Ultrasound-guided percutaneous scaphoid pinning: operator variability and comparison with traditional fluoroscopic procedure

Ultrasound-Based Registration for the Computer-Assisted Navigated Percutaneous Scaphoid Fixation

An ultrasound (US)-based computer-assisted approach has the potential to improve the accuracy and precision of screw placement for the percutaneous fixation of scaphoid fractures and also reduce the radiation dose for patient and clinical staff. Therefore, a surgical plan based on preoperative diagnostic computed tomography (CT) is registered with intraoperative US images, enabling a navigated percutaneous fracture fixation. However, approaches published so far rely on semimanual methods for intraoperative registration and are limited by long computation times. To address these challenges, we propose the employment of deep learning-based methods for US segmentation and registration in order to achieve a fast and fully automated yet robust registration process. For validation of the proposed US-based approach, we first provide a comparison of methods for segmentation and registration, assess their contribution to the overall error throughout our pipeline, and, finally, evaluate navigated screw placement in an in vitro study on 3-D printed carpal phantoms. Successful screw placement has been achieved for all ten screws, with deviations from the planned axis of 1.0 ± 0.6 and 0.7 ± 0.3 mm at the distal and proximal pole, respectively. The complete automation and total duration of about 12 s also allow seamless integration of our approach into the surgical workflow.

Review of Enhanced Handheld Surgical Drills

The handheld drill has been used as a conventional surgical tool for centuries. Alongside the recent successes of surgical robots, the development of new and enhanced medical drills has improved surgeon ability without requiring the high cost and consuming setup times that plague medical robot systems. This work provides an overview of enhanced handheld surgical drill research focusing on systems that include some form of image guidance and do not require additional hardware that physically supports or guides drilling. Drilling is reviewed by main contribution divided into audio-, visual-, or hardware-enhanced drills. A vision for future work to enhance handheld drilling systems is also discussed.

Percutaneous Treatment of Unstable Scaphoid Waist Fractures

BACKGROUND

Percutaneous techniques have been described for the treatment of nondisplaced scaphoid fractures, although less information has been reported about outcomes for unstable, displaced fractures. The aim of this study was to evaluate the union and complication rates following manual closed reduction and percutaneous screw placement for a consecutive series of unstable, displaced scaphoid fractures.

METHODS

A total of 28 patients (average age, 27 years; 22 male/6 female) were treated for isolated unstable displaced scaphoid waist fractures. Closed reduction and percutaneous headless, compression screw fixation was successfully performed in 14 patients (average age, 32 years; 10 male/4 female), and the remaining 14 patients required open reduction. Patients who underwent percutaneous treatment were followed for radiographic fracture union and clinical outcomes.

RESULTS

Thirteen of 14 fractures (93%) had clinical and radiographic evidence of bone union at an average of 2.8 months postoperatively. Average visual analog pain score at the time of union was 0.9. The average Quick Disability of the Arm, Shoulder, and Hand score at 2.5 years follow-up (range, 1.5-8.3 years) was 9.6 (range, 0.0-27.3). Complications included 1 case of nonunion and 1 case of intraoperative Kirschner wire breakage.

CONCLUSIONS

Manual closed reduction followed by percutaneous headless, compression screw fixation was possible in 50% of patients who presented with acute unstable, displaced scaphoid fractures. This technique appears to be a safe and effective method when a manual reduction is possible, and it may offer a less invasive option when compared with a standard open technique.