Intramedullary Nail Fixation Assisted by Orthopaedic Robot Navigation for Intertrochanteric Fractures in Elderly Patients

Abstract

Objective: To compare the clinical efficacy of intramedullary nail fixation for intertrochanteric fractures assisted by orthopaedic robot navigation and the traditional intramedullary nail fixation in elderly patients, and to investigate the application advantages of intramedullary nail fixation for femoral intertrochanteric fractures assisted by orthopaedic robot navigation in the elderly.

Methods: Among the 51 patients with intertrochanteric fractures who were selected from April 2015 to September 2017 in the Affiliated Hospital of Chengdu University, 25 patients underwent the intramedullary nail fixation assisted by orthopaedic robot navigation (orthopaedic robot navigation surgery group) and 26 patients underwent the traditional intramedullary nail fixation (traditional surgery group). The operation time, the number of intraoperative fluoroscopy images taken, the frequency of guide pins inserted into the femoral marrow cavity, the amount of intraoperative bleeding, and the one-time success rate of the guide pin inserted into the femoral marrow cavity were recorded. Fracture healing and internal fixation were observed. The Harris score was used to evaluate hip joint function 1 year after surgery.

Results: All patients were followed up for 12-24 months. The operation time was 65.44 ± 8.01 min in the orthopaedic robot navigation surgery group and 77.50 ± 16.64 min in the traditional surgery group. The number of intraoperative fluoroscopy images taken was 10.28 ± 0.61 in the orthopaedic robot navigation surgery group and 13.23 ± 1.75 in the traditional surgery group. The frequency of guide pins inserted into the femoral marrow cavity was 1.00 ± 0.00 times in the orthopaedic robot navigation surgery group and 2.46 ± 1.10 times in the traditional surgery group. The one-time success rate of intramedullary pin puncture was 100% (25/25) in the orthopaedic surgical robot navigation surgery group and 19.23% (5/26) in the traditional surgery group. The amount of surgical bleeding was 90.80 ± 14.98 mL in the orthopaedic robot navigation surgery group and 118.46 ± 32.21 mL in the traditional surgery group. Compared with the traditional surgery group, the operation time of the orthopaedic surgical robot navigation surgery group was shorter (P < 0.05), the number of intraoperative fluoroscopy images taken was fewer (P < 0.05), the frequency of guide pins inserted into the femoral marrow cavity was lower (P < 0.05), the one-time success rate of intramedullary pin puncture was higher (P < 0.05), and the amount of surgical bleeding was less (P < 0.05). One year after surgery, fracture healing occurred in both groups without failure of internal fixation or fracture displacement. The Harris score of hip function in the orthopaedic robot navigation surgery group was 86.68 ± 6.23 and that in the traditional surgery group was 82.69 ± 6.85. It was higher than that in the traditional surgery group (P < 0.05). The fine rate of hip joint function in the orthopaedic robot navigation surgery group was 84.00% (21/25) and that in the traditional surgery group was 73.07% (19/26). There was no significant difference between the two groups (P > 0.05).

Conclusion: Intramedullary nail fixation for intertrochanteric fractures assisted by orthopaedic robot navigation in elderly patients is an ideal method, offering a short operation time, minimal surgical trauma, less radiation, and good recovery of hip function.

Keywords: Intertrochanteric fracture; Intramedullary nail fixation; Orthopaedic robot navigation.

Figure 1

TiRobot, mainly composed of a workstation, an optical tracking system, and a robot arm (Photo provided by Beijing Tianzhihang Medical Technology).

Figure 2

Anteroposterior image of the hip joint, with all 10 location points on the positioning ruler in it.

Figure 3

Anteroposterior image of the hip joint, which was imported into the workstation. Create a guide pin graph on the image which was imported workstation, adjust the position of the guide pin to plan the insertion path of the guide pin.

Figure 4

Photograph of the operative region of a patient’s hip. A guide pin was drilled into the femoral medullary cavity percutaneously assisted by the robot arm.

Figure 5

Anteroposterior and lateral images of the hip joint after insertion of the guide pin. The guide pin was confirmed to have penetrated the medullary cavity through the fractured part.