Advertisement

Augmented reality patient-specific reconstruction plate design for pelvic and acetabular fracture surgery

  • Fangyang Shen
  • Bailiang Chen
  • Qingshan Guo
  • Yue Qi
  • Yue ShenEmail author
Original Article

Abstract

Purpose

The objective of this work is to develop a preoperative reconstruction plate design system for unilateral pelvic and acetabular fracture reduction and internal fixation surgery, using computer graphics and augmented reality (AR) techniques, in order to respect the patient-specific morphology and to reduce surgical invasiveness, as well as to simplify the surgical procedure.

Materials and methods

Our AR-aided implant design and contouring system is composed of two subsystems: a semi-automatic 3D virtual fracture reduction system to establish the patient-specific anatomical model and a preoperative templating system to create the virtual and real surgical implants. Preoperative 3D CT data are taken as input. The virtual fracture reduction system exploits the symmetric nature of the skeletal system to build a “repaired” pelvis model, on which reconstruction plates are planned interactively. A lightweight AR environment is set up to allow surgeons to match the actual implants to the digital ones intuitively. The effectiveness of this system is qualitatively demonstrated with 6 clinical cases. Its reliability was assessed based on the inter-observer reproducibility of the resulting virtual implants.

Results

The implants designed with the proposed system were successfully applied to all cases through minimally invasive surgeries. After the treatments, no further complications were reported. The inter-observer variability of the virtual implant geometry is 0.63 mm on average with a standard deviation of 0.49 mm. The time required for implant creation with our system is 10 min on average.

Conclusion

It is feasible to apply the proposed AR-aided design system for noninvasive implant contouring for unilateral fracture reduction and internal fixation surgery. It also enables a patient-specific surgical planning procedure with potentially improved efficiency.

