COMPUTER-ASSISTED TRAUMATOLOGY

Abstract

Purpose: We report the results of a study using fluoronavigation for distal locking of tibial and femoral nails and for screw fixation of femoral neck fractures in adults. We compared the duration of radiation exposure with the manual methods.

Material and methods: Among a cohort of 220, 32 were selected randomly for the distal locking or cervical screwing using fluoronavigation. The series included 22 tibial nails, 3 femoral nails, and seven femoral neck fixations. The Medtronic ION navigation system was used. The computerised system recognises the relative spatial positions of the patient, the fluoroscope and the instrument. Data are transmitted via an optical camera.

Results: We noted overall operative time and duration of radiation exposure by type of fracture. The duration of fluoroscopy ranged from 0.6 to 1.4 minutes for a tibial nailing using the conventional technique and 0.5 to 1 minute with fluoronavigation. For triple screwing, the fluoroscopy time was 1 minute 25 seconds. A total of 73 screws were inserted: 72 in correct position (one patient moved during the intervention). There were no nosocomial complications and no cases of compartment syndrome.

Discussion: Repeated exposure to x-rays can be a limiting factor for locked nailing. It takes only a short time to install the material and learn the software. During this first experience, the already short radiation exposure was divided in half despite the fact that each screw was controlled separately, which with experience would not be necessary. Improvements in the software will allow controlling the rotation of the limb and avoid length discrepancies.

Conclusion: In the traumatology unit, fluoronavigation is not a gadget to produce unnecessary virtual images. On the contrary, it improves safety for both the patient and the surgical team. This study demonstrates that patients can benefit from less radiating minimally invasive surgery allowing more precise insertion of the locking screws to avoid material failure. Future developments should improve the quality of the anatomic results of locked nailing and allow wider indications.