Developments in circular external fixators: a review

Circular external fixators (CEFs) are successfully used in orthopedics owing to their highly favorable stiffness characteristics which promote distraction osteogenesis. Although there are different designs of external fixators, how these features produce optimal biomechanics through structural and component designs is not well known. Therefore, the aim of this study was to conduct a review on CEFs following the PRISMA statement. A search for relevant research articles was performed on Scopus and PubMed databases providing the related keywords. Furthermore, a patent search was conducted on the Google Patent database. 126 records were found to be eligible for the review. Different designs of CEFs were summarized and tabulated based on their specific features. A bibliometric analysis was also performed on the eligible research papers. Based on the findings, the developments of CEFs in terms of materials, automation, adjustment methods, component designs, wire-clamping, and performance evaluation have been extensively discussed. The trends of the CEF design and future directions are also discussed in this review. Significant research gaps include a lack of consideration towards ease of assembly, effective wire-clamping methods, and CEFs embedded with online patient-monitoring systems, among others. An apparent lack of research interest from low-middle and low-income countries was also identified

Advances in identifying osseous fractured areas and virtually reducing bone fractures

[ES]Esta tesis pretende el desarrollo de técnicas asistidas por ordenador para ayudar a los especialistas durante la planificación preoperatoria de una reducción de fractura ósea. Como resultado, puede reducirse el tiempo de intervención y pueden evitarse errores de interpretación, con los consecuentes beneficios en el tratamiento y en el tiempo de recuperación del paciente. La planificación asistida por ordenador de una reducción de fractura ósea puede dividirse en tres grandes etapas: identificación de fragmentos óseos a partir de imágenes médicas, cálculo de la reducción y posterior estabilización de la fractura, y evaluación de los resultados obtenidos. La etapa de identificación puede incluir también la generación de modelos 3D de fragmentos óseos. Esta tesis aborda la identificación de fragmentos óseos a partir de imágenes médicas generadas por TC, la generación de modelos 3D de fragmentos, y el cálculo de la reducción de fracturas, sin incluir el uso de elementos de fijación.[EN]The aim of this work is the development of computer-assisted techniques for helping specialists in the pre-operative planning of bone fracture reduction. As a result, intervention time may be reduced and potential misinterpretations circumvented, with the consequent benefits in the treatment and recovery time of the patient. The computer-assisted planning of a bone fracture reduction may be divided into three main stages: identification of bone fragments from medical images, computation of the reduction and subsequent stabilization of the fracture, and evaluation of the obtained results. The identification stage may include the generation of 3D models of bone fragments, with the purpose of obtaining useful models for the two subsequent stages. This thesis deals with the identification of bone fragments from CT scans, the generation of 3D models of bone fragments, and the computation of the fracture reduction excluding the use of fixation devices.Tesis Univ. Jaén. Departamento de Informática. Leída 19 de septiembre de 201

ADVANCED MOTION MODELS FOR RIGID AND DEFORMABLE REGISTRATION IN IMAGE-GUIDED INTERVENTIONS

Image-guided surgery (IGS) has been a major area of interest in recent decades that continues to transform surgical interventions and enable safer, less invasive procedures. In the preoperative contexts, diagnostic imaging, including computed tomography (CT) and magnetic resonance (MR) imaging, offers a basis for surgical planning (e.g., definition of target, adjacent anatomy, and the surgical path or trajectory to the target). At the intraoperative stage, such preoperative images and the associated planning information are registered to intraoperative coordinates via a navigation system to enable visualization of (tracked) instrumentation relative to preoperative images. A major limitation to such an approach is that motions during surgery, either rigid motions of bones manipulated during orthopaedic surgery or brain soft-tissue deformation in neurosurgery, are not captured, diminishing the accuracy of navigation systems. This dissertation seeks to use intraoperative images (e.g., x-ray fluoroscopy and cone-beam CT) to provide more up-to-date anatomical context that properly reflects the state of the patient during interventions to improve the performance of IGS. Advanced motion models for inter-modality image registration are developed to improve the accuracy of both preoperative planning and intraoperative guidance for applications in orthopaedic pelvic trauma surgery and minimally invasive intracranial neurosurgery. Image registration algorithms are developed with increasing complexity of motion that can be accommodated (single-body rigid, multi-body rigid, and deformable) and increasing complexity of registration models (statistical models, physics-based models, and deep learning-based models). For orthopaedic pelvic trauma surgery, the dissertation includes work encompassing: (i) a series of statistical models to model shape and pose variations of one or more pelvic bones and an atlas of trajectory annotations; (ii) frameworks for automatic segmentation via registration of the statistical models to preoperative CT and planning of fixation trajectories and dislocation / fracture reduction; and (iii) 3D-2D guidance using intraoperative fluoroscopy. For intracranial neurosurgery, the dissertation includes three inter-modality deformable registrations using physic-based Demons and deep learning models for CT-guided and CBCT-guided procedures

Automatic Fracture Reduction

We present a method to automatically reposition the fragments of a broken bone based on surface meshes segmented from CT scans. The result of this virtual fracture reduction is intended to be used as an operation plan for a medical procedure. Particularly in minimally invasive surgery like intramedullary nailing, the correct repositioning of bone fragments is not always apparent or visible without an operation plan. We propose to achieve automatic fracture reduction by fitting the bone fragments to an intact reference bone mesh with a modified Iterative Closest Point (ICP) algorithm. A suitable reference could be the same patient’s contra-lateral bone. In the absence of a CT scan of this bone, we propose to use a statistical shape model as a reference. The shape model is automatically adapted to match the anatomy of the broken bone, apart from the bone’s length, which has to be correctly initialized. Our experiments show that we can limit the rotational alignment error to below 5 degrees, compared to 15 degrees in current medical practice

Automatic fracture reduction with a computer-controlled external fixator

The reduction of fractures by means of an Ilizarov's fixator is obtained by successively shortening or lengthening the rods. This entails that all reduction operations of the fracture stumps be performed with a series of empirical attempts, requiring great experience and manual dexterity in the surgeon. Moreover this process involves a long exposure of both physician and patient to potentially harmful radiation due to the continuous checking of the intermediate positions on the X-ray image intensifier. In order to overcome these limits a new device has been conceived, based on the application of three stepper-motors on three rods. Its basic principle is functionally very similar to Ilizarov's prototype. The relative motions between the two frames are carried out by controlling the three actuators with a computer, which processes the number of required steps on the basis of an algorithm, starting from a few inputs supplied by the surgeon. This article illustrates the functional kinematic study necessary for the complete automation of the reduction process. Also considered is the complex problem of the reduction trajectory definition, intended as a sequence of configurations of partial correction, obtained by formalizing in geometrical terms the empirical criterial followed by the orthopaedic surgeon in reducing fractures. Such a sequence is intended to be a suggestion for the surgeon who can visualize and possibly interact with the system to determine a trajectory harmless for the soft tissues surrounding the bone

Path planning for robot assisted femur shaft fracture reduction: A preliminary investigation

When doing femur fracture reduction surgery, both the patient and the surgeon are exposed to a great amount of radiation, which is harmful to their health. Computer assisted orthopaedic surgery (CAOS) is a less invasive approach for its ability to reduce the usage of image intensifier. The authors have developed a six degree of freedom (DOF) parallel-serial surgical robot named D'cros(Dual Cartesian robot for orthopaedic surgeon) for fracture reduction surgery. To perform automatic fracture reduction surgery, reduction path for D'cros is needed. This paper presents an initial investigation of an automatic reduction path planning algorithm based on the shortest linear path. ©2009 IEEE.link_to_subscribed_fulltex