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. 2023 Jan 9:10:1105717.
doi: 10.3389/fped.2022.1105717. eCollection 2022.

Robot-assisted cannulated compression screw internal fixation for treatment of femoral neck fracture in children: A case series of ten patients

Wei Feng  1 , Ziming Yao  1 , Haonan Liu  1 , Dong Guo  1 , Danjiang Zhu  1 , Baojian Song  1 , Qiang Wang  1 , Xuejun Zhang  1
Affiliations

Robot-assisted cannulated compression screw internal fixation for treatment of femoral neck fracture in children: A case series of ten patients

Wei Feng et al. Front Pediatr. .

Abstract

Purpose: To investigate the safety and efficacy of robot-assisted cannulated compression screw internal fixation in the treatment of femoral neck fracture in children.

Methods: We retrospectively reviewed the data of ten children with femoral neck fractures treated by robot-assisted internal fixation from January 2020 to June 2021. The clinical and radiological characteristics, operation duration, and fluoroscopy frequency of robot-assisted screws placement together with the complications and function were evaluated. At the 12-month follow-up, the hip joint function was evaluated using the Ratliff classification.

Results: Ten children, six boys and four girls, aged 4-14 years were included. There were eight type II and three type III femoral neck fractures using the Delbet classification. In the process of robot-assisted internal fixation, the median of fluoroscopy frequency was 22 times and the median of operation duration was 47 min. The median of screw parallelism was 1.33° and 0.66° on the anteroposterior and lateral x-ray films, and the median of screw distribution was 41.86% and 44.93% on the anteroposterior and lateral x-ray films, respectively. At the 12-month follow-up, there were two cases of femoral head necrosis, and fracture healing was achieved in all patients, of which eight fractures were excellent and three were good by the Ratliff function classification.

Discussion: The application of robot-assisted cannulated compression screw internal fixation could help us achieve more safe and accurate screw placement, as well as a good treatment effect for children's femoral neck fractures.

Level of evidence: Level IV. retrospective case series.

Keywords: children; femoral neck fracture; internal fixation; robot-assisted; screw.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The key surgical steps of the robot-assisted surgery. (A) The patient was placed on a traction bed; (B) The patient tracking device was fixed on the anterior superior iliac spine of the affected side. (C) Obtain the intraoperative fluoroscopy image containing the robot positioning marking point; (D) Placed a guide pin near the skin through a sleeve on mechanical arm.
Figure 2
Figure 2
A 5-year-old boy with left femoral neck fracture. All ten positioning marking points should be clearly displayed and transmitted to the workstation. Path planning of screw placement as shown in the AP (A) and lateral (B) images.
Figure 3
Figure 3
Three guide pins were drilled into the bone passage in sequence through the sleeve under fluoroscopy monitoring as shown in the AP (A) and lateral (B) images.
Figure 4
Figure 4
Three cannulated compression screws were inserted along the guide pins, and the guide pins are removed as shown in the AP (A) and lateral (B) images.
Figure 5
Figure 5
Evaluate the screw parallelism and screw distribution. (A) The shaft screw angle (α) was defined as the angle between the femoral shaft axis and the longitudinal axis of each screw. (B) The screw distribution was defined as the relative coverage of the neck width, which was calculated as the product of the distance between the borders of the outer screws at the fracture line divided by the neck width at the fracture level.
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