Image-Guided Surgical Robotic System for Percutaneous Reduction of Joint Fractures

Dagnino, Giulio; Georgilas, Ioannis; Morad, Samir; Gibbons, Peter; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja

Abstract

© 2017, The Author(s). Complex joint fractures often require an open surgical procedure, which is associated with extensive soft tissue damages and longer hospitalization and rehabilitation time. Percutaneous techniques can potentially mitigate these risks but their application to joint fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces involved in the fragment manipulation (due to the presence of soft tissue, e.g., muscles) which might result in fracture malreduction. Integration of robotic assistance and 3D image guidance can potentially overcome these issues. The authors propose an image-guided surgical robotic system for the percutaneous treatment of knee joint fractures, i.e., the robot-assisted fracture surgery (RAFS) system. It allows simultaneous manipulation of two bone fragments, safer robot-bone fixation system, and a traction performing robotic manipulator. This system has led to a novel clinical workflow and has been tested both in laboratory and in clinically relevant cadaveric trials. The RAFS system was tested on 9 cadaver specimens and was able to reduce 7 out of 9 distal femur fractures (T- and Y-shape 33-C1) with acceptable accuracy (≈1mm, demonstrating its applicability to fix knee joint fractures. This study paved the way to develop novel technologies for percutaneous treatment of complex fractures including hip, ankle, and shoulder, thus representing a step toward minimally-invasive fracture surgeries.

• Journal Article Type: Article
• Acceptance Date: Aug 9, 2017
• Online Publication Date: Aug 16, 2017
• Publication Date: Nov 1, 2017
• Deposit Date: Aug 23, 2017
• Publicly Available Date: Aug 30, 2017
• Journal: Annals of Biomedical Engineering
• Print ISSN: 0090-6964
• Electronic ISSN: 1573-9686
• Publisher: Springer (part of Springer Nature)
• Peer Reviewed: Peer Reviewed
• Volume: 45
• Issue: 11
• Pages: 2648-2662
• DOI: https://doi.org/10.1007/s10439-017-1901-x
• Keywords: image-guided, surgical robotic system, percutaneous reduction, joint fractures
• Public URL: https://uwe-repository.worktribe.com/output/877877
• Publisher URL: http://dx.doi.org/10.1007/s10439-017-1901-x
• Additional Information: Additional Information : The final publication is available at Springer via http://dx.doi.org/10.1007/s10439-017-1901-x
• Contract Date: Aug 23, 2017