1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
2
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
3
|
Tang L, Yi X, Yuan T, Li H, Xu C. Navigated intramedullary nailing for patients with intertrochanteric hip fractures is cost-effective at high-volume hospitals in mainland China: A markov decision analysis. Front Surg 2023; 9:1048885. [PMID: 36726954 PMCID: PMC9885142 DOI: 10.3389/fsurg.2022.1048885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/23/2022] [Indexed: 01/17/2023] Open
Abstract
Objective Previous studies have reported that navigation systems can improve clinical outcomes of intramedullary nailing (IMN) for patients with intertrochanteric fractures. However, information is lacking regarding the relationship between the costs of navigated systems and clinical outcomes. The present research aimed to evaluate the cost-effectiveness of navigated IMN as compared with traditional freehand IMN for patients with intertrochanteric fractures. Methods A Markov decision model with a 5-year time horizon was constructed to investigate the costs, clinical outcomes and incremental cost-effectiveness ratio (ICER) of navigated IMN for a 70-year-old patient with an intertrochanteric fracture in mainland China. The costs [Chinese Yuan (¥)], health utilities (quality-adjusted life-years, QALYs) and transition probabilities were obtained from published studies. The willingness-to-pay threshold for ICER was set at ¥1,40,000/QALY following the Chinese gross domestic product in 2020. Three institutional surgical volumes were used to determine the average navigation-related costs per patient: low volume (100 cases), medium volume (200 cases) and high volume (300 cases). Results Institutes at which 300, 200 and 100 cases of navigated IMN were performed per year showed an ICER of ¥43,149/QALY, ¥76,132.5/QALY and ¥1,75,083/QALY, respectively. Navigated IMN would achieve cost-effectiveness at institutes with an annual volume of more than 125 cases. Conclusions Our analysis demonstrated that the navigated IMN could be cost-effective for patients with inter-trochanteric fracture as compared to traditional freehand IMN. However, the cost-effectiveness was more likely to be achieved at institutes with a higher surgical volume.
Collapse
Affiliation(s)
- Liang Tang
- Department of Orthopaedics, Hengyang Central Hospital, The Affiliated Hengyang Hospital of Southern Medical University, Hengyang, China,Correspondence: Liang Tang Hua Li Cheng Xu
| | - Xiaoke Yi
- Department of Orthopaedics, Hengyang Central Hospital, The Affiliated Hengyang Hospital of Southern Medical University, Hengyang, China
| | - Ting Yuan
- Department of Orthopaedics, Hengyang Central Hospital, The Affiliated Hengyang Hospital of Southern Medical University, Hengyang, China
| | - Hua Li
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China,Correspondence: Liang Tang Hua Li Cheng Xu
| | - Cheng Xu
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China,Correspondence: Liang Tang Hua Li Cheng Xu
| |
Collapse
|
4
|
Murakami T, Yamazaki K, Ogasa H. ADAPT system is a dramatic advance in computer-assisted surgery for femoral trochanteric fractures. SICOT J 2021; 7:55. [PMID: 34738902 PMCID: PMC8570136 DOI: 10.1051/sicotj/2021056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: In recent years, computer-assisted surgery has made it possible to undergo surgery with a high degree of precision. This study aimed to investigate the usefulness of computer-assisted surgery for femoral trochanteric fractures using the ADAPT (ADAptive Positioning Technology) system. Methods: A total of forty patients with femoral trochanteric fracture underwent intramedullary nailing for fracture fixation: in twenty patients, the ADAPT system (ADAPT group), and in the other twenty, it was not used (control group). The operative time, intraoperative fluoroscopy time, tip apex distance (TAD), and tip to head surface distance (TSD) were measured and compared between the two groups to assess the efficiency and accuracy of the surgery. Results: The operative time was significantly shorter (P < 0.05), intraoperative fluoroscopy time was significantly reduced (P < 0.01), and implant placement was significantly better in the ADAPT group (P < 0.01). Conclusion: Navigation systems have been developed to improve the efficiency of surgery. The ADAPT system was considered a very useful device for intramedullary nailing of femoral trochanteric fractures, as it reduced the intraoperative fluoroscopy time and improved the accuracy of implant placement, also reducing the operative time.
