Principles of computer-aided surgery in trauma surgery

Computer-Aided Surgery (CAS) has started to have a significant impact on the practice of orthopaedic surgery [1]. Together with concurrent surgical and technological trends, such as minimal invasiveness and improved digital imaging, it has the potential to improve results, shorten operative time, reduce morbidity, and reduce variability in a number of common surgical orthopaedic procedures. Despite a slow beginning, in the last five years CAS has made inroads in orthopaedic trauma by providing support for the planning and execution of surgical procedures. Preoperative planning consists, among others, of digital two and three-dimensional implant templating with properly scaled digital X-ray and CT images, accurate measurements of anatomical angles and axes, and osteotomy planning. Intra-operative execution consists of fluoroscopy and CT-based navigation of surgical instruments and implants, and in some cases, mechatronics and robotic devices. Navigation systems are by far the most commonly used in orthopaedic trauma and hence our discussion is focused on them. First, we describe the types of navigation systems currently used in orthopaedic trauma. Next, we discuss the clinical considerations for fluoroscopy-based navigated trauma surgery and describe the clinical procedures in which it is used. We conclude with perspectives and our view of future developments.