Jaesung Hong

Previous research on computer-assisted jawbone reduction for mandibular fracture surgery has only focused on the relationship between fractured sections disregarding proper dental occlusion with the maxilla. To overcome malocclusion caused by overlooking dental articulation, this study aims to provide a model for jawbone reduction based on dental occlusion. After dental landmarks and fracture sectional features are extracted, the maxilla and two mandible segments are aligned first using the extracted dental landmarks. A swarm-based optimization is subsequently performed by simultaneously observing the fracture section fitting and the dental occlusion condition. The proposed method was evaluated using jawbone data of 12 subjects with simulated and real mandibular fractures. Results showed that the optimized model achieved both accurate jawbone reduction and desired dental occlusion, which may not be possible by existing methods.

Limited by rigid instruments, traditional open curettage of bone cysts requires large incisions and the removal of substantial amounts of healthy bone tissue to approach the lesion. This causes a lengthy recovery period with an increased risk for complications. While other less invasive methods have been suggested, none have been accepted as standard treatment modalities, and many of them have not been applied beyond academic studies. We propose a fully robotic compliant joint-based endoscopic surgery system capable of the minimally invasive removal of bone cysts. A drilling robot optimized to bend removes the lesion, while an endoscopic robot provides visual feedback as well as suction and irrigation for cleaning the inner bone. Two leader devices are used to precisely control the movement of each robot in a leader–follower configuration. The performance of the proposed system was evaluated in a series of experiments on animal femurs.

Notched compliant joints (NCJs) have been widely used in orthopedic surgeries requiring large curvatures for a minimally invasive approach to lesions and high rigidity for cutting hard tissues. With current NCJ designs, there is a trade-off between maximizing rigidity and maximizing curvature for a specified constrained size. Considering notch geometry, larger sizes of notch gaps lead to greater curvatures, however, smaller spacing between notches decreases rigidity. Herein, we propose an NCJ with a novel notch shape, such that the gap of the spacer can be increased without changing that of the notch. Furthermore, we determined the best design parameters for achieving the maximum rigidity for a given driving force. The higher rigidity of the proposed NCJ compared with that of general NCJs is shown through a simulation and experiments. The difference in rigidities between the proposed and general NCJs was 66% with the p-value of $5.68 \times {10}^{ - 9}$ in a 95% confidence interval which was found to be a statistically significant improvement. In a cutting test, while keeping the curvature, the proposed NCJ increased the cutting amount compared with general NCJs. We verified that the proposed NCJ can achieve both high rigidity and large curvature. The main feature of this study is the development of an NCJ in which both the gap of the spacer and the gap of the notch can be independently changed without affecting each other. The proposed NCJ achieves improved rigidity without loss of curvature.

To develop a patient-specific 3 D reconstruction of a femur modeled using the statistical shape model (SSM) and X-ray images, it is assumed that the target shape is not outside the range of variations allowed by the SSM built from a training dataset. We propose the shape-partitioned statistical shape model (SPSSM) to cover significant variations in the target shape. This model can divide a shape into several segments of anatomical interest. We break up the eigenvector matrix into the corresponding representative matrices for the SPSSM by preserving the relevant rows of the original matrix without segmenting the shape and building an independent SSM for each segment. To quantify the reconstruction error of the proposed method, we generated two groups of deformation models of the femur which cannot be easily represented by the conventional SSM. One group of femurs had an anteversion angle deformation, and the other group of femurs had two different scales of the femoral head. Each experiment was performed using the leave-one-out method for twelve femurs. When the femoral head was rotated by 30°, the average reconstruction error of the conventional SSM was 5.34 mm, which was reduced to 3.82 mm for the proposed SPSSM. When the femoral head size was decreased by 20%, the average reconstruction error of the SSM was 4.70 mm, which was reduced to 3.56 mm for the SPSSM. When the femoral head size was increased by 20%, the average reconstruction error of the SSM was 4.28 mm, which was reduced to 3.10 mm for the SPSSM. The experimental results for the two groups of deformation models showed that the proposed SPSSM outperformed the conventional SSM.

To overcome possible drawbacks of bone fracture reduction such as risks of malrotation, radiation exposure, as well as laborious traction, image-guided robotic surgery systems have been proposed. However, the use of optical tracking systems (OTS) creates inherent line-of-sight problems that cause frequent interruptions during surgery. We propose an OTS-free image-guided bone fracture reduction system utilizing a Stewart robot platform to solve the problem of conventional OTS-based robotic systems. The system applies inverse kinematics to compute the relative positions between the broken bone fragments. Each fragment is pre-operatively registered in the robotic system with a semi-automatic image-based registration method using an attachable jig designed for the proposed platform. This approach is particularly effective when the image features are not clearly detected in the fluoroscopic images. The accuracy of the proposed system was evaluated via pre- and post-operative computed tomography (CT) scans of femoral phantoms. Ex-vivo experiments were also performed on caprine legs to assess the clinical feasibility. In the phantom and ex-vivo experiments, the mean rotational errors of the reduction were 1.79° and 1.76°, respectively. The mean time for the reduction was approximately 3 min. This letter proposes a new method to compute the relative positions between the bone fragments using inverse kinematics and semi-automatic robot-patient registration without requiring a C-arm and an OTS. The OTS-free robotic surgery system has the potential advantages to enhance the accuracy of fracture reduction and reduce the surgery time and radiation exposure.

The C-arm X-ray system is a common intraoperative imaging modality used to observe the state of a fractured bone in orthopedic surgery. Using C-arm, the bone fragments are aligned during surgery, and their lengths and angles with respect to the entire bone are measured to verify the fracture reduction. Since the field-of-view of the C-arm is too narrow to visualize the entire bone, a panoramic X-ray image is utilized to enlarge it by stitching multiple images. To achieve X-ray image stitching with feature detection, the extraction of accurate and densely matched features within the overlap region between images is imperative. However, since the features are highly affected by the properties and sizes of the overlap regions in consecutive X-ray images, the accuracy and density of matched features cannot be guaranteed. To solve this problem, a heterogeneous stitching of X-ray images was proposed. This heterogeneous stitching was completed according to the overlap region based on homographic evaluation. To acquire sufficiently matched features within the limited overlap region, integrated feature detection was used to estimate a homography. The homography was then evaluated to confirm its accuracy. When the estimated homography was incorrect, local regions around the matched feature were derived from integrated feature detection and substituted to re-estimate the homography. Successful X-ray image stitching of the C-arm was achieved by estimating the optimal homography for each image. Based on phantom and ex-vivo experiments using the proposed method, we confirmed a panoramic X-ray image construction that was robust compared to the conventional methods.