Collapse
Affiliation(s)
- Tomotoshi Murakami
- Department of Orthopedic Surgery, Hagi Civil Hospital, 3460-3 Tubaki, Hagi City, Yamaguchi 758-0061, Japan
| | - Kazuhiro Yamazaki
- Department of Orthopedic Surgery, Hagi Civil Hospital, 3460-3 Tubaki, Hagi City, Yamaguchi 758-0061, Japan
| | - Hiroyoshi Ogasa
- Department of Orthopedic Surgery, Hagi Civil Hospital, 3460-3 Tubaki, Hagi City, Yamaguchi 758-0061, Japan
| |
Collapse
|
5
|
Simcox T, Tarazona D, Becker J, Ayres E, Gould J. Improved Implant Positioning of Cephalomedullary Nail for Trochanteric Fractures Using the Stryker ADAPT Navigation System. Injury 2021; 52:3404-3407. [PMID: 34311957 DOI: 10.1016/j.injury.2021.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/05/2021] [Accepted: 07/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tip-apex distance (TAD) of greater than 25 mm increases the risk of cephalomedullary nail (CMN) cutout for trochanteric hip fractures. The Stryker ADAPT navigation system provides intraoperative feedback to guide implant positioning. This study compares lag screw positioning using the ADAPT to conventional methods and investigates if the use of ADAPT impacts operating room efficiency. METHODS Retrospective review of 82 consecutive patients who underwent Stryker Gamma3 CMN for a peritrochanteric hip fracture. Study groups were assigned based on use of ADAPT navigation. Primary outcome was TAD. Secondary outcomes were lag screw position, operative time, and radiation dose. Univariate analysis of covariance was used to compare primary outcome measures, controlling for fracture classification. RESULTS 41 patients were assigned to each group. When comparing ADAPT and conventional groups mean TAD was 14.45±3.68 and 16.41±3.78 mm (p = 0.023). A higher portion of ADAPT nails (85.4% vs 63.4%, p = 0.024) were center- center within the femoral head compared to conventional methods. There were no significant differences with regards to operative time, fluoroscopy time, or radiation dose. CONCLUSION ADAPT navigation provides intraoperative feedback to achieve improved lag screw positioning, leading to improved TAD. The overall improvement in TAD does not likely reach clinical significance. The system requires minimal setup in the operating room, does not impact workflow, and the user interface is straight forward.
Collapse
Affiliation(s)
- Trevor Simcox
- Department of Orthopedic Surgery, NYU Langone - Long Island Hospital, NYU Langone Health, Mineola, New York, USA.
| | - Daniel Tarazona
- Department of Orthopedic Surgery, NYU Langone - Long Island Hospital, NYU Langone Health, Mineola, New York, USA
| | - Jacob Becker
- Department of Orthopedic Surgery, NYU Langone - Long Island Hospital, NYU Langone Health, Mineola, New York, USA
| | - Ethan Ayres
- Department of Orthopedic Surgery, NYU Langone - Long Island Hospital, NYU Langone Health, Mineola, New York, USA
| | - Jason Gould
- Department of Orthopedic Surgery, NYU Langone - Long Island Hospital, NYU Langone Health, Mineola, New York, USA
| |
Collapse
|
6
|
Gao Y, Wang H, Tu P, Hu J, Wang Q, Chen X. A novel dynamic electromagnetic tracking navigation system for distal locking of intramedullary nails. Comput Methods Programs Biomed 2021; 209:106326. [PMID: 34433127 DOI: 10.1016/j.cmpb.2021.106326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The accurate distal locking of intramedullary (IM) nails is a clinical challenge for surgeons. Although many navigation systems have been developed, a real-time guide method with free radiation exposure, better user convenience, and high cost performance has not been proposed. METHODS This paper aims to develop an electromagnetic navigation system named TianXuan-MDTS that provides surgeons with a proven surgical solution. And the registration method with external landmarks for IM nails and calibration algorithm for guiders were proposed. A puncture experiment, model experiments measured by 3D Slicer and cadaver experiments (2 cadaveric leg specimens and 6 drilling operations) are conducted to evaluate its performance and stability. RESULTS The registration deviations (TRE) is 1.05± 0.13 mm. In the puncture experiment, a success rate of 96% can be achieved in 45.94 s. TianXuan-MDTS were evaluated on 3 tibia model. The results demonstrated that all 9 screw holes were successfully prepared at a rate of 100% in 91.67 s. And the entry point, end point, and angular deviations were 1.60±0.20 mm, 1.47±0.18 mm, and 3.10±0.84°, respectively. Postoperative fluoroscopy in cadaver experiments showed that all drills were in the distal locking holes, with a success rate of 100% and the average time 143.17± 18.27 s. CONCLUSIONS The experimental results indicate that our system with novel registration and calibration methods could serve as a feasible and promising tool to assist surgeons during distal locking.
