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 fluoroscopy or CT scan to diagnose the femoral neck fracture.</li>
	<li>Order FNS treatment for patients who are less than 60 years old and diagnosed with femoral neck fracture. Use these additional criteria for inclusion: fracture with a clear history of trauma; no history or evidence of metabolic diseases or pathological fractures; well-developed hip joint, with no manifestations of FHN and no deformity; a diagnosis of femoral neck fracture by an X-ray or CT scan.</li>
</ol>
2. Fracture close reduction, X-ray examination, and preparation of the robot-assisted orthopedic surgery system
<ol>
	<li>After general anesthesia, conduct closed reduction of fracture by manual traction and adjustment.
	<ol>
		<li>Restore the length of the affected limb by longitudinal traction with the surgeon holding the limb for traction, and restore the alignment of the fracture gap through limb rotation.</li>
		<li>Fix the limb to the traction bed (a kind of operation table that provides continuous limb traction) for continuous traction during the operation.</li>
	</ol>
	</li>
	<li>Examine the quality of the closed reduction by X-ray fluoroscopy. Restore the neck-shaft angle and alignment of the cortex in the AP and lateral views, and ensure that no angular deformities occur.</li>
	<li>Before the operation, connect the components of the robot-assisted orthopedic surgery system-the workstation, the optical tracking system, and the robotic arm-with the C-arm X-ray machine. Log into the system, and record the patient&#39;s medical records.</li>
</ol>
3. Disinfection, image collection, and surgical path planning
<ol>
	<li>After routine surgical disinfection, place a Schanz pin on the ipsilateral iliac wing, and fix the patient&#39;s tracer on the pin.</li>
	<li>Put sterile protective sleeves on the robotic arm and C-arm. Assemble the positioning ruler (with the 10 identification points on the positioning ruler for the robot positioning system) with the robotic arm.</li>
	<li>Position the C-arm X-ray machine centrally to the femoral neck, and put the robotic arm with the positioning ruler between the C-arm and the patient. Ensure that there is no obstruction of the optical tracking system, including the patient tracer and the robotic arm.</li>
	<li>Collect AP view (the X-ray image intensifier is perpendicular to the plane of the patient) and lateral view (the X-ray image intensifier is perpendicular to the femoral neck channel plane) X-ray images containing the 10 identification points of the positioning ruler.</li>
	<li>Import the AP and lateral view images into the workstation; the images must clearly contain 10 identification points and the entire proximal femur.</li>
	<li>Perform surgical screw path planning on the software of the workstation.
	<ol>
		<li>Locate the screw channel in the center of the femoral neck, with a neck-shaft angle of 130&#176; and parallel to the long axis of the femoral neck on the AP and lateral views.</li>
		<li>Locate the tip of the screw 5 mm under the cartilage of the femoral head.</li>
	</ol>
	</li>
</ol>
4. FNS placement and verification
<ol>
	<li>Replace the positioning ruler to the sleeve on the robotic arm. Run the robotic arm to the position of the entry point according to the planned path. Make a 3 cm incision on the skin along the long axis of the femur with a knife, blunt separate the subcutaneous tissue, and insert the sleeve to contact the bone cortex.</li>
	<li>Confirm the entry point and direction of the sleeve in accordance with the planned path. Fine-tune the path if necessary.</li>
	<li>Drill the guide wire into the bone through the sleeve until it is 5 mm from the subchondral bone. Remove the robotic arm, and check the position of the guide wire by X-ray.</li>
	<li>Ream the hole along the guide wire using a hollow drill bit, and insert the bolt and plate into the femoral head. Place the anti-rotation screw and locking screw.</li>
	<li>Apply dynamic compression using the compression design of the FNS. The fluoroscopy verifies the FNS placement, with the bolt in the center of the femoral neck both on the AP and lateral views and 5 mm from the subchondral bone, and with the plate fitting the bone.</li>
	<li>Suggest assisted passive hip flexion activities and active exercise of the knee and ankle joints post-operation. Perform follow-ups at 4 weeks, 8 weeks, 12 weeks, 24 weeks, 36 weeks, and 48 weeks postoperatively, with the weight-bearing time depending on the follow-up.</li>
</ol>