Keywords

Augmented reality Implant templating Pelvis Acetabulum Fracture reduction and fixation 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Tile M, Helfet D, Kellam J (2003) Fractures of the pelvis and acetabulum. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  2. 2.
    Eggli S, Pisan M, Müller ME (1998) The value of preoperative planning for total hip arthroplasty. J Bone Joint Surg Br. 80: 382–390PubMedCrossRefGoogle Scholar
  3. 3.
    Heal J, Blewitt N (2002) Kinemax total knee arthroplasty: trial by template. The Journal of Arthroplasty. 17: 90–94PubMedCrossRefGoogle Scholar
  4. 4.
    Winder J, Bibb R (2005) Medical rapid prototyping technologies: state of the art and current limitations for application in oral and maxillofacial surgery. Journal of Oral and Maxillofacial Surgery. 63: 1006–1015PubMedCrossRefGoogle Scholar
  5. 5.
    Bibb R, Winder J (2010) A review of the issues surrounding three-dimensional computed tomography for medical modelling using rapid prototyping techniques. Radiography. 16: 78–83CrossRefGoogle Scholar
  6. 6.
    Rosa ELS, da Oleskovicz CF, Aragão BN (2004) Rapid prototyping in maxillofacial surgery and traumatology. Brazilian Dental Journal. 15: 243–247PubMedCrossRefGoogle Scholar
  7. 7.
    Robiony M, Salvo I, Costa F, Zerman N, Bazzocchi M, Toso F, Bandera C, Filippi S, Felice M, Politi M (2007) Virtual reality surgical planning for maxillofacial distraction osteogenesis: the role of reverse engineering rapid prototyping and cooperative work. J Oral Maxillofac Surg 65: 1198–1208PubMedCrossRefGoogle Scholar
  8. 8.
    Murray DJ, Edwards G, Mainprize JG, Antonyshyn O (2008) Optimizing craniofacial osteotomies: applications of haptic and rapid prototyping technology. J Oral Maxillofac Surg 66: 1766–1772PubMedCrossRefGoogle Scholar
  9. 9.
    Wu C-T, Lee S-T, Chen J-F, Lin K-L, Yen S-H (2008) Computer-aided design for three-dimensional titanium mesh used for repairing skull base bone defect in pediatric neurofibromatosis type 1. Pediatri Neurosurg 44: 133–139CrossRefGoogle Scholar
  10. 10.
    Cao D, Yu Z, Chai G, Liu J, Mu X (2010) Application of EH compound artificial bone material combined with computerized three-dimensional reconstruction in craniomaxillofacial surgery. J Craniofac Surg 21: 440–443PubMedCrossRefGoogle Scholar
  11. 11.
    Chai G, Zhang Y, Ma X, Zhu M, Yu Z, Mu X (2011) Reconstruction of fronto-orbital and nasal defects with compound epoxied maleic acrylate/hydroxyapatite implant prefabricated with a computer design program. Ann Plast Surg 67: 493–497PubMedCrossRefGoogle Scholar
  12. 12.
    Waran V, Devaraj P, Hari Chandran T, Muthusamy KA, Rathinam AK, Balakrishnan YK, Tung TS, Raman R, Rahman ZAA (2012) Three-dimensional anatomical accuracy of cranial models created by rapid prototyping techniques validated using a neuronavigation station. J Clin Neurosci 19: 574–577PubMedCrossRefGoogle Scholar
  13. 13.
    Brown GA, Milner B, Firoozbakhsh K (2002) Application of computer-generated stereolithography and interpositioning template in acetabular fractures: a report of eight cases. J Orthop Trauma 16: 347–352PubMedCrossRefGoogle Scholar
  14. 14.
    Mizutani J, Matsubara T, Fukuoka M, Tanaka N, Iguchi H, Furuya A, Okamoto H, Wada I, Otsuka T (2008) Application of full-scale three-dimensional models in patients with rheumatoid cervical spine. Eur Spine J 17: 644–649PubMedCrossRefGoogle Scholar
  15. 15.
    Bagaria V, Deshpande S, Rasalkar DD, Kuthe A, Paunipagar BK (2011) Use of rapid prototyping and three-dimensional reconstruction modeling in the management of complex fractures. Eur J Radiol 80: 814–820PubMedCrossRefGoogle Scholar
  16. 16.
    Zhou L, Shang H, He L, Bo B, Liu G, Liu Y, Zhao J (2010) Accurate reconstruction of discontinuous mandible using a reverse engineering/computer-aided design/rapid prototyping technique: a preliminary clinical study. Journal of Oral and Maxillofacial Surgery. 68: 2115–2121PubMedCrossRefGoogle Scholar
  17. 17.
    Caudell TP, Mizell DW (1992) Augmented reality: an application of heads-up display technology to manual manufacturing processes. In: IEEE Proceedings of the twenty-fifth Hawaii international conference on system sciences, 1992, vol 2, pp 659–669Google Scholar
