Automatic reduction planning of pelvic fracture based on symmetry

ABSTRACT

Pelvic fracture is known to be one of the most difficult injuries. The first and foremost step for pelvic fracture reduction is structural recovery. However, due to lack of data on healthy pelvis before fracture, the result of fracture reduction is entirely based on the experience of surgeons. This study proposed a novel method for automatic reduction planning based on the symmetry of the pelvis (pelvic symmetry reduction, PSR), which could provide a template for the pelvic reduction surgery as well as related surgical robot. A symmetrical area (ROI) without fracture fragments was extracted from the fractured pelvis through multiple SP mirroring, ICP registration and Boolean operation, so as to acquire the target position for reduction. Fifteen healthy pelvic models and three fractured pelvises were acquired to evaluate the accuracy and validity of the PSR method separately. The mean error of anatomical landmarks is 2.94 mm (translational error) and 1.08°, 0.67°, and 1.96° (rotational error on X, Y and Z axes, respectively). The average global distance error is below 4 mm except for a model with poor symmetry. The results of the actual fractured pelvis were recognised by clinicians. These results demonstrate the feasibility of the PSR method for restoring anatomical structure of the pelvis and achieve higher reduction accuracy than previous approach.

KEYWORDS:

• Pelvic fracture
• fracture reduction
• automatic planning
• pelvic symmetry
• computer-aided surgery

Acknowledgments

This research is supported by the National Key Research and Development Project (2019YFC0118002), National Natural Science Foundation of China (NSFC61871019), Beijing Science and Technology Project (Z18110001918024, Z201100005420033) and Natural Science Foundation of Beijing (19L2011).

Compliance with ethical standards

Conflict of Interest

All authors declare that they have no conflict of interest.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

Ethical approval was waived by the local Ethics Committee of BUAA in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [NSFC61871019]; Beijing science and technology project [Z18110001918024]; National Key Research and Development Project [2017YFC0110602,2019YFC0118002]; Natural Science Foundation of Beijing [19L2011].