Optimization of fracture reduction robot controller based on improved sparrow algorithm

The accuracy of a fracture reduction robot(FRR)is critical for ensuring the safety of surgery.Improving the repositioning accuracy of a FRR,reducing the error,and realizing a safer and more stable folding motion is critical.To achieve this,a sparrow search algorithm(SSA)based on the Levy flight operator was proposed in this study for self-tuning the robot controller parameters.An inverse kinematic analysis of the FRR was also performed.The robot dynamics model was established using Simulink,and the inverse dynamics controller for the fracture reduction mechanism was designed using the computed torque control method.Both simulation and physical experiments were also performed.The actual motion trajectory of the actuator drive rod and its error with a desired trajectory was obtained through simulation.An optimized Levy-sparrow search algorithm(Levy-SSA)crack reduction robot controller demonstrated an overall reduction of two orders of magnitude in the reduction error,with an average error reduction of 98.74%compared with the traditional unoptimized controller.The Levy-SSA increased the convergence of the crack reduction robot control system to the optimal solution,improved the accuracy of the motion trajectory,and exhibited important implications for robot controller optimization.

Bone Fracture Reduction Surgery-aimed Bone Connection Robotic Hand

Bone connection with robot is an important topic in the research of robot assisted fracture reduction surgery.With the method to achieve bone-robot connection in current robots,requirements on reliability and low trauma can not be satisfied at the same time.In this paper,the design,manufacturing,and experiments of a novel Bone Connection Robotic Hand(BCRH)with variable stiffness capability are carried out through the bionics research on human hand and the principle of particle jamming.BCRH’s variable stiffness characteristic is a special connection between“hard connection”and“soft connection”,which is different from the existing researches.It maximizes the reliability of bone-robot connection while minimizes trauma,meets the axial load requirement in clinical practice,and effectively shortens the operating time to less than 40 s(for mode 1)or 2 min(for mode 2).Meanwhile,a theoretical analysis of bone-robot connection failure based on particle jamming is carried out to provide references for the research in this paper and other related studies.

Diagnosis,treatment and complications of radial head and neck fractures in the pediatric patient

Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,which can easily be overlooked on the initial standard radiographs.The treatment options for proximal radius fractures in children range from non-surgical treatment,such as immobilization alone and closed reduction followed by immobilization,to more invasive options,including closed reduction with percutaneous pinning and open reduction with internal fixation.The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient;an angulation of less than 30 degrees and translation of less than 50%is generally accepted,whereas a higher degree of displacement is considered an indication for surgical intervention.Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures,range of motion and complications compared to severely displaced fractures requiring surgical intervention.With proper management,good to excellent results are achieved in most cases,and long-term sequelae are rare.However,severe complications do occur,including radio-ulnar synostosis,osteonecrosis,rotational impairment,and premature physeal closure with a malformation of the radial head as a result,especially after more invasive procedures.Adequate follow-up is therefore warranted.

Scoring system for poor limb perfusion after limb fracture in children

BACKGROUND Assessment of the vascular status following limb fracture in children is important to evaluate the risk of compartment syndrome,which is an emergency condition.AIM To establish a simple and efficient grading scale of limb perfusion in children undergoing surgery for limb fracture.METHODS This retrospective study included pediatric patients with a limb fracture and postoperative plaster fixation who were admitted at The Department of Pediatric Orthopedics of Xinhua Hospital between February 2017 and August 2017.The outcome was poor limb perfusion,which is defined as the postoperative use of mannitol.The children were divided into two groups:The normal perfusion group and the poor perfusion group.Key risk factors have been selected by univariable analyses to establish the Grading Scale for Vascular Status.RESULTS A total of 161 patients were included in the study:85 in the normal perfusion group and 76 in the poor perfusion group.There were no significant differences in age,sex,body mass index,ethnicity,cause of fracture,fixation,or site of fracture between the two groups.After surgery,the skin temperature(P=0.048)and skin color(P<0.001)of the affected limb were significantly different between the two groups.The relative risk and 95%confidence interval for skin temperature of the affected limb,skin color,and range of motion of the affected limb are 2.18(1.84-2.59),2.89(2.28-3.66),and 2.16(1.83-2.56),respectively.The grading scale was established based on those three factors(score range:0-3 points).Forty-one patients(32.5%)with score 0 had poor limb perfusion;all patients with scores 1(n=32)and 2(n=3)had poor limb perfusion(both 100%).CONCLUSION In children undergoing surgery for limb fracture,a higher Grading Scale for Vascular Status score is associated with a higher occurrence of poor limb perfusion.A prospective study is required for validation.

Pedicled abdominal flap using deep inferior epigastric artery perforators for forearm reconstruction: A case report

BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.

