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Wire Placement in the Lisfranc Joint Using a 2D Projection-Based Software Application for Mobile C-Arms: an Experimental Study in 20 Cadaver Specimens

6 pagesPublished: August 17, 2017

Abstract

In the surgical treatment of Lisfranc injuries, percutaneous wire transfixation of the
tarsometatarsal complex can be challenging due to it’s small corridors and complex anatomy. A novel 2D projection-based software application detects Kirschner wires (K- wires) and automatically indicates their intended direction as a colored trajectory. The aim was to investigate whether the software facilitates K-wire placement in the Lisfranc joint for the inexperienced and the experienced surgeon.
In 20 cadaver foot specimens, 5 K-wires were retrogradely placed into the tarsometatarsal complex from D1-D5 by an experienced and an inexperienced surgeon, with and without using the application. The specimens were presented in pairs; surgeons and software use were equally randomized. Number of placement attempts, duration of procedure, fluoroscopy time, and number of individual fluoroscopy images were recorded.
Use of the software by the inexperienced surgeon significantly reduced the number of placement attempts from 14.2 to 8.8 (p=0.008). The application also reduced the number of fluoroscopy images from 44.8 to 40.8 (p=0.230). Duration of procedure and fluoroscopy time were not affected significantly. The experienced surgeon needed more placement attempts using the software (8.2 vs. 9.2; p=0.351). Duration of procedure, fluoroscopy time and number of fluoroscopy images increased while using the software, yet not significantly.
During percutaneous K-wire transfixation of the Lisfranc joint, the novel software is a useful tool for the inexperienced surgeon. In our chosen study setting, the experienced surgeon did not benefit from the software.
Due to its independency on fixed reference markers or registration processes, the software contributes to the procedures in orthopedic surgery.

Keyphrases: cadaver specimens, Image Guided Surgery, K-wire Placement, Lisfranc joint, software application

In: Klaus Radermacher and Ferdinando Rodriguez Y Baena (editors). CAOS 2017. 17th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery, vol 1, pages 385--390

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