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Published in: Archives of Orthopaedic and Trauma Surgery 6/2012

01-06-2012 | Orthopaedic Surgery

A novel method of image-based navigation in fracture surgery

Authors: Michael David Kraus, Christoph Dehner, Christoph Riepl, Hendrik Schöll, Florian Gebhard

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2012

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Abstract

The treatment of three- and four-part fractures of the humeral head is still controversially discussed. Some advocate primary arthroplasty while the results of primary fixation seem to be superior if no necrosis of the humeral head develops. Today navigation is used in orthopaedic surgery mainly for interventions on the spine, the pelvis and arthroplasty. In trauma surgery it is still rarely used and some technical problems need to be overcome. We report on a case of a three part fracture of the humeral head with mini-open reduction and fixation with image-based guided headless compression screws. For the fixation each screw was placed on the first trial, total radiation time was 60 s. At 12-month follow-up assessment radiographs showed a consolidated fracture, no loosening of the screws and a good glenohumeral articulation. The patient had free function of the shoulder and no pain, the constant score was 98 and the dash score 0. There is no evidence of a necrosis of the humeral head. The literature focuses on shoulder arthroplasty. There are no reports on the use of image-based guidance in shoulder traumatology so far. In conclusion, the described technique allows an accurate fixation of the humeral head fracture as the guidance system (Surgix®) ensures the “first try first hit” screw positioning. The new system was integrated in the workflow and supports the surgeon as an aiming device. The role of navigation system in enhancing minimally invasive surgery of the shoulder should be further explored.
Literature
1.
go back to reference Atmani H, Merienne F, Fofi D, Trouilloud P (2007) Computer aided surgery system for shoulder prosthesis placement. Comput Aided Surg 12:60–70PubMed Atmani H, Merienne F, Fofi D, Trouilloud P (2007) Computer aided surgery system for shoulder prosthesis placement. Comput Aided Surg 12:60–70PubMed
2.
go back to reference Biasca N, Schneider TO, Bungartz M (2009) Minimally invasive computer-navigated total knee arthroplasty. Orthop Clin North Am 40:537–563 Biasca N, Schneider TO, Bungartz M (2009) Minimally invasive computer-navigated total knee arthroplasty. Orthop Clin North Am 40:537–563
3.
go back to reference Bicknell RT, DeLude JA, Kedgley AE et al (2007) Early experience with computer-assisted shoulder hemiarthroplasty for fractures of the proximal humerus: development of a novel technique and an in vitro comparison with traditional methods. J Should Elbow Surg 16:S117–S125CrossRef Bicknell RT, DeLude JA, Kedgley AE et al (2007) Early experience with computer-assisted shoulder hemiarthroplasty for fractures of the proximal humerus: development of a novel technique and an in vitro comparison with traditional methods. J Should Elbow Surg 16:S117–S125CrossRef
4.
go back to reference Bosch U, Skutek M, Fremerey RW, Tscherne H (1998) Outcome after primary and secondary hemiarthroplasty in elderly patients with fractures of the proximal humerus. J Should Elbow Surg 7:479–484CrossRef Bosch U, Skutek M, Fremerey RW, Tscherne H (1998) Outcome after primary and secondary hemiarthroplasty in elderly patients with fractures of the proximal humerus. J Should Elbow Surg 7:479–484CrossRef
5.
go back to reference Briem D, Ruecker AH, Neumann J et al (2011) 3D fluoroscopic navigated reaming of the glenoid for total shoulder arthroplasty (TSA). Comput Aided Surg 16:93–99PubMedCrossRef Briem D, Ruecker AH, Neumann J et al (2011) 3D fluoroscopic navigated reaming of the glenoid for total shoulder arthroplasty (TSA). Comput Aided Surg 16:93–99PubMedCrossRef
6.
go back to reference Den HD, Van Lieshout EM, Tuinebreijer WE et al (2010) Primary hemiarthroplasty versus conservative treatment for comminuted fractures of the proximal humerus in the elderly (ProCon): A Multicenter Randomized Controlled trial. BMC Musculoskelet Disord 11:97CrossRef Den HD, Van Lieshout EM, Tuinebreijer WE et al (2010) Primary hemiarthroplasty versus conservative treatment for comminuted fractures of the proximal humerus in the elderly (ProCon): A Multicenter Randomized Controlled trial. BMC Musculoskelet Disord 11:97CrossRef
7.
go back to reference Edwards TB, Gartsman GM, O’Connor DP, Sarin VK (2008) Safety and utility of computer-aided shoulder arthroplasty. J Should Elbow Surg 17:503–508CrossRef Edwards TB, Gartsman GM, O’Connor DP, Sarin VK (2008) Safety and utility of computer-aided shoulder arthroplasty. J Should Elbow Surg 17:503–508CrossRef
