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U.VA. SURGEON PIONEERS COMPUTER-GUIDED APPROACH FOR REPAIR OF PELVIC FRACTURES
CHARLOTTESVILLE, Va., June 16 - A surgeon from the University of Virginia Health Sciences Center has developed a computer-guided surgical technique for pelvic and hip socket fractures that is more accurate and less invasive than traditional surgery and dramatically reduces the patient's length of stay in the hospital. The technique, developed by Dr. David Kahler, associate professor of orthopaedic surgery at U.Va., uses a computer to build a virtual model of the patient's pelvis and to guide the placement of the surgical instruments and screws. Kahler will discuss the technique and its results at the Computer Assisted Orthopaedic Surgery annual meeting in Pittsburgh on June 19. With computer-assisted surgery, patients can go home within two days of surgery, compared with more than a week following the traditional surgery, Kahler said. The incision made with the new technique is small and often requires just one stitch, compared with incisions of up to two feet needed for traditional surgery. Fractures of the hip socket and pelvis occur most frequently during high-speed automobile accidents. Traditional surgery to repair these injuries exposes patients to a high risk of complications, including infection, poor wound healing, massive blood loss and nerve damage. So far, Kahler has performed the computer-assisted surgery on 20 patients. We're excited by the early results," he said. "We've had no accuracy problems, and the patients are healing much more rapidly simply by avoiding the complications associated with conventional surgery. We won't know for several years if this is a better technique than the conventional method, but the early results are extremely encouraging." Computer-assisted surgery begins with the surgeon loading a CT scan of the patient's pelvis onto a special computer work station, which builds a virtual three-dimensional model of the patient's pelvis. The surgeon can then rotate this pelvic model on the computer and look at cross sections to determine the best pathway in which to place the screws. A special camera in the operating room allows the computer to register or "see" the patient's pelvis through coded registration points attached to the patient. Using similarly coded instruments, the surgeon locates the pre-determined entry point on the patient, makes a small incision and inserts the screws according to the pre-operative plan, while following their progress on the computer model. The process takes about 20 minutes per screw.
"This technique gives us the ability to develop a precise, pre-operative plan and then to match that plan in the operating room," Kahler said. "That's extremely powerful. It also allows us to pass screws in directions and in places that would be too dangerous with conventional techniques." Currently U.Va. is the only hospital in the country offering computer-assisted surgery for pelvic and hip socket fractures. While the technique has been used in the field of neurosurgery for more than a decade, orthopaedic surgeons have been slow to incorporate it, Kahler said. He worked with a Memphis-based company called Sofamor Danek to develop the software package and instruments for orthopaedic use. Kahler said he is hopeful that computer-assisted orthopaedic surgery will eventually give surgeons the ability to put fractures back together. "If we can do that, we will drastically reduce the need to put any patient through an invasive, high-risk surgery."
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June 16, 1998
For more information, call Dr. David Kahler at (804) 982-0412. On Friday, June 19, he can be reached by contacting the conference coordinator, Joni Ropelewski, at pager (412) 263-9778 or by phone at (412) 623-2673.
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