Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery,, University of Foggia, Policlinico Riuniti di Foggia,
Foggia, Italy
Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia,
Foggia, Italy
Aim To demonstrate a reduction of risk factors ray-depending in proximal femur nailing of intertrochanteric femur fractures, comparing standard technique with computer-assisted navigation system. Methods One hundred patients hospitalised between October 2021 and June 2022 with intertrochanteric femur fractures type 31-A1 and 31-A2 were prospectively enrolled and divided randomly into two groups. A study group was treated with computer-assisted navigation system ATLAS (Masmec Biomed, Modugno, Bari, Italy) (20 patients), while a control group received the standard nailing technique. The same intertrochanteric nail was implanted by a single senior surgeon, Endovis BA 2 (EBA2, Citieffe, Calderara di Reno, Bologna, Italy). The following data were recorded: the setup time of operating room (STOR; minutes); surgical time (ST; minutes); radiation exposure time (ETIR; seconds) and dose area product (DAP; cGy·cm2). Results Patients underwent femur nailing with computer-assisted navigation system reported more set-up time of operating room (24.87±4.58; p<0.01), less surgical time (26.15±5.80; p<0.01), less time of radiant exposure (4.84±2.07; p<0.01) and lower dose area product (16.26±2.91; p<0.01). Conclusion The preliminary study demonstrated that computerassisted navigation allowed a better surgical technique standardization, significantly reduced exposure to ionizing radiation, including a reduction in surgical time. The ATLAS system could also play a key role in residents improving learning curve.
Carvajal-Pedrosa C, Gómez-Sánchez R, Hernández-Cortés P. Comparison of outcomes of intertrochanteric fracture fixation using percutaneous compression plate between stable and unstable fractures in the elderly. J Orthop Trauma. 2016. p. 201-e206.
2.
Maccagnano G, Solarino G, Pesce V, Vicenti G, Coviello M, Nappi V, et al. Plate vs reverse shoulder arthroplasty for proximal humeral fractures: The psychological health influence the choice of device? World J Orthop. 2022. p. 297–306.
3.
Rinonapoli G, Ruggiero C, Meccariello L, Bisaccia M, Ceccarini P, Caraffa A. Osteoporosis in men: a review of an underestimated bone condition. Int J Mol Sci. 2021. p. 2105.
4.
Bisaccia M, Meccariello L, Ripani U, Pace V, Rollo G, Ibáñez-Vicente C, et al. Caraffa A. Osteoporosis in male patients: epidemiology, clinical aspects and DEXA scan assessment. Clin Cases Miner Bone Metab. 2019. p. 31–5.
5.
Gupta R, Gupta V, Gupta N. Outcomes of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw. Indian J Orthop. 2012. p. 640–5.
6.
Rinonapoli G, Pace V, Ruggiero C, Ceccarini P, Bisaccia M, Meccariello L, et al. Obesity and bone: a complex relationship. Int J Mol Sci. 2021. p. 13662.
7.
Zhang Y, Zhang S, Wang S, Zhang H, Zhang W, Liu P, et al. Long and short intramedullary nails for fixation of intertrochanteric femur fractures (OTA 31-A1, A2 and A3): A systematic review and meta-analysis. Orthop Traumatol Surg Res. 2017. p. 685–90.
8.
Lanzetti R, Caraffa A, Lupariello D, Ceccarini P, Gambaracci G, Meccariello L, et al. Comparison between locked and unlocked intramedullary nails in intertrochanteric fractures. Eur J Orthop Surg Traumatol. 2018. p. 649–58.
9.
Kubiak E, Beebe M, North K, Hitchcock R, Potter M. Early weight bearing after lower extremity fractures in adults. J Am Acad Orthop Surg. 2013. p. 727–38.
10.
Meccariello L, Bisaccia M, Ronga M, Falzarano G, Caraffa A, Rinonapoli G, et al. Locking retrograde nail, non-locking retrograde nail and plate fixation in the treatment of distal third femoral shaft fractures: radiographic, bone densitometry and clinical outcomes. J Orthop Traumatol. 2021. p. 33.
11.
Gowda S, Mitchell C, Abouel-Enin S, Lewis C. Radiation risk amongst orthopaedic surgeons -Do we know the risk? J Perioper Pract. 2019. p. 115–21.
12.
Moretti L, Coviello M, Rosso F, Calafiore G, Monaco E, Berruto M, et al. Current trends in knee arthroplasty: are Italian surgeons doing what is expected? 2022.
13.
Jones C, Jerabek S. Current role of computer navigation in total knee arthroplasty. J Arthroplasty. 2018. p. 1989–93.
14.
Zhang Q, Han X, Xu Y, Fan M, Zhao J, Liu Y, et al. Robotic navigation during spine surgery. Expert Rev Med Devices. 2020. p. 27–32.
15.
Huntsman K, Riggleman J, Ahrendtsen L. Ledonio CG. Navigated robot-guided pedicle screws placed successfully in single-position lateral lumbar interbody fusion. Robot Surg. 2020. p. 643–7.
16.
Figueroa F, Wakelin E, Twiggs J, Fritsch B. Comparison between navigated reported position and postoperative computed tomography to evaluate accuracy in a robotic navigation system in total knee arthroplasty. Knee. 2019. p. 869–75.
17.
Ciolli G, Caviglia D, Vitiello C, Lucchesi S, Pinelli C, Mauro D, et al. Navigated percutaneous screw fixation of the pelvis with O-arm 2: two years’ experience. Med Glas (Zenica). p. 309–15.