8.
go back to reference Fankhauser F, Schippinger G, Weber K et al (2003) Cadaveric-biomechanical evaluation of bone-implant construct of proximal humerus fractures (Neer type 3). J Trauma 55:345–349PubMedCrossRef Fankhauser F, Schippinger G, Weber K et al (2003) Cadaveric-biomechanical evaluation of bone-implant construct of proximal humerus fractures (Neer type 3). J Trauma 55:345–349PubMedCrossRef
9.
go back to reference Goldman RT, Koval KJ, Cuomo F, Gallagher MA, Zuckerman JD (1995) Functional outcome after humeral head replacement for acute three- and four-part proximal humeral fractures. J Should Elbow Surg 4:81–86CrossRef Goldman RT, Koval KJ, Cuomo F, Gallagher MA, Zuckerman JD (1995) Functional outcome after humeral head replacement for acute three- and four-part proximal humeral fractures. J Should Elbow Surg 4:81–86CrossRef
10.
go back to reference Herman A, Dekel A, Botser IB, Steinberg EL (2009) Computer-assisted surgery for dynamic hip screw, using Surgix, a novel intraoperative guiding system. Int J Med Robot 5:45–50PubMedCrossRef Herman A, Dekel A, Botser IB, Steinberg EL (2009) Computer-assisted surgery for dynamic hip screw, using Surgix, a novel intraoperative guiding system. Int J Med Robot 5:45–50PubMedCrossRef
11.
go back to reference Jacob AL, Messmer P, Stock KW et al (1997) Posterior pelvic ring fractures: closed reduction and percutaneous CT-guided sacroiliac screw fixation. Cardiovasc Intervent Radiol 20:285–294PubMedCrossRef Jacob AL, Messmer P, Stock KW et al (1997) Posterior pelvic ring fractures: closed reduction and percutaneous CT-guided sacroiliac screw fixation. Cardiovasc Intervent Radiol 20:285–294PubMedCrossRef
12.
go back to reference Kedgley AE, DeLude JA, Drosdowech DS, Johnson JA, Bicknell RT (2008) Humeral head translation during glenohumeral abduction following computer-assisted shoulder hemiarthroplasty. J Bone Joint Surg Br 90:1256–1259PubMedCrossRef Kedgley AE, DeLude JA, Drosdowech DS, Johnson JA, Bicknell RT (2008) Humeral head translation during glenohumeral abduction following computer-assisted shoulder hemiarthroplasty. J Bone Joint Surg Br 90:1256–1259PubMedCrossRef
13.
go back to reference Kircher J, Wiedemann M, Magosch P, Lichtenberg S, Habermeyer P (2009) Improved accuracy of glenoid positioning in total shoulder arthroplasty with intraoperative navigation: a prospective-randomized clinical study. J Should Elbow Surg 18:515–520CrossRef Kircher J, Wiedemann M, Magosch P, Lichtenberg S, Habermeyer P (2009) Improved accuracy of glenoid positioning in total shoulder arthroplasty with intraoperative navigation: a prospective-randomized clinical study. J Should Elbow Surg 18:515–520CrossRef
14.
go back to reference Koulalis D, Kendoff D, Citak M, PF OL, Pearle AD (2011) Freehand versus navigated glenoid anchor positioning in anterior labral repair. Knee Surg Sports Traumatol Arthrosc 19(9):1554–1557 Koulalis D, Kendoff D, Citak M, PF OL, Pearle AD (2011) Freehand versus navigated glenoid anchor positioning in anterior labral repair. Knee Surg Sports Traumatol Arthrosc 19(9):1554–1557
15.
go back to reference Leung KS, Tang N, Cheung LW, Ng E (2010) Image-guided navigation in orthopaedic trauma. J Bone Joint Surg Br 92:1332–1337PubMedCrossRef Leung KS, Tang N, Cheung LW, Ng E (2010) Image-guided navigation in orthopaedic trauma. J Bone Joint Surg Br 92:1332–1337PubMedCrossRef
16.
go back to reference 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 88:1748–1754PubMedCrossRef 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 88:1748–1754PubMedCrossRef
17.
go back to reference Lill H, Josten C (2001) Conservative or operative treatment of humeral head fractures in the elderly? Chirurg 72:1224–1234PubMedCrossRef Lill H, Josten C (2001) Conservative or operative treatment of humeral head fractures in the elderly? Chirurg 72:1224–1234PubMedCrossRef
18.
go back to reference Mosheiff R, Weil Y, Peleg E, Liebergall M (2005) Computerised navigation for closed reduction during femoral intramedullary nailing. Injury 36:866–870PubMedCrossRef Mosheiff R, Weil Y, Peleg E, Liebergall M (2005) Computerised navigation for closed reduction during femoral intramedullary nailing. Injury 36:866–870PubMedCrossRef
19.
go back to reference Neer CS (1970) Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 52:1090–1103PubMed Neer CS (1970) Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 52:1090–1103PubMed
20.