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A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optimal+treatment+of+femoral+neck+fractures+according+to+patient's+physiologic+age:+An+evidence-based+review.">Optimal treatment of femoral neck fractures according to patient's physiologic age: An evidence-based review.</a> The Orthopedic Clinics of North America. 41 (2), 157-166 (2010).</li><li>Stoffel, K., 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=Biomechanical+evaluation+of+the+femoral+neck+system+in+unstable+Pauwels+III+femoral+neck+fractures:+A+comparison+with+the+dynamic+hip+screw+and+cannulated+screws.">Biomechanical evaluation of the femoral neck system in unstable Pauwels III femoral neck fractures: A comparison with the dynamic hip screw and cannulated screws.</a> Journal of Orthopaedic Trauma. 31 (3), 131-137 (2016).</li><li>Mei, J., 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=Finite+element+analysis+of+the+effect+of+cannulated+screw+placement+and+drilling+frequency+on+femoral+neck+fracture+fixation.">Finite element analysis of the effect of cannulated screw placement and drilling frequency on femoral neck fracture fixation.</a> Injury. 45 (12), 2045-2050 (2014).</li><li>Zheng, Y., Yang, J., Zhang, F., Lu, J., Qian, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robot-assisted+vs+freehand+cannulated+screw+placement+in+femoral+neck+fractures+surgery:+A+systematic+review+and+meta-analysis.">Robot-assisted vs freehand cannulated screw placement in femoral neck fractures surgery: A systematic review and meta-analysis.</a> Medicine. 100 (20), 25926 (2021).</li><li>Karthik, K., Colegate-Stone, T., Dasgupta, P., Tavakkolizadeh, A., Sinha, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+surgery+in+trauma+and+orthopaedics:+A+systematic+review.">Robotic surgery in trauma and orthopaedics: A systematic review.</a> The Bone and Joint Journal. 97-B (3), 292-299 (2015).</li><li>Garden, R. 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The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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><tbody><tr><td>C-arm X-ray</td><td>Siemens&amp;nbsp;</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),&lt;br/&gt; diameter (10mm);&lt;br/&gt; Anti-rotation screw:length (75mm-130mm,5mm interval,match the lenth of the blot),&lt;br/&gt; diameter (6.5mm);&lt;br/&gt; 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 ...

orthopedic-robot-assisted-femoral-neck-system-treatment-femoral-neck

Research

JoVE Journal

Medicine

2.4K Views.  Xi'an Jiaotong University. Femurhalsfractuur komt vaak voor. Traditioneel gebruiken we een methode uit de vrije hand voor het plaatsen van schroeven. Nu passen we het robot-geassisteerde orthopedische chirurgiesysteem toe bij chirurgische manipulatie, wat bevredigende resultaten heeft.Het robotbeoordelingssysteem kan zorgen voor een nauwkeurigere schroefplaatsing, een efficiëntere hechtingsnauwkeurigheid, verminderde intraoperatieve blootstelling aan straling en een beter resultaat bereiken. Dit systeem kan wor...

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

A Teleoperated Robotic System-Assisted Percutaneous Transiliac-Transsacral Screw Fixation Technique

Transiliac-transsacral screw fixation is challenging in clinical practice as the screws need to break through six layers of cortical bone. Transiliac-transsacral screws provide a longer lever arm to withstand the perpendicular vertical shear forces. However, the screw channel is so long that a minor discrepancy can lead to iatrogenic neurovascular injuries. The development of medical robots has improved the precision of surgery. The present protocol describes how to use a new teleoperated robotic system to execute transiliac-transacral screw fixation. The Robot was operated remotely to position the entry point and adjust the orientation of the sleeve. The screw positions were evaluated using postoperative computed tomography (CT). All the screws were safely implanted, as confirmed using intraoperative fluoroscopy. Postoperative CT confirmed that all the screws were in the cancellous bone. This system combines the doctor's initiative with the Robot's stability. The remote control of this procedure is possible. Robot-assisted surgery has a higher position-retention capacity compared with conventional methods. In contrast to active robotic systems, surgeons have full control over the operation. The robot system is fully compatible with operating room systems and does not require additional equipment.

Teleoperated robotic system-assisted percutaneous transiliac-transsacral screw fixation is a feasible technique. Screw channels can be implemented with high accuracy owing to the excellent freedom of movement and stability of the robotic arms.

