Evolution and Current Applications of Robot-Assisted Fracture Reduction: A Comprehensive Review

Robots in orthopedic surgery have been developed rapidly for decades and bring significant benefits to the patients and healthcare providers. However, robotics in fracture reduction remains at the infant stage. As essential components of the current robotic system, external fixators were used in fracture reduction, including the unilateral and Ilizarov-like ring fixators. With emerging of the industrial robots and mechanical arms, their sterilized variants were developed as the serial robots, including the traction device and robotic arm, for fracture reduction. Besides, parallel robots (e.g., Gough-Stewart platform) were devised for lower extremity traction and fracture reduction. After combining the advantages of the serial and parallel mechanisms, hybrid robots can fulfill specific clinical requirements (e.g., the joint fracture, including multiple major fragments). Furthermore, with the aid of intra-operative navigation systems, fracture reduction can be performed under real-time guidance. The paper presents a comprehensive overview of the advancement of the robots in fracture reduction and evaluates research challenges and future perspectives, including ergonomic and economic issues, operation time, artificial realities and intelligence, and telesurgery.