A Portable Intra-Operative Framework Applied to Distal Radius Fracture Surgery
Fractures of the distal radius account for about 15% of all extremity fractures. To date, open reduction and internal plate fixation is the standard operative treatment. During the procedure, only fluoroscopic images are available for the planning of the
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Pattern Recognition Lab, FAU Erlangen-N¨ urnberg, Erlangen, Germany 2 Siemens Healthcare GmbH, Erlangen, Germany 3 Research Training Group 1773 “Heterogeneous Image Systems”, Erlangen, Germany 4 BG Trauma Center, Ludwigshafen am Rhein, Germany
Abstract. Fractures of the distal radius account for about 15% of all extremity fractures. To date, open reduction and internal plate fixation is the standard operative treatment. During the procedure, only fluoroscopic images are available for the planning of the screw placement and the monitoring of the instrument trajectory. Complications arising from malpositioned screws can lead to revision surgery. With the aim of improving screw placement accuracy, we present a prototype framework for fully intra-operative guidance that simplifies the planning transfer. Planning is performed directly intra-operatively and expressed in terms of screw configuration w.r.t the used implant plate. Subsequently, guidance is provided solely by a combination of locally positioned markers and a small camera placed on the surgical instrument that allows real-time position feedback. We evaluated our framework on 34 plastic bones and 3 healthy forearm cadaver specimens. In total, 146 screws were placed. On bone phantoms, we achieved an accuracy of 1.02 ± 0.57mm, 3.68 ± 4.38◦ and 1.77 ± 1.38◦ in the screw tip position and orientation (azimuth and elevation) respectively. On forearm specimens, we achieved a corresponding accuracy of 1.63 ± 0.91mm, 5.85 ± 4.93◦ and 3.48 ± 3.07◦ . Our analysis shows that our framework has the potential for improving the accuracy of the screw placement compared to the state of the art.
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Introduction
Fractures of the distal radius account for up to 15% of all extremity fractures. Open reduction and internal plate fixation is the most common operative treatment. During the procedure, intra-operative correct estimation of screw length and position under fluoroscopic control still represents a challenge. Among the reported complications (ranging from 6% to 80% [9]), several studies describe how the irregular anatomy of the distal radius leads to unrecognized cortical
The presented method is investigational use and is limited by law to investigational use. It is not commercially available and its future availability cannot be ensured.
c Springer International Publishing Switzerland 2015 N. Navab et al. (Eds.): MICCAI 2015, Part I, LNCS 9349, pp. 323–330, 2015. DOI: 10.1007/978-3-319-24553-9_40
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perforation by screw tips, regardless of the art of locking plating: dorsal, palmar or volar [2, 11]. Sugun et al. [11] reported a screw prominence rate of 25.65%, ranging from 0.5 to 6.1mm. In fact, depending on the type of view used (lateral, anterior-posterior, supinated, pronated, etc.) protrusions ranging from 3 to 6.5mm on average are required before protruding screws can be detected. It was also suggested that screw prominence greater than 1.5mm is likely to lead to complications [11]. Aurora et al. [2] reported that 9% of all complications are
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