Session V - Polytrauma

Fri., 10/10/03 Polytrauma, Paper #29, 10:59 AM

Computerized Navigation Assisted Intramedullary Nailing: The First Generation

Amal Khoury, MD; Meir Liebergall, MD; Yoram Weil, MD; Rami Mosheiff, MD; Hadassah Medical Center, Jerusalem, Israel

Purpose: We evaluted the usefulness of a computerized fluoroscopic navigation system in different stages of intramedullary nailing.

Methods: During 2001 and 2002, the "Stealth-Station" Treatment Guidance Platform by Medtronic was employed to assist in intramedullary nailing. Sixty patients with long bone fractures were treated with humeral, femoral, and tibial nails. The computerized navigation system was used in several stages in the nailing procedure: determination of the entry point of the nail in all patients, placement of locking screws in 17 patients, localization of "Poller" or "miss a nail" screws in 6 patients, as well as screw and nail length measurements.

Results: The navigation system minimized the number of required fluoroscopic images. Nail entry point localization required two fluoroscopic images. Nail length measurement required only one additional image of the distal prospective site of the nail. The locking screw necessitated one or two images; and locating the "Poller" or "miss a nail" screw required two images. According to the final verification fluoroscopic images, we had no cases of entry point failure, and maximal accuracy was achieved in placement of locking screws. Nail length measurement was possible only in nails shorter than 30 cm.

Conclusions and Significance: Our experience suggests that computerized assisted navigation surgery may advance intramedullary nailing into a new era. Even the first generation of equipment provides ease of use and precision in the different stages of the procedure while requiring less radiation. Intraoperative planning becomes feasible throughout the operative course by using "dynamic and real-time data," making this system essential in trauma and fracture fixation. The main limitation of the first generation equipment is its lack of ability to assist in fracture reduction.