Name: orthopedic robot-assisted femoral neck system in the treatment of femoral neck fracture
Uploaded: 2023-03-03T13:45:00
Description: Watch this Scientific Journal Video about Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture at JoVE.com

This work was supported by the Youth Cultivation Project of Xi&#39;an Health Commission (Program No. 2023qn17) and the Key Research and Development Program of Shaanxi Province (Program No. 2023-YBSF-099).

The present study was approved by the ethics committee of Honghui Hospital Xi&#39;an Jiaotong University. Informed consent was obtained from the patients.
1. Diagnosis of femoral neck fracture by X-ray fluoroscopy
<ol>
	<li>Identify patients who have a femoral neck fracture with tenderness or percussed pain around the hip joint, shortening of the lower extremity, limitation of the hip joint, etc.</li>
	<li>Use an antero-posterior (AP) view and a lateral view of an X-ray fluo...

<ol>
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A meta-analysis of 18 published studies involving 564 fractures.</a> Injury. 36 (1), 131-141 (2005).</li><li>Hamelinck, H. K. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+of+computer-assisted+surgery+for+cannulated+hip+screws.">Safety of computer-assisted surgery for cannulated hip screws.</a> Clinical Orthopaedics and Related Research. 455, 241-245 (2007).</li><li>Wang, X., Lan, H., Li, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+femoral+neck+fractures+with+cannulated+screw+invasive+internal+fixation+assisted+by+orthopaedic+surgery+robot+positioning+system.">Treatment of femoral neck fractures with cannulated screw invasive internal fixation assisted by orthopaedic surgery robot positioning system.</a> Orthopaedic Surgery. 11 (5), 864-872 (2019).</li><li>Duan, S. 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FNS is a method for fixing femoral neck fractures, which has the advantages of angular stability of the sliding hip screws and minimal invasiveness of the placement of the multiple cannulated screws. This method is less prone to screw cutting and irritation of the surrounding soft tissues. In Tang et al.&#39;s study9, compared with the CCS group, patients in the FNS group had lower rates of no or mild femoral neck shortness, shorter healing times, and higher Harris scores. Biomechanical studies ha...

Femoral neck fracture is one of the most common fractures in the clinic and accounts for about 3.6% of human fractures and 54.0% of hip fractures1. For young patients with femoral neck fractures, surgical treatment is performed to reduce the risk of nonunion and femoral head necrosis (FHN) by anatomical reduction and rigid internal fixation and to restore their function to the preoperative level as much as possible2. The most commonly used surgical treatment is fixation by three cannulated compression screws (CCS). With the increase in patient requirements, especially in young patients, the femoral neck system (FNS) is gradually being used, which combines the advantages of angular stability, minimal invasiveness, and better biomechanical stability than CCS for unstable femoral neck fractures3.
Traditionally, the screws were placed freehand by surgeons under fluoroscopic intraoperative guidance. The freehand method has many shortcomings, such as inability to plan the path intraoperatively, difficulty in controlling the direction of the guide wire during drilling, damage to the bone and blood supply due to repeated drilling, and penetration of the screw through the cortex due to improper positioning. These factors can directly or indirectly cause postoperative complications, such as fracture nonunion, FHN, and internal fixation failure, which influence the functional prognosis4. The freehand method has also been associated with increased radiation injury to patients and surgeons from frequent fluoroscopies5. Therefore, determining the optimal screw entry point and precise screw placement during pre-operative planning are key to the success of the operation. In recent years, robot-assisted minimally invasive internal fixation has been used with increasing frequency in orthopedic surgery6, and it is widely accepted by orthopedic surgeons because of its high precision and its ability to reduce the operation time and radiation injury. We applied the robot-assisted orthopedic surgery system to assist in FNS fixation for the treatment of femoral neck fractures, which resulted in a more accurate and efficient screw placement process, a higher success rate of the screw placement, and better functional recovery.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>C-arm X-ray</td>
			<td>Siemens&#160;</td>
			<td>CFDA Certified No:20163542280</td>
			<td>Type: ARCADIS Orbic 3D</td>
		</tr>
		<tr>
			<td>Femoral neck system</td>
			<td>DePuy, Synthes, Zuchwil, Switzerland</td>
			<td>CFDA Certified No: 20193130357</td>
			<td>Blot:length (75mm-130mm,5mm interval), 
			diameter (10mm); 
			Anti-rotation screw:length (75mm-130mm,5mm interval,match the lenth of the blot), 
			diameter (6.5mm); 
			Locking screw:length(25mm-60mm,5mm interval),diameter(5mm)</td>
		</tr>
		<tr>
			<td>Robot-assisted orthopedic surgery system</td>
			<td>Tianzhihang, Beijing,China</td>
			<td>CFDA Certified No:20163542280</td>
			<td>3rd generation</td>
		</tr>
		<tr>
			<td>Traction Bed</td>
			<td>Nanjing Mindray biomedical electronics Co.ltd.</td>
			<td>Jiangsu Food and Drug Administration Certified No:20162150342</td>
			<td>Type:HyBase 6100s</td>
		</tr>
	</tbody>
</table>

orthopedic robot-assisted femoral neck system in the treatment of femoral neck fracture

Cannulated screw fixation is the main therapy for femoral neck fractures, especially in young patients. The traditional surgical procedure uses C-arm fluoroscopy to place the screw freehand and requires several guide wire adjustments, which increases the operation time and radiation exposure. Repeated drilling can also cause damage to the blood supply and bone quality of the femoral neck, which can be followed by complications such as screw loosening, nonunion, and femoral head necrosis. In order to make fixation more precise and reduce the incidence of complications, our team applied robot-assisted orthopedic surgery for screw placement using the femoral neck system to modify the traditional procedure. This protocol introduces how to import a patient's X-ray information into the system, how to perform screw path planning in software, and how the robotic arm assists in screw placement. Using this method, the surgeons can place the screw successfully the first time, improve the accuracy of the procedure, and avoid radiation exposure. The whole protocol includes the diagnosis of femoral neck fracture; the collection of intraoperative X-ray images; screw path planning in the software; precise placement of the screw under the assistance of the robotic arm by the surgeon; and verification of the implant placement.

The robot-assisted orthopedic surgery system simulates the screw path virtually and assists in the precise placement of the screw, meaning this system has the advantages of being highly stable, having improved surgical precision and success rate, and having a lower risk of surgical trauma and radiation injury. Finally, the accuracy of the screw fixation results in a better clinical prognosis and a lower incidence of complications.
Patients diagnosed with a femoral neck fracture received surger...

Watch this Scientific Journal Video about Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture at JoVE.com

Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture

This article introduces a method of robot-assisted orthopedic surgery for screw placement during the treatment of femoral neck fracture using the femoral neck system, which allows for more accurate screw placement, improved surgical efficiency, and fewer complications.

Cannulated screw fixation is the main therapy for femoral neck fractures, especially in young patients. The traditional surgical procedure uses C-arm ...

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