Download PDF
Osteosynthesis and Trauma Care 2003; 11(1): 29-34
DOI: 10.1055/s-2003-40120
Original Article

© Georg Thieme Verlag Stuttgart · New York

Experimental Comparison Between Computer Assisted Surgery (CAS) Based and C-Arm Based Correction of Hind- and Midfoot Deformities

M. Richter1
  • 1Trauma Department, Hannover Medical School, Hannover, Germany
Further Information

Publication History

Publication Date:
20 June 2003 (online)

    Permissions and Reprints

Abstract

This experimental study compares the accuracy of Computer Assisted Surgery (CAS) based correction of hind- and midfoot deformities, and C-arm based correction. Five specimens of three different deformity models (Sawbone™) were corrected with each method and the results were compared. The specimen visualization during correction was exclusively provided by the C-arm or CAS screen.
The shape was graded normal in all corrected specimens (n=15) in the CAS group, and in eight of the specimens in the C-arm group (Chi2-test, p=0.05). Parameters (t-test utilized): time entire procedure, CAS, 782 (450-1 020) s, C-arm, 410 (210-600) s, p < 0.001; fluoroscopy time, CAS, 0s, C-arm, 11 (8-19) s, p < 0.001; measurement differences between corrected specimens and normal specimen model: foot length, CAS, -1.7 ± 1.9 mm, C-arm, -4.1 ± 3.8 mm, p=0.03; length longitudinal arch, CAS, -0.9 ± 0.9 mm, C-arm, -5.6 ± 4.9 mm, p =0.001; height longitudinal arch, CAS, -0.1 ± 0.5 mm, C-arm, 1.7 ± 4.3 mm, p=0.14; calcaneus inclination, CAS, 0.1 ± 1.4°, C-arm, 2.7 ± 4.8°, p=0.05; calcaneus length, CAS, -0.5 ± 0.4 mm, C-arm, -2.8 ± 1.3 mm, p=0.005; Boehler's angle, CAS, 0.4 ± 1.1°, C-arm, 4.1 ± 8.6°, p=0.37.
CAS promises to be a valuable tool for higher accuracy for correction or reduction in the hind- or midfoot region. Clinical studies must show if this higher accuracy can be achieved in real operations also, and if this leads to better clinical results.

