PURPOSE: In the treatment of small bone fractures, such as the scaphoid bone, conventional navigation is limited by its dependence on fixed reference arrays. We introduce a new technique based on reference markers in surgical instruments. If visible on a standard fluoroscopic image, static trajectories are overlaid in this image to guide implant insertions. Fixed markers are not required. The purpose of this study was to identify the possible advantages of the new guidance technique. METHODS: For this study, 20 artificial hand specimens were randomized into two groups and blinded with polyurethane foam: 10 were treated conventionally and 10 were image guided. We used a clip containing radiopaque markers, which was detected by the system's workstation. A static trajectory was displayed consecutively in the fluoroscopic image to serve as an aiming device. Secondly, we included 3 patients with fractures of the scaphoid bone to test the integrability of this novel method in a clinical setting. RESULTS: In the experimental setup, trajectory guidance reduced the duration of surgery and radiation exposure. Furthermore, it reduced the perforation rate. Accuracy was not improved by the new technique. For clinical cases, the system was integrated into the accommodated surgical workflow and rated as very helpful by users. CONCLUSION: The system helped reduce the misplacement rate and the emission of radiation. The main limitations were that trajectories were not displayed in real time and could only be shown in a single fluoroscopic image. However, the system is simple and can be easily integrated into the surgical workflow.
RCT Entities:
PURPOSE: In the treatment of small bone fractures, such as the scaphoid bone, conventional navigation is limited by its dependence on fixed reference arrays. We introduce a new technique based on reference markers in surgical instruments. If visible on a standard fluoroscopic image, static trajectories are overlaid in this image to guide implant insertions. Fixed markers are not required. The purpose of this study was to identify the possible advantages of the new guidance technique. METHODS: For this study, 20 artificial hand specimens were randomized into two groups and blinded with polyurethane foam: 10 were treated conventionally and 10 were image guided. We used a clip containing radiopaque markers, which was detected by the system's workstation. A static trajectory was displayed consecutively in the fluoroscopic image to serve as an aiming device. Secondly, we included 3 patients with fractures of the scaphoid bone to test the integrability of this novel method in a clinical setting. RESULTS: In the experimental setup, trajectory guidance reduced the duration of surgery and radiation exposure. Furthermore, it reduced the perforation rate. Accuracy was not improved by the new technique. For clinical cases, the system was integrated into the accommodated surgical workflow and rated as very helpful by users. CONCLUSION: The system helped reduce the misplacement rate and the emission of radiation. The main limitations were that trajectories were not displayed in real time and could only be shown in a single fluoroscopic image. However, the system is simple and can be easily integrated into the surgical workflow.
Authors: Nael Hawi; Jonas Haentjes; Eduardo M Suero; Emmanouil Liodakis; Christian Krettek; Timo Stübig; Tobias Hüfner; Musa Citak Journal: Technol Health Care Date: 2012 Impact factor: 1.285
Authors: Jörn Zwingmann; Gerhard Konrad; Elmar Kotter; Norbert P Südkamp; Michael Oberst Journal: Clin Orthop Relat Res Date: 2008-11-26 Impact factor: 4.176
Authors: M Schädel-Höpfner; M Marent-Huber; M Sauerbier; T Pillukat; A Eisenschenk; H R Siebert Journal: Unfallchirurg Date: 2010-10 Impact factor: 1.000
Authors: Geert A Buijze; Job N Doornberg; John S Ham; David Ring; Mohit Bhandari; Rudolf W Poolman Journal: J Bone Joint Surg Am Date: 2010-06 Impact factor: 5.284