Projector-based visualization for intraoperative navigation: first clinical results
Harald HoppeGeorg EggersThorsten HeurichJ. RaczkowskyRüdiger MarmullaH. WörnStefan HaßfeldJosé Luis Moctezuma
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Navigation System
Objective Toestablish femoral fracture models in goats,and compare the effect of using carmulated interlocking intramedullary nail and intramedullary nail with tail wire.Methods 40 adult male goats were selected,and the bilateral posterior middle femoral fracture models were artificially established.Twenty goats were fixed with cannulated interlocking intramedullary nail (group A),and 20 with intramedullary nail with tail wire (group B).X-ray examination was done at 4th and 8th week postoperatively and the nails were removed after fractures were healed.All the operative data were recorded and analyzed statistically.Results All fractures were healed in about 8 weeks postoperatively.Implanting operative time was (37.9 ± 5.1) min,blood loss was (38.0 + 66.0) mL,intraoperative fluoroscopy time was (6.8 + 3.1) s,and removal operative time was (24.4 + 5.3) min,blood loss was (26.3 ± 7.8) mL in group B,which were significantly different from those in group A (P ＜ 0.05 for all).End cap falls in both groups had no significant differences (P ＞ 0.05).One goat in group B was died after the implanting operation.Conclusion Intramedullary nail with tail wire in fixing femoral fractures has the same effects as cannulated interlocking intramedullary nail,but it has many advantages,including shorter operative time,less blood loss and X-ray exposure,and simple steps.
Key words:
Goats; Femoral fracture; Intramedullary nail with tail wire; Cannulated interlocking intramedullary nail; Intramedullary nail removal operation
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Studies show promising results that intramedullary nailing may be a better treatment than cast immobilization for closed or grade I open tibial fractures. Time-to-union and time away from work is significantly shorter, and there are fewer delayed unions and non-unions in the groups treated by intramedullary nailing. Pain is consistently greater in the groups treated by intramedullary nailing compared with casting; however, several aspects of health-related quality of life are superior in the intramedullary nailing group despite more pain complaints.
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Objective To observe the self-locking intramedullary nail’s advantage in femoral shaft fracture treatment. Methods 22 cases of femoral shaft fractures were treated with self-locking intramedullary nail, and 18 cases were treated with interlocking intramedullary nail. Measure the bleeding and time consuming in operation. Results In bleeding and time consuming, the group using self-locking intramedullary nail are better than using interlocking intramedullary nail. Conclusion The self-locking intramedullary nail is a good internal fixation method to treat femoral shaft fractures. It’s a minimally invasive intramedullary nail.
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The past decade has seen a dramatic increase in the use of intramedullary nailing for fracture manage- ment. Increased availability of new techniques and instrumentation have contributed to the continuing expansion of applications for intramedullary nailing. The introduction and availability of image intensi- fiers into American hospitals has also led to the popularization of closed intramedullary nailing techniques, and locking nails have expanded the indications of closed intramedullary nailing to unstable long bone frac- tures of the femur, tibia, and humerus. New classes of nails such as the second generation Reconstruction Nail have expanded the use of intramedullary nailing for more proximal femoral fractures. In addition, advances in biomechanical and locking designs have recently led to the use of intramedullary nailing in distal femur fractures and forearm fractures. There is continuing evolution of specialized nails including a self-guiding nail, nails for use in femoral lengthening, and nails used in conjunction with intramedullary osteotomies.
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PURPOSE: To investigate the efficacy of a second-generation prototype magnetic guidance system in complex vessel phantoms versus conventional navigation in simulated interventional radiology procedures and to analyze procedure and fluoroscopy times. MATERIALS AND METHODS: The magnetic guidance system consists of two focused-field permanent magnets on each side of the body that create a 0.1-T navigation field and is integrated with a modified C-arm single-planar digital angiography system. Forty-nine navigations in a glass phantom and 80 navigations in a three-dimensional liver phantom were performed with a magnetically tipped floppy 0.014-inch guide wire and a conventional 0.014-inch microcatheter system. Rates of success and fluoroscopy and procedure times were quantified for both techniques. For the liver phantom experiment, the Mann-Whitney U test was used. For the glass phantom experiment, the Wilcoxon matched pair test was used with the Hodges-Lehmann estimator. RESULTS: In the glass phantom experiments, 42 of 49 turns were successfully performed with both methods. Procedure time to reach a target did not differ significantly between methods, while fluoroscopy time was significantly different when compared with that of the magnetic guidance system (P < .01). Navigation in the liver phantom was successful in 80 of 80 turns with the magnetic guidance system and in 76 of 80 turns with conventional navigation. With the support of the magnetic guidance system, procedure time and fluoroscopy time were significantly different from those with conventional navigation (P < .001). CONCLUSION: The magnetic guidance system allows the precise navigation of a magnetic guide wire in complex vessel phantoms with significantly shorter fluoroscopy and procedure times. © RSNA, 2004
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Objective To compare and analyse the related factors in the treatment of tibial shaft fracture with expandable intramedullary and interlocking intramedullary nailing systems. Methods From June 2004 to October 2005,57cases with tibial shaft fractures were followed up.They were treated with two kinds of fixations: interlocking intramedullary nail(42cases) and expandable intramedullary nail(15cases).The data of each group were collected for comparison on the following aspects:operative time,blood loss,fluoroscopy exposures,post-operative complications and healing time of fracture. Results The differences of the operative time,blood loss,fluoroscopy exposures and healing time of fracture between two groups were of statistical significance (P0.05). The differences in the post-operative complications between two groups were of no statistical significance (P0.05).The group of expandable intramedullary nail was more satisfactory than the group of interlocking intramedullary nail on many aspects. Conclusion The expandable intramedullary nailing systems have many advantages over intramedullary nailing systems,such as easy operation,less trauma and soon healing.but they are more costly and less indication.
