Acta Orthopaedica et Traumatologica Turcica
Research Articles

Intraoperative fluoroscopic safety assessment of femoral head implants with 3-dimensional risk parameters to minimize cut-out


Manufacturing and Automation Research Center, Koç University, Istanbul, Turkey


Department of Orthopaedics and Traumatology, Koç University Hospital, Istanbul, Turkey

AOTT 2023; 57: 134-140
DOI: 10.5152/j.aott.2023.22175
Read: 841 Downloads: 496 Published: 23 August 2023

Objective: This study aimed to introduce a method to extract the 3-dimensional spatial position of the femoral head implant from 2-dimensional fluoroscopic projections, allowing surgeons to assess fixation much more accurately and prevent cut-out complications in proximal femoral nailing.

Methods: To define a safety region for the tip in the femoral head, a novel 3-dimensional distance-based risk parameter called TSD3D was introduced. An intersection algorithm was developed that solely takes the fluoroscopic anteroposterior and lateral distances to reveal the 3-dimensional location of the screw or Kirschner wire tip, enabling the utilization of the 3-dimensional parameter. Orthogonal per- spectives of 6 femur proximal bone substitutes with randomly inserted Kirschner wires were imaged under fluoroscopy. The developed algorithm was used to calculate the implant tip location in 3-dimensional from 2-dimensional images for each case. Algorithm accuracy was validated with the computed tomography-obtained 3-dimensional models of the same femur substitutes.

Results: The newly introduced risk parameter successfully visualizes 3-dimensional safety regions. Utilizing the 2-dimensional fluoro- scopic distances as inputs to the algorithm, the 3-dimensional position of the implanted Kirschner wire tip is calculated with a maximum of 9.8% error for a single Cartesian-coordinate measurement comparison.

Conclusion: By incorporating the newly introduced 3-dimensional risk parameter, surgeons can more precisely evaluate the position of the implant and avoid cut-out complications, instead of relying solely on misleading 2-dimensional fluoroscopic projections of the femoral head.

Cite this article as: Subaşı Ö, Aslan L, Oral A, Demirhan M, Seyahi A, Lazoğlu İ. Intraoperative fluoroscopic safety assessment of femoral head implants with 3-dimensional risk parameters to minimize cut-out. Acta Orthop Traumatol Turc., 2023;57(4):134-140.

ISSN 1017-995X EISSN 2589-1294