J Orthop Surg Res. 2010 Aug 04;5:50. doi: 10.1186/1749-799X-5-50.

An interactive surgical planning tool for acetabular fractures: initial results.

Journal of orthopaedic surgery and research

Jürgen Fornaro, Marius Keel, Matthias Harders, Borut Marincek, Gábor Székely, Thomas Frauenfelder

PMID: 20684761 PMCID: PMC2923114 DOI: 10.1186/1749-799X-5-50

Abstract

BACKGROUND: Acetabular fractures still are among the most challenging fractures to treat because of complex anatomy, involved surgical access to fracture sites and the relatively low incidence of these lesions. Proper evaluation and surgical planning is necessary to achieve anatomic reduction of the articular surface and stable fixation of the pelvic ring. The goal of this study was to test the feasibility of preoperative surgical planning in acetabular fractures using a new prototype planning tool based on an interactive virtual reality-style environment.

METHODS: 7 patients (5 male and 2 female; median age 53 y (25 to 92 y)) with an acetabular fracture were prospectively included. Exclusion criterions were simple wall fractures, cases with anticipated surgical dislocation of the femoral head for joint debridement and accurate fracture reduction. According to the Letournel classification 4 cases had two column fractures, 2 cases had anterior column fractures and 1 case had a T-shaped fracture including a posterior wall fracture.The workflow included following steps: (1) Formation of a patient-specific bone model from preoperative computed tomography scans, (2) interactive virtual fracture reduction with visuo-haptic feedback, (3) virtual fracture fixation using common osteosynthesis implants and (4) measurement of implant position relative to landmarks. The surgeon manually contoured osteosynthesis plates preoperatively according to the virtually defined deformation. Screenshots including all measurements for the OR were available.The tool was validated comparing the preoperative planning and postoperative results by 3D-superimposition.

RESULTS: Preoperative planning was feasible in all cases. In 6 of 7 cases superimposition of preoperative planning and postoperative follow-up CT showed a good to excellent correlation. In one case part of the procedure had to be changed due to impossibility of fracture reduction from an ilioinguinal approach. In 3 cases with osteopenic bone patient-specific prebent fixation plates were helpful in guiding fracture reduction. Additionally, anatomical landmark based measurements were helpful for intraoperative navigation.

CONCLUSION: The presented prototype planning tool for pelvic surgery was successfully integrated in a clinical workflow to improve patient-specific preoperative planning, giving visual and haptic information about the injury and allowing a patient-specific adaptation of osteosynthesis implants to the virtually reduced pelvis.

References

1. Comput Aided Surg. 2002;7(3):169-78 - PubMed
2. J Bone Joint Surg Br. 2007 Feb;89(2):145-54 - PubMed
3. J Orthop Trauma. 2006 Jan;20(1 Suppl):S20-9 - PubMed
4. Injury. 2007 Apr;38(4):442-9 - PubMed
5. Stud Health Technol Inform. 2008;132:123-5 - PubMed
6. J Trauma. 2006 Sep;61(3):662-7 - PubMed
7. J Orthop Res. 2008 Apr;26(4):547-52 - PubMed
8. Injury. 2007 Apr;38(4):463-77 - PubMed
9. Radiology. 2006 Nov;241(2):386-91 - PubMed
10. Clin Orthop Relat Res. 1994 Aug;(305):112-23 - PubMed
11. Orthop Clin North Am. 1997 Jul;28(3):419-34 - PubMed
12. Emerg Radiol. 2007 Oct;14(5):271-87 - PubMed
13. J Orthop Trauma. 1987;1(3):227-32 - PubMed
14. J Trauma. 1999 Dec;47(6):1063-71 - PubMed
15. Unfallchirurg. 1999 Aug;102(8):589-90 - PubMed
16. J Orthop Trauma. 2002 May;16(5):347-52 - PubMed
17. Clin Orthop Relat Res. 1993 Jul;(292):62-76 - PubMed
18. Injury. 2007 Apr;38(4):431-41 - PubMed
19. AJR Am J Roentgenol. 2004 Oct;183(4):1000-2 - PubMed
20. Clin Orthop Relat Res. 1993 Dec;(297):28-32 - PubMed
21. Injury. 2007 Apr;38(4):497-508 - PubMed
22. Clin Orthop Relat Res. 1980 Sep;(151):81-106 - PubMed

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• Journal Article