Computer software helps repair broken bones

A broken pelvis is a painful injury that is often difficult to repair. Getting to the bones can be tricky because many organs, nerves, and blood vessels lie within the pelvis. Now, surgeons are using new technology to fix the problem.

Jenna Guarne recently shattered her pelvis during a terrifying bike ride. Guarne explains, “The car in front of me was taking a right so I just moved over to kind of go around them.”

Her bike got caught in railway tracks and the momentum of the downward hill kicked in. "It just threw me off the bike and I landed in the street. I knew that something probably severe was wrong,” says Guarne.

Guarne needed surgery to repair her shattered pelvis. Her doctor, orthopedic surgeon Amir Matityahu from UCSF, used computer-guided navigation to fix Guarne’s fracture.

Dr. Matityahu says, "The whole idea of navigation is pretty simple. It's creating a virtual space for you to work in so you don't have to use radiation."

Instead of having to take numerous x-rays during the surgery, the doctor uses the computer software to plan the procedure. First, sensors are placed on the pelvis. Then, the system turns cat scans into a 3-D model. The computer creates a road map, much like a GPS, that tells the surgeons precisely where to place the bone-repairing screws.

"The trajectory has to be almost exact. It has to be between 1and 2 degrees and 1and 2 millimeters,” explains Dr. Matityahu.

The navigation method means better accuracy, possible quicker surgery, and fewer pieces of hardware. In addition, since surgeons do not have to keep taking x-rays, there is less radiation exposure.

It has been four months since Guarne’s surgery and she is already back to walking the hills of the city she loves with no pain at all.

Dr. Matityahu says he is one of only about five surgeons in the country using the software for this type of surgery. It was just recently FDA approved for Guarne’s procedure as well as a few other orthopedic applications.

RESEARCH SUMMARY

BACKGROUND: The pelvis consists of three major bones joined together in a ringed shape and held by strong ligaments. General characteristics of pelvic fracture include severe pain, pelvic bone instability, and associated internal bleeding. Pelvic fractures occur rarely. They are commonly associated with high-energy traumatic events such as falls or automobile or motorcycle accidents. A variety of pelvic fracture injuries may occur. Zones of typical injury include: symphysis pubis dislocation; pubic ramus fracture; iliac fracture; sacroiliac joint dislocation and sacral fracture. (www.orthop.washington.edu)

COMPUTER-ASSISTED NAVIGATION: Computer-assisted navigation offers several potential

benefits in the surgical management of patients. Preoperatively, this technology offers improved visualization of the operative field and facilitates surgical planning. Intraoperatively, data from real-time imaging can be merged with MRI and CT scans to create a virtual map of the operative field. Initially used in applications related to total joint reconstructive surgery, spine surgery, and orthopedic trauma computer-assisted navigation improves accuracy and has superior precision, particularly with regard to implant positioning and function. Doctors have been able to minimize leg length discrepancies, improve restoration of the joint line, and address rotational concerns of implant alignment. A current limitation of computer-assisted navigation is the need for increased surgical time. Critics and even early proponents of the technology noted that adding more time to already lengthy surgeries increases the risk of infection and adverse events. Cost has also been noted as a negative consequence of the technology. (www.moffitt.org/CCJRoot/v18n3/pdf/171.pdf)

DR. AMIR MATITYAHU: In 2003, Dr. Amir Matityahu joined the staff at UCSF/SFGH. He is presently the Director of Pelvis and Acetabular Trauma Reconstruction at San Francisco General Hospital and is an Assistant Clinical Professor in the Department of Orthopaedics at the University of California, San Francisco, (UCSF). His clinical areas of interest are high-energy complex periarticular fractures, pelvis and acetabular fractures, and the polytraumatic patient with orthopaedic injuries. His research interests include the bio mechanics of fracture fixation and the post-traumatic hip joint. In addition, Dr. Matityahu is constantly developing innovative and minimally invasive surgical techniques. Dr. Matityahu's goal is to provide the highest quality of medical care available to all of his patients, promote, encourage, foster, and advance the art and science of orthopedic surgery. Matityahu was born in Israel and moved to Palo Alto, CA in 1978. He received his bachelor of science degree in Kinesiology from UCLA in 1992 and graduated from the Hahnemann University Medical School in Philadelphia in 1997. He received his orthopaedic residency training from Maimonides Medical Center in Brooklyn, NY. In 2002, he further trained in Orthopaedic Traumatology through a fellowship at the Adams R. Cowley Shock Trauma Center, a world-renowned trauma center.

For more information please contact:
Amir Matityahu, MD
UCSF
(415) 206-8812
amirmatityahu@yahoo.com


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