Short-term effectiveness of TiRobot combined with O-arm navigation system in minimally invasive treatment of hindfoot fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEN Hongquan , WANG Pengfei , FU Yahui , WEI Xing , WEI Wei , LEI Jinlai , WANG Hu , WEN Shiming , ZHANG Kun ,  ZHOU Fengjin ,  ZHUANG Yan

Department of Orthopaedic Trauma, Honghui Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P. R. China;

Corresponding author：

ZHOU Fengjin, Email: dr.zhoufj@163.com; ZHUANG Yan, Email: zhuangyan2512@163.com

Keywords：

TiRobot; O-arm navigation system; calcaneus fracture; talus fracture; minimally invasive surgery

DOI：

10.7507/1002-1892.202204057

Video：

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Objective To investigate the short-term effectiveness of TiRobot combined with O-arm navigation system in the minimally invasive treatment of hindfoot fracture. Methods Between March 2019 and March 2021, 25 patients with hindfoot fractures were admitted. There were 14 males and 11 females, with an average age of 51.7 years (range, 19-76 years). The causes of injuries included falling from height in 17 cases and traffic accident in 8 cases. The interval between injury and operation was 1-3 days (mean, 2.1 days). There were 16 cases of calcaneus fracture, 7 cases of talus fracture, and 2 cases of calcaneus and talus fractures. According to Sanders classification criteria, the calcaneus fractures were classified as type Ⅱ in 10 cases and type Ⅲ in 8 cases; according to the Hawkins classification criteria, the talus fractures were classified as type Ⅱ in 4 cases and type Ⅲ in 5 cases. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 48.1±9.1. During operation, the fractures were fixed with the percutaneous cannulated screws with the assistance of the TiRobot combined with the O-arm navigation system. The operation time, hospital stay, and the occurrence of related complications were recorded. X-ray films were reviewed to evaluate the fracture healing and the occurrence of talus osteonecrosis, and the width, length, height, Böhler’s angle, and Gissane’s angle of the calcaneus were measured; AOFAS ankle-hindfoot score was used to evaluated the foot function. Results The operation time ranged from 47 to 71 minutes (mean, 60.5 minutes). The length of hospital stay ranged from 2 to 5 days (mean, 3.4 days). All incisions healed by first intention. All patients were followed up 12-24 months (mean, 17.3 months). One patient demonstrated hypoesthesia on the lateral side of foot after operation and recovered after symptomatic treatment. All fractures healed confirmed by X-ray films and the healing time ranged from 10 to 16 weeks (mean, 11.8 weeks). No talus osteonecrosis occurred during follow-up. There were significant differences in the width, length, height, Böhler’s angle, and Gissane’s angle of the calcaneus between pre-operation and at last follow-up (P<0.05). At last follow-up, AOFAS ankle-hindfoot score was 91.2±5.0, the difference was significant when compared with preoperative score (t=22.169, P<0.001). The results were excellent in 16 cases and good in 9 cases, with an excellent and good rate of 100%. Conclusion TiRobot combined with O-arm navigation system for minimally invasive treatment of hindfoot fractures can obtain the satisfactory short-term effectiveness, with the advantages of less surgical trauma, precise fixation, and fewer complications.

Citation： WEN Hongquan, WANG Pengfei, FU Yahui, WEI Xing, WEI Wei, LEI Jinlai, WANG Hu, WEN Shiming, ZHANG Kun, ZHOU Fengjin, ZHUANG Yan. Short-term effectiveness of TiRobot combined with O-arm navigation system in minimally invasive treatment of hindfoot fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(8): 951-956. doi: 10.7507/1002-1892.202204057 Copy

