaertner et al. The study evaluated the accuracy of ADAPT. PATIENTS AND METHODS A total of 55 patients operated with ADAPT between August 2016 and March 2017 were included as subjects. TSD and TAD were measured postoperatively using computed tomography (CT) and X-rays. The intraclass correlation coefficient (ICC) was checked in advance. The error was defined as the difference between postoperative and intraoperative measurement values of ADAPT. Summary statistics, root mean square errors (RMSEs), and correlations were evaluated. RESULTS ICC was 0.94 [95% CI: 0.90-0.96] in TSD and 0.99 [95% CI: 0.98-0.99] in TAD. The error was -0.35 mm (-1.83 mm to 1.12 mm) in TSD and +0.63 mm (-5.65 mm to 4.59 mm) in TAD. RMSE was 0.63 mm in TSD and 1.53 mm in TAD. Pearson's correlation coefficient was 0.79 [95% CI: 0.66-0.87] in TSD and 0.83 [95% CI: 0.72-0.89] in TAD. There were no adverse events with ADAPT use. CONCLUSION ADAPT is highly accurate and useful in guiding surgeons in properly positioning the screws.
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Affiliation(s)
- Hirokazu Takai
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan.
| | - Masatoshi Murayama
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan
| | - Sakumo Kii
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan
| | - Daisuke Mito
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan
| | - Chihiro Hayai
- Imaging Diagnostic Center, Kumamoto Kinoh Hospital, Kumamoto, Japan
| | | | - Tomoki Takahashi
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan
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Konya MN, Verim Ö. Numerical Optimization of the Position in Femoral Head of Proximal Locking Screws of Proximal Femoral Nail System; Biomechanical Study. Balkan Med J 2017; 34:425-431. [PMID: 28443571 PMCID: PMC5635629 DOI: 10.4274/balkanmedj.2016.0732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Proximal femoral fracture rates are increasing due to osteoporosis and traffic accidents. Proximal femoral nails are routinely used in the treatment of these fractures in the proximal femur. Aims: To compare various combinations and to determine the ideal proximal lag screw position in pertrochanteric fractures (Arbeitsgemeinschaft für Osteosynthesefragen classification 31-A1) of the femur by using optimized finite element analysis. Study Design: Biomechanical study. Methods: Computed tomography images of patients’ right femurs were processed with Mimics. Afterwards a solid femur model was created with SolidWorks 2015 and transferred to ANSYS Workbench 16.0 for response surface optimization analysis which was carried out according to anterior-posterior (-10°<anterior-posterior<10°), inferior-superior (-6°<inferior-superior<7°) and tip-apex distance (10 mm<tip-apex distance<30 mm) proximal lag screw positions in the fracture region. The optimum position of the proximal lag screw was determined based on the von Mises stress values occurring on the fracture line. Initial analysis of the system was realized under the surgeon’s normal positioning conditions (anterior-posterior, inferior-superior=0°; tip-apex distance=12 mm). Results: The maximum and minimum (compression) von Mises stresses were found to be 438 MPa and 0.003 MPa, respectively, and risky stresses for the system occurred in the regions where the proximal lag screw passes through the proximal femoral nail hole, the small diameter portion of stem joints with a large diameter and lag screw mounts to the stem. The most suitable position of the proximal lag screw was found at the middle position of the tip-apex distance (20 mm) and femoral neck (anterior-posterior, inferior-superior=0°), according to von Mises compression stress values occurring on the fracture line. Conclusion: In our study, we couldn’t find any correlation between proximal lag screw movement and tip-apex distance on stresses of the fracture surfaces, but the proximal lag screw position in the inferior (inferior-superior<0)-superior (inferior-superior>0) and posterior-anterior directions of the femur neck significantly increased these stresses. The most suitable position of the proximal lag screw was confirmed as the middle of the femoral neck by using optimized finite element analysis.