Transiliac-transsacral screw fixation is challenging in clinical practice as the screws need to break through six layers of cortical bone. ...

Engineering

A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement

Pedicle screw implantation has excellent treatment effects and is often used by surgeons in spinal fusion surgery. However, due to the complexity of human body anatomy, this surgical procedure is difficult and challenging, especially in minimally invasive surgery or patients with congenital anomalies and kyphoscoliosis deformity. In addition to the abovementioned factors, the surgical experience and technique of the surgeon also affect the recovery rates and complications of the patients after the surgical operation. Therefore, accurately performing pedicle screw implantation has is a constant topic of common concern for surgeons and patients. In recent years, with the technological development, robot-assisted navigation systems have gradually become adopted. These robot-assisted navigation systems provide surgeons with complete preoperative planning before surgery. The system provides 3D reconstructed images of each vertebra, allowing surgeons to understand the patient&#39;s physiological characteristics more quickly. It also provides 2D images of sagittal, coronal, axial and oblique planes so that surgeons can accurately perform pedicle screw placement plan.
Previous studies have demonstrated the effectiveness of robot-assisted navigation systems for pedicle screw implantation procedures, including accuracy and safety assessments. This step-by-step protocol aims to outline a standardized surgical technique note for robotic-assisted pedicle screw placement.

This article presents a standardized surgical technique for robotic-assisted pedicle screw placement by using robotic-assisted navigational systems. We present a step-by-step protocol and describe the workflow and precautions of this procedure.

Pedicle screw implantation has excellent treatment effects and is often used by surgeons in spinal fusion surgery. However, due to the complexity of human ...

Bioengineering

Cantilever Bending of Murine Femoral Necks

Fractures in the femoral neck are a common occurrence in individuals with osteoporosis. Many mouse models have been developed to assess disease states and therapies, with biomechanical testing as a primary outcome measure. However, traditional biomechanical testing focuses on torsion or bending tests applied to the midshaft of the long bones. This is not typically the site of high-risk fractures in osteoporotic individuals. Therefore, a biomechanical testing protocol was developed that tests the femoral necks of murine femurs in cantilever bending loading to replicate better the types of fractures experienced by osteoporosis patients. Since the biomechanical outcomes are highly dependent on the flexural loading direction relative to the femoral neck, 3D printed guides were created to maintain a femoral shaft at an angle of 20&#176; relative to the loading direction. The new protocol streamlined the testing by reducing variability in alignment (21.6&#176; &plusmn; 1.5&#176;, COV = 7.1%, n = 20) and improved reproducibility in the measured biomechanical outcomes (average COV = 26.7%). The new approach using the 3D printed guides for reliable specimen alignment improves rigor and reproducibility by reducing the measurement errors due to specimen misalignment, which should minimize sample sizes in mouse studies of osteoporosis.

The present protocol describes the development of a reproducible testing platform for murine femoral necks in a cantilever bending set-up. Custom 3D printed guides were used to consistently and rigidly fix the femurs in optimal alignment.

Fractures in the femoral neck are a common occurrence in individuals with osteoporosis. Many mouse models have been developed to assess disease states and ...

The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed reality were used to perform complex revision hip arthroplasty in January 2019. The use of mixed reality allowed for a very good visualization of the structures and resulted in precise implant fixation. According to the authors' knowledge, this is the first described case report of the combined use of these two innovations. The diagnosis preceding the qualification for the procedure was the loosening of the left hip's acetabular component. Mixed reality headset and holograms prepared by engineers were used during the surgery. The operation was successful, and it was followed by early verticalization and patient rehabilitation. The team sees opportunities for technology development in joint arthroplasty, trauma, and orthopedic oncology.

A complex revision hip arthroplasty was performed using a custom-made implant and mixed reality technology. According to the authors&#39; knowledge, this is the first report of such procedure described in the literature.

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed ...

Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head

Osteonecrosis of the femoral head (ONFH) is a common joint disease in young and middle-aged patients, which seriously burdens their lives and work. For early-stage ONFH, core decompression surgery is a classical and effective hip preservation therapy. In traditional procedures of core decompression with Kirschner wire, there are still many problems such as X-ray exposure, repeated puncture verification, and damage to normal bone tissue. The blindness of the puncture process and the inability to provide real-time visualization are crucial reasons for these problems.
To optimize this procedure, our team developed an intraoperative navigation system on the basis of augmented reality (AR) technology. This surgical system can intuitively display the anatomy of the surgical areas and render preoperative images and virtual needles to intraoperative video in real-time. With the guide of the navigation system, surgeons can accurately insert Kirschner wires into the targeted lesion area and minimize the collateral damage. We conducted 10 cases of core decompression surgery with this system. The efficiency of positioning and fluoroscopy is greatly improved compared to the traditional procedures, and the accuracy of puncture is also guaranteed.

Augmented reality technology was applied to core decompression for osteonecrosis of the femoral head to realize real-time visualization of this surgical procedure. This method can effectively improve the safety and precision of core decompression.

Osteonecrosis of the femoral head (ONFH) is a common joint disease in young and middle-aged patients, which seriously burdens their lives and work. For ...

Application of the O-arm Intraoperative Imaging System to Assist Anterior Cervical Screw Fixation for Odontoid Fractures

Odontoid fractures account for a large proportion of cervical spine fractures in the elderly, causing pain in the occiput and the back of the neck and restricting neck movement. Anterior cervical screw fixation is a common surgical procedure to treat odontoid fractures. Due to the special location and complex anatomy of the odontoid, surgeons need to perform intraoperative fluoroscopies repeatedly to ensure correct screw position and avoid damage to the peripheral nerves and vessels of the odontoid. The traditional anterior cervical screw fixation is usually conducted with the assistance of a C-arm. However, compared to the C-arm, an O-arm intraoperative imaging system can provide 3D images during surgery, which improves the accuracy of screw placement. This study retrospectively analyzed patients with anterior cervical odontoid fractures treated in our hospital. The application of the O-arm intraoperative imaging system for assisting screw placement in the treatment of odontoid fractures can reduce intraoperative blood loss, operation time, and trauma to the patients.

This study describes the application of the O-arm intraoperative imaging system in odontoid fractures.

Odontoid fractures account for a large proportion of cervical spine fractures in the elderly, causing pain in the occiput and the back of the neck and ...

Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy

Anterior knee pain (AKP) is a common pathology among adolescents and adults. Increased femoral anteversion (FAV) has many clinical manifestations, including AKP. There is growing evidence that increased FAV plays a major role in the genesis of AKP. Furthermore, this same evidence suggests that derotational femoral osteotomy is beneficial for these patients, as good clinical results have been reported. However, this type of surgery is not widely used among orthopedic surgeons.
The first step in attracting orthopedic surgeons to the field of rotational osteotomy is to give them a methodology that simplifies preoperative surgical planning and allows for the previsualization of the results of surgical interventions on computers. To that end, our working group uses 3D technology. The imaging dataset used for surgical planning is based on a CT scan of the patient. This 3D method is open access (OA), meaning it is accessible to any orthopedic surgeon at no economic cost. Furthermore, it not only allows for the quantification of femoral torsion but also for carrying out virtual surgical planning. Interestingly, this 3D technology shows that the magnitude of the intertrochanteric rotational femoral osteotomy does not present a 1:1 relationship with the correction of the deformity. Additionally, this technology allows for the adjustment of the osteotomy so that the relationship between the magnitude of the osteotomy and the correction of the deformity is 1:1. This paper outlines this 3D protocol.

This work presents a detailed surgical planning protocol using 3D technology with free open-source software. This protocol can be used to correctly quantify femoral anteversion and simulate derotational proximal femoral osteotomy for the treatment of anterior knee pain.

Anterior knee pain (AKP) is a common pathology among adolescents and adults. Increased femoral anteversion (FAV) has many clinical manifestations, ...

Evaluating Brain Activation by fNIRS During a Lower Limb Robotic Therapy Session

An Experiment Using Functional Near-Infrared Spectroscopy and Robot-Assisted Multi-Joint Pointing Movements of the Lower Limb

Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise in helping stroke patients regain lost motor functions. One potential avenue for increasing the understanding of how motor recovery occurs is to study brain activation during the movements that are targeted by therapy in healthy individuals. Functional Near-Infrared Spectroscopy (fNIRS) has emerged as a promising neuroimaging technique for examining neural underpinnings of motor function. This study aimed to investigate fNIRS neural correlates of complex lower limb movements in healthy subjects. Participants were asked to perform cycles of rest and movement for 6 min using a robotic device for motor rehabilitation. The task required coordinated knee and ankle joint movements to point to targets displayed on a computer screen. Two experimental conditions with different levels of movement assistance provided by the robot were explored. The results showed that the fNIRS protocol effectively detected brain regions associated with motor control during the task. Notably, all subjects exhibited greater activation in the contralateral premotor area during the no-assistance condition compared to the assisted condition. In conclusion, fNIRS appears to be a valuable approach for detecting changes in oxyhemoglobin concentration associated with multi-joint pointing movements of the lower limb. This research might contribute to the understanding of stroke motor recovery mechanisms and might pave the way for improved rehabilitation treatments for stroke patients. However, further research is needed to fully elucidate the potential of fNIRS in studying motor function and its applications in clinical settings.

Author Spotlight: Assessing Brain Activity in Robotic-Assisted Lower Limb Rehabilitation Using fNIRS

It is estimated that 1 in 6 individuals worldwide will have a stroke in their lifetime, causing long-term disability, whose rehabilitation mechanisms are still poorly understood. This study proposes a protocol to evaluate brain activation by functional near-infrared spectroscopy (fNIRS) during a lower limb robotic therapy session.

Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise ...

Neuroscience

Combination of Anatomical Plates and Rotator Cuff Reinforcement for Minimally Invasive Treatment of Greater Tuberosity Fractures of the Humerus

Greater tuberosity fractures of the humerus can be challenging to manage due to their complex anatomy and the potential for compromised shoulder function. We present a novel technique for treating greater tuberosity fractures utilizing specialized anatomical plates and rotator cuff reinforcement. The technique involves the use of an anatomically T-shaped plate designed specifically for the greater tuberosity region of the humerus, allowing for precise fixation and stability. Additionally, rotator cuff reinforcement is performed using sutures to enhance structural integrity and promote early mobilization. The simplified process is as follows: After administering anesthesia, a 3 cm incision is made along the lateral aspect of the shoulder to precisely expose the fracture site of the greater tuberosity. A suture of size 5 is skillfully threaded through the tough rotator cuff tendon to securely attach the proximal humerus to the anatomical plate after the greater tuberosity has been reduced. Intraoperative fluoroscopy is utilized to verify the accurate positioning of plates and screws. After ensuring everything is correct, the surgery concludes.

Here, we present a protocol to utilize anatomical plates alongside rotator cuff reinforcement in a minimally invasive surgery to efficiently treat humerus greater tuberosity fractures, promising quicker healing and improved stability.

Greater tuberosity fractures of the humerus can be challenging to manage due to their complex anatomy and the potential for compromised shoulder function. ...

Technique of Sagittal Adjusting Screw System for Thoracolumbar Burst Fractures

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device

Thoracolumbar (TL) burst fracture is one of the most common indications for minimally invasive percutaneous pedicle screw fixation. Although the indication for surgical treatment of neurologically intact TL fractures remains under debate, studies have demonstrated that posttraumatic malalignment may lead to a deterioration in the patient&#39;s quality of life. For burst fractures with malalignment or fragments in the spinal canal, a reduction technique using ligamentotaxis is commonly used to improve long-term outcomes.
The sagittal adjusting screw (SAS) system is a monoaxial screw system with a fixed head and concave sliding saddle that allows lordotic sliding of the rod in the sagittal plane after screw insertion. SAS also has a percutaneous option and has been used for TL spine fractures. Notably, the SAS only allows motion on the sagittal plane, allowing both secure fixation and angular reduction. The SAS has certain advantages over the conventional Schanz screw system or normal mono-/multiaxial pedicle screws for TL spine fracture treatment. In addition, specialized trauma reduction devices are available for the SAS system. In this video protocol, we discuss the indication for the SAS system in TL burst fracture and describe a technique of TL burst fracture reduction and fixation using the SAS system. Additionally, we describe our recent case series with radiological evaluation, including regional kyphotic angle and percent loss of anterior vertebral body height, to evaluate the newly introduced trauma reduction device.

The sagittal adjusting screw (SAS) system has been widely used for thoracolumbar (TL) spinal trauma. Percutaneous options and specialized trauma reduction devices are also available for the SAS system. We describe a technique for reducing TL burst fractures using an SAS system and a newly introduced trauma reduction device.

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

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