Study on the interactive deformation of bone needles and circum-pelvic soft tissue

During the robot-assisted pelvic fracture reduction,the needle-tissue interactive deformation characteristic is not clear,which affects the accuracy of robotic surgery.In this paper,a layered rig-id-flexible coupling model is proposed,and the needle-tissue interactive deformation under the load-ing is analyzed by the Rayleigh-Ritz method,in accordance with the principle of minimum potential energy.The pelvic musculoskeletal tissue is reversely reconstructed,and the structure of the bone is segmented into cancellous bone and cortical bone.The Mooney-Rivlin five-parameter hyperelastic model is used to simulate muscle,and the Ogden hyperelastic model is used to simulate adipose tis-sue.Finite element simulation is performed by loading different magnitudes of forces.The accuracy of the rigid-flexible coupling model is 0.432 mm,which indicates the correctness of the needle-tis-sue interactive deformation theory analysis.

Indirect reduction technique using a distraction support in minimally invasive percutaneous plate osteosynthesis of tibial shaft fractures

Purpose： To describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis （MIPPO） of tibial shaft fractures with the use of a distraction support. Methods： Between March 2011 and October 2014, 52 patients with a mean age of 48 years （16-72 years） sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goniometer measurement on preoperative and postoperative images. Results： Preoperative radiographs revealed a mean of 7.6°（1.2°-28°） angulation in coronal plane and a mean of 6.8°（0.5°-19°） angulation in sagittal plane. Postoperative anteroposterior and lateral radio graphs showed a mean of 0.8°（0°-4.0°） and 0.6°00-3.6°） of varusvalgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted. Conclusions： This study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.

Experimental and finite element analysis studies of a reduction-force reducing traction method for pelvic fracture surgeries

Pelvic fracture is among the most complicated fractures in traumatic orthopedics,with high mortality and morbidity rates.The main difficulty associated with the reduction surgery is significant muscle resistance.It then becomes necessary to decrease the reduction force against this strong muscle resistance,for improving surgical safety.Here,we propose a novel traction method for decreasing the reduction force during pelvic reduction,and investigate the performance of the elastic traction method on decreasing the reduction force using experimental tests and simulation-based analyses.From the experimental results,the reduction force decreased by 59.2%when 10 kg of elastic traction was applied.We also establish a musculoskeletal model of the pelvic fracture reduction,for analyzing the muscle resistance and the optimal traction force applied in reduction surgeries.The elastic traction method can counteract the muscle resistance increase in the non-traction direction owing to its flexibility.We conclude that the optimal traction force applied should be in the 10–15 kg range,and recommend adopting a dynamic traction strategy rather than continuous traction in clinical settings.Elastic traction is very promising for various surgeries that require traction,including pelvic reduction.It significantly reduces force,which can significantly reduce the physical exertion of the operating surgeon,the possibility of additional injuries to the operated patient,and promotes robot-assisted reduction surgeries.

Comparative prospective study between medial and lateral distal tibial locking compression plates for distal third tibial fractures

Purpose： Tibial fracture is the most common long bone fracture. Distal third tibial fractures are chal- lenging though open reduction and plating can result in anatomical reduction and rigid fixation. This paper aimed to evaluate and compare the results of medial and lateral locking compression plates for distal third tibial fractures. Methods： This prospective clinical study involved 36 patients with distal tibial fractures admitted in Department of Orthopaedics, Sawai Mansingh Medical College ＆ Affiliated Hospital, Jaipur, India, from June 2011 to May 2012, including 29 closed fractures and 7 open fractures at the mean age of 38.9 years. Thirty-six patients were divided equally into two groups based on treatment method, including medial plating group （18 patients） and lateral plating group （18 patients）. They were followed up for at least 5 months after discharge. The functional outcomes were evaluated using Tenny and Wiss clinical assess- ment criteria. Results： Malunion was found in 3 cases of medial plating group and in 1 case of lateral plating group. In the medial plating group, there were 5 cases of superficial infections, 1 deep infection, 1 nonunion and 3 wound dehiscence. In the lateral plating group, there was 1 case of superficial infections, 1 deep infection and 1 nonunion, in the lateral plating group, 4 patients reported feeling the plates and screws but none of them asked to remove the hardware. In the medial plating group, 9 patients reported symptomatic hardware problems and 7 asked to remove the hardware. The number of cases graded as excellent/good/ fair was 1/8/7 in the medial plating group and 3/7/7 in the lateral plating group respectively. In the medial plating group, the final range of motion was 17.2° in ankle dorsiflexion and 30.7° in ankle plantar flexion. In the lateral plating group, the final range of motion was 19° in ankle dorsiflexion and 34.2° in ankle plantar flexion. Conclusion： Lateral plating of distal tibia is safe and feasible, which can provide biological fixation and prevent the soft tissue complications associated with medial plating.