Abstract
Complex joint fractures often require an open surgical procedure, which is associated with extensive soft tissue damages and longer hospitalization and rehabilitation time. Percutaneous techniques can potentially mitigate these risks but their application to joint fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces involved in the fragment manipulation (due to the presence of soft tissue, e.g., muscles) which might result in fracture malreduction. Integration of robotic assistance and 3D image guidance can potentially overcome these issues. The authors propose an image-guided surgical robotic system for the percutaneous treatment of knee joint fractures, i.e., the robot-assisted fracture surgery (RAFS) system. It allows simultaneous manipulation of two bone fragments, safer robot-bone fixation system, and a traction performing robotic manipulator. This system has led to a novel clinical workflow and has been tested both in laboratory and in clinically relevant cadaveric trials. The RAFS system was tested on 9 cadaver specimens and was able to reduce 7 out of 9 distal femur fractures (T- and Y-shape 33-C1) with acceptable accuracy (≈1 mm, ≈5°), demonstrating its applicability to fix knee joint fractures. This study paved the way to develop novel technologies for percutaneous treatment of complex fractures including hip, ankle, and shoulder, thus representing a step toward minimally-invasive fracture surgeries.
Highlights
Traumatic fractures can lead to devastating clinical consequences for patients and substantial burden to healthcare systems
Cadaveric trials demonstrated the potential that the robot-assisted fracture surgery (RAFS) system can have for joint fracture surgery
Image-guidance and robotic assistance are combined to improve the surgical management of distal femur fractures
Summary
Traumatic fractures can lead to devastating clinical consequences for patients and substantial burden to healthcare systems. To avoid painful arthritis and/or additional surgeries, the fragments must be correctly aligned and fixed.[29] This often involves an open incision (i.e., open surgery) to expose the fractured bones and allow the surgeon to perform the anatomical reduction, i.e., to reposition and align the fragments as precisely as possible, ensuring the correct joint functionality. The 2D field of view does not provide enough information to the surgeon regarding the fracture alignment and rotation, necessitating multiple intra-operative images. This leads to prolonged radiation exposure of patient and staff[1] or, in up to 5% of cases, expensive revision operations to correct mal-positioned fractures.[23].
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