Recent trends, technical concepts and components of computer-assisted orthopedic surgery systems: A comprehensive review

Computer-assisted orthopedic surgery (CAOS) systems have become one of the most important and challenging types of system in clinical orthopedics, as they enable precise treatment of musculoskeletal diseases, employing modern clinical navigation systems and surgical tools. This paper brings a comprehensive review of recent trends and possibilities of CAOS systems. There are three types of the surgical planning systems, including: systems based on the volumetric images (computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound images), further systems utilize either 2D or 3D fluoroscopic images, and the last one utilizes the kinetic information about the joints and morphological information about the target bones. This complex review is focused on three fundamental aspects of CAOS systems: their essential components, types of CAOS systems, and mechanical tools used in CAOS systems. In this review, we also outline the possibilities for using ultrasound computer-assisted orthopedic surgery (UCAOS) systems as an alternative to conventionally used CAOS systems.Web of Science1923art. no. 519

The role of camera convergence in stereoscopic video see-through augmented reality displays

In the realm of wearable augmented reality (AR) systems, stereoscopic video see-through displays raise issues related to the user's perception of the three-dimensional space. This paper seeks to put forward few considerations regarding the perceptual artefacts common to standard stereoscopic video see-through displays with fixed camera convergence. Among the possible perceptual artefacts, the most significant one relates to diplopia arising from reduced stereo overlaps and too large screen disparities. Two state-of-the-art solutions are reviewed. The first one suggests a dynamic change, via software, of the virtual camera convergence, whereas the second one suggests a matched hardware/software solution based on a series of predefined focus/vergence configurations. Potentialities and limits of both the solutions are outlined so as to provide the AR community, a yardstick for developing new stereoscopic video see-through systems suitable for different working distances

Body sensor networks: smart monitoring solutions after reconstructive surgery

Advances in reconstructive surgery are providing treatment options in the face of major trauma and cancer. Body Sensor Networks (BSN) have the potential to offer smart solutions to a range of clinical challenges. The aim of this thesis was to review the current state of the art devices, then develop and apply bespoke technologies developed by the Hamlyn Centre BSN engineering team supported by the EPSRC ESPRIT programme to deliver post-operative monitoring options for patients undergoing reconstructive surgery. A wireless optical sensor was developed to provide a continuous monitoring solution for free tissue transplants (free flaps). By recording backscattered light from 2 different source wavelengths, we were able to estimate the oxygenation of the superficial microvasculature. In a custom-made upper limb pressure cuff model, forearm deoxygenation measured by our sensor and gold standard equipment showed strong correlations, with incremental reductions in response to increased cuff inflation durations. Such a device might allow early detection of flap failure, optimising the likelihood of flap salvage. An ear-worn activity recognition sensor was utilised to provide a platform capable of facilitating objective assessment of functional mobility. This work evolved from an initial feasibility study in a knee replacement cohort, to a larger clinical trial designed to establish a novel mobility score in patients recovering from open tibial fractures (OTF). The Hamlyn Mobility Score (HMS) assesses mobility over 3 activities of daily living: walking, stair climbing, and standing from a chair. Sensor-derived parameters including variation in both temporal and force aspects of gait were validated to measure differences in performance in line with fracture severity, which also matched questionnaire-based assessments. Monitoring the OTF cohort over 12 months with the HMS allowed functional recovery to be profiled in great detail. Further, a novel finding of continued improvements in walking quality after a plateau in walking quantity was demonstrated objectively. The methods described in this thesis provide an opportunity to revamp the recovery paradigm through continuous, objective patient monitoring along with self-directed, personalised rehabilitation strategies, which has the potential to improve both the quality and cost-effectiveness of reconstructive surgery services.Open Acces

Pelvic ring injuries:recovery of patient-perceived physical functioning and quality of life

Sustaining a pelvic ring injury is a life event that is likely to have a major and long-lasting effect on the patient’s daily life. Even after two years, 25% of patients have not yet returned to their pre-injury level of physical functioning and quality of life. The physical and mental consequences require a holistic approach to both treatment and outcome evaluation. Valid and reliable patient-reported outcome measures (PROMs) on physical and mental functioning and quality of life should be the most important aspects in evaluation of treatment and rehabilitation protocols. These PROMs may be an important step toward further improving rehabilitation programs. Ideally, rehabilitation should be approached multidisciplinary and involves trauma surgeons, rehabilitations physicians, geriatricians, physiotherapists, psychologists and dieticians. By encouraging the patient to stay in charge of his own health, the focus can shift towards the patient’s strength rather than his weakness, and subsequently improve resilience. Special attention should be paid to the fragile elderly patient who is at risk for serious injuries, even after minor trauma, complications and high-mortality up to 27% within a year. This can be related to the pre-existing limited physical condition as a result of comorbidities or decreased muscle quality and quantity, of which the latter was found to be present in almost half of elderly patients with pelvic ring injuries. Surgical treatment of pelvic ring injuries can be improved by using three-dimensional assisted techniques which tend to have a positive influence on operating time, blood loss, radiation and screw accuracy