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Objective To systematically compare the therapeutical effects of self-locking intramedullary nail and inter-locking intramedullary nail on tibia fracture.Methods This study retrieved the literatures from CNKI,WanFang,VIP database between 1990 and Oct.2011.Meta-analysis on the rate of excellent and good results,incidence of the complication,operation time,blood loss,and hospital stays were performed by Stata 10.0.Results 20 literatures were searched.Among them,9 literatures were selected in the following meta-analysis,including 762 tibia fracture patients.Among these patients,378 were included in self-locking intramedullary nail group and 384 were in inter-locking intramedullary nail group.The rate of excellent and good results was not statistically significant between two groups(combined OR=2.075,95% CI 0.781-5.512,Z=1.46,P=0.143).However,the incidence of the complication of self-locking intramedullary nail group was significantly lower than inter-locking intramedullary nail group(combined OR=0.168,95% CI 0.082-0.344,Z=4.87,P0.001).Furthermore,other effective indexes of self-locking intramedullary nail group were superior to inter-locking intramedullary nail group.Conclusions Although the rate of excellent and good results between two groups was not significant,compared with inter-locking intramedullary nail,self-locking intramedullary nail group showed the significant advantages in the treatment of tibia fracture,which should be widely applied in clinical.However,it′s necessary to synthetically analyze individual situation for the selection of therapeutic methods.
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There are various extremity lengthening methods in the literature. Lengthening with intramedullary nails is also important method which is emphasized recent years. In this study, in the light of previous studies, it is aimed to develop a new expandable intramedullary system providing lengthening in order to remove previous problems and complications and to annihilate leg length discrepancies at present and future without second surgical intervention as far as possible by lengthening the intramedullary nail.To this end, a new mechanically active intramedullary nail has been designed and constructed.The prototype of constructed intramedullary nail has been inserted in a synthetic femur (saw-bone ) and subjected to cyclic loading with Schimadzu AG-10 test device, thus, the operation of the system and the amount of lengthening per each loading were tested. As a result of the measurements, the intramedullary nail has achieved 0,1 mm lengthening per each loading. Consequently, it is evident that the system we developed, have several advantages in respect of the present leg lengthening systems. According to the results with in-vivo animal experiments, the success of the system will be examined and it will be ready for use on human.
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Background: Intramedullary fixation a standard surgical technique for long bone meta/diaphyseal fractures. There were many difficulties in removal of the intractable intramedullary device. The authors reported a new technique to remove the intractable intramedullary nail by using a self-made connecting device. Methods: The subject underwent removal of the intramedullary nail using a self-made connecting device, the core components of which were a caudal connecting rod and a sliding hammer in the common intramedullary nail removal device, and the auxiliary device was mainly a clinically commonly used Kirschner wire (K-wire; diameter 1.5–2.5 mm). In technical procedure, the key point was the connection between the k-wire and the intramedullary device, according to the specific conditions of the intramedullary device. Results: From 2012 to 2017, a total of 10 cases of intractable intramedullary devices were taken out using this self-made connection device, including 7 cases of tibial intramedullary nails, 1 case of femoral nail, and 1 case of tibial elastic nail. The technique provided satisfactory results, no infection or re-fracture occurred after the. Conclusion: The self-made connecting device may provide new technique for more surgeons in the face of intractable intramedullary device.
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[Objective] To comparatively analyze the effect of expandable intramedullary nail and interlocking intramedullary nail fixation in the treatment of the tibial shaft fractures.[Methods]Totally 40 cases of the tibial shaft fractures underwent surgical treatment with different fixation including expandable intramedullary nails in 19 cases and interlocking intramedullary nails in 21 cases.The operative difficulties,outcomes and complications were analyzed and compared retrospectively.[Results]The operation with expandable intramedullary nails was much easier than interlocking intramedullary nails.According to average 18 months postoperative follow-up,the average duration of bone union was 14 weeks and the complication rate was 0 in the cases fixed with expandable intramedullary nails,19 weeks and 38.1% in the cases fixed with interlocking intramedullary nails respectively.[Conclusion]The application of expandable intramedullary nails in the treatment of tibial shaft fractures has advantages of less trauma,more simple operation,and less complications.It's a new method of the treatment of the tibial shaft fractures better than interlocking intramedullary nails,and It's worthy of recommending.
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