Navigation system for robot-assisted intra-articular lower-limb fracture surgery

Article


Dagnino, G., Georgilas, I., Köhler, P., Morad, S., Atkins, R. and Dogramadzi, S. 2016. Navigation system for robot-assisted intra-articular lower-limb fracture surgery. International Journal of Computer Assisted Radiology and Surgery. 11, p. 1831–1843.
AuthorsDagnino, G., Georgilas, I., Köhler, P., Morad, S., Atkins, R. and Dogramadzi, S.
Abstract

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 0.95±0.3mm (translational) and 1.4∘±0.5∘ (rotational). Correspondent physical reductions resulted in an accuracy of 1.03 ± 0.2 mm and 1.56∘±0.1∘, 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 1.5∘, and meeting the clinical requirements for distal femur fracture reduction procedures.

JournalInternational Journal of Computer Assisted Radiology and Surgery
Journal citation11, p. 1831–1843
ISSN1861-6410
Year2016
PublisherSpringer
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Digital Object Identifier (DOI)doi:10.1007/s11548-016-1418-z
Web address (URL)https://doi.org/10.1007/s11548-016-1418-z
Publication dates
Online28 May 2016
Publication process dates
Accepted09 May 2016
Deposited09 Mar 2020
FunderNational Institute for Health Research
Copyright holder© 2016 The Authors
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