Robotic reduction of complex fractures using 3D puzzle solving algorithm

The joints of the body are frequently involved in bone breaks, typically classified as intra-articular fractures. If a joint is to function properly again, that is to provide pain-free stability and movement, the broken pieces of the joint must be subjected to an anatomic reduction e.g. put back together as perfectly as possible. This project's aim is to set a research basis for creating a robotics device for precise anatomic reduction of complex, joints' fractures using the state of the art of 3D imaging, pattern recognition and robotics. The cost of trauma in hospitals is massive and a saving that robotics could potentially bring is promising. We believe that Bristol Robotics Laboratory's vibrant cross-disciplinary environment and its close association with Bristol Royal Infirmary places the investigators in an excellent position to exploit the opportunity of combining their robotics and clinical expertise with commercial 3D imaging software solutions developed by Simpleware.Trauma accounts for the highest proportion of healthcare expenditure. The BRI Limb unit has been at the forefront of injury research for the past three decades. BRL has, on the robotics side, been a fast developing robotics laboratory with a wide expertise in many areas of service and swarm robots. In order to promote the research in the area of orthopaedic robotics, we have formed a collaboration between the department of orthopedic surgery at the University of Bristol (Professor Roger Atkins), the Bristol Robotics Laboratory (Dr S Dogramadzi), the Centre for Fine Print Research at the University of the West of England (Dr P Walters and Dr D Huson) and a software company (Simpleware Ltd). This proposal is a first attempt to initiate the realization of an ambitious idea that can potentially bring benefits to a broad community of stakeholders. It is a feasibility study that aims to develop a novel robotic device capable of reducing complex joint fractures at the appropriate level of autonomy. An automated 3D jigsaw solving algorithm needs to be developed at this stage that would allow calculation of the optimum paths in overall alignment of the broken joint's segments. When the fracture is successfully reduced in simulation, the next step is to develop a robotic device to manipulate the fractured joint's parts using a fine wire circular frame applied across the joint. This will allow less exposure to CT scan for patients and staff, considerable resource saving, more rapid recovery and less scarring of the limb.Robot assisted surgery is an emerging interdisciplinary field that aims at improving the outcome of surgical procedures, reducing intra-operative time and radiation exposure to patients and staff as well as minimizing the invasiveness of a variety of surgical procedures. It seems very likely that Medical Robotics and Computer Assisted Surgery (MRCAS) will be a pervasive element of future society; there are many indications e.g. MRCAS report (http://www.piribo.com/publications/medical_devices/medical_robotics_computerassisted_surgery.html) that this will be a huge opportunity for life enhancement and commercial exploitation. The total worldwide market for MRCAS devices and equipment was around $1.3 billion in 2006 and is expected to reach $5.7 billion by 2011, an average annual grow rate of 34.7%. There is a natural synergy in this project; the PI has a track record in robotics and a strong background in mathematics and control, the Advisor is an experienced clinician with an academic portfolio of developments in orthopaedics surgery. The collaborating company Simpleware will provide their software licence for the duration of the project as well as the software support. BRL's rapid prototyping facilities will contribute to realisation of the project's hardware and the visualisation of the real fractures obtained from BRI's medical archives.

We beleieve that the following groups and institutions will benefit from the results of this proposal: Orthopaedic surgeons - This work will bring about a significant advance in the way that orthopaedic surgeons visualise and understand complex fractures. Although CT scan allows visualisation of the fractures on daily basis, having the physical models in front of them will lead to new insights even for experienced orthopaedic clinicians. This project's results could be further developed into a useful tool for the trainee doctors and students. The 3D puzzle solving both in simulation and on the robotic device will provide the surgeons with new approaches to solve the complex fractures reductions. NHS and Overseas health organisations - We would like to create a first step to a more sustainable and resource saving solution for the frequent and expensive orthopaedic hospital procedures. The economic cost of trauma accounts for the highest proportion of healthcare expenditure. As explained in the 'Case for Support', trauma patients require long hospitalization periods pre and post operatively. Rehabilitation period is substantial and similarly is the off-sick leave. This research could result in a reduction of not only the patients' hospital stays but also a number of patients returning to hospitals due to recurring pains and misaligned fractures. Patients treated for the orthopaedic types of injuries who potentially face long term disability or osteoporosis if the reduction is not accurately managed. Another advantage of utilizing robots is the ability for a gentler interaction with the patient, due to direct and well-controlled trajectories without repetitive and uncontrolled movements, which usually occur during manual reductions. Utilizing robotic solutions could remove the experienced surgeon from the treatment loop and allow an accurate fracture treatment in district hospitals or remote areas where specialist doctors are not available (battlefields, etc.). This will consequently bring the cost of the patient or the consultant transportation down and allow faster treatment of a fracture. UK robotics industry and biomedical engineering - Knowledge transfer and commercialisation of the project results related to the proposed software developments will be agreed with Simpleware. This project has potentially a good commercial value as stated in Simpleware's letter of support. On the other side, Medical Robotics is one of the robotics areas that have already proved to have a clear commercial impact in UK - Acrobot Ltd, Prosurgics Ltd, Renishaw, etc. A majority of other robotics research results are still confined to research laboratories. The first prototype of robotic device developed for the anatomic reduction of complex joints fractures will be a good showpiece for new, engineering collaborations with UK companies interested in this area. This project being a feasability study will have a little impact on commerical exploitation by Medical robotics industry. All impact and dissemination activities will be carried out by the project members. Each project member will publicise the project in his/her discipline through a participation in national and international conferences, lectures, seminars and relevant meetings but also using media tools in their respective institutions, all of which will ensure an excellent coverage in medical, academic and commercial societies. We all have a considerable experience in producing and delivering scientific material which is also a projected requirement for a research assistant that will be employed on the project.