[FLUOROSCOPIC BASED NAVIGATION IN ORTHOPAEDIC TRAUMA - A REVIEW OF A LARGE CENTER'S EXPERIENCE].

INTRODUCTION: Computer Assisted Orthopaedic Surgery (CAOS) was introduced in the late 1990's and early 2000's. Since then its application in orthopaedic trauma has been utilized mainly as augmented fluoroscopy for intraoperative navigation. From 2010 our center implemented an advanced system allowing further expansion of this technology.

AIMS: The aim of this study was to describe the experience with an advanced fluoroscopic based CAOS system in our center.

METHODS: The BrainLabTM Trauma 3.0 utilizes a handheld fluoroscope tracker, enables tracking of two anatomical objects and intraoperative planning. We implemented this system for the performance of 126 navigated procedures between the years 2011-2014. The procedures included 58 cases of navigated hip fracture pinning, 9 plate navigation for distal femoral fractures, 19 iliosacral screw insertions, 20 femoral fracture reductions, and 12 other procedures (acetabular screws, osteotomies etc).

RESULTS: The mean age of patients was 52 years (range 16-82 years); 46 male and 80 female patients. The mean operating room time was 157 minutes (range 70 to 470 minutes). The average radiation required was 550 rad cm2 (~30 sec fluoroscopic time). Overall estimated additional OR time was estimated as 10-15 minutes for hip pinning, 15-20 minutes for pelvic iliosacral screws and 30-45 minutes of additional OR time for femur fracture reduction for length and rotation. In 5% of cases (6 patients), navigation was aborted due to technical reasons. No misplaced hardware due to the use of navigation was documented.

CONCLUSIONS: CAOS is a powerful tool in trauma surgery with 95% success rate, with a reasonable added burden time. Although 3D navigation may be more useful in the pelvis, even two-dimensional navigation increases precision and implant placement. Femoral fracture reduction for accurate length and rotation control is solely enabled by CAOS. In the future, more time efficient and user-friendly systems will enable widespread use of these technologies in orthopaedic trauma.