Computer-assisted simulated workplace-based assessment in surgery: application of the universal framework of intraoperative performance within a mixed-reality simulation.

Objectives: Workplace-based assessment (WBA) is a key requirement of competency-based medical education in postgraduate surgical education. Although simulated workplace-based assessment (SWBA) has been proposed to complement WBA, it is insufficiently adopted in surgical education. In particular, approaches to criterion-referenced and automated assessment of intraoperative surgical competency in contextualized SWBA settings are missing.

[Prophylactic fasciotomy in tibial osteotomies: functional results].

Background: Intramedullary nailing in tibial osteotomy (TO) can be combined with minimally invasive prophylactic fasciotomy (PF) of the anterior compartment of the lower leg to prevent postoperative acute compartment syndrome (CS). So far no studies are available on the effects of TO or PF on specific functions of the extensor muscles.

Objective: To investigate the medium-term outcome after PF in TO in patients without preoperative functional impairment.

Complications and Effectiveness of Intramedullary Limb Lengthening: A Matched Pair Analysis of Two Different Lengthening Nails.

Background: Intramedullary limb lengthening has become an accepted concept in reconstructive surgery, but as yet comparative clinical studies are missing. We compared the complications and effectiveness of two types of intramedullary limb lengthening devices (ISKD®; Fitbone®).

Materials And Methods: In a retrospective series of 278 consecutive patients with internal limb lengthening, we found 17 matching pairs in terms of predefined matching parameters (group I with ISKD® and group II with Fitbone®).

Three-dimensional-Printed Computed Tomography-Based Bone Models for Spine Surgery Simulation.

Introduction: We present a novel 3-dimensional (3D) printing method for low-cost and widely available reproduction of computed tomography (CT)-based synthetic bone models for spine surgery simulation, optimized to reproduce realistic haptic properties. The method allows reproduction of either normal or abnormal patient anatomy. The models are fluoroscopy compatible and contain deformities and fractures present in the underlying CT data.

Video-augmented fluoroscopy for distal interlocking of intramedullary nails decreased radiation exposure and surgical time in a bovine cadaveric setting.

Background: We aimed to assess the feasibility of a video-augmented fluoroscopy (VAF) technique using a camera-augmented mobile C-arm (CamC) for distal interlocking of intramedullary nails.

Methods: Three surgeons performed distal interlocking on seven pairs of cadaveric bovine carpal bones using the VAF system and conventional fluoroscopy. We compared radiation exposure, procedure time, and drilling quality between the VAF system and conventional fluoroscopic guidance.

Camera-augmented mobile C-arm (CamC): A feasibility study of augmented reality imaging in the operating room.

Background: In orthopaedic trauma surgery, image-guided procedures are mostly based on fluoroscopy. The reduction of radiation exposure is an important goal. The purpose of this work was to investigate the impact of a camera-augmented mobile C-arm (CamC) on radiation exposure and the surgical workflow during a first clinical trial.

Analysis of the three-dimensional anatomical variance of the distal radius using 3D shape models.

Background: Various medical fields rely on detailed anatomical knowledge of the distal radius. Current studies are limited to two-dimensional analysis and biased by varying measurement locations. The aims were to 1) generate 3D shape models of the distal radius and investigate variations in the 3D shape, 2) generate and assess morphometrics in standardized cut planes, and 3) test the model's classification accuracy.

An augmented reality C-arm for intraoperative assessment of the mechanical axis: a preclinical study.

Background: Determination of lower limb alignment is a prerequisite for successful orthopedic surgical treatment. Traditional methods include the electrocautery cord, alignment rod, or axis board which rely solely on C-arm fluoroscopy navigation and are radiation intensive.

Study Objectives: To assess a new augmented reality technology in determining lower limb alignment.

Preclinical usability study of multiple augmented reality concepts for K-wire placement.

Purpose: In many orthopedic surgeries, there is a demand for correctly placing medical instruments (e.g., K-wire or drill) to perform bone fracture repairs.

Using self-drilling screws in volar plate osteosynthesis for distal radius fractures: a feasibility study.

Background: Symptomatic extensor tendon irritation is a frequent complication in volar plate osteosynthesis of distal radius fractures. It is typically caused by dorsal screw protrusion and overdrilling of the dorsal cortex. The use of self-drilling locking screws (SDLS) could overcome both causes.

Personalized augmented reality for anatomy education.

Anatomy education is a challenging but vital element in forming future medical professionals. In this work, a personalized and interactive augmented reality system is developed to facilitate education. This system behaves as a "magic mirror" which allows personalized in-situ visualization of anatomy on the user's body.

Intra-operative disruptions, surgeon's mental workload, and technical performance in a full-scale simulated procedure.

Background And Aim: Surgical flow disruptions occur frequently and jeopardize perioperative care and surgical performance. So far, insights into subjective and cognitive implications of intra-operative disruptions for surgeons and inherent consequences for performance are inconsistent. This study aimed to investigate the effect of surgical flow disruption on surgeon's intra-operative workload and technical performance.

Intra-operative augmented reality in distal locking.

Purpose: To design an augmented reality solution that assists surgeons during the distal locking of intramedullary nailing procedures.

Method: Traditionally, the procedure is performed under X-ray guidance and requires a significant amount of time and radiation exposure. To absolve these complications, we propose video guidance that allows surgeons to achieve both the down-the-beam position of the intramedullary nail and its subsequent locking.

Multi-modal intra-operative navigation during distal locking of intramedullary nails.

