Mixed Reality for Localisation of Rib Fractures Before Surgical Stabilization: A Pilot Study of an Innovative Tool

Abstract

BackgroundAccurate localisation of rib fractures is crucial for successful surgical stabilisation of rib fractures (SSRF). Mixed reality (MR) technology can overlay anatomical imaging onto a patient in real-time, which may facilitate the visualisation of rib fractures, allowing accurate skin surface markings for incision. This pilot study assessed the feasibility of using mixed reality (MR) for rib fracture localisation in SSRF.MethodsThis study involved a pre-clinical phase with two healthy patients and a clinical phase with six patients undergoing SSRF in a single tertiary trauma centre. CT scans were transformed into patient-specific 3D holographic models, which were projected through Microsoft HoloLens2TM (HL2) onto the patient after anatomical calibration. The study assessed hologram projection, number of fractures identified, time taken, and distance from skin marking to the fracture site. Iterative improvements to the MR system were implemented throughout the study.ResultsStable and accurate hologram projection was achieved in both phases. In the clinical portion, MR identified 54 rib fractures, including subscapular fractures, compared to 30 identified by US. The mean time to mark all fractures was 9.07 minutes for MR and 10.02 minutes for US. The mean displacement from skin marking to the fracture site was 2.89 cm for MR and 2.04 cm for US. Technical challenges included distorted surface anatomy and positional variations.ConclusionMR technology in the setting of SSRF is feasible and facilitates de-novo visualisation of rib fractures. Technical limitations must be addressed before widespread clinical use.

Keywords: augmented reality (AR); image-guided surgery; mixed reality (MR); pre-operative planning; surgical stabilisation of rib fractures (SSRF).