Planning acetabular fracture reduction using patient-specific multibody simulation of the hip

Hadrien Oliveri 1 Mehdi Boudissa 1, 2 Jerome Tonetti 1, 2 Matthieu Chabanas 1
1 GMCAO
TIMC-IMAG - Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications [Grenoble]
Abstract : Acetabular fractures are a challenge in orthopedic surgery. Computer-aided solutions were proposed to segment bone fragments, simulate the fracture reduction or design the osteosynthesis fixation plates. This paper addresses the simulation part, which is usually carried out by freely moving bone fragments with six degrees of freedom to reproduce the pre-fracture state. Instead we propose a different paradigm, closer to actual surgeon's requirements: to simulate the surgical procedure itself rather than the desired result. A simple, patient-specific, biomechanical multibody model is proposed, integrating the main ligaments and muscles of the hip joint while accounting for contacts between bone fragments. Main surgical tools and actions can be simulated, such as clamps, Schanz screws or traction of the femur. Simulations are computed interactively, which enables clinicians to evaluate different strategies for an optimal surgical planning. Six retrospective cases were studied, with simple and complex fracture patterns. After interactively building the models from preoperative CT, gestures from the surgical reports were reproduced. Results of the simulations could then be compared with postoperative CT data. A qualitative study shows the model behavior is excellent and the simulated reductions fit the observed data. A more quantitative analysis is currently being completed. Two cases are particularly significant, for which the surgical reduction actually failed. Simulations show it was indeed not possible to reduce these fractures with the chosen approach. Had our simulator being used, a better planning may have avoided a second surgery to these patients.
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SPIE Medical Imaging, Feb 2017, Orlando, United States. 10135, SPIE Medical Imaging 2017: Image-Guided Procedures, Robotic Interventions, and Modeling. 〈10.1117/12.2250380〉
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Hadrien Oliveri, Mehdi Boudissa, Jerome Tonetti, Matthieu Chabanas. Planning acetabular fracture reduction using patient-specific multibody simulation of the hip. SPIE Medical Imaging, Feb 2017, Orlando, United States. 10135, SPIE Medical Imaging 2017: Image-Guided Procedures, Robotic Interventions, and Modeling. 〈10.1117/12.2250380〉. 〈hal-01490266〉

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