Radiation-free methods for navigated screw placement in slipped capital femoral epiphysis surgery

Purpose: For orthopedic procedures, surgeons utilize intra-operative medical images such as fluoroscopy to plan screw placement and accurately position the guide wire with the intended trajectory. The number of fluoroscopic images needed depends on the complexity of the case and skill of the surgeon. Since more fluoroscopic images lead to more exposure and higher radiation dose for both surgeon and patient, a solution that decreases the number of fluoroscopic images would be an improvement in clinical care. Methods: This article describes and compares three different novel navigation methods and techniques for screw placement using an attachable Inertial Measurement Unit device or a robotic arm. These methods provide projection and visualization of the surgical tool trajectory during the slipped capital femoral epiphysis procedure. Results: These techniques resulted in faster and more efficient preoperative calibration and set up times compared to other intra-operative navigation systems in our phantom study. We conducted an experiment using 120 model bones to measure the accuracy of the methods. Conclusion: As conclusion, these approaches have the potential to improve accuracy of surgical tool navigation and decrease the number of required X-ray images without any change in the clinical workflow. The results also show 65% decrease in total error compared to the conventional manual approach.