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Robotic technique improves entry point alignment for intramedullary nailing of femur fractures compared to the conventional technique: a cadaveric study

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Abstract

We aimed to test whether a robotic technique would offer more accurate access to the proximal femoral medullary cavity for insertion of an intramedullary nail compared to the conventional manual technique. The medullary cavity of ten femur specimens was accessed in a conventional fashion using fluoroscopic control. In ten additional femur specimens, ISO-C 3D scans were obtained and a computer program calculated the ideal location of the cavity opening based on the trajectory of the medullary canal. In both techniques, the surgeon opened the cavity using a drill and inserted a radiopaque tube that matched the diameter of the cavity. The mean difference in angle between the proximal opening and the medullary canal in the shaft of the femur was calculated for both groups. Robotic cavity opening was more accurate than the manual technique, with a mean difference in trajectory between the proximal opening and the shaft canal of 2.0° (95% CI 0.6°–3.5°) compared to a mean difference of 4.3° (95% CI 2.11°–6.48°) using the manual technique (P = 0.0218). The robotic technique was more accurate than the manual procedure for identifying the optimal location for opening the medullary canal for insertion of an intramedullary nail. Additional advantages may include a reduction in total radiation exposure, as only one ISO-C 3D scan is needed, as opposed to multiple radiographs when using the manual technique.

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Acknowledgements

We thank Prof. Andreas Schmiedl from the Anatomy Department at the Hannover Medical School for his help with procuring the necessary anatomic specimens.

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Authors and Affiliations

  1. Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Eduardo M. Suero, Musa Citak, Nael Hawi, Emmanouil Liodakis, Christian Krettek & Timo Stuebig

  2. Institute for Robotics and Process Control, Braunschweig University of Technology, Brunswick, Germany

    Ralf Westphal

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  1. Eduardo M. Suero
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  2. Ralf Westphal
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  3. Musa Citak
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  4. Nael Hawi
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  7. Timo Stuebig
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Correspondence to Eduardo M. Suero.

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Funding

This study was performed with funding from the Deutsche Forschungsgemeinschaft (DFG) (Grant number KR 2161/4-1 | WA 848/19-1).

Conflict of interest

Author Eduardo M. Suero, Author Ralf Westphal, Author Musa Citak, Author Nael Hawi, Author Emmanouil Liodakis, Author Christian Krettek, and Author Timo Stuebig declare that they have no conflict of interest.

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This article does not contain any studies with human subjects or with animals performed by any of the authors.

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This article does not contain any studies with human participants or animals performed by any of the authors. No informed consent was required.

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Suero, E.M., Westphal, R., Citak, M. et al. Robotic technique improves entry point alignment for intramedullary nailing of femur fractures compared to the conventional technique: a cadaveric study. J Robotic Surg 12, 311–315 (2018). https://doi.org/10.1007/s11701-017-0735-8

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  • DOI: https://doi.org/10.1007/s11701-017-0735-8

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