Robot-assisted S2 screw fixation for posterior pelvic ring injury

A case report of S1-S3 sacroiliac screw fixation for posterior pelvic ring injury with S1 sacral dysmorphism

INTRODUCTION

There are few reports on the treatment of pelvic posterior ring injury with Sacral 1 - Sacral 3(S1-S3)sacroiliac screw fixation. This article reports a case of pelvic posterior ring injury with S1 sacral dysmorphism treated with S1-S3 sacroiliac screw fixation and reviews the relevant research progress.

PRESENTATION OF THE CASE

A 72-year-old man riding e-bike was struck by a car at a high speed and diagnosed with pelvic fracture. The patient successfully underwent treatment of 3 sacroiliac screws (S1-S3) fixation. Postoperative X-rays and CT scans confirmed that all screws were in good position and located in the bone corridors. Follow up pelvic Majeed score of 96 at 11th month after surgery.

DISCUSSION

Preoperative CT scans of this patient showed that S1 segment was a dysmorphic sacrum with narrow corridor while S2 and S3 segments were wide corridors. S1-S3 sacroiliac screw fixation can be attempted.

CONCLUSION

For patients with posterior pelvic ring injury with S1 sacral dysmorphism, S1-S3 sacroiliac screw fixation may be a better choice.

Robotic Placement of 3 Trans-Sacral TransiIliac Screws Through a Single Corridor for U-Type Sacrum Fracture: A Case Report

CASE

We present a case of robot-assisted placement of 3 trans-sacral transiliac screws through a single corridor for an unstable U-type sacral fracture in a 95-year-old woman. She had persistent pain and inability to mobilize with physical therapy. At 3-month follow-up, the patient had evidence of interval healing and stable hardware and was able to return to her prior functional baseline.

CONCLUSION

We demonstrate successful utilization of robotics to place 3 trans-sacral transiliac screws in a single corridor for fixation of an unstable pelvic ring injury. This technique was used to overcome challenges with visualization and implant placement.

Complications of conventional percutaneous sacroiliac screw fixation of traumatic pelvic ring injuries: a systematic review and meta-analysis

OBJECTIVES

The objective of this review was to present a thorough overview of the complications associated with conventional percutaneous sacroiliac screw fixation to identify areas for improvement in surgical technique and patient selection.

METHODS

PubMed/Medline, Web of Science, Embase, Ovid, Cochrane library, and Google Scholar were systematically searched for original human studies reporting on complications of conventional percutaneous sacroiliac fixation in traumatic pelvic ring injuries from January 1, 2000, to April 30, 2022. The main meta-analysis was based on the random effect model to pool all complications reported in the included studies. The results were reported as weighted proportions with 95% confidence intervals. This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

A total of 56 studies with 3644 screws (2871 procedures) met the inclusion criteria, with a mean age of 40.5 years. The most frequently reported complications were screw malposition with a weighted proportion of 6% (95% CI: 5-9%) and involved 189 out of 3644 screws, persistent pain following the procedure with a weighted proportion of 3% (95% CI: 2-4%) and affected 98 out of 2871 patients, and nerve injury, which had a weighted proportion of 2% (95% CI: 1-3%) and was observed in 41 out of 2871 procedures. The L5 and S1 nerve roots were more frequently affected. Revision surgery was required for 184 out of 2871 patients with a weighted proportion of 5% (95% CI: 3-7%). The primary reason for the revision was persistent pain after the initial procedure, which affected 74 out of 184 patients, with a weighted proportion of 2.0% (95% CI: 1.2-2.8%).

CONCLUSIONS

This study showed that screw malposition, the need for revision surgery, persistent pain, and nerve injuries were the most frequent complications following conventional percutaneous sacroiliac screw fixation. However, these results must be interpreted in context due to confounding factors, including the lack of high-quality studies and the absence of uniformity in defining some complications across studies.

Effectiveness and Accuracy of a Patient-Specific Instrumentation System for Total Hip Arthroplasty

OBJECTIVE

Traditional total hip arthroplasty (THA) is often performed by visual inspection due to the lack of reliable reference, which results in inappropriate position of prosthesis and poor outcomes. This study attempts to introduce a novel patient-specific instrumentation (PSI) system and assess its effectiveness and accuracy compared with freehand operation and robot system through bone model experiments.

