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Image guidance can support scaphoid K-wire insertion: an experimental study and initial clinical experience

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

In the treatment of small bone fractures, such as the scaphoid bone, conventional navigation is limited by its dependence on fixed reference arrays. We introduce a new technique based on reference markers in surgical instruments. If visible on a standard fluoroscopic image, static trajectories are overlaid in this image to guide implant insertions. Fixed markers are not required. The purpose of this study was to identify the possible advantages of the new guidance technique.

Methods

For this study, 20 artificial hand specimens were randomized into two groups and blinded with polyurethane foam: 10 were treated conventionally and 10 were image guided. We used a clip containing radiopaque markers, which was detected by the system’s workstation. A static trajectory was displayed consecutively in the fluoroscopic image to serve as an aiming device. Secondly, we included 3 patients with fractures of the scaphoid bone to test the integrability of this novel method in a clinical setting.

Results

In the experimental setup, trajectory guidance reduced the duration of surgery and radiation exposure. Furthermore, it reduced the perforation rate. Accuracy was not improved by the new technique. For clinical cases, the system was integrated into the accommodated surgical workflow and rated as very helpful by users.

Conclusion

The system helped reduce the misplacement rate and the emission of radiation. The main limitations were that trajectories were not displayed in real time and could only be shown in a single fluoroscopic image. However, the system is simple and can be easily integrated into the surgical workflow.

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Acknowledgments

We thank Dr. med. Bettina Ammann (Ulm University, Department of Interventional and Diagnostic Radiology) for her support regarding radiological matters. We thank Surgix (Surgix\(^{\circledR }\), Tel Aviv, Israel) for delivering and maintaining the guidance system and Siemens (Siemens\(^{\circledR }\), Erlangen, Germany) for connecting the guidance system to the fluoroscopes.

Conflict of interest

The authors declare that there is no conflict of interest. No company had influence in the collection of data or did contribute to or had influence on the conception, design, analysis and writing of the study. No further funding was received. No author is affiliated to any of the supporting companies or received or will receive any form of payment related to this study.

Ethical approval

The study was approved by the local (Ethikkomission Universität Ulm, Nr. 159, 09) and the international (freiburger ethic-kommission, Nr. 09/1385) ethics committee and has been performed in accordance with the ethical standards in the 1964 Declaration of Helsinki.

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Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081 , Ulm, Germany

    Hendrik Schöll, Martin Mentzel, Joachim Gülke & Florian Gebhard

  2. Department of Diagnostic and Interventional Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 , Ulm, Germany

    Almut Jones

  3. Institute of Research in Rehabilitation Medicine, Ulm University, Wuhrstrasse 2/1, 88422 , Bad Buchau, Germany

    Michael Kraus

  4. Federseeklinik Bad Buchau, Freihofgasse 14, 88422 , Bad Buchau, Germany

    Michael Kraus

Authors
  1. Hendrik Schöll
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  2. Martin Mentzel
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  3. Almut Jones
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  4. Joachim Gülke
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  5. Florian Gebhard
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  6. Michael Kraus
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Corresponding author

Correspondence to Michael Kraus.

Additional information

Technical support was provided by Surgix (Surgix\(^{\circledR }\), Tel Aviv, Israel) in delivering and maintaining the guidance system and Siemens (Siemens\(^{\circledR }\), Erlangen, Germany) in connecting the guidance system to the fluoroscopes.

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Schöll, H., Mentzel, M., Jones, A. et al. Image guidance can support scaphoid K-wire insertion: an experimental study and initial clinical experience. Int J CARS 8, 471–480 (2013). https://doi.org/10.1007/s11548-012-0799-x

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  • DOI: https://doi.org/10.1007/s11548-012-0799-x

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