Computer-assisted orthopaedic fracture reduction: clinical evaluation of a second generation prototype

Background The goal of this study was to evaluate a new second generation of computer-assisted fluoroscopic navigation software for fracture reduction (SGFR) of long-bone fractures. The new software allows simultaneous tracking of two moving bone fragments. Methods Between 2005--2007, patients with isolated, extra-articular longbone fracture of either the femur or tibia were considered for computer-assisted fluoroscopic fracture reduction surgery. The operative tasks were: (1) fracture reduction; (2) determination of the entry point, and; (3) Poller screw insertion, when needed. Fracture reduction was achieved by one of two methods: (1) fracture edges or (2) medullary canal recognition. Fracture reduction was considered successful if the guide wire was introduced through the fracture without further radiation. Results We treated 38 patients (27 men and 11 women); with 15 femoral and 23 tibial fractures, with intramedullary nail fixation. In all patients, the point of entry was navigated successfully. In four patients, the insertion of the blocking screw was planned and executed without further radiation. All fractures were successfully reduced using the SGFR system. In nine patients, we used method 1, in 22 patients method 2, and in six a combination of both. The number of fluoroscopic images was dramatically reduced to four to six images. Conclusions Fracture reduction was reliably achievable in all patients using the SGFR. A key conclusion is that only a small number of fluoroscopic images are required. Although timing was not an objective of this study, we believe that there was a noticeable reduction of intraoperative time.