18.
Crookshank M, Edwards M, Sellan M, Whyne C, Schemitsch E. Can fluoroscopy-based computer navigation improve entry point selection for intramedullary nailing of femur fractures? Clin Orthop Relat Res. 2014. p. 2720–7.
19.
Von Elm E, Altman D, Egger M, Pocock S, Gøtzsche P, Vandenbroucke J. STROBE Initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008. p. 344–9.
20.
Marsh J, Slongo T, Agel J, Broderick J, Creevey W, Decoster T, et al. Fracture and Dislocation Classification Compendium -2007. J Orthop Trauma. 2007. p. 1-S6.
21.
Ryan S, Politzer C, Green C, Wellman S, Bolognesi M, Seyler T. Albumin versus American Society of Anesthesiologists Score: which is more predictive of complications following total joint arthroplasty? Orthopedics. 2018. p. 354–62.
22.
Caiaffa V, Vicenti G, Mori C, Panella A, Conserva V, Corina G, et al. Is distal locking with short intramedullary nails necessary in stable pertrochanteric fractures? A prospective, multicentre, randomised study. Injury. 2016. p. 98–106.
23.
Italian society of orthopaedics and traumatology. Proximal femur fractures in the elderly guidelines. 2011.
24.
Augat P, Bliven E, Hackl S. Biomechanics of femoral neck fractures and implications for fixation. J Orthop Trauma. 2019. p. 27–32.
25.
Socci A, Casemyr N, Leslie M, Baumgaertner M. Implant options for the treatment of intertrochanteric fractures of the hip. Bone & Joint. 2017. p. 128–33.
26.
Ziranu A, Noia G, Cipolloni V, Coviello M, Maccagnano G, Liuzza F, et al. Revision surgery using retrograde nail versus replating in nonunion distal femur fracture treated with plate. Adv Orthop. 2022. p. 1–8.
27.
David G, Umberto M, Cioancă R, F, Alfonso A, Cristina C, et al. Metabolic shock in elderly pertrochanteric or intertrochanteric surgery. Comparison of three surgical methods. Is there a much safer? Rom J Anaesth Intensive Care. 2020. p. 17–26.
28.
Ripani U, Manzarbeitia-Arroba P, Guijarro-Leo S, Urrutia-Graña J, Masi-De Luca D, A. Vitamin C may help to reduce the knee’s arthritic symptoms. Outcomes assessment of nutriceutical therapy. Med Arch. 2019. p. 173–7.
29.
Duan SJ, Liu H, -S, Wu W, -C, Yang K, et al. Robot-assisted percutaneous cannulated screw fixation of femoral neck fractures: preliminary clinical results. Orthop Surg. 2019. p. 34–41.
30.
Prasarn M, Cattaneo M, Achor T, Ahn J, Klinger C, Helfet D, et al. The effect of entry point on malalignment and iatrogenic fracture with the Synthes lateral entry femoral nail. J Orthop Trauma. 2010. p. 224–9.
31.
Lan H, Tan Z, Kn L, Jh G, Th L. Intramedullary nail fixation assisted by orthopaedic robot navigation for intertrochanteric fractures in elderly patients. Orthop Surg. 2019. p. 255–62.
32.
Schiavone A, Bisaccia M, Inkov I, Rinonapoli G, Manni M, Rollo G, et al. Tranexamic acid in pertrochanteric femoral fracture: is it a safe drug or not. Folia Med (Plovdiv). 2018. p. 67–78.
33.
Suero E, Westphal R, Citak M, Hawi N, Liodakis E, Krettek C, et al. Robotic technique improves entry point alignment for intramedullary nailing of femur fractures compared to the conventional technique: a cadaveric study. J Robot Surg. 2018. p. 311–5.
34.
Liebergall M, Ben-David D, Weil Y, Peyser A, Mosheiff R. Computerized navigation for the internal fixation of femoral neck fractures. J Bone Joint Surg Am. 2006. p. 1748–54.
35.
Hayda R, Hsu R, Depasse J, Gil J. Radiation exposure and health risks for orthopaedic surgeons. J Am Acad Orthop Surg. 2018. p. 268–77.
36.
Matityahu A, Duffy R, Goldhahn S, Joeris A, Richter P, Gebhard F. The great unknown-a systematic literature review about risk associated with intraoperative imaging during orthopaedic surgeries. Injury. 2017. p. 1727–34.
37.
Honl M, Schwieger K, Gauck C, Lampe F, Morlock M, Wimmer M, et al. Pfannenposition und Orientierung im Vergleich. Orthopäde. 2005. p. 1131–6.
38.
Myden C, Anglin C, Kopp G, Hutchison C. Computer-assisted surgery simulations and directed practice of total knee arthroplasty: educational benefits to the trainee. Comput Aided Surg. 2012. p. 113–27.
39.
Takai H, Mizuta K, Murayama M, Nakayama D, Kii S, Hayai C, et al. Comparing the usefulness of a fluoroscopic navigation system in femoral trochanteric fracture for orthopaedic residents with the conventional method. Injury. 2020. p. 1840–5.
40.
Lee H, Song S, Bae D, Park C. The influence of computer-assisted surgery experience on the accuracy and precision of the postoperative mechanical axis during computer-assisted lateral closing-wedge high tibial osteotomy. Knee Surg Relat Res. 2019. p. 15.
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