Developing and Evaluating Computer-Assisted Surgical Techniques for Percutaneous Scaphoid Fixation using Additive Manufacturing Technology
Smith, Erin Janine
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This dissertation presents a thesis on the use of additive manufacturing in the development and evaluation of a computer-assisted system for wrist-fracture repair. The work developed tools for performing navigated wrist surgery, developed methods for evaluating surgical performance, and provided novel experience with model-based surgical evaluation. Patient-derived bone models, fabricated using additive manufacturing, were proposed as an alternative to cadaver specimens for testing and validating the new surgical system. The accuracy of fabricating these models from computed-tomography imaging was investigated using laser scanning and was found to be reproducible to within half a millimeter. Three generations of a surgical system for navigated wrist-fracture repair were developed and evaluated using a wrist model that was produced by additive manufacturing. Compared to cadaver specimens, the model was less expensive and performed equally well under simulated surgical conditions. The model-based evaluation permitted larger study sizes that increased the statistical power of the experimental results. Criteria for surgical performance included surgical and technical measurement of screw placement. The navigation system was superior in optimizing screw placement compared to conventional surgical methods. Navigation also reduced the risk of radiation exposure and clinical complications of wrist-fracture repair. Surgical tools, including a drill guide and wrist-stabilization device were developed with the use of additive manufacturing. Prototype devices could be quickly and economically fabricated for testing under realistic conditions. A system for performing navigated wrist fracture repair was successfully developed through the use of additive-manufacturing prototyping and evaluation. Additive manufacturing was integral to the successful evaluation of the system's improvement in performance.