[Evaluation of a 2D fluoroscopy-based navigation system for insertion of the dynamic hip screw (DHS): an experimental...

Dynamic hip screw (DHS) insertion for the fixation of lateral femoral neck fractures is an accepted surgical treatment method. A computer-assisted planning and navigation system based on 2D fluoroscopy has been developed for guidewire insertion in order to perform screw placement. The image acquisition process was supported by a radiation-saving procedure called "zero-dose C-arm navigation". The aim of this study was to evaluate this new system.

In the context of a sawbone study, we inserted dynamic hip screws. The procedure was performed under navigation control and in the conventional technique in 12 sawbones. Both procedures were performed in an open and closed technique.

The computer-assisted technique significantly reduced the number of intraoperative fluoroscopic images (open technique: -8.1 ± 0.5; p < 0.001 - closed technique: -12.3 ± 3.7; p < 0.001) and the number of guidewire passes (open technique: -1.3 ± 1.2; p < 0.05 - closed technique: -1.5 ± 1.2; p < 0,05). There was no difference with respect to precision in both groups. The operation time was significantly longer in the navigation-assisted groups (open technique: + 14.6 ± 5.4 min; p < 0.001 - closed technique: + 13 ± 3 min; p < 0.001).

The addition of computer-assisted planning and surgical guidance supported by "zero-dose C-arm navigation" may be useful for the fixation of lateral femoral neck fractures by the DHS as it reduces the amount of fluoroscopic images and requires fewer drill tracks. Further studies with the goal of reducing the operation time are necessary.