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Hestehave RA, Gundtoft PH, Nielsen CL, Brink O, Rölfing JD. Poor usability of computer-assisted navigation for hip fracture surgery. Arch Orthop Trauma Surg 2024; 144:251-257. [PMID: 37878075 PMCID: PMC10774189 DOI: 10.1007/s00402-023-05096-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/28/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION The STRYKER ADAPT computer-assisted navigation system provides intraoperative feedback to the surgeon regarding implant placement of the Gamma3 nail. The usability of the ADAPT system has not been evaluated. The aim of the study was to investigate the perceived usability of the ADAPT system. MATERIALS AND METHODS This was a descriptive study with prospectively collected data. ADAPT was introduced at Aarhus University Hospital in February 2021. Prior to introduction, surgeons at the department attended a general introduction to the system. ADAPT was introduced to the surgical nurses and was on display at the surgical ward at more than one occasion, where personal introduction to the system was possible. After introduction, it was mandatory to use ADAPT when using the Gamma3 nail to treat intertrochanteric femur fractures. After each procedure, primary and an eventual supervisor answered a questionnaire, which encompassed the System Usability Scale (SUS) questionnaire. The SUS is a ten-item questionnaire regarding the perceived usability of a system. SUS scores were translated to adjectives, describing user experience on a 7-point adjective scale (worst imaginable, awful, poor, ok, good, excellent, best imaginable). User acceptability, defined as "not acceptable", "marginal" or "acceptable", was also used to interpret the SUS scores. RESULTS ADAPT was used in 50 procedures by 29 different surgeons, with varying skill-level. Median SUS-score after first-time use of ADAPT for all 29 surgeons was 43 (range: 5-60), which translated to "poor" or "not acceptable". For surgeons who performed ≥ 3 ADAPT-assisted procedures, there were no statistically significant difference in their first to latest SUS-score (median difference: 4.3, p = 0.5). In free text comments ADAPT was positively described as helpful in placement of K-wire and providing educational opportunities for inexperienced surgeons and negatively as inconsistent, slow, time consuming, and causing excessive fluoroscopy. CONCLUSIONS Usability and acceptability of ADAPT was rated as "poor" or "not acceptable" by the majority of operating surgeons. ADAPT has not been used at our institution based on these findings. The System Usability Scale may be used in further research exploring usability and acceptability of novel computer-assisted navigation systems for orthopaedic surgery.
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Affiliation(s)
- Rasmus Abildtrup Hestehave
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J801, 8200, Aarhus, Denmark
| | - Per Hviid Gundtoft
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J801, 8200, Aarhus, Denmark
| | - Christian Lind Nielsen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J801, 8200, Aarhus, Denmark
| | - Ole Brink
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J801, 8200, Aarhus, Denmark
| | - Jan Duedal Rölfing
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J801, 8200, Aarhus, Denmark.
- Corporate HR, MidtSim, Central Denmark Region, Hedeager 5, 8200, Aarhus, Denmark.
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Lazzarini F, Paoli T, Cozzi Lepri A, Secci G, Zanna L, Innocenti M, Matassi F, Carulli C, Civinini R. Accuracy of radiographic projections to guide cephalic screw position in pertrochanteric fracture: a cadaveric study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:479-487. [PMID: 37624410 PMCID: PMC10771593 DOI: 10.1007/s00590-023-03690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE The aim of this study was to evaluate the relationship between the Löwenstein Lateral view and the True Lateral view for the positioning of the cephalic hip screw, through a cadaveric study. MATERIALS AND METHODS We placed two Kirschner wires in eight femur specimens using an Antero-Posterior view, Löwenstein Lateral view and True Lateral view. The distances between the Kirschner wires and the anterior, posterior, superior and inferior cortex were measured in all projections. The head of the femur was then sectioned, and the same macroscopic distances were measured. Finally, we could calculate the accuracy of the two radiographic lateral projections. RESULTS When the Kirschner wire was placed in the center of the head using the Antero-Posterior and the True Lateral view, the accuracy of Antero-Posterior view was 0.9705 while the accuracy of True Lateral view and Löwenstein Lateral view was 1.1479 and 1.1584, respectively. When the Kirschner wire was placed superior on the Antero-Posterior and centrally on the True Lateral view, the accuracy of Antero-Posterior view was 0.9930 while the accuracy of True Lateral view and Löwenstein Lateral view was 1.1159 and 0.7224, respectively. CONCLUSION When the Kirschner wire was positioned proximal in Antero-Posterior view and central in True Lateral view, only the True Lateral view showed high accuracy.
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Affiliation(s)
- Francesco Lazzarini
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital,, Via Antella 58, 50012, Bagno a Ripoli, Italy
| | - Tommaso Paoli
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital,, Via Antella 58, 50012, Bagno a Ripoli, Italy
| | - Andrea Cozzi Lepri
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
| | - Gregorio Secci
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy.