1.	Pitts CC, Almaguer A, Wilson JT, et al. Radiographic and postoperative outcomes of plate versus screw constructs in open reduction and internal fixation of calcaneus fractures via the sinus tarsi. Foot Ankle Int, 2019, 40(8): 929-935.
2.	Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
3.	Segura FP, Eslava S. Talar Neck fractures: single or double approach? Foot Ankle Clin, 2020, 25(4): 653-665.
4.	Lee C, Brodke D, Perdue PW, et al. Talus fractures: evaluation and treatment. J Am Acad Orthop Surg, 2020, 28(20): e878-e887.
5.	Joseph NM, Benedick A, McMellen C, et al. Acute fixation of displaced intra-articular calcaneus fractures is safe using the sinus tarsi approach. J Orthop Trauma, 2021, 35(6): 289-295.
6.	Xu H, Hou R, Ju J, et al. Articular calcaneal fractures: open or minimally invasive surgery, when the medial wall reduction is obtained percutaneously from the lateral side. Int Orthop, 2021, 45(9): 2365-2373.
7.	Liu HS, Duan SJ, Xin FZ, et al. Robot-assisted minimally-invasive internal fixation of oelvic ring injuries: A single-center experience. Orthop Surg, 2019, 11(1): 42-51.
8.	He M, Han W, Zhao CP, et al. Evaluation of a bi-planar robot navigation system for insertion of cannulated screws in femoral neck fractures. Orthop Surg, 2019, 11(3): 373-379.
9.	郑博隆, 郝定均, 林斌, 等. 天玑骨科手术机器人辅助与徒手穿刺椎体成形术治疗上胸椎骨质疏松性椎体压缩骨折的疗效比较. 中华创伤骨科杂志, 2021, 23(1): 20-26.
10.	Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg (Am), 1970, 52(5): 991-1002.
11.	Chen G, Hu M, Xu Y, et al. Joint-preserving surgery for talar malunions or nonuions. Orthop Surg, 2017, 9(1): 34-41.
12.	Fournier A, Barba N, Steiger V, et al. Total talar fracture—long-term results of internal fixation of talar fractures. A multicentric study of 114 cases. Orthop Traumatol Surg Res, 2012, 98(4 Suppl): S48-S55.
13.	Dodd A, Lefaivre KA. Outcomes of talar neck fractures: A systematic review and meta-analysis. J Orthop Trauma, 2015, 29(5): 210-215.
14.	Veliceasa B, Filip A, Pinzaru R, et al. Treatment of displaced intra-articular calcaneal fractures with an interlocking nail (C-Nail). J Orthop Trauma, 2020, 34(11): e414-e419.
15.	Vicenti G, Carrozzo M, Solarino G, et al. Comparison of plate, calcanealplasty and external fixation in the management of calcaneal fractures. Injury, 2019, 50 Suppl 4: S39-S46.
16.	Kline AJ, Anderson RB, Davis WH, et al. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int, 2013, 34(6): 773-780.
17.	Amani A, Shakeri V, Kamali A. Comparison of calcaneus joint internal and external fractures in open surgery and minimal invasive methods in patients. Eur J Transl Myol, 2018, 28(2): 7352. doi: 10.4081/ejtm.2018.7352.
18.	Driessen M, Edwards M, Biert J, et al. Long-term results of displaced intra-articular calcaneal fractures treated with minimal invasive surgery using percutaneous screw fixation. Injury, 2021, 52(4): 1054-1059.

1. Pitts CC, Almaguer A, Wilson JT, et al. Radiographic and postoperative outcomes of plate versus screw constructs in open reduction and internal fixation of calcaneus fractures via the sinus tarsi. Foot Ankle Int, 2019, 40(8): 929-935.
2. Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
3. Segura FP, Eslava S. Talar Neck fractures: single or double approach? Foot Ankle Clin, 2020, 25(4): 653-665.
4. Lee C, Brodke D, Perdue PW, et al. Talus fractures: evaluation and treatment. J Am Acad Orthop Surg, 2020, 28(20): e878-e887.
5. Joseph NM, Benedick A, McMellen C, et al. Acute fixation of displaced intra-articular calcaneus fractures is safe using the sinus tarsi approach. J Orthop Trauma, 2021, 35(6): 289-295.
6. Xu H, Hou R, Ju J, et al. Articular calcaneal fractures: open or minimally invasive surgery, when the medial wall reduction is obtained percutaneously from the lateral side. Int Orthop, 2021, 45(9): 2365-2373.
7. Liu HS, Duan SJ, Xin FZ, et al. Robot-assisted minimally-invasive internal fixation of oelvic ring injuries: A single-center experience. Orthop Surg, 2019, 11(1): 42-51.
8. He M, Han W, Zhao CP, et al. Evaluation of a bi-planar robot navigation system for insertion of cannulated screws in femoral neck fractures. Orthop Surg, 2019, 11(3): 373-379.
9. 郑博隆, 郝定均, 林斌, 等. 天玑骨科手术机器人辅助与徒手穿刺椎体成形术治疗上胸椎骨质疏松性椎体压缩骨折的疗效比较. 中华创伤骨科杂志, 2021, 23(1): 20-26.
10. Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg (Am), 1970, 52(5): 991-1002.
11. Chen G, Hu M, Xu Y, et al. Joint-preserving surgery for talar malunions or nonuions. Orthop Surg, 2017, 9(1): 34-41.
12. Fournier A, Barba N, Steiger V, et al. Total talar fracture—long-term results of internal fixation of talar fractures. A multicentric study of 114 cases. Orthop Traumatol Surg Res, 2012, 98(4 Suppl): S48-S55.
13. Dodd A, Lefaivre KA. Outcomes of talar neck fractures: A systematic review and meta-analysis. J Orthop Trauma, 2015, 29(5): 210-215.
14. Veliceasa B, Filip A, Pinzaru R, et al. Treatment of displaced intra-articular calcaneal fractures with an interlocking nail (C-Nail). J Orthop Trauma, 2020, 34(11): e414-e419.
15. Vicenti G, Carrozzo M, Solarino G, et al. Comparison of plate, calcanealplasty and external fixation in the management of calcaneal fractures. Injury, 2019, 50 Suppl 4: S39-S46.
16. Kline AJ, Anderson RB, Davis WH, et al. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int, 2013, 34(6): 773-780.
17. Amani A, Shakeri V, Kamali A. Comparison of calcaneus joint internal and external fractures in open surgery and minimal invasive methods in patients. Eur J Transl Myol, 2018, 28(2): 7352. doi: 10.4081/ejtm.2018.7352.
18. Driessen M, Edwards M, Biert J, et al. Long-term results of displaced intra-articular calcaneal fractures treated with minimal invasive surgery using percutaneous screw fixation. Injury, 2021, 52(4): 1054-1059.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of TiRobot combined with O-arm navigation system in minimally invasive treatment of hindfoot fracture

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