American Association for Hand Surgery

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Robot-Assisted of Volar Percutaneous Scaphoid Screw Placement: Initial Clinical Experience
Yang Guo, MD FRCS HKCOS, Jishuitan Hospital, Beijing, China

Robot-Assisted of Volar Percutaneous Scaphoid Screw Placement: initial clinical experience

To investigate a robot-assisted technique for volar insertion of a percutaneous scaphoid screw and compare insertion time, accuracy, and radiation exposure to the traditional technique. We hypothesize that robot-assisted navigation of volar percutaneous scaphoid screw placement would improve accuracy, require less time, and diminish radiation exposure when compared to the free hand technique.

16 patients with acute Herbert B2 scaphoid fracture were randomized to computer-assisted versus traditional volar percutaneous scaphoid screw placement. Time of the overall procedure, set-up time, time for ideal guide wire placement, and radiation time were recorded. Number of guide wire attempts was also recorded. Finally, accuracy of planned screw axis and actual screw axis were compared. Student's t-tests were used to determine whether the differences in outcome variables between computer-assisted and free hand techniques were significant. Postoperative outcome measures included time to union based on computed tomography, patient-reported pain and range of motion,

Results Sixteen screws were placed in 8 patients in the robot-assisted group and 16 screws in 8 patients in the freehand group; no postoperative complications or revisions were reported. The overall time of the 2 procedures and the set-up time were not different between the 2 groups, the time for placement of the K-wire was 60% in the robot-assisted percutaneous scaphoid fixation group, and the number of K-wire attempts needed for accurate screw placement approached clinical significance. Although the radiation exposures of set-up time were higher in robot-assisted group, the radiation exposures for global time of the procedure and guide-wire placement were clinically lower in robot-assisted group.
Conclusions Robot-assisted navigation of volar percutaneous scaphoid screw placement takes no more time that traditional methods and significantly reduces the amount of radiation exposure to the patient. This technique also significant reduced the number of incorrect placement of the guide wire compare to free hand guide wire insertion.

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