Hendrik Schöll

Integration of fluoroscopy-based guidance in orthopaedic trauma surgery – A prospective cohort study

INTRODUCTION Computer-assisted guidance systems are not used frequently for musculoskeletal injuries unless there are potential advantages. We investigated a novel fluoroscopy-based image guidance system in orthopaedic trauma surgery. MATERIALS AND METHODS The study was a prospective, not randomised, single-centre case series at a level I trauma centre. A total of 45 patients with 46 injuries (foot 12, shoulder 10, long bones seven, hand and wrist seven, ankle seven and spine and pelvis four) were included. Different surgical procedures were examined following the basic principles of the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF). Main outcome measurements were the number of trials for implant placement, total surgery time, usability via user questionnaire and system failure rate. RESULTS In all cases, the trajectory function was used, inserting a total of 56 guided implants. The system failed when used in pelvic and spinal injuries, resulting in a total failure rate of 6.5% (n=3) of all included cases. The overall usability was rated as good, scoring 84.3%. CONCLUSION The novel image-guidance system could be integrated into the surgical workflow and was used successfully in orthopaedic trauma surgery. Expected advantages should be explored in randomised studies.

Therapy Recommendation “Act as Usual” in Patients with Whiplash Injuries QTF I°

Up to now no therapy study has used the classification system of the Quebec Task Force (QTF) to differentiate between patients with (QTF II°) and without functional disorders (QTF I°). This differentiation seems meaningful, as this difference may be relevant for the correct treatment planning. In this context the effect of the therapy recommendation “act as usual” has been evaluated in a homogeneous patient collective with whiplash injuries QTF I°. 470 patients with acute whiplash injuries had been catched in this study and classified according to the QTF. 359 patients (76.4%) with QTF I° injuries could be identified. Out of that 162 patients were enrolled to the study and received the therapy recommendation “act as usual” and the adapted pain treatment with non-steroidal anti-inflammatory drugs (NSAID). After six months the outcome was evaluated by phone. After injury the median pain score assessed by a visual analogue scale (VAS) was 5.4 (min = 3.3; max = 8.5). After six months 5 of the 162 patients complained intermittent pain symptoms (VAS values < 2). This is consistent with a chronification rate of 3.1%. After injury, the median pain disability index (PDI) was 3.9 (min = 1.9; max = 7.7). After six months 3 of the 162 patients stated persisting disability during sporting and physical activities (VAS values < 1). The therapy recommendation “act as usual” in combination with an adapted pain treatment is sufficient. Usually patients with whiplash injuries QTF I° do not need physical therapy. An escalation of therapy measures should be reserved to patients with complicated healing processes.

Image guidance can support scaphoid K-wire insertion: an experimental study and initial clinical experience

PurposeIn the treatment of small bone fractures, such as the scaphoid bone, conventional navigation is limited by its dependence on fixed reference arrays. We introduce a new technique based on reference markers in surgical instruments. If visible on a standard fluoroscopic image, static trajectories are overlaid in this image to guide implant insertions. Fixed markers are not required. The purpose of this study was to identify the possible advantages of the new guidance technique.MethodsFor this study, 20 artificial hand specimens were randomized into two groups and blinded with polyurethane foam: 10 were treated conventionally and 10 were image guided. We used a clip containing radiopaque markers, which was detected by the system’s workstation. A static trajectory was displayed consecutively in the fluoroscopic image to serve as an aiming device. Secondly, we included 3 patients with fractures of the scaphoid bone to test the integrability of this novel method in a clinical setting.ResultsIn the experimental setup, trajectory guidance reduced the duration of surgery and radiation exposure. Furthermore, it reduced the perforation rate. Accuracy was not improved by the new technique. For clinical cases, the system was integrated into the accommodated surgical workflow and rated as very helpful by users.ConclusionThe system helped reduce the misplacement rate and the emission of radiation. The main limitations were that trajectories were not displayed in real time and could only be shown in a single fluoroscopic image. However, the system is simple and can be easily integrated into the surgical workflow.

Navigated treatment of metatarsal V fractures using a new image based guidance system.

Computer assisted imaging systems are rarely used for fracture treatment and foot surgery. We introduce a new system for image based guidance in traumatology.

Image guidance shortens the learning curve for K‐wire placement – an experimental study

Computer assisted systems in orthopaedic trauma depend in most cases on fixed reference markers. This work evaluated a reference‐free image‐based guidance system. Outcome parameters were the number of trials needed to achieve an optimal wire position, the radiation and procedure time, and the learning curve.

Mittelfristige Ergebnisse nach alleiniger perkutaner Versorgung zentraler Impressionsfrakturen der Mittelphalanxbasis

PURPOSE This study investigated the midterm results after sole percutaneous treatment for central depression fractures of the base of the middle phalanx. PATIENTS AND METHODS 19 men and 2 women with an average age of 31.9 (18 - 57) years with a central depression fracture of the middle phalanx treated solely by intramedullary reposition with a bended K-wire and percutaneous K-wire fixation were followed on average of 13.2 (3 - 40) months. RESULTS At the time of the last follow-up, all patients were able to pursue their previous occupational activity as well as their usual leisure activities and were painfree (VAS 0). The postoperative active flexion of the affected PIP joint was 86° with an average extension deficit of 1° or 93 % of the range of motion of the uninjured PIPJ of the opposite side. Radiologically there was a nice remodeling of the articular surface with no osteoarthrosis. There were no pin-associated complications or wound healing disorders. CONCLUSION The sole intramedullary reduction with K-wire osteosynthesis is a suitable and reliable method for the treatment of the central impression fracture. Good functional results can be achieved with low surgical effort.