Computer-Assisted Planning and Navigation for Corrective Distal Radius Osteotomy, Based on Pre- and Intraoperative Imaging

• Published in: IEEE transactions on biomedical engineering Vol. 58; no. 1; pp. 182 - 190
• Main Authors: Dobbe, J. G. G., Strackee, S. D., Schreurs, A. W., Jonges, R., Carelsen, B., Vroemen, J. C., Grimbergen, C. A., Streekstra, G. J.
• Format: Journal Article
• Language: English
• Published: New York, NY IEEE 01-01-2011; Institute of Electrical and Electronics Engineers; The Institute of Electrical and Electronics Engineers, Inc. (IEEE)
• Subjects: Accuracy; Biological and medical sciences; Bones; Computed tomography; Computer-assistance; Computerized, statistical medical data processing and models in biomedicine; Cone-Beam Computed Tomography - methods; cone-beam CT; corrective distal radius osteotomy; Female; Fractures, Malunited - diagnostic imaging; Fractures, Malunited - surgery; Humans; Image Processing, Computer-Assisted - methods; Image segmentation; Manipulators; Medical management aid. Diagnosis aid; Medical sciences; navigation; Orthopedic surgery; Osteotomy - methods; Pins; Planning; Preoperative Care; Radius - anatomy & histology; Radius Fractures - diagnostic imaging; Radius Fractures - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery, Computer-Assisted - methods; virtual planning; Radius; Radiodiagnosis; Image processing; Osteotomy; Assisted planning; Surgical navigation; Cone beam; corrective distal radius osteotomy; navigation; Orthopedic surgery; Treatment; Computer-assistance; Imaging; Medical imagery; virtual planning; Tridimensional image; Computerized axial tomography; cone-beam CT; Computer aid; Biomedical engineering
• ISSN: 0018-9294; 1558-2531
• DOI: 10.1109/TBME.2010.2084576

Malunion after a distal radius fracture is very common and if symptomatic, is treated with a so-called corrective osteotomy. In a traditional distal radius osteotomy, the radius is cut at the fracture site and a wedge is inserted in the osteotomy gap to correct the distal radius pose. The standard procedure uses two orthogonal radiographs to estimate the two inclination angles and the dimensions of the wedge to be inserted into the osteotomy gap. However, optimal correction in 3-Dspace requires restoring three angles and three displacements. This paper introduces a new technique that uses preoperative planning based on 3-D images. Intraoperative 3-D imaging is also used after inserting pins with marker tools in the proximal and distal part of the radius and before the osteotomy. Positioning tools are developed to correct the distal radius pose in six degrees of freedom by navigating the pins. The method is accurate (d err <; 1.2 mm, φ err <; 0.9°, mTRE = 1.7 mm), highly reproducible (SE d <; 1.0 mm, SE φ ≤ 1.4°, SE mTRE = 0.7 mm), and allows intraoperative evaluation of the end result. Small incisions for pin placement and for the osteotomy render the method minimally invasive.