The interlocking of intramedullary nails is a technically demanding procedure which involves a considerable amount of X-ray acquisitions; one study lists as many as 48 to successfully complete the procedure and fix screws into 4-6 mm distal holes of the nail. We propose to design an augmented radiolucent drill to assist surgeons in completing the distal locking procedure without any additional X-ray acquisitions. Using an augmented reality fluoroscope that coregisters optical and X-ray images, we exploit solely the optical images to detect the augmented radiolucent drill and estimate its tip position in real-time.

Necrotizing fasciitis in a young patient with acute myeloid leukemia - a diagnostic challenge.

Background: Necrotizing fasciitis is characterized by a fulminant destruction of the soft tissue with an alarmingly high mortality rate. One of the main reasons for the continued high mortality is due to the challenge to punctual recognize and diagnose this disease, as specific cutaneous signs can vary or even be missing early in its evolution - especially in case of simultaneous first manifestation of an acute leukemia.

Case Presentation: An untypical case of necrotizing fasciitis disease in a young patient with the first diagnosis of acute myeloid leukemia is presented.

Machine learning-based augmented reality for improved surgical scene understanding.

In orthopedic and trauma surgery, AR technology can support surgeons in the challenging task of understanding the spatial relationships between the anatomy, the implants and their tools. In this context, we propose a novel augmented visualization of the surgical scene that mixes intelligently the different sources of information provided by a mobile C-arm combined with a Kinect RGB-Depth sensor. Therefore, we introduce a learning-based paradigm that aims at (1) identifying the relevant objects or anatomy in both Kinect and X-ray data, and (2) creating an object-specific pixel-wise alpha map that permits relevance-based fusion of the video and the X-ray images within one single view.

Intra-op measurement of the mechanical axis deviation: an evaluation study on 19 human cadaver legs.

The alignment of the lower limb in high tibial osteotomy (HTO) or total knee arthroplasty (TKA) must be determined intraoperatively. One way to do so is to deform the mechanical axis deviation (MAD), for which a tolerance measurement of 10 mm is widely accepted. Many techniques are proposed in clinical practice such as visual inspection, cable method, grid with lead impregnated reference lines, or more recently, navigation systems.

Radiation-free drill guidance in interlocking of intramedullary nails.

Intramedullary nailing is a technically demanding procedure which involves an excessive amount of x-ray acquisitions; one study lists as many as 48 to successfully complete the procedure. In this work, a novel low cost radiation-free drilling guide is designed to assist surgeons in completing the distal locking procedure without any x-ray acquisitions. Using an augmented reality fluoroscope that coregisters optical and x-ray images, we exploit solely the optical images to detect the drilling guide in order to estimate the tip position in real-time in x-ray.

Parallax-free intra-operative X-ray image stitching.

We present a novel method to generate parallax-free panoramic X-ray images during surgery by enabling the mobile C-arm to rotate around its X-ray source center, relative to the patient's table. Rotating the mobile C-arm around its X-ray source center is impractical and sometimes impossible due to the mechanical design of mobile C-arm systems. In order to ensure that the C-arm motion is a relative pure rotation around its X-ray source center, we propose to move the table to compensate for the translational part of the motion based on C-arm pose estimation.

Flexible intramedullary nailing of a displaced transverse sternal fracture associated with a flexion-compression injury of the thoracic spine.

Study Design: A case report.

Objective: To report the successful surgical management of a patient with a displaced sternal fracture associated with flexion-compression injury to the thoracic spine by flexible intramedullary nailing of the sternum, thereby emphasizing the existence and clinical relevance of the concept of the fourth column of the thoracic spine.

Summary Of Background Data: Displaced sternal fractures resulting from indirect trauma are often associated with unstable injuries to the thoracic spine that require stabilization of the spine to prevent increasing kyphosis.

Parallax-free long bone X-ray image stitching.

In this paper, we present a novel method to create parallax-free panoramic X-ray images of long bones during surgery by making the C-arm rotate around its X-ray source, relative to the patient's table. In order to ensure that the C-arm motion is a relative pure rotation around its X-ray source, we move the table to compensate for the translational part of the motion based on C-arm pose estimation, for which we employed a Camera Augmented Mobile C-arm system and a visual planar marker pattern. Thus, we are able to produce a parallax-free panoramic X-ray image that preserves the property of linear perspective projection.

Long bone X-ray image stitching using Camera Augmented Mobile C-arm.

X-ray images are widely used during surgery for long bone fracture fixation. Mobile C-arms provide X-ray images which are used to determine the quality of trauma reduction, i.e.

Visual servoing for intraoperative positioning and repositioning of mobile C-arms.

The problem of positioning mobile C-arms, e.g. for down the beam techniques, as well as repositioning during surgical procedures currently requires time, skill and additional radiation.

Hybrid navigation interface for orthopedic and trauma surgery.

Several visualization methods for intraoperative navigation systems were proposed in the past. In standard slice based navigation, three dimensional imaging data is visualized on a two dimensional user interface in the surgery room. Another technology is the in-situ visualization i.

Analysis of NF-kappaB nuclear translocation in PMN-neutrophils of major trauma patients in the early post-traumatic period: a pilot study.

Background: Post-traumatic inflammation is connected to polymorphonuclear neutrophil (PMN)-dysfunction characterized by reduced nuclear translocation of NF-kappaB during the post-traumatic period. However, the dynamic of NF-kappaB translocation in PMN of major trauma patients remains unclear. Hence, the aim of this pilot study was to analyze NF-kappaB in PMN from multiply injured patients immediately after trauma.