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Reinforcing the role of the conventional C-arm - a novel method for simplified distal interlocking

BACKGROUND: The common practice for insertion of distal locking screws of intramedullary nails is a freehand technique under fluoroscopic control. The process is technically demanding, time-consuming and afflicted to considerable radiation exposure of the patient and the surgical personnel. A new co...

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Autores principales: Windolf, Markus, Schroeder, Josh, Fliri, Ladina, Dicht, Benno, Liebergall, Meir, Richards, R Geoff
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305668/
https://www.ncbi.nlm.nih.gov/pubmed/22276698
http://dx.doi.org/10.1186/1471-2474-13-8
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author Windolf, Markus
Schroeder, Josh
Fliri, Ladina
Dicht, Benno
Liebergall, Meir
Richards, R Geoff
author_facet Windolf, Markus
Schroeder, Josh
Fliri, Ladina
Dicht, Benno
Liebergall, Meir
Richards, R Geoff
author_sort Windolf, Markus
collection PubMed
description BACKGROUND: The common practice for insertion of distal locking screws of intramedullary nails is a freehand technique under fluoroscopic control. The process is technically demanding, time-consuming and afflicted to considerable radiation exposure of the patient and the surgical personnel. A new concept is introduced utilizing information from within conventional radiographic images to help accurately guide the surgeon to place the interlocking bolt into the interlocking hole. The newly developed technique was compared to conventional freehand in an operating room (OR) like setting on human cadaveric lower legs in terms of operating time and radiation exposure. METHODS: The proposed concept (guided freehand), generally based on the freehand gold standard, additionally guides the surgeon by means of visible landmarks projected into the C-arm image. A computer program plans the correct drilling trajectory by processing the lens-shaped hole projections of the interlocking holes from a single image. Holes can be drilled by visually aligning the drill to the planned trajectory. Besides a conventional C-arm, no additional tracking or navigation equipment is required. Ten fresh frozen human below-knee specimens were instrumented with an Expert Tibial Nail (Synthes GmbH, Switzerland). The implants were distally locked by performing the newly proposed technique as well as the conventional freehand technique on each specimen. An orthopedic resident surgeon inserted four distal screws per procedure. Operating time, number of images and radiation time were recorded and statistically compared between interlocking techniques using non-parametric tests. RESULTS: A 58% reduction in number of taken images per screw was found for the guided freehand technique (7.4 ± 3.4) (mean ± SD) compared to the freehand technique (17.6 ± 10.3) (p < 0.001). Total radiation time (all 4 screws) was 55% lower for the guided freehand technique compared to conventional freehand (p = 0.001). Operating time per screw (from first shot to screw tightened) was on average 22% reduced by guided freehand (p = 0.018). CONCLUSIONS: In an experimental setting, the newly developed guided freehand technique for distal interlocking has proven to markedly reduce radiation exposure when compared to the conventional freehand technique. The method utilizes established clinical workflows and does not require cost intensive add-on devices or extensive training. The underlying principle carries potential to assist implant positioning in numerous other applications within orthopedics and trauma from screw insertions to placement of plates, nails or prostheses.
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spelling pubmed-33056682012-03-16 Reinforcing the role of the conventional C-arm - a novel method for simplified distal interlocking Windolf, Markus Schroeder, Josh Fliri, Ladina Dicht, Benno Liebergall, Meir Richards, R Geoff BMC Musculoskelet Disord Technical Advance BACKGROUND: The common practice for insertion of distal locking screws of intramedullary nails is a freehand technique under fluoroscopic control. The process is technically demanding, time-consuming and afflicted to considerable radiation exposure of the patient and the surgical personnel. A new concept is introduced utilizing information from within conventional radiographic images to help accurately guide the surgeon to place the interlocking bolt into the interlocking hole. The newly developed technique was compared to conventional freehand in an operating room (OR) like setting on human cadaveric lower legs in terms of operating time and radiation exposure. METHODS: The proposed concept (guided freehand), generally based on the freehand gold standard, additionally guides the surgeon by means of visible landmarks projected into the C-arm image. A computer program plans the correct drilling trajectory by processing the lens-shaped hole projections of the interlocking holes from a single image. Holes can be drilled by visually aligning the drill to the planned trajectory. Besides a conventional C-arm, no additional tracking or navigation equipment is required. Ten fresh frozen human below-knee specimens were instrumented with an Expert Tibial Nail (Synthes GmbH, Switzerland). The implants were distally locked by performing the newly proposed technique as well as the conventional freehand technique on each specimen. An orthopedic resident surgeon inserted four distal screws per procedure. Operating time, number of images and radiation time were recorded and statistically compared between interlocking techniques using non-parametric tests. RESULTS: A 58% reduction in number of taken images per screw was found for the guided freehand technique (7.4 ± 3.4) (mean ± SD) compared to the freehand technique (17.6 ± 10.3) (p < 0.001). Total radiation time (all 4 screws) was 55% lower for the guided freehand technique compared to conventional freehand (p = 0.001). Operating time per screw (from first shot to screw tightened) was on average 22% reduced by guided freehand (p = 0.018). CONCLUSIONS: In an experimental setting, the newly developed guided freehand technique for distal interlocking has proven to markedly reduce radiation exposure when compared to the conventional freehand technique. The method utilizes established clinical workflows and does not require cost intensive add-on devices or extensive training. The underlying principle carries potential to assist implant positioning in numerous other applications within orthopedics and trauma from screw insertions to placement of plates, nails or prostheses. BioMed Central 2012-01-25 /pmc/articles/PMC3305668/ /pubmed/22276698 http://dx.doi.org/10.1186/1471-2474-13-8 Text en Copyright ©2012 Windolf et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Technical Advance
Windolf, Markus
Schroeder, Josh
Fliri, Ladina
Dicht, Benno
Liebergall, Meir
Richards, R Geoff
Reinforcing the role of the conventional C-arm - a novel method for simplified distal interlocking
title Reinforcing the role of the conventional C-arm - a novel method for simplified distal interlocking
title_full Reinforcing the role of the conventional C-arm - a novel method for simplified distal interlocking
title_fullStr Reinforcing the role of the conventional C-arm - a novel method for simplified distal interlocking
title_full_unstemmed Reinforcing the role of the conventional C-arm - a novel method for simplified distal interlocking
title_short Reinforcing the role of the conventional C-arm - a novel method for simplified distal interlocking
title_sort reinforcing the role of the conventional c-arm - a novel method for simplified distal interlocking
topic Technical Advance
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305668/
https://www.ncbi.nlm.nih.gov/pubmed/22276698
http://dx.doi.org/10.1186/1471-2474-13-8
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