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Robot-assisted Long Bone Fracture Reduction

Institute for Robotics and Process Control, Technical University of Braunschweig, Germany ralf.westphal{at}tu-bs.de

Simon Winkelbach

Institute for Robotics and Process Control, Technical University of Braunschweig, Germany, s.winkelbach{at}tu-bs.de

Friedrich Wahl

Institute for Robotics and Process Control, Technical University of Braunschweig, Germany,f.wahl{at}tu-bs.de

Thomas Gösling

Department of Trauma Surgery, Hannover Medical School, Germany, goesling.thomas{at}mh-hannover

Markus Oszwald

Department of Trauma Surgery, Hannover Medical School, Germany, oszwald.markus{at}mh-hannover.de

Tobias Hüfner

Department of Trauma Surgery, Hannover Medical School, Germany, huefner.tobias{at}mh-hannover

Christian Krettek

Department of Trauma Surgery, Hannover Medical School, Germany, krettek{at}compuserve.com

The preferred treatment of femoral (thigh bone) shaft fractures nowadays is the minimally invasive technique of intramedullary nailing. However, in addition to its advantages, this technique also has a number of disadvantages, such as the frequent occurrence of malaligned fracture reductions and high X-ray exposure, especially to the operating team. The aim of our research is to overcome these shortcomings by utilizing modern techniques such as three-dimensional (3D) imaging, navigation, and robotics. In this paper we present the current state of our interdisciplinary research project. We first introduce a telemanipulated fracture reduction procedure, which is based on 3D imaging data. This set-up is improved one step further towards an automated fracture reduction procedure. Finally, two drilling tasks, namely the opening of the medullar cavity and the distal locking of the intramedullary nail, are presented, which are supported by automated X-ray-based image analysis and robot-assisted drill guidance. We show that high reduction accuracies can be achieved with our robotic system. Furthermore, the robot-assisted drill guidance achieves superior results with respect to increased precision and decreased X-ray exposure compared with the conventional procedure. We conclude that this surgical procedure benefits conspicuously from the support of robotic assistance systems and that further research and development in this field is worthwhile.

Key Words: robot-assisted fracture reduction • telemanipulation • distal locking • intramedullary nailing • computer-assisted orthopedic surgery • drill guidance.

This version was published on October 1, 2009

The International Journal of Robotics Research, Vol. 28, No. 10, 1259-1278 (2009)
DOI: 10.1177/0278364909101189


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