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

Summary

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.

Abstract

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.

Introduction

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 g....

Protocol

The present study was approved by the ethics committee of Honghui Hospital Xi'an Jiaotong University. Informed consent was obtained from the patients.

1. Diagnosis of femoral neck fracture by X-ray fluoroscopy

1. 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.
2. Use an antero-posterior (AP) view and a lateral view of an X-ray fluo.......

Discussion

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.'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.......

Materials

Name	Company	Catalog Number	Comments
C-arm X-ray	Siemens	CFDA Certified No:20163542280	Type: ARCADIS Orbic 3D
Femoral neck system	DePuy, Synthes, Zuchwil, Switzerland	CFDA Certified No: 20193130357	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)
Robot-assisted orthopedic surgery system	Tianzhihang, Beijing,China	CFDA Certified No:20163542280	3rd generation
Traction Bed	Nanjing Mindray biomedical electronics Co.ltd.	Jiangsu Food and Drug Administration Certified No:20162150342	Type:HyBase 6100s