Improved lag screw positioning in the treatment of proximal femur fractures using a novel computer assisted surgery method: a cadaveric study

BMC Musculoskeletal Disorders

Brian D Solberg¹  James W Maxey⁵  Robert A Probe³  Arno Blau²  Matthias Regling⁴ 

[1] Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA;Stryker Leibinger GmbH & Co. KG, Freiburg, Germany;Department of Orthopaedics, Scott & White Memorial Hospital, Temple, TX, USA;Stryker Trauma GmbH, Schoenkirchen, Germany;University of Illinois College of Medicine, Peoria, IL, USA

关键词: Surgical technique;    Cut-out;    Hip fractures;    Proximal femur fractures;    Lag screw placement;    Computer assisted surgery;   

Others  :  1125613
DOI  :  10.1186/1471-2474-15-189

 received in 2013-11-01, accepted in 2014-05-14,  发布年份 2014

【 摘 要 】

Background

The importance of the tip-apex distance (TAD) to predict the cut-out risk of fixed angle hip implants has been widely discussed in the scientific literature. Intra-operative determination of TAD is difficult and can be hampered by image quality, body habitus, and image projection. The purpose of this paper is to evaluate, through a cadaveric study, a novel computer assisted surgery system (ADAPT), which is intended for intraoperative optimisation of lag screw positioning during antegrade femoral nailing. A 3D measure for optimal lag screw position, the tip-to-head-surface distance (TSD), is introduced.

Methods

45 intra-medullary hip screw procedures were performed by experienced and less experienced surgeons in a cadaveric test series: in 23 surgeries the ADAPT system was used, and in 22 it was not used. The position of the lag screw within the femoral head and neck was evaluated using post-operative CT scans. TAD, TSD, fluoroscopy as well as procedure time and variability were assessed.

Results

The use of the ADAPT system increased accuracy in TSD values (i.e. smaller variability around the target value) for both groups of surgeons (interquartile range (IQR) of experienced surgeons: 4.10 mm (Conventional) vs. 1.35 mm (ADAPT) (p = 0.004)/IQR of less experienced surgeons: 3.60 mm (Conventional) vs. 0.85 mm (ADAPT) (p = 0.002)). The accuracy gain in TAD values did not prove to be significant in the grouped analysis (p = 0.269 for experienced surgeons; p = 0.066 for less experienced surgeons); however, the overall analysis showed a significant increase in accuracy (IQR: 4.50 mm (Conventional) vs. 2.00 mm (ADAPT) (p = 0.042)). The fluoroscopy time was significantly decreased by the use of the ADAPT system with a median value of 29.00 seconds (Conventional) vs. 17.00 seconds (ADAPT) for the less experienced surgeons (p = 0.046). There was no statistically significant impact on the procedure time (p = 0.739).

Conclusions

The ADAPT system improved the position of the lag screw within the femoral head, regardless of the surgeon’s level of clinical experience, and at the same time decreased overall fluoroscopy usage. These positive effects are achieved without increasing procedure time.

【 授权许可】

   
2014 Regling et al.; licensee BioMed Central Ltd.

【 图 表 】

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