Collapse
Affiliation(s)
- Yao Gao
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Huixiang Wang
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Puxun Tu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Junlei Hu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qiugen Wang
- Trauma Center, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaojun Chen
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China; Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
7
|
Era M, Maeda J, Tomonaga T. Effect of a computer-assisted navigation system on the lag screw placement accuracy of less experienced surgeons. J Orthop Sci 2021; 26:823-6. [PMID: 32863102 DOI: 10.1016/j.jos.2020.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Femoral trochanteric fracture is treated by osteosynthesis using an angle-fixed implant. Lag screw cut-out is a postoperative complication, and a tip-apex distance (TAD) of 20 mm or shorter is recommended to prevent it. The use of a navigation system for lag screw placement has been reported, but the use and non-use of navigation systems by less experienced surgeons has not been assessed. The objective of this study was to retrospectively investigate the usefulness of a navigation system for short femoral nailing. METHODS The subjects were 101 patients with femoral trochanteric fracture treated by osteosynthesis at our hospital between May 2017 and December 2018 (male, 14; female, 87; mean age, 84.7 years; navigation use group, 55; non-navigation use group, 46). The patients were divided into four groups: groups treated by less experienced surgeons with (Navigation-Young surgeon [NY] group, n = 35) and without (Manual-Young surgeon [MY] group, n = 23) the use of a navigation system; and groups treated by experienced surgeons with (Navigation-Aged surgeon [NA] group, n = 20) and without (Manual-Aged surgeon [MA] group, n = 23) the use of a navigation system. TAD (mm) and operative time (min) were compared. RESULTS The TAD was significantly longer in the MY group than in the NY group. The percentages of patients with 10-20 mm TAD were as follows: NY group, 94.3%; MY group, 65.2%; NA group, 100%; MA group, 100%. The mean operative time was significantly longer in the NY group than in the MA group, but no significant difference in mean operative time was noted between the NY and MY groups or between the NA and MA groups. CONCLUSIONS A computer-assisted navigation system improves the accuracy of lag screw placement performed by less experienced operators without increasing the operative time.
Collapse
|
8
|
Gao H, Liu Z, Wang G, Wang B. A New Accurate, Simple and Less Radiation Exposure Device for Distal Locking of Femoral Intramedullary Nails. Int J Gen Med 2021; 14:4145-4153. [PMID: 34377014 PMCID: PMC8349542 DOI: 10.2147/ijgm.s321005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Due to the metal elasticity of intramedullary nails (IMs) and irregularities of the long bone marrow cavity and other reasons, one of the greatest challenges for surgeons is to position the distal locking screw. Therefore, a novel laser guiding navigation device was designed for the distal locking of femoral IMs. The purpose of this study was to compare the effectiveness of the novel device and freehand technique for distal locking of IMs in the femoral model. Methods The laser guiding navigation device (laser group) and freehand technique (freehand group) were used in the distal locking of the IMs in the femoral model. All operations were performed by surgeons of the same level. The differences between the two groups were compared in terms of operative time, radiation exposure time, first success rate, deviation angle between ideal trajectory and actual trajectory, and learning curve. Results The distal locking of the IMs in the femoral model was performed 40 times in each group. The results showed that the laser group was better than the freehand group in terms of operative time (345±165 VS 212±105 seconds, t=4.27, P<0.001), radiation exposure time (164±57 VS 41±15 seconds, t=13.15, P<0.001) and first successrate (χ 2=21.36, P<0.001). Compared with the freehand group, the actual trajectory of the laser group was closer to the ideal trajectory in coronal and horizontal planes. Furthermore, the learning curve time of the laser group was shorter. Conclusion Compared with traditional freehand technique, the novel laser guiding navigation device can shorten the operative time and reduce radiation exposure invitro. In addition, it is easy to master with more accuracy and a higher first success rate in vitro.
