To develop an artificial intelligence (AI) algorithm for automated measurements of spinopelvic parameters on lateral radiographs and compare its performance to multiple experienced radiologists and surgeons. On lateral full-spine radiographs of 295 consecutive patients, a two-staged region-based convolutional neural network (R-CNN) was trained to detect anatomical landmarks and calculate thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), and sagittal vertical axis (SVA). Performance was evaluated on 65 radiographs not used for training, which were measured independently by 6 readers (3 radiologists, 3 surgeons), and the median per measurement was set as the reference standard. Intraclass correlation coefficient (ICC), mean absolute error (MAE), and standard deviation (SD) were used for statistical analysis; while, ANOVA was used to search for significant differences between the AI and human readers. Automatic measurements (AI) showed excellent correlation with the reference standard, with all ICCs within the range of the readers (TK: 0.92 [AI] vs. 0.85–0.96 [readers]; LL: 0.95 vs. 0.87–0.98; SS: 0.93 vs. 0.89–0.98; SVA: 1.00 vs. 0.99–1.00; all p < 0.001). Analysis of the MAE (± SD) revealed comparable results to the six readers (TK: 3.71° (± 4.24) [AI] v.s 1.86–5.88° (± 3.48–6.17) [readers]; LL: 4.53° ± 4.68 vs. 2.21–5.34° (± 2.60–7.38); SS: 4.56° (± 6.10) vs. 2.20–4.76° (± 3.15–7.37); SVA: 2.44 mm (± 3.93) vs. 1.22–2.79 mm (± 2.42–7.11)); while, ANOVA confirmed no significant difference between the errors of the AI and any human reader (all p > 0.05). Human reading time was on average 139 s per case (range: 86–231 s). Our AI algorithm provides spinopelvic measurements accurate within the variability of experienced readers, but with the potential to save time and increase reproducibility.

OBJECTIVE This study evaluates the precision of a commercially available spine planning software in automatic spine labelling and screw-trajectory proposal. METHODS The software uses automatic segmentation and registration of the vertebra to generate screw proposals. 877 trajectories were compared. Four neurosurgeons assessed suggested trajectories, performed corrections, and manually planned pedicle screws. Additionally, automatic identification/labelling was evaluated. RESULTS Automatic labelling was correct in 89% of the cases. 92.9% of automatically planned trajectories were in accordance with G&R grade A + B. Automatic mode reduced the time spent planning screw trajectories by 7 s per screw to 20 s per vertebra. Manual mode yielded differences in screw-length between surgeons (largest distribution peak: 5 mm), automatic in contrast at 0 mm. The size of suggested pedicle screws was significantly smaller (largest peaks in difference between 0.5 and 3 mm) than the surgeon's choice. CONCLUSION Automatic identification of vertebrae works in most cases and suggested pedicle screw trajectories are acceptable. So far, it does not substitute for an experienced surgeon's assessment.

Enabling collaborative telepresence in healthcare, especially surgical procedures, presents a critical challenge. The decompressive craniotomy procedure stands out as particularly complex and time-sensitive. The current teleconsultation approach relies on 2D color cameras, often offering only a fixed view and limited visual capabilities between experts and surgeons. However, teleconsultation can be addressed with Mixed Reality and immersive technology to potentially enable a better consultation of the procedure. We conducted an extensive user study focusing on decompressive craniotomy to investigate the advantages and challenges of our 3D teleconsultation system compared to a 2D video-based consultation system. Our 3D teleconsultation system leverages real-time 3D reconstruction of the patient and environment to empower experts to provide guidance and create virtual 3D annotations. The study utilized 3D-printed head models to perform a lifelike surgical intervention. It involved 14 medical residents and demonstrated an in-vitro 17% improvement in accurately describing the incision size on the patient's head, contributing to potentially improved patient outcomes.

