Computer-assisted guidewire insertion for hip fracture fixation.
OBJECTIVE
: This study was designed to test in a laboratory setting a novel computer-assisted fluoroscopic technique and a conventional fluoroscopic technique for open reduction and internal fixation (ORIF) of hip fractures. Our hypothesis is that a novel computer-assisted fluoroscopic technique will achieve acceptable guidewire placement in one pass, with decreased fluoroscopic time and with accuracy and precision better than conventional technique.


METHODS
Prospective, randomized trials.


METHODS
Laboratory.


METHODS
Thirty, Sawbone, femur phantoms.


METHODS
Dynamic hip screw guidewires were inserted into 15 femur phantoms under fluoroscopic guidance by using computer-assisted fluoroscopic ORIF technique, and 15 femurs were inserted by using a conventional fluoroscopic-assisted ORIF technique.


METHODS
Ideal guidewire placement was defined as the center of the femoral head, 5 mm from the apical bone edge on anteroposterior and lateral views. Accuracy was measured as distance to ideal placement, and the number of passes and fluoroscopic time were noted for each trial.


RESULTS
The computer-assisted technique achieved an average guidewire placement that was as accurate as the conventional technique in fewer passes, 1.1 +/- 0.2 (mean +/- standard deviation) compared with 2.4 +/- 1.1 (P < 0.0001), respectively, and with fewer fluoroscopic images, 2 +/- 0 compared with 13.5 +/- 3 (P < 0.0002), respectively. Guidewire placement in both groups was within the tip-apex distance defined by Baumgaertner et al.


CONCLUSIONS
The computer-assisted technique was significantly more accurate and precise than conventional technique. It also required fewer drill tracks through the femur and exposed the patient and the surgical team to significantly less ionizing radiation.
Mayman
D
D
Department of Surgery, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, Canada K7L 2V7.
Vasarhelyi
E M
EM
Long
W
W
Ellis
R E
RE
Rudan
J
J
Pichora
D R
DR
D001864:Bone Wires; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006620:Hip Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D019047:Phantoms, Imaging; D019919:Prosthesis Implantation / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014584:User-Computer Interface