Abstract
Purpose: Fracture reduction (FR) during intra-medullary nailing of long bone fractures requires an extensive use of fluoroscopic radiation. Fluoroscopy based navigation system using custom FR software is introduced of which the main advantage is its ability to track simultaneously the two fracture segments during fracture reduction. The aim of this study was to test the feasibility of this system.
Methods: 26 Patients 17 males and 7 females suffering from 10 tibial shaft and 14 femoral shaft fracture were operated using the FR software. Two trackers were attached to each of the main fracture segments. Image registration was done by acquiring fluoroscopic images including the fracture site and the two metaphysial areas of the long bone on both perpendicular planes. The system uses two cylinder models representing the fracture segments, each defined between two points chosen by the surgeon on the acquired images, these are tracked by the system. Fracture reduction was qualitatively evaluated as well as other features of the system. Overall radiation was registered.
Results: A small number (< 10) of flouroscopic images was acquired; this decreased as we gained more experience. FR software was helpful in all the cases and accomplished good and quick reduction; it reduced the need for added radiation to 2–4 verification images.
The system was utilized as well in all cases for choosing the nail point of entry, in 7 (25%) for blocking screws planning and in 4 (16%) for nail locking successfully.
Conclusion: The FR software enabled and improved significantly the performance of this surgical task with a dramatic decrease in radiation and FR time. The software still lacks the fine tuning needed for best performance.
Correspondence should be addressed to: Orah Naor, IOA Secretary and Co-ordinator (email: ioanaor@netvision.net.il)
