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>
	<li>Thorngren, K. G., Hommel, A., Norrman, P. O., Thorngren, J., Wingstrand, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epidemiology+of+femoral+neck+fractures.">Epidemiology of femoral neck fractures.</a> Injury. 33, 1-7 (2002).</li><li>Lowe, J. A., Crist, B. D., Bhandari, M., Ferguson, T. 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. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Low-angle+fixation+in+fractures+of+the+femoral+neck.">Low-angle fixation in fractures of the femoral neck.</a> The Bone and Joint Journal. 43 (4), 647-663 (1961).</li><li>Harris, W. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Traumatic+arthritis+of+the+hip+after+dislocation+and+acetabular+fractures:+Treatment+by+mold+arthroplasty.+An+end-result+study+using+a+new+method+of+result+evaluation.">Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. An end-result study using a new method of result evaluation.</a> Journal of Bone and Joint Surgery. American Volume. 51 (4), 737-755 (1968).</li><li>Tang, Y., 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=Femoral+neck+system+versus+inverted+cannulated+cancellous+screw+for+the+treatment+of+femoral+neck+fractures+in+adults:+A+preliminary+comparative+study.">Femoral neck system versus inverted cannulated cancellous screw for the treatment of femoral neck fractures in adults: A preliminary comparative study.</a> Journal of Orthopaedic Surgery and Research. 16, 504 (2021).</li><li>Da Many, D. S., Parker, M. J., Chojnowski, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+after+intracapsular+hip+fractures+in+young+adults.+A+meta-analysis+of+18+published+studies+involving+564+fractures.">Complications after intracapsular hip fractures in young adults. 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. 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=Robot-assisted+percutaneous+cannulated+screw+fixation+of+femoral+neck+fractures:+Preliminary+clinical+results.">Robot-assisted percutaneous cannulated screw fixation of femoral neck fractures: Preliminary clinical results.</a> Orthopaedic Surgery. 11 (1), 34-41 (2019).</li><li>Zwingmann, J., Hauschild, O., Bode, G., S&#252;dkamp, N. S., Schmal, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Malposition+and+revision+rates+of+different+imaging+modalities+for+percutaneous+iliosacral+screw+fixation+following+pelvic+fractures:+A+systematic+review+and+meta-analysis.">Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: A systematic review and meta-analysis.</a> Archives of Orthopaedic &amp; Trauma Surgery. 133 (9), 1257-1265 (2013).</li><li>Zwingmann, J., Konrad, G., Kotter, E., S&#252;dkamp, N. P., Oberst, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computer-navigated+iliosacral+screw+insertion+reduces+malposition+rate+and+radiation+exposure.">Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure.</a> Clinical Orthopaedics and Related Research. 467 (7), 1833-1838 (2009).</li><li>Stockton, D. 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=Failure+patterns+of+femoral+neck+fracture+fixation+in+young+patients.">Failure patterns of femoral neck fracture fixation in young patients.</a> Orthopedics. 42 (4), 376-380 (2019).</li><li>Wu, X. -. B., Wang, J. -. Q., Sun, X., Han, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidance+for+the+treatment+of+femoral+neck+fracture+with+precise+minimally+invasive+internal+fixation+based+on+the+orthopaedic+surgery+robot+positioning+system.">Guidance for the treatment of femoral neck fracture with precise minimally invasive internal fixation based on the orthopaedic surgery robot positioning system.</a> Orthopaedic Surgery. 11 (3), 335-340 (2019).</li></ol>

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 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 ...

Femoral neck fracture is common. Traditionally, we use a freehand method for screw placement. Now we apply the robot-assisted orthopedic surgery system in surgical manipulation, which has satisfactory results.The robot assess system could provide more accurate screw placement, a more efficient suture precise, reduced intraoperative radiation exposure, and achieve a better outcome. This system can be used in minimal invasive orthopedic surgery, particular in the procedure recurrent process screw placement, such as pelvic or acetabular fracture and the spine injury. Demonstrating the procedure, we have Yongchao Duan, an intraoperative imaging technologist, and Hai Huang, a surgeon from my department.To begin, identify the patient with a femoral neck fracture with tenderness or percussed pain around the hip joint. Fix the limb to the traction bed for continuous traction during the operation. Before starting the operation, connect the components of the robot-assisted orthopedic surgery system and unfold the robot arm.Log into the system and record the patient's medical records. After routine surgical disinfection, place a Schanz pin on the ipsilateral iliac wing, and fix the patient's tracer on the pin. Put sterile protective sleeves on the robotic arm and on the C-arm.Assemble the positioning ruler with the 10 identification points for the robot positioning system with the robotic arm. 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. Collect anteroposterior and lateral view X-ray images containing the 10 identification points of the positioning ruler.Import the anteroposterior and lateral view images containing 10 identification points, and the entire proximal femur into the workstation. Locate the screw channel in the center of the femoral neck with the neck shaft angle of 130 degrees, and parallel to the long axis of the femoral neck on the anteroposterior and lateral views. Locate the tip of the screw five millimeters under the cartilage of the femoral head.Replace the positioning ruler with the sleeve on the robotic arm. Run the robotic arm to the position of the entry point according to the planned path. Then make a three centimeter 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. Confirm the entry point and direction of the sleeve in accordance with the planned path. Drill the guide wire into the bone through the sleeve until it is five millimeters from the subchondral bone.Remove the robotic arm and check the position of the guide wire by x-ray. Ream the hole along the guidewire using a hollow drill bit, and insert the bolt and plate into the femoral head. Then place the anti-rotation screw and locking screw.After applying dynamic compression, verify the FNS placement with the bolt in the center of the femoral neck, both on the anterior, posterior and lateral views, and five millimeters from the subchondral bone and with the plate fitting the bone. Following the operation, suggest assisted passive hip flexion activities, and active exercise of the knee and ankle joints. The pre-operation x-ray images of the femoral neck fracture in anteroposterior and lateral view are shown here.The fracture was reduced by closed reduction to a proper position. The collected x-ray images using the patient tracer and the positioning ruler with the positioning ruler between the C-arm and the patient are demonstrated along with the fluoroscopy images containing the positioning ruler. Surgical path planning was performed on the software, and the screw channel was virtually displayed.The structure of the FNS process, the reaming process, the placement of the bolt and plate, the anti-rotation screw, and the locking screw are shown. X-ray images confirmed dynamic compression in anteroposterior and lateral view. This robot-assisted orthopedic surgery system simulates the screw plates virtually, assisting the screw placement precisely and reduce the risk of surgical procedure.

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

Research

JoVE Journal

Medicine

2.2K visualizações.  Xi'an Jiaotong University. A fratura do colo do fêmur é comum. Tradicionalmente, usamos um método à mão livre para a colocação do parafuso. Agora aplicamos o sistema de cirurgia ortopédica robô-assistida na manipulação cirúrgica, que apresenta resultados satisfatórios.O sistema de avaliação do robô poderia fornecer uma colocação mais precisa do parafuso, uma sutura mais eficiente, precisa, menor exposição à radiação intraoperatória e alcançar um melhor resultado. Este sistema pode ser ut...