The prevention of infection in open fractures: an experimental study of the effects of fracture stability and of antibiotic therapy

An experimental model of a contaminated open fracture has been developed in rabbits, using a reproducible midshaft fracture of the tibia. This model has been used to: 1) Test the hypothesis that stable fixation of an open fracture will reduce its susceptibility to infection. 2) Assess the effect of antibiotics on infection rate, with particular reference to the delay in administering the initial dose. The pattern of fracture healing was initially determined for stable and unstable fixation, without inoculation with bacteria. Fractures fixed with a dynamic compression plate ("stable" group) healed by primary bone union, while fractures stabilised with a loose-fitting intramedullary rod ("unstable" group) healed by external callus formation. Forty- one rabbits were used in the definitive study of the effect of stability. All fractures were inoculated with Staphylococcus aureus in a standard concentration. There were twenty rabbits in the stable group (compression plate) and osteomyelitis developed in seven (35%). Of the twenty- one rabbits in the unstable group (loose- fitting intramedullary rod), fifteen (71%) became infected. This difference in infection rate is statistically significant (p<0.02). The "rod- fixed fracture" model had the highest infection rate and was therefore used to study the effect of antibiotics. Fifty-one rabbits were used; a single intramuscular injection of cephradine was given to each animal at varying times in relation to inoculation with bacteria. Although the maximal reduction in infection rate was observed when the antibiotic was given before inoculation with bacteria, a 40% decrease in the infection rate was still seen when the antibiotic was given after bacterial inoculation. This effect persisted even if the initial dose of antibiotic was delayed four hours after inoculation. These findings support the concept of stabilisation of open fractures in man; and suggest that appropriate systemic antibiotics should be routinely used in the management of open fractures in man, even if the treatment is delayed up to four hours after injury

The biology and treatment of acute long-bones diaphyseal fractures: Overview of the current options for bone healing enhancement

Diaphyseal fractures represent a complex biological entity that could often end into impaired bone-healing, with delayed union and non-union occurring up to 10% of cases. The role of the modern orthopaedic surgeon is to optimize the fracture healing environment, recognize and eliminate possible interfering factors, and choose the best suited surgical fixation technique. The impaired reparative process after surgical intervention can be modulated with different surgical techniques, such as dynamization or exchange nailing after failed intramedullary nailing. Moreover, the mechanical stability of a nail can be improved through augmentation plating, bone grafting or external fixation techniques with satisfactory results. According to the “diamond concept”, local therapies, such as osteoconductive scaffolds, bone growth factors, and osteogenic cells can be successfully applied in “polytherapy” for the enhancement of delayed union and non-union of long bones diaphyseal fractures. Moreover, systemic anti-osteoporosis anabolic drugs, such as teriparatide, have been proposed as off-label treatment for bone healing enhancement both in fresh complex shaft fractures and impaired unions, especially for fragility fractures. The article aims to review the biological and mechanical principles of failed reparative osteogenesis of diaphyseal fractures after surgical treatment. Moreover, the evidence about the modern non-surgical and pharmacological options for bone healing enhancement will discussed

A Textbook of Advanced Oral and Maxillofacial Surgery

The scope of OMF surgery has expanded; encompassing treatment of diseases, disorders, defects and injuries of the head, face, jaws and oral cavity. This internationally-recognized specialty is evolving with advancements in technology and instrumentation. Specialists of this discipline treat patients with impacted teeth, facial pain, misaligned jaws, facial trauma, oral cancer, cysts and tumors; they also perform facial cosmetic surgery and place dental implants. The contents of this volume essentially complements the volume 1; with chapters that cover both basic and advanced concepts on complex topics in oral and maxillofacial surgery

Oral and Maxillofacial Surgery

Oral and maxillofacial surgery is a specialized branch of dentistry that deals with the surgical management of various head and neck pathologies. The specialty focuses on reconstructive surgery of the oro-facial region, surgery of facial trauma, the oral cavity and jaws, dental implants as well as cosmetic surgery. As such, surgeons in this field require extensive knowledge of not only these various surgical procedures but also head and neck anatomy. This book provides comprehensive information on both. Its goal is to educate oral and maxillofacial surgeons to enable them to treat a wide range of conditions and diseases using the most current surgical trends