METHODS

Equally divide 30 sawbone models into the freehand group, PSI group, and robot group. Ten sets of prosthesis parameters were randomly generated as planning, and the three groups underwent simulated THA depending on these parameters. After the placement of the femoral prosthesis, the acetabular anteversion plan was adjusted in the PSI and robot groups so that the combined anteversion was maintained before and after adjustment. After the surgery, the actual prosthesis parameters of all bone models were measured and analyzed statistically.

RESULTS

No statistically significant difference was found in femoral anteversion error among the three groups (p = 0.951). The errors of acetabular cup anteversion, acetabular cup abduction, and combined anteversion in PSI group were 3.92° (2.94°, 4.62°), 5.65° (4.63°, 6.70°), and 3.93° (2.94°, 4.62°), respectively, which were significantly smaller than those in the freehand group [11.84° (9.92°, 13.87°), 13.54° (9.81°, 15.21°), 16.04° (8.18°, 19.25°), respectively, p < 0.05], but significantly larger than those in the robot group [1.34° (0.98°, 1.70°), 1.80° (1°, 2.02°), 1.34° (0.98°, 1.70°), respectively, p < 0.05].

CONCLUSION

Compared with the traditional freehand operation, the patient-specific instrumentation system is feasible in total hip arthroplasty because it improves the accuracy of prosthesis placement. In addition, the rapid measurement of intraoperative femoral prosthesis parameters can help surgeons optimize preoperative planning.

Robot-assisted versus conventional percutaneous sacroiliac screw fixation for posterior pelvic ring injuries: a systematic review and meta-analysis

PURPOSE

Robot-assisted pelvic screw fixation is a new technology with promising benefits on intraoperative outcomes for patients with posterior pelvic ring injuries. We aim to compare robot-assisted pelvic screw fixation to the traditional fluoroscopy-assisted technique with regards to intraoperative and postoperative outcomes.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used along with a search of electronic information to identify all studies comparing the outcomes of robot-assisted versus conventional screw fixation in patients with posterior pelvic ring injuries. Primary outcomes included operative duration (minutes), intraoperative bleeding (mL), fluoroscopy exposure and intraoperative drilling frequency. Secondary outcome measures included Majeed score, healing time (minutes) and rate (%), postoperative complications, screw positioning, incision length (cm) and guide wire insertion times (minutes). The random effects model was used for analysis.

RESULTS

Four observational studies including a total of 294 patients were identified. There was a significant difference between robot-assisted and conventional groups in terms of operative duration (MD = - 24.66, p < 0.05), intraoperative bleeding (MD = - 10.37, P < 0.05), fluoroscopy exposure (MD = - 2.15, P < 0.05) and intraoperative drilling frequency (MD = - 2.42, P =  < 0.05). For secondary outcomes, no significant difference was seen in Majeed score, healing time and rate and postoperative complications. The robot-assisted group had better screw positioning, smaller incision length, and shorter anaesthesia and guide wire insertion times.

CONCLUSIONS

Robot-assisted fixation has superior intraoperative outcomes compared to conventional fixation. Further studies are needed to look at postoperative outcomes as there is no significant difference in postoperative prognosis between the techniques.

TiRobot‑assisted versus conventional fluoroscopy-assisted percutaneous sacroiliac screw fixation for pelvic ring injuries: a meta‑analysis

BACKGROUND

The TiRobot is the only robot that has been reported in the literature for posterior pelvic injuries. We aim to compare TiRobot-assisted pelvic screw fixation with the conventional fluoroscopy-assisted percutaneous sacroiliac screw fixation.

METHODS

We conducted a meta-analysis to identify studies involving TiRobot‑assisted versus conventional percutaneous sacroiliac screw fixation for pelvic ring injuries in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and WanFang database, up to April 2022. The following keywords were used: "TiRobot," "robot," "robotic," "pelvic fracture," "screw fixation," "percutaneous," and "pelvic ring injury." Pooled effects of this meta-analysis were calculated using STATA SE version 15.0.

