Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture
March 3rd, 2023
This article introduces a method of robot-assisted orthopedic surgery for screw placement during the treatment of femoral neck fracture using the femoral neck system, which allows for more accurate screw placement, improved surgical efficiency, and fewer complications.
Femoral neck fracture is common. Traditionally, we use a freehand method for screw placement. Now we apply the robot-assisted orthopedic surgery system in surgical manipulation, which has satisfactory results.
The robot assess system could provide more accurate screw placement, a more efficient suture precise, reduced intraoperative radiation exposure, and achieve a better outcome. This system can be used in minimal invasive orthopedic surgery, particular in the procedure recurrent process screw placement, such as pelvic or acetabular fracture and the spine injury. Demonstrating the procedure, we have Yongchao Duan, an intraoperative imaging technologist, and Hai Huang, a surgeon from my department.
To begin, identify the patient with a femoral neck fracture with tenderness or percussed pain around the hip joint. Fix the limb to the traction bed for continuous traction during the operation. Before starting the operation, connect the components of the robot-assisted orthopedic surgery system and unfold the robot arm.
Log into the system and record the patient's medical records. After routine surgical disinfection, place a Schanz pin on the ipsilateral iliac wing, and fix the patient's tracer on the pin. Put sterile protective sleeves on the robotic arm and on the C-arm.
Assemble the positioning ruler with the 10 identification points for the robot positioning system with the robotic arm. Position the C-arm x-ray machine centrally to the femoral neck, and put the robotic arm with the positioning ruler between the C-arm and the patient. Collect anteroposterior and lateral view X-ray images containing the 10 identification points of the positioning ruler.
Import the anteroposterior and lateral view images containing 10 identification points, and the entire proximal femur into the workstation. Locate the screw channel in the center of the femoral neck with the neck shaft angle of 130 degrees, and parallel to the long axis of the femoral neck on the anteroposterior and lateral views. Locate the tip of the screw five millimeters under the cartilage of the femoral head.
Replace the positioning ruler with the sleeve on the robotic arm. Run the robotic arm to the position of the entry point according to the planned path. Then make a three centimeter incision on the skin along the long axis of the femur with a knife.
Blunt separate the subcutaneous tissue, and insert the sleeve to contact the bone cortex. Confirm the entry point and direction of the sleeve in accordance with the planned path. Drill the guide wire into the bone through the sleeve until it is five millimeters from the subchondral bone.
Remove the robotic arm and check the position of the guide wire by x-ray. Ream the hole along the guidewire using a hollow drill bit, and insert the bolt and plate into the femoral head. Then place the anti-rotation screw and locking screw.
After applying dynamic compression, verify the FNS placement with the bolt in the center of the femoral neck, both on the anterior, posterior and lateral views, and five millimeters from the subchondral bone and with the plate fitting the bone. Following the operation, suggest assisted passive hip flexion activities, and active exercise of the knee and ankle joints. The pre-operation x-ray images of the femoral neck fracture in anteroposterior and lateral view are shown here.
The fracture was reduced by closed reduction to a proper position. The collected x-ray images using the patient tracer and the positioning ruler with the positioning ruler between the C-arm and the patient are demonstrated along with the fluoroscopy images containing the positioning ruler. Surgical path planning was performed on the software, and the screw channel was virtually displayed.
The structure of the FNS process, the reaming process, the placement of the bolt and plate, the anti-rotation screw, and the locking screw are shown. X-ray images confirmed dynamic compression in anteroposterior and lateral view. This robot-assisted orthopedic surgery system simulates the screw plates virtually, assisting the screw placement precisely and reduce the risk of surgical procedure.
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Overview
This article discusses a robot-assisted orthopedic surgery method for screw placement in femoral neck fractures. This approach enhances accuracy, efficiency, and reduces complications during surgery.
Key Study Components
Area of Science
- Orthopedic surgery
- Robotic systems in medicine
- Minimally invasive techniques
Background
- Femoral neck fractures are common injuries.
- Traditional screw placement methods are often freehand.
- Robot-assisted systems can improve surgical outcomes.
- Intraoperative imaging plays a crucial role in these procedures.
Purpose of Study
- To evaluate the effectiveness of robot-assisted screw placement.
- To enhance surgical precision and reduce complications.
- To explore applications in minimally invasive orthopedic surgery.
Methods Used
- Implementation of a robot-assisted orthopedic surgery system.
- Assessment of screw placement accuracy.
- Evaluation of intraoperative radiation exposure.
- Collaboration with imaging technologists and surgeons.
Main Results
- Improved accuracy in screw placement.
- Enhanced surgical efficiency.
- Reduced intraoperative radiation exposure.
- Better overall surgical outcomes.
Conclusions
- Robot-assisted systems are beneficial for orthopedic surgeries.
- They provide a reliable alternative to traditional methods.
- Future applications may extend to other orthopedic procedures.
Frequently Asked Questions
Executive Industry Relevance
Robotic assistance in orthopedic screw placement addresses critical challenges in surgical precision, intraoperative reproducibility, and radiation minimization. By integrating imaging data with robotic path planning, this workflow enhances procedural accuracy and reduces operator-dependent variability at a key intervention point. These advances support risk-adjusted decision-making and portfolio confidence in device-enabled surgical innovation.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables quantitative assessment of device-guided intervention accuracy in bone fixation models.
- Supports mechanistic de-risking by isolating robotic precision from manual variability.
- Facilitates functional validation of orthopedic device performance in controlled settings.
Screening & Assay Development
- Standardizes imaging and placement protocols for reproducible evaluation of fixation outcomes.
- Provides a platform for comparative studies of device-assisted versus manual techniques.
- Generates quantitative outputs on placement accuracy and procedural efficiency.
Translational & Preclinical Research
- Aligns preclinical device testing with clinically relevant imaging and placement endpoints.
- Enables continuity from benchtop validation to translational orthopedic research.
- Supports risk-adjusted advancement of robotic surgical systems for broader indications.
Pipeline & Workflow Integration
This robotic workflow integrates from device discovery through preclinical validation, supporting iterative optimization and translational readiness.
- Discovery Biology: Provides a controlled system for hypothesis testing on device precision and biological impact.
- Screening: Delivers standardized, reproducible imaging and placement metrics for device evaluation.
- Analytics: Enables quantitative comparison of placement accuracy, radiation exposure, and procedural efficiency.
- Translational Research: Bridges preclinical device validation with clinical imaging and procedural endpoints.
- Enterprise Reuse: Establishes a reusable robotic platform for diverse orthopedic device studies.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in device performance and reduces mechanistic ambiguity.
- Operational Value: Enhances standardization, reproducibility, and scalability of orthopedic intervention studies.
- Strategic Value: Improves go/no-go decisions and reduces late-stage risk in device development portfolios.
- Portfolio Impact: Supports risk-adjusted prioritization and advancement of robotic surgical technologies.
Implementation Considerations
- Requires expertise in robotic system operation and intraoperative imaging analysis.
- Demands integration of imaging, planning software, and robotic hardware infrastructure.
- Necessitates cross-team standardization of imaging and procedural protocols.
- Adaptation may be needed for different anatomical models or device types.
- Practical limitations include system setup time and imaging quality dependencies.
Biopharma FAQs
Chapters in this video
0:04
Introduction
1:12
Preparation of the Robot-Assisted Orthopedic Surgery System, Disinfection, Image Collection, and Surgical Path Planning
2:51
Femoral Neck System (FNS) Placement and Verification
4:12
Results: Treatment of Femoral Neck Fracture Using the Femoral Neck System
5:12
Conclusion
