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Navigation system for robot-assisted intra-articular lower-limb fracture surgery
PURPOSE: In the surgical treatment for lower-leg intra-articular fractures, the fragments have to be positioned and aligned to reconstruct the fractured bone as precisely as possible, to allow the joint to function correctly again. Standard procedures use 2D radiographs to estimate the desired reduc...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034012/ https://www.ncbi.nlm.nih.gov/pubmed/27236651 http://dx.doi.org/10.1007/s11548-016-1418-z |
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author | Dagnino, Giulio Georgilas, Ioannis Köhler, Paul Morad, Samir Atkins, Roger Dogramadzi, Sanja |
author_facet | Dagnino, Giulio Georgilas, Ioannis Köhler, Paul Morad, Samir Atkins, Roger Dogramadzi, Sanja |
author_sort | Dagnino, Giulio |
collection | PubMed |
description | PURPOSE: In the surgical treatment for lower-leg intra-articular fractures, the fragments have to be positioned and aligned to reconstruct the fractured bone as precisely as possible, to allow the joint to function correctly again. Standard procedures use 2D radiographs to estimate the desired reduction position of bone fragments. However, optimal correction in a 3D space requires 3D imaging. This paper introduces a new navigation system that uses pre-operative planning based on 3D CT data and intra-operative 3D guidance to virtually reduce lower-limb intra-articular fractures. Physical reduction in the fractures is then performed by our robotic system based on the virtual reduction. METHODS: 3D models of bone fragments are segmented from CT scan. Fragments are pre-operatively visualized on the screen and virtually manipulated by the surgeon through a dedicated GUI to achieve the virtual reduction in the fracture. Intra-operatively, the actual position of the bone fragments is provided by an optical tracker enabling real-time 3D guidance. The motion commands for the robot connected to the bone fragment are generated, and the fracture physically reduced based on the surgeon’s virtual reduction. To test the system, four femur models were fractured to obtain four different distal femur fracture types. Each one of them was subsequently reduced 20 times by a surgeon using our system. RESULTS: The navigation system allowed an orthopaedic surgeon to virtually reduce the fracture with a maximum residual positioning error of [Formula: see text] (translational) and [Formula: see text] (rotational). Correspondent physical reductions resulted in an accuracy of 1.03 ± 0.2 mm and [Formula: see text] , when the robot reduced the fracture. CONCLUSIONS: Experimental outcome demonstrates the accuracy and effectiveness of the proposed navigation system, presenting a fracture reduction accuracy of about 1 mm and [Formula: see text] , and meeting the clinical requirements for distal femur fracture reduction procedures. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11548-016-1418-z) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5034012 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-50340122016-10-09 Navigation system for robot-assisted intra-articular lower-limb fracture surgery Dagnino, Giulio Georgilas, Ioannis Köhler, Paul Morad, Samir Atkins, Roger Dogramadzi, Sanja Int J Comput Assist Radiol Surg Original Article PURPOSE: In the surgical treatment for lower-leg intra-articular fractures, the fragments have to be positioned and aligned to reconstruct the fractured bone as precisely as possible, to allow the joint to function correctly again. Standard procedures use 2D radiographs to estimate the desired reduction position of bone fragments. However, optimal correction in a 3D space requires 3D imaging. This paper introduces a new navigation system that uses pre-operative planning based on 3D CT data and intra-operative 3D guidance to virtually reduce lower-limb intra-articular fractures. Physical reduction in the fractures is then performed by our robotic system based on the virtual reduction. METHODS: 3D models of bone fragments are segmented from CT scan. Fragments are pre-operatively visualized on the screen and virtually manipulated by the surgeon through a dedicated GUI to achieve the virtual reduction in the fracture. Intra-operatively, the actual position of the bone fragments is provided by an optical tracker enabling real-time 3D guidance. The motion commands for the robot connected to the bone fragment are generated, and the fracture physically reduced based on the surgeon’s virtual reduction. To test the system, four femur models were fractured to obtain four different distal femur fracture types. Each one of them was subsequently reduced 20 times by a surgeon using our system. RESULTS: The navigation system allowed an orthopaedic surgeon to virtually reduce the fracture with a maximum residual positioning error of [Formula: see text] (translational) and [Formula: see text] (rotational). Correspondent physical reductions resulted in an accuracy of 1.03 ± 0.2 mm and [Formula: see text] , when the robot reduced the fracture. CONCLUSIONS: Experimental outcome demonstrates the accuracy and effectiveness of the proposed navigation system, presenting a fracture reduction accuracy of about 1 mm and [Formula: see text] , and meeting the clinical requirements for distal femur fracture reduction procedures. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11548-016-1418-z) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2016-05-28 2016 /pmc/articles/PMC5034012/ /pubmed/27236651 http://dx.doi.org/10.1007/s11548-016-1418-z Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Article Dagnino, Giulio Georgilas, Ioannis Köhler, Paul Morad, Samir Atkins, Roger Dogramadzi, Sanja Navigation system for robot-assisted intra-articular lower-limb fracture surgery |
title | Navigation system for robot-assisted intra-articular lower-limb fracture surgery |
title_full | Navigation system for robot-assisted intra-articular lower-limb fracture surgery |
title_fullStr | Navigation system for robot-assisted intra-articular lower-limb fracture surgery |
title_full_unstemmed | Navigation system for robot-assisted intra-articular lower-limb fracture surgery |
title_short | Navigation system for robot-assisted intra-articular lower-limb fracture surgery |
title_sort | navigation system for robot-assisted intra-articular lower-limb fracture surgery |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034012/ https://www.ncbi.nlm.nih.gov/pubmed/27236651 http://dx.doi.org/10.1007/s11548-016-1418-z |
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