Key words

Correction - Deformity - Midfoot - Hindfoot - Fluoroscopy - Navigation System

References

  • 1 Adelaar R S. The treatment of complex fractures of the talus.  Orthop Clin North Am. 1989;  20 (4) 691-707
    PubMedSearch in Google Scholar
  • 2 Adelaar R S, Kyles M K. Surgical correction of resistant talipes equinovarus: observations and analysis - preliminary report.  Foot Ankle. 1981;  2 (3) 126-137
    PubMedSearch in Google Scholar
  • 3 Amon K. Luxationsfraktur der kuneonavikularen Gelenklinie. Klinik, Pathomechanismus und Therapiekonzept einer sehr seltenen Fußverletzung.  Unfallchirurg. 1990;  93 (9) 431-434
    PubMedSearch in Google Scholar
  • 4 Bailey E J, Waggoner S M, Albert M J, Hutton W C. Intraarticular calcaneus fractures: a biomechanical comparison or two fixation methods.  J Orthop Trauma. 1997;  11 (1) 34-37
    CrossrefPubMedSearch in Google Scholar
  • 5 Bargar W L, Bauer A, Borner M. Primary and revision total hip replacement using the Robodoc system.  Clin Orthop. 1998;  (354) 82-91
    PubMedSearch in Google Scholar
  • 6 Bechtold J E, Powless S H. The application of computer graphics in foot and ankle surgical planning and reconstruction.  Clin Podiatr Med Surg. 1993;  10 (3) 551-562
    PubMedSearch in Google Scholar
  • 7 Birkfellner W, Huber K, Larson A, Hanson D, Diemling M, Homolka P. et al . A modular software system for computer-aided surgery and its first application in oral implantology [In Process Citation].  IEEE Trans Med Imaging. 2000;  19 (6) 616-620
    CrossrefPubMedSearch in Google Scholar
  • 8 Brutscher R. Frakturen und Luxationen des Mittel- und Vorfußes.  Orthopäde. 1991;  20 (1) 67-75
    PubMedSearch in Google Scholar
  • 9 Claes J, Koekelkoren E, Wuyts F L, Claes G M, Van Den H L, Van De Heyning P H. Accuracy of computer navigation in ear, nose, throat surgery: the influence of matching strategy [In Process Citation].  Arch Otolaryngol Head Neck Surg. 2000;  126 (12) 1462-1466
    PubMedSearch in Google Scholar
  • 10 Coetzee J C, Hansen S T. Surgical management of severe deformity resulting from posterior tibial tendon dysfunction.  Foot Ankle Int. 2001;  22 (12) 944-949
    PubMedSearch in Google Scholar
  • 11 Delp S L, Stulberg S D, Davies B, Picard F, Leitner F. Computer assisted knee replacement.  Clin Orthop. 1998;  354 49-56
    PubMedSearch in Google Scholar
  • 12 DiGioia A M III, Jaramaz B, Colgan B D. Computer assisted orthopaedic surgery. Image guided and robotic assistive technologies.  Clin Orthop. 1998;  (354) 8-16
    PubMedSearch in Google Scholar
  • 13 DiGioia A M III, Jaramaz B, Plakseychuk A Y, Moody J E Jr, Nikou C, Labarca R S. et al . Comparison of a mechanical acetabular alignment guide with computer placement of the socket.  J Arthroplasty. 2002;  17 (3) 359-364
    CrossrefPubMedSearch in Google Scholar
  • 14 Foley K T, Smith M M. Image-guided spine surgery.  Neurosurg Clin N Am. 1996;  7 (2) 171-186
    PubMedSearch in Google Scholar
  • 15 Gebhard F, Kinzl L, Arand M. [Computer-assisted surgery].  Unfallchirurg. 2000;  103 (8) 612-617
    CrossrefPubMedSearch in Google Scholar
  • 16 Gebhard F, Kinzl L, Arand M. [Limits of CT-based computer navigation in spinal surgery].  Unfallchirurg. 2000;  103 (8) 696-701
    Search in Google Scholar
  • 17 Hansen S TJ. Functional reconstruction of the foot and ankle. Lippincott Williams & Wilkins, Philadelphia, Baltimore, New York 2000
  • 18 Hassfeld S, Muhling J. Navigation in maxillofacial and craniofacial surgery.  Comput Aided Surg. 1998;  3 (4) 183-187
    CrossrefPubMedSearch in Google Scholar
