Although mandatory for joint replacement surgery, precise surgical planning and documentation is arriving only now for trauma surgery. Siemens Healthcare has developed the software package PreOPlan with Synthes (Soloturn, Switzerland) and reports that the programme enables the virtual, precise planning of routine operations for new fractures and deformity corrections.
For 18 months, Dr Steffen Schröter, orthopaedics and trauma surgery specialist at the BG Accident and Emergency Hospital, Tübingen, Germany, has been one of the system’s first regular European users. Prior to PreOPlan, he used X-ray images ‘in his head’ to plan routine operations for fractures of the extremities, or he manually marked the planned procedure to correct deformities on the images. ‘Sometimes there were moments of surprise in the course of operations when the nails or plates chosen to fix a fracture didn’t actually fit,’ he recalled.
Using the PreOPLan software he can measure and choose on the monitor the exact implant for the patient. The PreOPlan trauma module enables very careful planning of the repositioning of the actual bone continuity by segmenting the fragments of the fracture, measuring them and reassembling them anatomically correctly. A database containing osteosynthesis material automatically suggests suitable implants for the respective body region. ‘There are bones that, by nature, have a strong curve, which makes it very problematic to place a normal nail. In such cases there’s a chance you might have to deviate from the planned procedure and if you only realise this during the course of the operation you have to solve the problem very spontaneously,’ Dr Schröter explains. ‘However, if you can virtually plan the surgical procedure beforehand -- which can be done very quickly -- and you find a problem is likely, you can adjust your approach accordingly and this also allows the operating theatre staff to prepare properly for the intervention.’ Since all implants are not always available in a hospital, pre-surgical planning can ensure the right one is. However, the trauma surgeon must make decide on the dcorrect implant -- the length, for example, from a list suggested.
Dr Schröter says the software also enables young doctors to feel what the fracture is like, i.e. what the shift is and which implants are possible. With its osteotomy module, PreOPlan also supports surgeons in deformity corrections – through prior measuring and with all joint angles shown in a table, PreOPlan has the European CE mark and is already in use in many countries here, with all Finnish trauma centres using this system.