gms | German Medical Science

Objectives/Interrogation: Despite available technologies for planning of surgical treatments, definition of an optimal preoperative plan for complex forearm osteotomies can take up to 6 hours, requiring several adjustment iterations. Existing automatic approaches often fail to provide surgeons with ready-to-use solutions that can be implemented without further adjustments. Thus, clinical times and costs of computer-assisted planning remain too high, limiting its clinical use. A new computer algorithm has been developed to provide surgeons with complete preoperative planning solutions encompassing the position and orientation of the osteotomy cut, the required reduction of the bone fragments, and optimal positions of the fixation plate and screws. Goal of this study was to evaluate the capability of our approach to generating planning solutions that can be directly used in the clinical setting, without requiring further manual tuning.

Methods: 38 patients who underwent corrective osteotomy (14 distal radius, 24 shaft) were included in the study with baseline data: affected side: 19 left, 20 right; gender: 20 males, 19 females. The developed algorithm was based on artificial intelligence and statistical shape models. Additionally, bone density of each patient was considered for the automatic implant optimization. A clinical validation compared solutions generated by the algorithm (OA) against manually generated 3D preoperative planning by expert surgeons, considered as the gold standard (GS). Both solutions were blinded and presented to 6 expert hand surgeons, who had then to choose the better operative plan for each case. A technical evaluation was also done, comparing reduction accuracy, position of implant relative to the bone fragments and screw purchase.

Results and Conclusions: Clinical validation showed that surgeons favored OA solutions to be better than the corresponding GS solutions in 60% of the tested cases. Subsequent technical evaluation indicated an improvement of 40% on the reduction accuracy, 60% on the implant position and 80% on the screw purchase, in comparison to GS solutions. OA solutions particularly outperformed the GS in cases with a difficult fixation, further improved when considering variable-angle screws.

The presented computer approach allows generating complete solutions for patient specific pre-operative planning of distal and shaft radius osteotomies, which can improve planning times and help assist surgeons on better surgical decisions.