  • 19 Hildebrand K A, Buckley R E, Mohtadi N G, Faris P. Functional outcome measures after displaced intra-articular calcaneal fractures.  J Bone Joint Surg [Br]. 1996;  78 (1) 119-123
    PubMedSearch in Google Scholar
  • 20 Jaramaz B, DiGioia A M III, Blackwell M, Nikou C. Computer assisted measurement of cup placement in total hip replacement.  Clin Orthop. 1998;  354 70-81
    PubMedSearch in Google Scholar
  • 21 Kamimura M, Ebara S, Itoh H, Tateiwa Y, Kinoshita T, Takaoka K. Accurate pedicle screw insertion under the control of a computer-assisted image guiding system: laboratory test and clinical study.  J Orthop Sci. 1999;  4 (3) 197-206
    CrossrefPubMedSearch in Google Scholar
  • 22 Kato A, Yoshimine T, Hayakawa T, Tomita Y, Ikeda T, Mitomo M. et al . [Computer assisted neurosurgery: development of a frameless and armless navigation system (CNS navigator)].  No Shinkei Geka. 1991;  19 (2) 137-142
    PubMedSearch in Google Scholar
  • 23 Kerschbaumer F. [”Numerical imaging, operation planning, simulation, navigation, robotics”. Do the means determine the end? (editorial)].  Orthopade. 2000;  29 (7) 597-598
    CrossrefPubMedSearch in Google Scholar
  • 24 Klos T V, Banks S A, Habets R J, Cook F F. Sagittal plane imaging parameters for computer-assisted fluoroscopic anterior cruciate ligament reconstruction.  Comput Aided Surg. 2000;  5 (1) 28-34
    CrossrefPubMedSearch in Google Scholar
  • 25 Klos T V, Habets R J, Banks A Z, Banks S A, Devilee R J, Cook F F. Computer assistance in arthroscopic anterior cruciate ligament reconstruction.  Clin Orthop. 1998;  354 65-69
    PubMedSearch in Google Scholar
  • 26 Koczewski P, Shadi M, Napiontek M. Foot lengthening using the Ilizarov device: the transverse tarsal joint resection versus osteotomy.  J Pediatr Orthop B. 2002;  11 (1) 68-72
    PubMedSearch in Google Scholar
  • 27 Laine T, Lund T, Ylikoski M, Lohikoski J, Schlenzka D. Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients [In Process Citation].  Eur Spine J. 2000;  9 (3) 235-240
    Search in Google Scholar
  • 28 Langlotz F, Bachler R, Berlemann U, Nolte L P, Ganz R. Computer assistance for pelvic osteotomies.  Clin Orthop. 1998;  354 92-102
    PubMedSearch in Google Scholar
  • 29 Marti R K, de Heus J A, Roolker W, Poolman R W, Besselaar P P. Subtalar arthrodesis with correction of deformity after fractures of the os calcis.  J Bone Joint Surg [Br]. 1999;  81 (4) 611-616
    PubMedSearch in Google Scholar
  • 30 Merloz P, Tonetti J, Cinquin P, Lavallee S, Troccaz J, Pittet L. [Computer-assisted surgery: automated screw placement in the vertebral pedicle].  Chirurgie. 1998;  123 (5) 482-490
    CrossrefPubMedSearch in Google Scholar
  • 31 Merloz P, Tonetti J, Pittet L, Coulomb M, Lavallee S, Troccaz J. et al . Computer-assisted spine surgery.  Comput Aided Surg. 1998;  3 (6) 297-305
    CrossrefPubMedSearch in Google Scholar
  • 32 Mosier-LaClair S, Pomeroy G, Manoli A. Operative treatment of the difficult stage 2 adult acquired flatfoot deformity.  Foot Ankle Clin. 2001;  6 (1) 95-119
    PubMedSearch in Google Scholar
  • 33 Ploder O, Wagner A, Enislidis G, Ewers R. [Computer-assisted intraoperative visualization of dental implants. Augmented reality in medicine ].  Radiologe. 1995;  35 (9) 569-572
    PubMedSearch in Google Scholar
  • 34 Radermacher K, Portheine F, Anton M, Zimolong A, Kaspers G, Rau G. et al . Computer assisted orthopaedic surgery with image based individual templates.  Clin Orthop. 1998;  354 28-38
    PubMedSearch in Google Scholar
  • 35 Richter M, Wippermann B, Krettek C, Schratt E, Hufner T, Thermann H. Fractures and Fracture Dislocations of the Midfoot - Occurence, Causes and Long-Term Results.  Foot Ankle Int. 2001;  22 (5) 392-398