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Affiliation(s)
- Mehmet Nuri Konya
- Department of Orthopeadics and Traumatology, Afyon Kocatepe University School of Medicine, Afyon, Turkey
| | - Özgür Verim
- Department of Mechanics, Afyon Kocatepe University School of Engineering, Afyon, Turkey
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Cao Y, Zhao Y, Hu L, Li Z, Zou Y, Lou S, Zhang Y, Hao M, Zhang H, Tang P. [Clinical application of computer-assisted cannulated screw internal fixation system based on error correction method for femoral neck fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:257-261. [PMID: 29806250 PMCID: PMC8458120 DOI: 10.7507/1002-1892.201611066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/16/2017] [Indexed: 11/03/2022]
Abstract
Objective To investigate the clinical efficacy of computer-assisted cannulated screw internal fixation system based on error correction method for femoral neck fractures. Methods A retrospective analysis was made on the clinical data of 20 femoral neck fracture patients treated by computer-assisted cannulated screw internal fixation system based on error correction method between January 2014 and October 2015 (trial group), and 36 femoral neck fracture patients undergoing traditional manual surgery with closed reduction by cannulated screw fixation in the same period (the control group). There was no significant difference in gender, age, injury cause, side of fracture, types of fracture, and time from injury to operation between 2 groups ( P>0.05). The operation time, intraoperative blood loss, intraoperative frequency of fluoroscopy and guide pin insertion, fracture healing time, fracture healing rate, and Harris hip score were compared between 2 groups. Results All incisions healed by first intention after operation, and no complication of blood vessel and nerve injury occurred. The operation time of trial group was significantly longer than that of control group ( t=2.290, P=0.026), however, the intraoperative blood loss, intraoperative frequency of fluoroscopy and guide pin insertion of trial group were significantly less than those of control group ( t=-10.650, P=0.000; t=18.320, P=0.000; t=-16.625, P=0.000). All patients were followed up 12-18 months (mean, 14.7 months). X-ray films showed that fracture healing was obtained in 2 groups, showing no significant difference in fracture healing time between 2 groups ( t=0.208, P=0.836). No complication of ischemic necrosis of femoral head occurred during follow-up period. At last follow-up, the Harris hip score was 87.05±3.12 in trial group and was 86.78±2.83 in control group, showing no significant difference ( t=0.333, P=0.741). Conclusion Computer-assisted cannulated screw internal fixation surgery based on error correction method for femoral neck fractures is better than traditional manual surgery in decreasing intraoperative radiation and surgical trauma during operation.
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Affiliation(s)
- Yanxiang Cao
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Yanpeng Zhao
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Lei Hu
- Robotics Institute, Beihang University, Beijing, 100191, P.R.China
| | - Zhirui Li
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Yunpeng Zou
- Robotics Institute, Beihang University, Beijing, 100191, P.R.China
| | - Shenghan Lou
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Yafang Zhang
- Robotics Institute, Beihang University, Beijing, 100191, P.R.China
| | - Ming Hao
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Hao Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Peifu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853,
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Kuhl M, Beimel C. Enhanced cephalomedullary nail lag screw placement and intraoperative tip-apex distance measurement with a novel computer assisted surgery system. Injury 2016; 47:2155-2160. [PMID: 27469401 DOI: 10.1016/j.injury.2016.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/23/2016] [Accepted: 07/18/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The goal of this study was to evaluate the ability of a novel computer assisted surgery system to guide ideal placement of a lag screw during cephalomedullary nailing and then accurately measure the tip-apex distance (TAD) measurement intraoperatively. DESIGN Retrospective case review. SETTING Level II trauma hospital. PATIENTS The initial 98 consecutive clinical cases treated with a cephalomedullary nail in conjunction with a novel computer assisted surgery system were retrospectively reviewed. INTERVENTION A novel computer assisted surgery system was utilized to enhance lag screw placement during cephalomedullary nailing procedures. The computer assisted surgery system calculates the TAD intraoperatively after final lag screw placement. MAIN OUTCOME MEASURES The ideal TAD was considered to be within a range of 5mm-20mm. The ability of the computer assisted surgery system (CASS) to assist in placement of a lag screw within the ideal TAD was evaluated. Intraoperative TAD measurements provided by the computer assisted surgery system were then compared to standard postoperative TAD measurements on PACS (picture archiving and communication system) images to determine whether these measurements are equivalent. RESULTS 79 cases (80.6%) were available with complete information for a retrospective review. All cases had CASS TAD and PACS TAD measurements >5mm and<20mm. In addition, no significant difference could be detected between the intraoperative CASS TAD and the postoperative PACS TAD (p=0.374, Wilcoxon Test; p=0.174, paired T-Test). A cut-out rate of 0% was observed in all patients who were treated with CASS in this case series (95% CI: 0 - 3.01%). CONCLUSIONS The novel computer assisted surgery system tested here is an effective and reliable adjunct that can be utilized for optimal lag screw placement in cephalomedullary nailing procedures. The computer assisted surgery system provides an accurate intraoperative TAD measurement that is equivalent to the standard postoperative measurement utilizing PACS images. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Mitchell Kuhl
- Department of Orthopaedic Surgery, St. Cloud Orthopedics and St. Cloud Hospital, St. Cloud, MN, United States.
| | - Claudia Beimel
- Scientific Research and Statistics with Stryker, Trauma and Extremities, Kiel, Germany
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