Collapse
Affiliation(s)
- Hua Gao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Zhenyu Liu
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Gang Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Baojun Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| |
Collapse
|
9
|
Takai H, Kitajima M, Takahashi T. Response to 'Letter to the editor about "Comparing the usefulness of a fluoroscopic navigation system in femoral trochanteric fracture for orthopaedic residents with the conventional method". Injury 2020; 51:2723-2724. [PMID: 32868070 DOI: 10.1016/j.injury.2020.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/22/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Hirokazu Takai
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kitaku, Kumamoto 860-8518, Japan.
| | - Masato Kitajima
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kitaku, Kumamoto 860-8518, Japan
| | - Tomoki Takahashi
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kitaku, Kumamoto 860-8518, Japan
| |
Collapse
|
10
|
Takai H, Mizuta K, Murayama M, Nakayama D, Kii S, Hayai C, Takahashi T. Comparing the usefulness of a fluoroscopic navigation system in femoral trochanteric fracture for orthopaedic residents with the conventional method. Injury 2020; 51:1840-1845. [PMID: 32540179 DOI: 10.1016/j.injury.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/29/2020] [Accepted: 06/01/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Lag screw insertion into the ideal position is essential to obtain good results in open reduction and internal fixation for femoral trochanteric fracture. Tip-apex distance (TAD) is a widely adopted method for evaluating the risk of lag screw cut-out. Adaptive positioning technology (ADAPT) is a fluoroscopic computer-assisted surgery system that enables orthopaedic surgeons to guide the screw into a proper position intraoperatively. A randomized control study concluded that ADAPT resulted in excellent TAD. However, it was not significantly better than conventional methods when performed by fellowship-trained traumatologists. Therefore, we hypothesised that ADAPT would be useful to orthopaedic residents and evaluated this usefulness. METHODS We reviewed 102 patients who underwent open reduction and internal fixation for femoral trochanteric fracture from May 2017 to March 2019 using Gamma-3 intertrochanteric nails. Two residents performed all procedures; 51 patients underwent surgery using ADAPT and the others underwent surgery without navigation. The number of attempts to drill guide-wire, operation time, lag screw insertion time, radiation exposure time, TAD, and lag screw position were evaluated for each surgeon. RESULTS In one resident, when using the ADAPT system, the number of attempts to drill guide-wire (p=0.001), lag screw insertion time (p=0.000), radiational exposure time (p=0.009) and TAD (p=0.007) were lower, and the percentage of ideal lag screw position (p=0.035) were better than that in the conventional method. However, there was no significant difference in the performance of another resident with respect to the aforementioned factors, whether using ADAPT or not. CONCLUSION One resident showed better results with the ADAPT system than with conventional osteosynthesis. However, another resident received no benefit from ADAPT. The efficiency may not apply to everyone as individual competence can influence efficiency when using ADAPT system. Therefore, as a new device, it must be used cautiously because skill or experience may influence its use, especially by orthopaedic residents.
