Robot-assisted System for Joint Fracture Surgery

Incidence of fractures is steadily increasing and is expected that in 2025, Germany will have the largest number of fractures per year in Europe (≈928,000), followed by the UK (≈682,000) (Hernlund 2013). This work is concerned with distal-femur-fractures (DFF) where the bone breaks either straight across or into many pieces, extending into the knee joint and separate the articular surface of the bone into fragments. Because they damage the cartilage surface of the bone, intra-articular fractures can be difficult to treat. When the distal femur breaks, hamstrings and quadriceps muscles tend to contract and shorten the fracture, changing fragment position and making line up with a cast difficult to achieve (Kulkarni 2008). The traditional treatment of DFF is surgical manual reduction and rigid internal fixation of these fractures using metallic plates and screws (Muller 1991) involving open incisions into the knee. Manipulating diminutive fragments to a high-standard of positional accuracy is critical to avoid clinical complications and to ensure a complete recovery from the injury (Gaston 2005). At the same time, a minimally invasive approach is crucial to minimise surgical impact on soft tissues and reduce the recovery time. We believe that robotic assistance can have a positive impact in this field, allowing more accurate fracture fragment repositioning without open surgery, and obviating problems related to the current manual percutaneous surgical techniques. Robot-assisted fracture surgery (RAFS) is potentially able to combine the required high-positioning accuracy with the minimally invasive approach, reducing in-patient stays and making recovery swifter and more complete.