go back to reference Nguyen D, Ferreira LM, Brownhill JR, Faber KJ, Johnson JA (2007) Design and development of a computer assisted glenoid implantation technique for shoulder replacement surgery. Comput Aided Surg 12:152–159PubMed Nguyen D, Ferreira LM, Brownhill JR, Faber KJ, Johnson JA (2007) Design and development of a computer assisted glenoid implantation technique for shoulder replacement surgery. Comput Aided Surg 12:152–159PubMed
21.
go back to reference Nguyen D, Ferreira LM, Brownhill JR et al (2009) Improved accuracy of computer assisted glenoid implantation in total shoulder arthroplasty: an in vitro randomized controlled trial. J Should Elbow Surg 18:907–914CrossRef Nguyen D, Ferreira LM, Brownhill JR et al (2009) Improved accuracy of computer assisted glenoid implantation in total shoulder arthroplasty: an in vitro randomized controlled trial. J Should Elbow Surg 18:907–914CrossRef
22.
go back to reference Schep NW, van Vugt AB (2006) Navigation surgery and fracture treatment. Ned Tijdschr Geneeskd 150:2301–2306PubMed Schep NW, van Vugt AB (2006) Navigation surgery and fracture treatment. Ned Tijdschr Geneeskd 150:2301–2306PubMed
23.
go back to reference Solberg BD, Moon CN, Franco DP, Paiement GD (2009) Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am 91:1689–1697PubMedCrossRef Solberg BD, Moon CN, Franco DP, Paiement GD (2009) Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am 91:1689–1697PubMedCrossRef
24.
go back to reference Sperling JW (2010) Operative treatment of proximal humerus fractures. J Should Elbow Surg 19:479CrossRef Sperling JW (2010) Operative treatment of proximal humerus fractures. J Should Elbow Surg 19:479CrossRef
25.
go back to reference Suhm N, Jacob LA, Zuna I, Regazzoni P, Messmer P (2003) Fluoroscopy based surgical navitation vs. mechanical guidance system for percutaneous interventions. A controlled prospective study exemplified by distal locking of intramedullary nails. Unfallchirurg 106:921–928PubMed Suhm N, Jacob LA, Zuna I, Regazzoni P, Messmer P (2003) Fluoroscopy based surgical navitation vs. mechanical guidance system for percutaneous interventions. A controlled prospective study exemplified by distal locking of intramedullary nails. Unfallchirurg 106:921–928PubMed
26.
go back to reference Suhm N, Messmer P, Zuna I, Jacob LA, Regazzoni P (2004) Fluoroscopic guidance versus surgical navigation for distal locking of intramedullary implants. A prospective, controlled clinical study. Injury 35:567–574PubMedCrossRef Suhm N, Messmer P, Zuna I, Jacob LA, Regazzoni P (2004) Fluoroscopic guidance versus surgical navigation for distal locking of intramedullary implants. A prospective, controlled clinical study. Injury 35:567–574PubMedCrossRef
27.
go back to reference Tjardes T, Shafizadeh S, Rixen D et al (2010) Image-guided spine surgery: state of the art and future directions. Eur Spine J 19:25–45PubMedCrossRef Tjardes T, Shafizadeh S, Rixen D et al (2010) Image-guided spine surgery: state of the art and future directions. Eur Spine J 19:25–45PubMedCrossRef
28.
go back to reference Tyryshkin K, Mousavi P, Beek M et al (2007) A navigation system for shoulder arthroscopic surgery. Proc Inst Mech Eng H 221:801–812PubMed Tyryshkin K, Mousavi P, Beek M et al (2007) A navigation system for shoulder arthroscopic surgery. Proc Inst Mech Eng H 221:801–812PubMed
29.
go back to reference Tyryshkin K, Mousavi P, Pichora DR, Abolmaesumi P (2006) Identification of anatomical landmarks for registration of CT and ultrasound images in computer-assisted shoulder arthroscopy. Conf Proc IEEE Eng Med Biol Soc 1:416–419PubMed Tyryshkin K, Mousavi P, Pichora DR, Abolmaesumi P (2006) Identification of anatomical landmarks for registration of CT and ultrasound images in computer-assisted shoulder arthroscopy. Conf Proc IEEE Eng Med Biol Soc 1:416–419PubMed
30.
go back to reference Verborgt O, De ST, Vanhees M et al (2011) Accuracy of placement of the glenoid component in reversed shoulder arthroplasty with and without navigation. J Should Elbow Surg 20:21–26CrossRef Verborgt O, De ST, Vanhees M et al (2011) Accuracy of placement of the glenoid component in reversed shoulder arthroplasty with and without navigation. J Should Elbow Surg 20:21–26CrossRef
31.
go back to reference Zyto K, Kronberg M, Brostrom LA (1995) Shoulder function after displaced fractures of the proximal humerus. J Should Elbow Surg 4:331–336CrossRef Zyto K, Kronberg M, Brostrom LA (1995) Shoulder function after displaced fractures of the proximal humerus. J Should Elbow Surg 4:331–336CrossRef
Metadata
Title
A novel method of image-based navigation in fracture surgery
Authors
Michael David Kraus
Christoph Dehner
Christoph Riepl
Hendrik Schöll
Florian Gebhard
Publication date
01-06-2012
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 6/2012
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-012-1471-1

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