RESULTS

Compared with conventional fluoroscopy-assisted percutaneous sacroiliac screw fixation, TiRobot will result in less radiation exposure time of screw implantation (P = 0.000), less frequency of intraoperative fluoroscopy (P = 0.000), fewer guide wire attempts (P = 0.000), less intraoperative blood loss (P = 0.005), better screw accuracy (P = 0.011), better Majeed score (P = 0.031), and higher overall excellent and good rates of Majeed score (P = 0.018). However, there were no significant differences in terms of operative time (P = 0.055), fracture healing time (P = 0.365), and overall excellent and good rate of reduction accuracy (P = 0.426) between the two groups.

CONCLUSION

TiRobot-assisted fixation has less intraoperative fluoroscopy and intraoperative blood loss, superior screw accuracy, and Majeed score compared with conventional percutaneous sacroiliac screw fixation. TiRobot has no significant effect on operative time, fracture healing time, and reduction accuracy. Given the relevant possible biases in our meta-analysis, we required more adequately powered and better-designed RCT studies with long-term follow-up to reach a firmer conclusion.

Multimodal Neuroelectrophysiological Monitoring Combined with Robot-Assisted Placement of a Transiliac–Transsacral Screw for the Treatment of Transforaminal Sacral Fractures

Objective

This study aimed to evaluate the safety and efficacy of the fixation of transforaminal sacral fractures using TiRobot-assisted transiliac-transsacral (TITS) screws under multimodal neuroelectrophysiological monitoring (MNM).

Methods

From January 2019 to May 2021, 22 patients (17 male and 5 female patients) with transforaminal sacral fractures who were treated with closed reduction and placement of TiRobot-assisted TITS screws under MNM were retrospectively evaluated. The average age of the patients was 43.32 ± 11.40 years (range: 19–63). The patients received MNM, including somatosensory-evoked potentials (SEPs), motor-evoked potentials (MEPs), and electromyographic monitoring (EMG), prior to surgery, during closed reduction and the placement of the guidewire and TITS screw, and at the end of surgery. The operation was adjusted according to the MNM results.

Results

Overall, 22 TITS screws were inserted in 22 patients, including 5 TITS screws in the S1 body and 17 TITS screws in the S2 body. The average time needed for screw placement was 27.95 ± 6.84 mins, and the average frequency of X-ray fluoroscopy exposures was 31.00 ± 5.56 for each patient. Anterior ring fixation was performed in 4 patients using an external fixator, in 5 patients using cannulated screws, and in 13 patients using reconstruction plates. The mean follow-up time was 14.46 ± 2.46 months (12–20 months). Tornetta and Matta radiographic outcomes were excellent in 10 patients, good in 9 patients, fair in 2 patients, and poor in 1 patient. The proportion of excellent and good ratings was 86.36%. At the final follow-up, the average Majeed score was 82.18 ± 14.52, with clinical outcomes that were excellent in 9 patients, good in 9 patients, fair in 1 patient, and poor in 3 patients. The proportion of excellent and good ratings was 82.82%. Preoperatively, the amplitude of the SEP on the injured side was lower than that on the contralateral side before reduction in 9 patients (>50%). In this study, no screw was mistakenly inserted into the sacral canal, and no surgical site infection occurred.

Conclusion

MNM combined with TiRobot assistance can safely implant TITS screws and can effectively identify the neurological function of patients under anesthesia and reduce iatrogenic nerve injury.

Feasibility and accuracy of orthopaedic surgical robot system for intraoperative navigation to locate bone tunnel in anterior cruciate ligament reconstruction

BACKGROUND

The combination of navigational system and robotics has the potential to accurately identify and drill bone tunnels in anterior cruciate ligament (ACL) reconstruction. This study explores the feasibility and accuracy of bone tunnel positioning using the TiRobot, an orthopaedic surgical robot.

METHODS

The experiment was divided into two groups. In group A, the bone tunnels were positioned using the TiRobot surgical robot (n = 8). In group B, handheld locators were used for positioning (n = 8).

RESULTS

TiRobot can be used for positioning the ACL bone tunnel. The accuracy of positioning the femoral tunnel in group A and B was 1.00 ± 0.20 and 3.10 ± 0.59 mm, respectively (t = -9.49, P < 0.001). As for tibial tunnel, the accuracy was 1.02 ± 0.20 and 2.64 ± 0.14 mm, respectively (t = -18.54, P < 0.001).

CONCLUSIONS

The bone tunnel drilling precision using TiRobot for ACL reconstruction surgery was more accurate than traditional surgical techniques.