Collapse
Affiliation(s)
- Hirokazu Takai
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan.
| | - Kazutaka Mizuta
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan
| | - Masatoshi Murayama
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan
| | - Daisuke Nakayama
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan
| | - Sakumo Kii
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan
| | - Chihiro Hayai
- Imaging Diagnostic Center, Kumamoto Kinoh Hospital, Kumamoto, Japan
| | - Tomoki Takahashi
- Department of Orthopaedic Surgery, Kumamoto Kinoh Hospital, Kumamoto, Japan
| |
Collapse
|
11
|
Weidert S, Sommer F, Suero EM, Becker CA, Pieske O, Greiner A, Kammerlander C, Böcker W, Grote S. Fluoroscopic Marker-Based Guidance System Improves Gamma Lag Screw Placement During Nailing of Intertrochanteric Fractures: A Randomized Controlled Trial. J Orthop Trauma 2020; 34:145-50. [PMID: 31725087 DOI: 10.1097/BOT.0000000000001662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine whether a fluoroscopy-based navigation system would improve tip-apex distance (TAD) compared with the conventional technique. DESIGN Randomized controlled trial. SETTING Level 1 trauma center. PATIENTS A total of 161 patients were screened for inclusion in the study. After meeting inclusion and exclusion criteria, 31 patients were randomized (n = 18 navigated vs. n = 13 control group), with the patient blinded to the result. INTERVENTION Fluoroscopy-based navigated guidance of lag screw length and position. MAIN OUTCOME MEASURES Average TAD and the proportion of TAD over 25 mm. RESULTS TAD was lower in the navigated group compared with the control group (mean = 17.5 vs. 24.2 mm; P = 0.0018). No navigated cases exceeded the 25 mm TAD threshold, compared with 39% of conventional cases (P = 0.0076). Navigation resulted in fewer drilling attempts compared with the conventional technique (median = 1 vs. 4 attempts; P < 0.0001). We detected no significant differences in operation time or total number of fluoroscopic images (P > 0.05). CONCLUSIONS Fluoroscopy-based computer navigated Gamma nailing for intertrochanteric fractures improved TAD and reduced the number of drilling attempts without increasing operation time compared with the conventional fluoroscopy-guided technique in a teaching hospital setting. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
12
|
Wu J, Shi Z, Li J, Xu S, Wang S, Wang Y. [Research progress of lateral wall injury of intertrochanteric fracture]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018; 32:1605-1610. [PMID: 30569691 PMCID: PMC8414235 DOI: 10.7507/1002-1892.201806115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/27/2018] [Indexed: 12/24/2022]
Abstract
Objective To summarize the general concept of lateral wall, the causes of lateral wall injury, and surgical strategies in order to improve the understanding of lateral wall and reduce the complications of operation. Methods The related literature on lateral wall was extensively reviewed, summarized, and analyzed. Results The superior extent of the lateral wall is vastus lateralis ridge and the inferior extent is the intersection between the lateral femoral cortex and a line drawn at a tangent to the inferior femoral neck. The integrity of the lateral wall is important to prevent the failure of fixation and reoperation of intertrochanteric fractures. The main causes of injury are that there is no suitable typing criteria as a guide, the fracture pattern shown by X-ray does not match with the actual situation of the fracture, the type of fracture is special, and the operation is improper. The main treatment is to reconstruct the lateral wall and choose different reconstruction methods according to different fracture patterns. Conclusion The lateral wall is very important for the treatment of intertrochanteric fracture. Lateral wall fracture should be internal fixation in order to minimize the risk of reoperation.
Collapse
Affiliation(s)
- Jianchao Wu
- Department of Orthopedics, the Second Affiliated Hospital of Lanzhou University, Lanzhou Gansu, 730030, P.R.China
| | - Zhengwei Shi
- Department of Orthopedics, the Second Affiliated Hospital of Lanzhou University, Lanzhou Gansu, 730030, P.R.China
| | - Jipeng Li
- Department of Orthopedics, the Second Affiliated Hospital of Lanzhou University, Lanzhou Gansu, 730030, P.R.China
| | - Shaoce Xu
- Department of Orthopedics, the Second Affiliated Hospital of Lanzhou University, Lanzhou Gansu, 730030, P.R.China
| | - Shiyao Wang
- Department of Orthopedics, the Second Affiliated Hospital of Lanzhou University, Lanzhou Gansu, 730030, P.R.China
| | - Yuliang Wang
- Department of Orthopedics, the Second Affiliated Hospital of Lanzhou University, Lanzhou Gansu, 730030,
| |
Collapse
|