Skip to main content

Advertisement

SpringerLink
Log in

Three-dimensional computer-assisted navigation for the placement of cannulated hip screws. A pilot study

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Medial femoral neck fractures are common, and closed reduction and internal fixation by three cannulated screws is an accepted method for the surgical treatment. Computer navigation for screw placement may reduce fluoroscopy time, the number of guidewire passes and optimise screw placement.

Methods

In the context of a sawbone study, a computer-assisted planning and navigation system based on 3D-imaging for guidewire placement in the femoral neck was tested to improve screw placement. Three screws were inserted into 12, intact, femoral sawbones using the conventional technique and into 12, intact, femoral sawbones guided by the computer-based navigation system. Guidewire and subsequent screw placement in the femoral neck were evaluated.

Results

Use of the navigation system resulted in a significant reduction of the number of drilling attempts (p ≤ 0.05) and achieved optimised accuracy of implant placement by attaining significantly better screw parallelism (p ≤ 0.05) and significantly enlarged neck-width coverage by the three screws (p ≤ 0.0001). Computer assistance significantly increased the number of fluoroscopic images (p ≤ 0.001) and the operation time (p ≤ 0.0001).

Conclusions

Three-dimensional computer-assisted navigation improves accuracy of cannulated screw placement in femoral neck while increasing the number of fluoroscopic images and operation time. Additional studies including fractured sawbones and cadaver models with the goal of reducing operation time are indispensable before introduction of this navigation system into clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Järvinen M (1999) Hip fractures in Finland between 1970 and 1977 and predictions for the future. Lancet 353:802–805

    Article  PubMed  CAS  Google Scholar 

  2. Selvan VT, Oakley MJ, Rangan A, Al-Lami MK (2004) Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: a biomechanical study. Injury 35:136–141

    Article  PubMed  CAS  Google Scholar 

  3. Kloen P, Rubel IF, Lyden JP, Helfet DL (2003) Subtrochanteric fracture after cannulated screw fixation of femoral neck fractures: a case report of four cases. J Orthop Trauma 17:225–229

    Article  PubMed  Google Scholar 

  4. Lindequist S, Tornkvist H (1995) Quality of reduction and cortical screw support in femoral neck fractures. An analysis of 72 fractures with a new computerized measuring method. J Orthop Trauma 9:215–221

    Article  PubMed  CAS  Google Scholar 

  5. Szita J, Cserhati P, Bosch U, Manninger J, Bodzay T, Fekete K (2002) Intracapsular femoral neck fractures: the importance of early reduction and stable osteosynthesis. Injury 33:41–46

    Article  Google Scholar 

  6. Mehlman CT, DiPasquale TG (1997) Radiation exposure to the orthopaedic surgical team during fluoroscopy: “how far away is far enough?”. J Orthop Trauma 11:392–398

    Article  PubMed  CAS  Google Scholar 

  7. Sanders R, Koval KJ, Di Pasquale T, Schmelling G, Stenzler S, Ross E (1993) Exposure of the orthopaedic surgeon to radiation. J Bone Joint Surg [Am] 75:326–330

    CAS  Google Scholar 

  8. Kendoff D, Citak M, Gardner MJ, Kfuri M Jr, Thumes B, Krettek C, Hüfner T (2007) Three-dimensional fluoroscopy for evaluation of articular reduction and screw placement in calcaneal fractures. Foot Ankle Int 28:1165–1171

    Article  PubMed  Google Scholar 

  9. Kotsianos D, Rock C, Euler E, Wirth S, Linsenmaier U, Brandl R, Mutschler W, Pfeifer KJ (2001) 3-D imaging with a mobile surgical image enhancement equipment (ISO-C-3D). Initial examples of fracture diagnosis of peripheral joints in comparison with spiral CT and conventional radiography. Unfallchirurg 104:834–838

    Article  PubMed  CAS  Google Scholar 

  10. Wendl K, von Recum J, Wentzensen A, Grützner PA (2003) Iso-C 3D assisted navigated implantation of pedicle screws in thoracic lumbar vertebrae. Unfallchirurg 106:907–913

    PubMed  CAS  Google Scholar 

  11. Stöckle U, König B, Schaser K, Melcher I, Haas NP (2003) CT and fluoroscopy based navigation in pelvic surgery. Unfallchirurg 106:914–920