ObjectivesWorkplace-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.Main objectives were (1) application of the universal framework of intraoperative performance and exemplary adaptation to spine surgery (vertebroplasty); (2) development of computer-assisted assessment based on criterion-referenced metrics; and (3) implementation in contextualized, team-based operating room (OR) simulation, and evaluation of validity.DesignMultistage development and assessment study: (1) expert-based definition of performance indicators based on framework’s performance domains; (2) development of respective assessment metrics based on preoperative planning and intraoperative performance data; (3) implementation in mixed-reality OR simulation and assessment of surgeons operating in a confederate team. Statistical analyses included internal consistency and interdomain associations, correlations with experience, and technical and non-technical performances.SettingSurgical simulation center. Full surgical team set-up within mixed-reality OR simulation.ParticipantsEleven surgeons were recruited from two teaching hospitals. Eligibility criteria included surgical specialists in orthopedic, trauma, or neurosurgery with prior VP or kyphoplasty experience.Main outcome measuresComputer-assisted assessment of surgeons’ intraoperative performance.ResultsPerformance scores were associated with surgeons’ experience, observational assessment (Objective Structured Assessment of Technical Skill) scores and overall pass/fail ratings. Results provide strong evidence for validity of our computer-assisted SWBA approach. Diverse indicators of surgeons’ technical and non-technical performances could be quantified and captured.ConclusionsThis study is the first to investigate computer-assisted assessment based on a competency framework in authentic, contextualized team-based OR simulation. Our approach discriminates surgical competency across the domains of intraoperative performance. It advances previous automated assessment based on the use of current surgical simulators in decontextualized settings. Our findings inform future use of computer-assisted multidomain competency assessments of surgeons using SWBA approaches.

Zusammenfassung3-D-Druck wird in der Unfallchirurgie und Orthopädie zunehmend für die Herstellung patientenspezifischer Implantate verwendet. Ziel dieses strukturierten Reviews ist es, aktuelle Merkmale und Fähigkeiten zu ermitteln und hieraus Anforderungen an das Implantatdesign und den -druck abzuleiten. Hierzu wurden 98 Veröffentlichungen der letzten 5 Jahre analysiert.Neben Kunststoffen und Metallen können auch biologisches Material und Medikamentensuspensionen zum Druck verwendet werden. Der 3-D-Druck bietet den Vorteil, dass die Implantate individuell an die Anatomie und Pathologie des Patienten angepasst werden können, also auch bewusst Einfluss auf biomechanischen und -mimetischen Eigenschaften genommen werden kann. Beispielsweise kann die Oberfläche der Implantate gezielt so optimiert werden, dass eine Osteoinduktivität bewirkt wird. Angewandt wird das Verfahren zum Gelenk- und Knochenersatz sowie für Knorpel- und Weichteilrekonstruktionen.Somit ergeben sich diverse Anforderungen an das Design und die Herstellung. Da es sich um ein sehr zeit- und kostenintensives Verfahren handelt, sollte eine klare Überlegenheit zu herkömmlichen Behandlungsmethoden bestehen. Aufgrund der Komplexität des Prozesses ist eine Qualitätssicherung unabdingbar, um die Sicherheit des Patienten zu gewährleisten.Bei komplexen oder von der Norm abweichenden Fällen wird der 3-D-Druck sich zunehmend durchsetzen. Um Qualität zu gewährleisten und effiziente Prozesse zu etablieren, ist eine engere Verzahnung zwischen Behandlern und Herstellern unabdingbar.

BACKGROUND:Two-dimensional (2D)-3D registration is challenging in the presence of implant projections on intraoperative images, which can limit the registration capture range. Here, we investigate the use of deep-learning-based inpainting for removing implant projections from the X-rays to improve the registration performance.METHODS:We trained deep-learning-based inpainting models that can fill in the implant projections on X-rays. Clinical datasets were collected to evaluate the inpainting based on six image similarity measures. The effect of X-ray inpainting on capture range of 2D-3D registration was also evaluated.RESULTS:The X-ray inpainting significantly improved the similarity between the inpainted images and the ground truth. When applying inpainting before the 2D-3D registration process, we demonstrated significant recovery of the capture range by up to 85%.CONCLUSION:Applying deep-learning-based inpainting on X-ray images masked by implants can markedly improve the capture range of the associated 2D-3D registration task.