  18. 18.
    Aiteanu D, Hillers B, Graser A (2003) A step forward in manual welding: demonstration of augmented reality helmet. In: The second IEEE and ACM international symposium on mixed and augmented reality, 2003, pp 309–310Google Scholar
  19. 19.
    Berlage T Augmented reality for diagnosis based on ultrasound images. In: Troccaz J, Grimson E, Mösges R (eds) CVRMed-MRCAS’97. Springer, Berlin, pp 253–262Google Scholar
  20. 20.
    De Momi E, Chapuis J, Pappas I, Ferrigno G, Hallermann W, Schramm A, Caversaccio M (2006) Automatic extraction of the mid-facial plane for cranio-maxillofacial surgery planning. Int J Oral Maxillofac Surg 35: 636–642PubMedCrossRefGoogle Scholar
  21. 21.
    Chapuis J, Schramm A, Pappas I, Hallermann W, Schwenzer-Zimmerer K, Langlotz F, Caversaccio M (2007) A new system for computer-aided preoperative planning and intraoperative navigation during corrective jaw surgery. IEEE Trans Inf Tech Biomed 11: 274–287CrossRefGoogle Scholar
  22. 22.
    Ai Z, Evenhouse R, Leigh J, Charbel F, Rasmussen M (2007) Cranial implant design using augmented reality immersive system. Stud Health Technol Inform 125: 7–12PubMedGoogle Scholar
  23. 23.
    Fornaro J, Keel M, Harders M, Marincek B, Székely G, Frauenfelder T (2010) An interactive surgical planning tool for acetabular fractures: initial results. J Orthop Surg Res 5: 50PubMedCrossRefGoogle Scholar
  24. 24.
    Konishi K, Nakamoto M, Kakeji Y, Tanoue K, Kawanaka H, Yamaguchi S, Ieiri S, Sato Y, Maehara Y, Tamura S, Hashizume M (2010) A real-time navigation system for laparoscopic surgery based on three-dimensional ultrasound using magneto-optic hybrid tracking configuration. Int J Comput Assist Radiol Surg 2: 1–10CrossRefGoogle Scholar
  25. 25.
    Boulay C, Tardieu C, Bénaim C, Hecquet J, Marty C, Prat-Pradal D, Legaye J, Duval-Beaupère G, Pélissier J (2006) Three-dimensional study of pelvic asymmetry on anatomical specimens and its clinical perspectives. J Anat 208: 21–33PubMedCrossRefGoogle Scholar
  26. 26.
    Scharsach H (2005) Advanced GPU raycasting. In: Proceedings of CESCG 2005, pp 69–76Google Scholar
  27. 27.
    Christian Doppler Lab HAR (2006) ARToolkitPlusGoogle Scholar
  28. 28.
    Tile M (1988) Pelvic ring fractures: should they be fixed?. J Bone Joint Surg Br 70: 1–12PubMedGoogle Scholar
  29. 29.
    Letournel E (1980) Acetabulum fractures: classification and management. Clin Orthop Relat Res 151: 81–106PubMedGoogle Scholar
  30. 30.
    Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 78: 1632–1645PubMedGoogle Scholar
  31. 31.
    Borrelli J Jr, Ricci WM, Steger-May K, Totty WG, Goldfarb C (2005) Postoperative radiographic assessment of acetabular fractures: a comparison of plain radiographs and CT scans. J Orthop Trauma 19: 299–304PubMedGoogle Scholar
  32. 32.
    Moed BR, WillsonCarr SE, Watson JT (2002) Results of operative treatment of fractures of the posterior wall of the acetabulum. J Bone Joint Surg Am 84(A): 752–758PubMedGoogle Scholar
  33. 33.
    Burgess A, Jones A (1996) Fractures of the pelvic ring. In: Charles AR Jr, Kaye WE, James HB (eds) Rockwood and Green’s fractures in adults, p 1611Google Scholar
  34. 34.
    Raobaikady R, Redman J, Ball JAS, Maloney G, Grounds RM (2005) Use of activated recombinant coagulation factor VII in patients undergoing reconstruction surgery for traumatic fracture of pelvis or pelvis and acetabulum: a double-blind, randomized, placebo-controlled trial. Br J Anaesth 94: 586–591PubMedCrossRefGoogle Scholar

Copyright information

© CARS 2012

Authors and Affiliations

  • Fangyang Shen
    • 1
  • Bailiang Chen
    • 2
    • 3
  • Qingshan Guo
    • 4
  • Yue Qi
    • 1
  • Yue Shen
    • 4
    Email author
  1. 1.State Key Laboratory of Virtual Reality Technology and SystemsBeihang UniversityBeijingChina
  2. 2.IADI, INSERM U947, Université de LorraineNancyFrance
  3. 3.Pôle Imagerie, CHU de NancyNancyFrance
  4. 4.State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping HospitalThird Military Medical UniversityChongqingChina

Personalised recommendations