Robot-assisted Long Bone Fracture Reduction

The preferred treatment of femoral (thigh bone) shaft fractures nowadays is the minimally invasive technique of intramedullary nailing. However, in addition to its advantages, this technique also has a number of disadvantages, such as the frequent occurrence of malaligned fracture reductions and high X-ray exposure, especially to the operating team. The aim of our research is to overcome these shortcomings by utilizing modern techniques such as three-dimensional (3D) imaging, navigation, and robotics. In this paper we present the current state of our interdisciplinary research project. We first introduce a telemanipulated fracture reduction procedure, which is based on 3D imaging data. This set-up is improved one step further towards an automated fracture reduction procedure. Finally, two drilling tasks, namely the opening of the medullar cavity and the distal locking of the intramedullary nail, are presented, which are supported by automated X-ray-based image analysis and robot-assisted drill guidance. We show that high reduction accuracies can be achieved with our robotic system. Furthermore, the robot-assisted drill guidance achieves superior results with respect to increased precision and decreased Xray exposure compared with the conventional procedure. We conclude that this surgical procedure benefits conspicuously from the support of robotic assistance systems and that further research and development in this field is worthwhile. The International Journal of Robotics Research Vol. 28, No. 10, October 2009, pp. 1259–1278 DOI: 10.1177/0278364909101189 c The Author(s), 2009. Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav Figures 1–4, 6–10, 12–19 appear in color online: http://ijr.sagepub.com KEY WORDS—robot-assisted fracture reduction, telemanipulation, distal locking, intramedullary nailing, computerassisted orthopedic surgery, drill guidance.