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Thursday, February 6, 2003

Computers are valuable aides in femoral fracture surgery

Scientific Exhibit No. SE110

Investigators for Scientific Exhibit SE110 conclude that the application of computers to femoral fracture surgery can not only improve the surgeon's performance but also result in better treatment options. Their exhibit provides an overview of several applications and techniques used with computer-assisted orthopaedic surgery (CAOS) in treating femoral fractures.

Some of the surgical techniques and computer navigation systems presented are already in clinical use. Others are near clinical application. For example, systems to assist with femoral neck and intertrochanteric fracture fixation are currently in clinical trials. The FDA generally regards computer navigation systems as instruments and has approved their use as adjuncts in the performance of orthopaedic surgical procedures. For example, in the treatment of intracapsular hip fractures, computers can facilitate the placement of a percutaneous guide-wire using only two orthogonal fluoroscopic images. This information can then be combined with the preoperative images in treating any early avascular necrosis of the femoral head that develops after thehip fracture.

CAOS can also be applied to the treatment of intertrochanteric fractures by enabling accurate placement of a guide wire in the femoral head for nail/side plate fixation devices. A virtual intramedullary fixation device can also be navigated across an intertrochanteric or subtrochanteric fracture, decreasing both procedure time and radiographic exposure. These techniques and devices are already in limited clinical use. Diaphyseal femoral fractures also can be reduced and fixed using a virtual intramedullary device, again reducing both operating time and radiographic exposure. Finally, techniques are being developed to apply CAOS to the fixation of supracondylar and more complex femoral fractures.

Investigators for the exhibit include John F. Pojedinec, MD, of Hackensack, N.J.; Chris Harber, BS, of Memphis, Tenn.; and Gordon Goodchild, BS, of Louisville, Colo. Funding was provided by Smith & Nephew.

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Last modified 20/January/2003