    PubMed  Google Scholar 

  12. Stöckle U, Schaser K, König B (2007) Image guidance in pelvic and acetabular surgery—expectations, success and limitations. Injury 38:450–462

    Article  PubMed  Google Scholar 

  13. Hamelinck HKM, Haagmans M, Snoeren MM (2006) Safety of computer-assisted surgery for cannulated hip screws. Clin Orthop Rel Res 455:241–245

    Google Scholar 

  14. Mayman D, Vasarhelyi EM, Long W, Ellis RE, Rudan J, Pichora DR (2005) Computer-assisted guidewire insertion for hip fracture fixation. J Orthop Trauma 19:610–615

    Article  PubMed  CAS  Google Scholar 

  15. Suhm N, Beck T, Zuna I, Marazzi C, Staedele H, Jacob AL, Messmer P, Regazzoni P (2004) Fluoroscopy-based surgical navigation versus fluoroscopic guidance to control guide wire insertion for osteosynthesis of femoral neck fractures. Eur J Trauma 1:23–28

    Article  Google Scholar 

  16. Mueller MC, Belei P, de la Fuente M, Strake M, Weber O, Burger C, Radermacher K, Wirtz DC (2011) Evaluation of a fluoroscopy-based navigation system enabling a virtual radiation-free preview of X-ray images for placement of cannulated hip screws. A cadaver study. Comp Aided Surg 16:22–31

    Article  Google Scholar 

  17. Gurusamy K, Parker MJ, Rowlands TK (2005) The complications of displaced intracapsular fractures of the hip: the effect of screw positioning and angulation on fracture healing. J Bone Joint Surg Br 87:632–634

    Article  PubMed  CAS  Google Scholar 

  18. Liebergall M, Ben-David D, Weil Y, Peyser A, Mosheiff R (2006) Computerized navigation for the internal fixation of femoral neck fractures. J Bone Joint Surg [Am] 88:1748–1754

    Article  Google Scholar 

  19. Kendoff D, Hüfner T, Citak M, Maier C, Wesemeier F, Pearle A, Krettek C (2006) A new parallel drill guide for navigating femoral neck screw placement. Development and evaluation. Unfallchirurg 109:875–880

    Article  PubMed  CAS  Google Scholar 

  20. Rock C, Kotsianos D, Linsenmaier U, Fischer T, Brandl R, Vill F, Wirth S, Kaltschmidt R, Euler E, Pfeifer KJ, Reiser M (2002) Studies on image quality, high contrast resolution and dose for the axial skeleton and limbs with a new, dedicated CT system (ISO-D-3D). Rofo 174:170–176

    Article  PubMed  CAS  Google Scholar 

  21. Kwong L, Johanson PH, Zinar DM, Lenihan MR, Herman MW (1990) Shielding of the patient’s gonads during intramedullary interlocking femoral nailing. J Bone Joint Surg [Am] 72:1523–1526

    CAS  Google Scholar 

  22. Kendoff D, Bogojevic A, Citak M, Citak M, Maier C, Maier G, Krettek C, Hüfner T (2007) Experimental validation of non-invasive referencing in navigated procedures on long bones. J Orthop Res 25:201–207

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study has been funded by the German Federal Ministry of Education and Research (BMBF) within the framework of the research program OrthoMIT through grants BMBF 01EQ0802 and 01IBE02C.

Conflict of interest

The authors declare that they have no conflict of interest

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany

    Marcus Christian Müller, Peter H. Pennekamp, Koroush Kabir, Dieter C. Wirtz, Christof Burger & Oliver Weber

  2. Helmholtz-Institute for Biomedical Engineering, Pauwelsstr. 20, 52074, Aachen, Germany

    Peter Belei

Authors
  1. Marcus Christian Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Belei
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter H. Pennekamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Koroush Kabir
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dieter C. Wirtz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christof Burger
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Oliver Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcus Christian Müller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Müller, M.C., Belei, P., Pennekamp, P.H. et al. Three-dimensional computer-assisted navigation for the placement of cannulated hip screws. A pilot study. International Orthopaedics (SICOT) 36, 1463–1469 (2012). https://doi.org/10.1007/s00264-012-1496-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-012-1496-7

Keywords

Search

Navigation