Elderly patients suffering from hip fractures are usually not able to fulfill postoperative weight-bearing restrictions. Therefore, the operative fixation construct has to be as stable as possible. Aim of the present study was to determine: (1) whether a therapeutic advantage could be achieved when using hip arthroplasty to treat acetabular fractures in geriatric patients; (2) whether an acetabular revision cup would be suitable for achieving fast postoperative mobilization and full weight-bearing; and (3) when a treatment with an uncemented hip revision cup for the primary fixation of osteoporotic acetabular fractures in geriatric patients is indicated. The functional outcome of THA using a reconstruction cup for an acetabular fracture was evaluated in ten patients using standardized scoring instruments. In addition, an analysis of the preexisting literature referring to total hip replacement in geriatric acetabular fractures was conducted and an algorithm for standardizing the treatment approach for geriatric patients with acetabular fractures was developed. The mean EQ-5D-3L quality of life score 0.7. The mean VAS score was 58.2. The average Barthel Index was 80.0 points [range: 0–100]. The mean HHS was 72.0 points, while the MHH Score yielded an average of 63.4 points. The average AP Score was 7.5. The literature analysis showed that total hip arthroplasty could be a feasible option for geriatric acetabular fractures. Primary hip arthroplasty using uncemented revision cup fixed with angular stable screws showed good results and is a feasible treatment option of acetabular fractures in geriatric patients. The approach is especially beneficial in patients with poor bone stock and allows postoperative full weight-bearing. The presented treatment algorithm could be a useful tool for identifying the most appropriate treatment option. IIb.

Current teleconsultation solutions for preclinical emergencies can transmit knowledge from a remote expert to a local paramedic using audio and 2D video channels. Such technology lacks precision and efficiency for medical diagnostic tasks, and visual feedback is often missing between participants. We investigate a mixed reality 3D teleconsultation solution for preclinical use, which provides a 3D reconstruction of the local scene to a remote expert, displayed in Virtual Reality. A remote expert can join the local scene virtually as an Augmented Reality avatar. The remote expert can annotate the local scene and guide the local paramedics through the procedure. We explored our system in a user study within a preclinical scenario on a collaborative task of attaching chest lead electrodes of a 12 channel electrocardiogram on a mannequin. We compared the 3D teleconsultation system to a 2D video-mediated teleconsultation via a top-mounted camera and report results from the consultee side in AR. Based on our empirical user study with 10 paramedics with an average of 17 years experience, we observe an improvement in the electrode placement quality using the 3D teleconsultation system. Results indicate no significant difference in the cognitive task-load between conditions. Participants perceived the video-mediated consultation as more usable due to their unfamiliarity with the 3D teleconsultation system. However, participants acknowledge the potential of 3D teleconsultation and believe such a system can significantly improve the preclinical treatment.

A correction to this paper has been published: https://doi.org/10.1007/s11548-021-02348-7

The use of three-dimensional (3D) printing for surgical applications is steadily increasing. Errors in the printed models can lead to complications, especially when the model is used for surgery planning or diagnostics. In patient care, the validation of printed models should therefore be performed routinely. However, there currently is no standard method to determine whether the printed model meets the necessary quality requirements. In this work, we present a method that not only finds surface deviations of a printed model, but also shows high accuracy zones of a potentially corrupted model, that are safe to be used for surgery planning. Our method was tested on printed patient bone models with acetabular fractures and was compared to two common methods in orthopedics, simple landmark registration as well as landmark plus subsequent iterative closest point registration. In order to find suitable parameters and to evaluate the performance of our method, 15 digital acetabular bone models were artificially deformed, imitating four typical 3D printing errors. A sensitivity of over 95% and a specificity of over 99% was observed in finding these surface deformations. Then, the method was applied to 32 printed models that had been re-digitized using a computed tomography scanner. It was found that only 25% of these printed models were free of significant deformations. However, focussing on two common implant locations, our method revealed that 72% of the models were within the acceptable error tolerance. In comparison, simple landmark registration resulted in a 9% acceptance rate and landmark registration followed by iterative closest point registration resulted in a 41% acceptance rate. This outcome shows that our method, named Similarity Subgroups Registration, allows clinicians to safely use partially corrupted 3D printed models for surgery planning. This improves efficiency and reduces time to treatment by avoiding reprints. The similarity subgroups registration is applicable in further clinical domains as well as non-medical applications that share the requirement of local high accuracy zones on the surface of a 3D model.

Intensive care units (ICUs) that host patients infected by the SARS-CoV-2 Coronavirus are separated from other care units. In regular ICU ward rounds, a number of experts from different medical areas and expertise are present to discuss the situation and care of the patient. However, this procedure is contrasting COVID-19 measures such as reduced contact and personnel traffic. In this project, we demonstrate a system for mixed reality (MR) teleconsultation to support ICU wards (ARTEKMED). Through ARTEKMED, remote experts can join a local 3D reconstructed ICU visit in virtual reality (VR) and support local experts that are equipped with an augmented reality (AR) system. Our goal is to reduce personnel traffic and in turn the risk of an infection spread.