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital,, Via Antella 58, 50012, Bagno a Ripoli, Italy.
| | - Luigi Zanna
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital,, Via Antella 58, 50012, Bagno a Ripoli, Italy
| | - Matteo Innocenti
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
| | - Fabrizio Matassi
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
| | - Christian Carulli
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
| | - Roberto Civinini
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
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Gao H, Liu Z, Bai X, Wang G, Xu G, Ma J, Wang Y, Wang J, Chen W, Wang B. Comparison of freehand technique and a novel laser-guiding navigation system in femoral neck-cannulated screw fixation: a randomized controlled trial. BMC Surg 2023; 23:319. [PMID: 37872521 PMCID: PMC10594929 DOI: 10.1186/s12893-023-02226-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
Cannulated screw fixation is essential in treating femoral neck fractures, and the widely used freehand technique has several limitations. Therefore, we designed a new laser-positioning and navigation system and compared its efficacy with that of the traditional freehand technique in the cannulated screw fixation of femoral neck fractures. This randomized controlled single-blind trial recruited patients with femoral neck fracture, who were treated using either the newly designed laser-navigation device or the freehand technique. In in-vitro experiments, using the femoral neck model, the laser group was better than the freehand group in terms of operation time (P = 0.0153) and radiation exposure time (P < 0.001). In in-vivo experiments, involving 30 patients (15 in each group), the laser group was better than the freehand group in terms of operation time (P < 0.001), radiation exposure time (P < 0.001), blood loss (P < 0.001) and first success rate (P = 0.03). There was no difference in visual analog scale score, Harris score, and fracture-healing time between the two groups. In conclusion, the novel laser-guiding navigation system resulted in shorter operation time, less radiation exposure, and higher first success rate compared with the freehand technique. Further qualified investigations with a larger number of patients and longer follow-up are required in the future.
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Affiliation(s)
- Hua Gao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Liu
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaodong Bai
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Gang Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guoqiang Xu
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ji Ma
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yijun Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiatian Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wentao Chen
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Baojun Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Li H, Wang D, Zhang W, Xu G, Xu C, Zhang H, Zhang L, Li J, Tang P. Does computer-assisted orthopaedics system (ADAPT system) improve outcomes of intertrochanteric hip fractures? Injury 2023; 54:1047-1054. [PMID: 36759309 DOI: 10.1016/j.injury.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Intramedullary nailing (IMN) is a general treatment for intertrochanteric hip fractures. The computer-assisted orthopaedics system (CAOS), ADAPT system (Stryker, NJ), has been developed to facilitate lag screw insertion. When compared to the conventional freehand method, the efficacy of CAOS has not been clearly clarified. Therefore, we conducted this systematic review and meta-analysis to answer: does the CAOS performed better than freehand method in IMN. MATERIALS AND METHODS Studies published up to January 2023 were searched in the PubMed, Embase, Web of Science and Cochrane Library databases with predetermined key words. Comparative clinical studies between CAOS (ADAPT system) and freehand method were included. The primary outcomes of interest were the tip-apex-distance (TAD) and positions of lag screw. Fluoroscopy use, operation duration and intraoperative/postoperative complications were also extracted. A meta-analysis was performed for pooled analysis. RESULTS There were seven studies with 326 fractures in CAOS group and 325 fractures in Freehand group. All studies included presented high qualities. The CAOS group showed a statistically smaller TAD than Freehand group (weighted mean difference = -3.24 mm; 95% confidence interval [CI] -5.10 to -1.37 mm; p = 0.0007) and a better lag screw position (83/92 [90.2%] VS 64/92 [69.6%]; RR = 1.3; 95% CI 1.12 to 1.51; p = 0.0007). The operative time and radiation use revealed no difference between two groups. CONCLUSIONS The current evidence indicated that ADAPT system could help to perform a more accurate lag screw than freehand manipulation while the operative time and radiation time was not reduced as expectations on such new technique. Long-term follow-up studies are appealed.
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Affiliation(s)
- Hua Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wupeng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China; School of Medicine, Nankai University, No.94 Weijin Road, Tianjin, 300071, China
| | - Gaoxiang Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Hao Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Licheng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| | - Jiantao Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| | - Peifu Tang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
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Oberthür S, Sehmisch S, Weiser L, Viezens L, Stübig T. [Does navigation still have a value in trauma surgery?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:719-726. [PMID: 35960322 DOI: 10.1007/s00132-022-04288-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Navigation systems are supposed to increase precision and support surgeons while they perform certain interventions. 2D, or nowadays 3D, systems are used in image-based approaches. Image-free navigation uses 3D printing. INDICATIONS There are several studies on navigation procedures in trauma surgery. In contrast to limb surgery, the use of 3D navigation in pelvic and spine surgery is already well established. Navigation is especially regularly used to treat fractures of the posterior pelvic ring and for posterior stabilization of the cervical spine. REQUIREMENTS To be able to utilize navigation systems optimally, the learning curve should be completed, and the technique should be used regularly. In addition, the surgeon should know the surgical technique without navigation in order to recognize potential errors of the navigation. ADVANTAGES AND DISADVANTAGES Advantages include increased patient safety, reduction in radiation exposure and less invasive surgical procedures. However, among other disadvantages, initial costs are high.
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Affiliation(s)
- Swantje Oberthür
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Stephan Sehmisch
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Lukas Weiser
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Lennart Viezens
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Sektion Wirbelsäulenchirurgie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - Timo Stübig
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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