Intra-operative biomechanical analysis for improvement of intra-articular fracture reduction

Bone fractures involving load bearing joints such as the hip, knee or ankle (also known as intra-articular fractures or IAFs) are difficult to treat, as they often lead to a form of arthritis, post-traumatic osteoarthritis (PTOA). The effects of PTOA, such as joint pain and reduced mobility significantly degrade a patient’s quality of life contributing to lost productivity, depression, obesity, and heart disease.

Surgeons attempt to prevent PTOA by accurately reconstructing fractured joint surfaces. Despite their best efforts, the prevalence of PTOA remains high. There is a growing body of evidence that joint reconstruction is limited by visualization and assessment of the fracture during surgery.

This work addresses this problem through the development of a computer-based visualization system for use during fracture reduction surgery. To determine appropriate information for display to the surgeon, multiple methods for assessment of fracture reduction are explored. It is found that methods that account for three-dimensional geometry of the fracture and mechanical function of the joint have strong correlations with PTOA development.

The computer-based visualization system is tested in a series of ten cadaver ankle fracture surgeries. It is found to have acceptable levels of accuracy and usability. Use of enhanced visualization corresponded to improved quality in joint reconstruction, as assessed by mechanical simulation. Implications for this work suggest that with further development this system may facilitate improved long-term outcomes following intra-articular fracture.