Download Navigation in Hip Fracture

Computer Assisted Orthopaedic
Surgery (CAOS)
Navigation in Hip Fracture
Chau Pui Man, Jasmine, Registered Nurse,
Department of Anaesthesia & Intensive Care
(Operating Theatre),
Prince of Wales Hospital, Hong Kong
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Source: http://www.stryker.com/navigation/us/trauma/apps.htm
The Development of CAOS
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1st performed by Prof. K. S. Leung in 2001 Sept
Totally more than 300 operations
Leading position
Routine orthopaedic practice, especially in
fracture fixation
Different from CAOS in total joint arthroplasty
Increasing demands on perioperative nurse
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Applications of CAOS in fracture
fixation surgery
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Fixation of femoral neck fractures with
percutaneous cannulated screw
Intramedullary locked nails for long bone
fractures
Intramedullary fixation of trochanteric fractures
e.g. Gamma nails
Percutaneous fixation of sacro-iliac fracture
dislocations (SI joint screw)
Percutaneous fixation of iliac wing fractures
Percutaneous fixation of acetabulum fractures
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Types of Navigation for surgical
planning
Image-guided navigation
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CT, MRI based
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Fluoroscopy
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Intra-op registration of anatomical landmark that
correspond to pre-op CT scan
Make use of C-arm fluroscope to create images in operating
room
Image-free navigation
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Intra-operative determination of anatomical structures and
reference landmarks to establish a virtual representation of
the surgical object
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How to localizing target within the
operating room?
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Principle of tracking system
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Infra-red
Electromagnetic wave
Ultrasound and
Laser
Most commonly used technique is infrared
optical tracking system
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Essential Equipments and
Instrument
Source: http://www.stryker.com/navigation/us/trauma/apps.htm
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The Computer Workstation
with Monitor
Localize Camera
Computer monitor
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Fluoro Machine System (Siemens)
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Robotic arm (Surgical navigation arm)
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The strength of
robots includes:
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Precision
Stability
repeatability
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Tracking Devices
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Phantom and C-arm tracker
LEDs
Phantom
Phantom attached on the C-arm tracker to correct image distortion.
The C-arm tracker is located with the LEDs.
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Basic Instrument
Extension pin
Anchoring pins
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Specifically designed axis adaptor
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Tool Assembly
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Technique of Fluoro-Navigation
Four basic steps
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(Referencing): The patient tracker is anchored to the
part of the bone that is going to be operated
(Tracking): The surgical instruments are fitted with
tracking sensor
(Image acquisition and transfer): Images are taken
using the C-arm and loaded into the navigation
computer
(Navigation): The surgical instrument is displayed as
a virtual instrument in the medical images in real
time
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Workflow of computer
Infrared optical tracking navigation system (image-guided)
Patient tracker
anchored on
anterior iliac crest
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Calibration of surgical instrument
Calibration device
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Image acquisition (AP/Lat view)
AP view
Lat view
C-arm tracker calibration
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Skin incision planning
The camera receive the
signal then the computer
recognize the signal
The result is shown
on the computer screen
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Lag screw position planning
Lag screw length measurement
Virtual lag screw position
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Operation Room Layout (Hip fracture)
The operating room should be of
adequate size to accommodate the
fluoro unit, fluoro monitor and the
computer system
Sensor/camera
Patient
Tracker
Monitor/screen
Fluoro
machine
Computer
System
Fluoro
monitor
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Fluoroscopic navigation
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Iso-C 3D navigation
Solid carbon
table
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Advanced Practice Nursing Role
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Orthopaedic team nurses
- Have expert clinical skills and knowledge
- Have thorough understanding of how equipment
function, distinguishing between a device failure
and user error
- Quick response in the complexity of new devices,
their application and integration with traditional
instrument
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Advanced Practice Nursing Role
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Circulating Nurse
2 circulating nurses – one for operating the
computer, one for providing patient care
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Scrub Nurse
well familiar with the navigation instrument
Formation of a surgical team dedicated to CAOS
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Enhancement
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Departmental training and education
Protocols and procedure guidelines
Organize one day course
Nurse teleconference on live demonstration
Active participate in live surgery
Design in the theatre layout
Virtual lab study in Orthopaedic Learning Center
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Virtual Lab
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