Case description:
Around 3 days ago a 44-year-old male was transferred from another hospital who has fallen from the fourth storey of the building who has sustained multiple injuries like,
Vertically unstable fracture of the left hemipelvis with a morel Lavallee lesion.
Bust fracture of L2 vertebrae with neurological deficit.
Fracture of the left elbow with dislocation.
The prerenal failure is stabilized in the first step which is followed by the intravascular coagulopathy along with severe anaemia. To the left leg, the skeletal traction is applied.
Orthopedic Indication
A Minimally invasive fixation is required by the critical, local, and general condition of the patient for the pelvis fracture. Due to the degloved buttock, the open compressive screws insertion can lead to the high risk of infections along with the suprapubic catheter with the prolonged open surgery.
Preoperative preparation
The spine position is maintained by the patient with the extended radiolucent on the operative table. The position of the C-arm is kept in such a way that it allows the pelvic inlet, shot through a lateral sacral view and pelvic outlet. With the infrared cameras, the C-arm needs to be trackable in all views.
Indirect reduction
With the skeletal traction, the restoration of the limb is managed from the lower limb. By the use of taping the reduction of rotation needs to be maintained together through the knees.
Surgical approach
The patient should be cleaned and draped properly. In the left anterior superior iliac spine, the base of reference was affixed. It is required to acquire the pelvic outlet, inlet, lateral sacral views, and the transfer of navigation computers. The tracking for the drill trajectory is required which is majorly represented with the coloured lines that are superimposed over the stored fluoroscopic views. For the drills, the percutaneous insertion point along with the drilling direction is guided through the navigation system.
The real-time trajectory information is accessed by the surgeon in the case of four key fluoroscopic views that makes the procedure more reliable and quick. Before the computer-assisted navigation, n, the advancement of the drill was made with the alteration between pelvic inlet and outlet. In the sagittal plane, the pelvis is oriented at the angle of 45 degrees which makes the appreciation and targeting difficult.
In the vertebral bodies of S1 and S2, the drill tracks inside and is replaced with the K wires of 7.3mm cannulated cancellous bone screws. With the help of C-arm, a double check is required for the K wire positions to ensure the complete accuracy of the navigation. In the spinal canal, it is important that there should be no hard wire. Later the cannulated cancellous bone screws replaced these K wires. Firm confirmation of the C-arm imaging a postoperative X-ray is taken. After the duration of 1 week the corpectomy, fusion, and L2 decompression were performed. The healing for pelvic sacral fractures can be shown through the x-ray.
Orthopedic Future
The shortcoming can remain in three main aspects even after the proper efforts made for intensive development using orthopedic implants.
Basic connectivity
For space, a logistic demand is increased by the wired components along with the connection management. The set-up time is majorly increased by this. The wireless components are having low real-time accuracy and majorly suffer from the slow refresh rates. In the situation of ergonomics, with the adequate refresh rate, the wireless low profile is a prerequisite for the wide spreading of the application for this technology.
Fragment segmentation
From the imaging data, the extraction of bony outlines is the first step for tracking the fragments in the individual at the time of intraoperative manipulation along with the reduction. A virtual bone plates representation is morphed for enhancing the visual fragment representation at the time of surgery.
Integration with Implants and instrumentation
By the AOTK (AO technical commission) strong efforts are put for integrating Implants in the navigation along with the designing of Implants and instrumentation for alignment which is followed by the biological and Minimally invasive surgery. In the future, the integration of all three aspects will be helpful.
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