A correction to this paper has been published: https://doi.org/10.1007/s11548-021-02348-7

Background: Percutaneous sacroiliac (SI) screw fixation is the standard operative treatment of traumatic disruptions to the posterior pelvic ring. The technique offers good outcomes and early postoperative mobilization, which is vital in elderly patients with fragility fractures of the pelvis. While a double-screw technique has been shown to provide optimal biomechanical stability compared to a single-screw construct, anatomic variations and patient-specific characteristics may prevent the safe insertion of two SI screws. We aimed to determine whether cement augmentation of a single SI screw would provide biomechanical stability comparable to that of the double-screw technique. Methods: Three sacroiliac screw osteosynthesis configurations were tested on 10 human cadaveric pelvis specimens: a single cannulated screw; two cannulated screws; and a single, cement-augmented cannulated screw. Displacement and stiffness of the anterior and posterior pelvic ring after fixation with each technique were measured under axial load. Results where compared using linear regression and paired t-tests. Results: A single uncemented screw offered significantly worse stability in the anterior pelvis compared to a double-screw technique ( P < 0.05) and to a single cement-augmented screw technique ( P < 0.05). There was no significant difference in anterior pelvic ring stability between the single cement-augmented screw technique and the double-screw technique ( P > 0.05). There was no significant difference in the stability of the posterior pelvic ring between the three techniques ( P > 0.05). Conclusions: A single cement-augmented cannulated sacroiliac screw provides biomechanical stability similar to that of a non-augmented double-screw technique in the treatment of posterior pelvic ring fractures. (c) 2020 Elsevier Ltd. All rights reserved.

Background: Elderly patients suffering from hip fractures are usually not able to fulfil postoperative weight-bearing restrictions. Therefore, the operative fixation construct has to be as stable as possible. Aim of the present study was to determine (1) whether a therapeutic advantage could be achieved when using hip arthroplasty to treat acetabular fractures in geriatric patients; (2) whether an acetabular revision cup would be suitable for achieving fast postoperative mobilization and full weight-bearing; and (3) when a treatment with an uncemented hip revision cup for the primary fixation of osteoporotic acetabular fractures in geriatric patients is indicated. Materials and methods: The functional outcome of THA using a reconstruction cup for an acetabular fracture was evaluated in ten patients using standardized scoring instruments. In addition, an analysis of the preexisting literature referring to total hip replacement in geriatric acetabular fractures was conducted and an algorithm for standardizing the treatment approach for geriatric patients with acetabular fractures was developed. Results: The mean EQ-5D-3L quality of life score 0.7. The mean VAS Score was 58.2. The average Barthel Index was 80.0 points [range: 0-100]. The mean HHS was 72.0 points, while the MHH Score yielded an average of 63.4 points. The average AP Score was 7.5. The literature analysis showed that total hip arthroplasty could be a feasible option for geriatric acetabular fractures. Conclusion: Primary hip arthroplasty using uncemented revision cup fixed with angular stable screws showed good results and is a feasible treatment option of acetabular fractures in geriatric patients. The approach is especially beneficial in patients with poor bone stock and allows postoperative full weight bearing. The presented treatment algorithm could be a useful tool for identifying the most appropriate treatment option. (C) 2020 Elsevier Masson SAS. All rights reserved.

Objectives Chronic pain as a result of failed back surgery is a difficult to treat condition. Despite advances in surgical techniques and medication strategies, a long-term reduction in pain after failed back surgery may be difficult to achieve, leading to a decrease in quality of life and to permanent disability.

Objectives Percutaneous sacroiliac (SI) screw fixation is the standard operative treatment of traumatic disruptions to the posterior pelvic ring. The technique offers good outcomes and early postoperative mobilization, which is vital in elderly patients with fragility fractures of the pelvis. While a double-screw technique has been shown to provide optimal biomechanical stability compared to a single-screw construct, anatomic variations and patient-specific characteristics may prevent the safe insertion of two SI screws. We aimed to determine whether cement augmentation of a single SI screw would provide biomechanical stability comparable to that of the double-screw technique.

Fragestellung: Viele chirurgische Eingriffe in der Unfallchirurgie und Orthopädie werden Fluoroskopie-gesteuert durchgeführt. Die Darstellung der anatomischen Leitstrukturen ist jedoch häufig ein zeit- und strahlenintensiver Faktor. Ausgehend von einem primären Röntgenbild wird sich dem angestrebten Strahlenfenster durch wiederholtes Röntgen angenähert.