title: Application of an innovative computerized virtual planning system in acetabular fracture surgery: A feasibility study.
abstract: BACKGROUND
  Acetabular fracture surgery is amongst the most challenging tasks in the field of trauma surgery and careful preoperative planning is crucial for success. The aim of this paper is to describe the preliminary outcome of the utilization of an innovative computerized virtual planning system for acetabular fractures.
  
  
  METHODS
  3D models of acetabular fractures and surrounding soft tissues from six patients were constructed from preoperative CT scans. A novel highly-automatic segmentation technique was performed on the 3D model to separate each fracture fragment, then 3D virtual reduction was performed. Additionally, the models were used to assess potential surgical approaches with reference to both the fracture and the surrounding soft tissues. The time required for virtual planning was recorded. After surgery, the virtual plan was compared to the real surgery with respect to surgical approach and reduction sequence. A Likert scale questionnaire was completed by the surgeons to evaluate their satisfaction with the system.
  
  
  RESULTS
  Virtual planning was successfully completed in all cases. The planned surgical approach was followed in all cases with the planned reduction sequence followed completely in five cases and partially in one. The mean time required for virtual planning was 38.7min (range 21-57, SD=15.5). The mean time required for planning of B-type fractures was 25.0min (range 21-30, SD=4.6), of C-type fracture 52.3min (range 49-57, SD=4.2). The results of the questionnaire demonstrated a high level of satisfaction with the planning system.
  
  
  CONCLUSIONS
  This study demonstrates that the virtual planning system is feasible in clinical settings with high satisfaction and acceptability from the surgeons. It provides a viable option for the planning of acetabular fracture surgery.
authors.affiliation: Orthopaedic Traumatology, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China.
authors.forename: Huixiang
authors.initials: H
authors.lastname: Wang
authors.affiliation: Orthopaedic Traumatology, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China.
authors.forename: Fang
authors.initials: F
authors.lastname: Wang
authors.affiliation: MSk Lab, Imperial College London, Charing Cross Hospital, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Newman
authors.affiliation: School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, PR China.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Lin
authors.affiliation: School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, PR China.
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Chen
authors.affiliation: School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, PR China.
authors.forename: Lu
authors.initials: L
authors.lastname: Xu
authors.affiliation: Orthopaedic Traumatology, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China. Electronic address: wangqiugen@outlook.com.
authors.forename: Qiugen
authors.initials: Q
authors.lastname: Wang
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D000328:Adult; D000368:Aged; D003198:Computer Simulation; D005240:Feasibility Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface
keywords: Acetabular fracture; Computer-assisted; Preoperative planning; Segmentation; Volume rendering