Trauma Navigation Module 3.0

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Trauma Navigation Module 3.0

Florian Gebhard

Navigation used in an operating room setting.

The trauma two-dimensional (2-D) navigation module was developed together with Brainlab to support the broad range of indications and to improve speed, first-pass accuracy, and radiation efficiency in trauma procedures. Trauma 3.0 offers dedicated workflows for navigated treatments in most regions of the body including inferior and superior extremities, the spine, and the pelvis, complemented by generic navigation workflows without localization presetting for regions. Those allow navigating in C-arm projections without prior region definition, just as specified by the surgeon.

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All workflows support targeting of trajectories, eg, for drilling or for the placement of wires or screws. Where appropriate, the software supports specific planning or navigation tools to answer specific questions, eg, fragment alignment in long bone fractures. The software additionally offers for appropriate indications a virtual aiming device, which necessitates neither image intensifier images nor reference fixation to the bone.

Clinical benefits of the use of the trauma module can be summarized:

First-pass targeting accuracy reduces iatrogenic trauma by trial and error approaches
Improved fracture alignment and implant positioning reduces fracture malalignment
Virtual image intensification, planning, and navigation reduces invasiveness of implant placement
Virtual image intensification reduces radiation exposure

Fast C-arm image registration

Registration of C-arm images is a crucial step in the trauma navigation workflow. To face this, the new xSpot registers even tricky projections in specific indications easily and within seconds for reliable and accurate navigation image data.

The system offers:

Wireless carbon registration device
Autoclavable—no draping
Works with almost all C-arms
Fast, reliable, and reproducible result

Fig 2 xSpot C-arm registration.

One program for many different indications

Because there are as many different indications as injuries, the scope of trauma 3.0 navigation meets the challenges facing trauma surgeons in their daily practice. The optimized user interface gives intuitive access to most of the anatomy via the "bone man" surgical reference guide.

This allows for:

Accurate, quick, and easy guidance in most regions of the body for many different tasks
Specific workflows for specific tasks
Generic approaches for universal tasks
Based on AO techniques and workflows

Fig 3 Access through bone man.

Time-saving and innovative trauma navigation tools

Virtual tools on the screen add vital information during procedures and smart planning tools speed up intraoperative planning, such as

Angulation template
Automatic axis detection in long bones
Cutout warning for femoral and humeral head
Collision check for acetabular screws

Fig 4 Break-in/break-out warning for spherical targets, collision check.

Reduces invasiveness through new implant handling

The integration of dedicated implants into trauma navigation helps to extend the potential of many less-invasive implant lines by targeting entry points on the smallest access paths or placing interlocked plates while virtually checking implant and fragment positions. Among the integrated implants are Synthes locking compression and dynamic locking compression plates, as well as the LFN. (Regulatory approval for the respective handles pending at the time of print.)

Fig 5 Navigated positioning of LCP-DF with simultaneous fracture reduction control.

Introduce trauma navigation to arthroscopic procedures

The new pinless and x-ray-free trauma navigation concept "image-free navigation" works without bone references and without x-ray imaging. This opens up arthroscopic procedures and articular lesions to treatment, even when accessibility is reduced. Pin placement or retrograde access to lesions can be fully supported by trauma navigation.

Fig 6 Image-free navigation: the pointer determines the target. A drill guide aims towards the target. A cone indicates both entry depth and remaining distance to target for a drill.

Navigation systems bring trauma navigation to the surgeons hands

The trauma 3.0 software runs on a Brainlab navigation system. This consists of a computer and monitor suitable for intraoperative use, a stereoscopic camera and navigated instruments for referencing and targeting.

System configurations range from small mobile trolleys, as shown in Fig 7, to fully integrated ceiling-mounted systems, adapted to specific needs of the surgeon. Different software applications (like the described trauma 3.0 software) may run on the system and cover—beneath trauma—eg, arthroplasty, spine, CMF, or neurosurgical navigation, depending on the individual system configuration.

Trauma-relevant applications enable the use of intraoperative imaging, eg, different C-arm types for 2-D navigation, and 3-D image intensification, or intraoperative CT for 3-D navigation, depending on configurations.

Fig 7 Navigation platform "Kolibri" for navigation with trauma 3.0.

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