    CrossrefPubMedSearch in Google Scholar
  • 36 Sammarco G J, Conti S F. Surgical treatment of neuroarthropathic foot deformity.  Foot Ankle Int. 1998;  19 (2) 102-109
    PubMedSearch in Google Scholar
  • 37 Schiffers N, Schkommodau E, Portheine F, Radermacher K, Staudte H W. [Planning and performance of orthopedic surgery with the help of individual templates].  Orthopade. 2000;  29 (7) 636-640
    CrossrefPubMedSearch in Google Scholar
  • 38 Schlenzka D, Laine T, Lund T. [ Computer-assisted spine surgery: principles, technique, results and perspectives].  Orthopade. 2000;  29 (7) 658-669
    CrossrefPubMedSearch in Google Scholar
  • 39 Schlenzka D, Laine T, Lund T. Computer-assisted spine surgery.  Eur Spine J. 2000;  9 Suppl 1 S57-64
    CrossrefPubMedSearch in Google Scholar
  • 40 Stephens H M, Walling A K, Solmen J D, Tankson C J. Subtalar repositional arthrodesis for adult acquired flatfoot.  Clin Orthop. 1999;  365 69-73
    PubMedSearch in Google Scholar
  • 41 Suren E G, Zwipp H. Luxationsfrakturen im Chopart- und Lisfranc-Gelenk.  Unfallchirurg. 1989;  92 (3) 130-139
    PubMedSearch in Google Scholar
  • 42 Thoma W, Schreiber S, Hovy L. [Computer-assisted implant positioning in knee endoprosthetics. Kinematic analysis for optimization of surgical technique].  Orthopade. 2000;  29 (7) 614-626
    CrossrefPubMedSearch in Google Scholar
  • 43 Tonetti J, Carrat L, Blendea S, Merloz P, Troccaz J, Lavallee S. et al . Clinical results of percutaneous pelvic surgery. Computer assisted surgery using ultrasound compared to standard fluoroscopy.  Comput Aided Surg. 2001;  6 (4) 204-211
    CrossrefPubMedSearch in Google Scholar
  • 44 Tonetti J, Carrat L, Lavallee S, Pittet L, Merloz P, Chirossel J P. Percutaneous iliosacral screw placement using image guided techniques.  Clin Orthop. 1998;  354 103-110
    PubMedSearch in Google Scholar
  • 45 Toolan B C, Sangeorzan B J, Hansen Jr S T. Complex reconstruction for the treatment of dorsolateral peritalar subluxation of the foot. Early results after distraction arthrodesis of the calcaneocuboid joint in conjunction with stabilization of, and transfer of the flexor digitorum longus tendon to, the midfoot to treat acquired pes planovalgus in adults.  J Bone Joint Surg Am. 1999;  81 (11) 1545-1560
    PubMedSearch in Google Scholar
  • 46 Trnka H J, Easley M E, Lam P W, Anderson C D, Schon L C, Myerson M S. Subtalar distraction bone block arthrodesis.  J Bone Joint Surg Br. 2001;  83 (6) 849-854
    CrossrefPubMedSearch in Google Scholar
  • 47 Wei S Y, Sullivan R J, Davidson R S. Talo- navicular arthrodesis for residual midfoot deformities of a previously corrected clubfoot.  Foot Ankle Int. 2000;  21 (6) 482-485
    PubMedSearch in Google Scholar
  • 48 Weihe S, Wehmoller M, Schliephake H, Hassfeld S, Tschakaloff A, Raczkowsky J. et al . Synthesis of CAD/CAM, robotics and biomaterial implant fabrication: single-step reconstruction in computer aided frontotemporal bone resection [In Process Citation ].  Int J Oral Maxillofac Surg. 2000;  29 (5) 384-388
    CrossrefPubMedSearch in Google Scholar
  • 49 Zwipp H. Chirurgie des Fußes. Springer-Verlag, Wien, New York 1994
  • 50 Zwipp H, Dahlen C, Randt T, Gavlik J M. Komplextrauma des Fußes.  Orthopade. 1997;  26 (12) 1046-1056
    CrossrefPubMedSearch in Google Scholar

Priv.-Doz. Dr. med. Martinus Richter

Unfallchirurgische Klinik · Medizinische Hochschule Hannover

Carl-Neuberg-Str. 1

30625 Hannover

Germany

Phone: +49/5 11/5 32-20 50

Fax: +49/5 11/5 32-58 77

Email: Richter.Martinus@MH-Hannover.de