Abstract
Objectives
Mechanical axis deviation of the lower extremity as a result of malreduction or malunion of fractures plays an important role in the development of arthritis. Therefore it is crucial to restore the limb alignment as accurate as possible. The purpose of this study was to evaluate the accuracy and precision of navigation in assessing isolated frontal plane (varus/valgus) deviations of the lower limb in a simulated fracture model of the femur.
Materials and methods
Three fracture models with ten specimens in each were created in femoral synthetic composite bones to simulate a subtrochanteric (AO/OTA 31-A1), mid-diaphyseal (AO/OTA 32-A3), and supracondylar (AO/OTA 33-A1) femur fracture. Each specimen was mounted on a custom holding device and registered with the navigation system. Eight custom-made aluminum wedges of varying angles (5°–26°) were used to create varus/valgus angulations at the fracture site. After wedge placement, the frontal plane deformity was recorded and registered by the navigation system. The means and standard deviations for each navigated wedge angle were calculated and compared to the actual wedge angle using a one sample t test. A single factor ANOVA test was subsequently performed to see if the differences between the navigated mean angles in each fracture group were statistically significant. The level of significance was defined as P < 0.05.
Results
None of the navigated mean angles were found to be significantly different from the actual wedge angles (P = 0.05–1.00). More specifically, the differences between the navigated mean angles and the actual wedge angles ranged from 0° to 0.7°. Furthermore, the differences between the navigated mean angles in each angle group were found to be statistically insignificant (P = 0.53–0.99).
Conclusion
The high accuracy and precision of navigation systems in determining frontal plane deformities of long bones can make them an invaluable tool for the exact reduction and realignment of lower extremity fractures.
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References
Hankemeier S, Hufner T, Wang G, Kendoff D, Zheng G, Richter M, Gosling T, Nolte L, Krettek C (2005) Navigated intraoperative analysis of lower limb alignment. Arch Orthop Trauma Surg 125:531–535
Heller M, Taylor W, Perka C, Duda G (2003) The influence of alignment on the musculo-skeletal loading conditions at the knee. Langenbecks Arch Surg 388:291–297
Gugenheim J, Brinker M (2003) Bone realignment with use of temporary external fixation for distal femoral valgus and varus deformities. J Bone Joint Surg Am 85:1229–1237
Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286:188–195
Paley D, Tetsworth K (1992) Mechanical axis deviations of the lower limbs. Clin Orthop Relat Res 280:48–64
Hsu RW, Himeno S, Coventry MB, Chao EY (1991) Normal axial alignment of the lower extremity and load bearing distribution at the knee. Clin Orthop 255:215–227
Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J (2004) Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 86:682–687
Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73:709–714
Lotke PA, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 59:77–79
Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 89:236–243
Pandher DS, Oh KJ, Boaparai RS, Josan GS (2007) Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 454:281–282
Nabeyama R, Matsuda S, Miura H, Mawatari T, Kawano T, Iwamoto Y (2004) The accuracy of image-guided knee replacement based on computer tomography. J Bone Joint Surg Br 86:366–371
Gottschling H, Roth M, Schweikard A, Burgkart R (2005) Intraoperative, fluoroscopy-based planning for complex osteotomies of the proximal femur. Int J Med Robot 1:67–73
Jackson DW, Warkentine B (2007) Technical aspects of computer-assisted opening wedge high tibial osteotomy. J Knee Surg 20:134–141
Maurer F, Wassmer G (2007) High tibial osteotomy: does navigation improve results? Orthopedics 30:327
Liebergall M, Ben-David D, Weil Y, Peyser A, Mosheiff R (2006) Computerized navigation for the internal fixation of femoral neck fractures. J Bone Joint Surg Am 88:1748–1754
Mosheiff R, Weil Y, Peleg E, Liebergall M (2005) Computerised navigation for closed reduction during femoral intramedullary nailing. Injury 36:866–870
Grutzner PA, Suhm N (2004) Computer aided long bone fracture treatment. Injury 35(suppl 1):S-A57–S-A64
Slomczykowski MA, Hofstetter R, Sati M, Krettek C, Nolte LP (2001) Novel computer-assisted fluoroscopy system for intraoperative guidance: feasibility study for distal locking of femoral nails. J Orthop Trauma 15:122–131
Chong KW, Wong MK, Rikhraj IS, Howe TS (2006) The use of computer navigation in performing minimally invasive surgery for intertrochanteric hip fractures–the experience in Singapore. Injury 37:755–762
Hofstetter R, Slomczykowski M, Krettek C, Koppen G, Sati M, Nolte LP (2000) Computer-assisted fluoroscopy-based reduction of femoral fractures and antetorsion correction. Comput Aided Surg 5:311–325
Citak M, Hufner T, Geerling J, Kfuri M Jr, Gansslen A, Look V, Kendoff D, Krettek C (2006) Navigated percutaneous pelvic sacroiliac screw fixation: experimental comparison of accuracy between fluoroscopy and Iso-C3D navigation. Comput Aided Surg 11:209–213
Hufner T, Kendoff D, Citak M, Geerling J, Krettek C (2006) Precision in orthopaedic computer navigation. Orthopade 35:1043–1055
Kendoff D, Bogojevic A, Citak M, Citak M, Maier C, Maier G, Krettek C, Hufner T (2007) Experimental validation of noninvasive referencing in navigated procedures on long bones. J Orthop Res 25:201–207
Matziolis G, Krocker D, Tohtz S, Weiss U, Perka C (2006) Accuracy of determination of the hip centre in navigated total knee arthroplasty. Z Orthop Ihre Grenzgeb 144:362–366
Kendoff D, Hufner T, Citak M, Geerling J, Maier C, Wesemeier F, Krettek C (2006) Implementation of a new navigated parallel drill guide for femoral neck fractures. Comput Aided Surg 11:317–321
Gardner MJ, Citak M, Kendoff D, Hufner T, Krettek C (2007) Decreased navigated drilling time using an external guide stabilizing device. Injury 38:755–758
Acknowledgments
This investigation was supported by internal research funds available through the Department of Orthopaedics and Trauma Surgery at the Hannover Medical School, Hannover, Germany. The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.
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Khalafi, A., Citak, M., Kendoff, D. et al. The accuracy and precision of computer assisted surgery in the assessment of frontal plane deviations of the lower extremity: a femoral fracture model. Arch Orthop Trauma Surg 129, 1183–1187 (2009). https://doi.org/10.1007/s00402-009-0818-8
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DOI: https://doi.org/10.1007/s00402-009-0818-8