Improved lag screw positioning in the treatment of proximal femur fractures using a novel computer assisted surgery method: a cadaveric study

Research article

Improved lag screw positioning in the treatment of proximal femur fractures using a novel computer assisted surgery method: a cadaveric study

 Mejora de posicionamiento tornillo de tracción en el tratamiento de las fracturas de fémur proximal utilizando un nuevo método de cirugía asistida por ordenador: un estudio de cadáver

Matthias Regling1*, Arno Blau2, Robert A Probe3, James W Maxey4 and Brian D Solberg5
1Stryker Trauma GmbH, Schoenkirchen, Germany
2Stryker Leibinger GmbH & Co. KG, Freiburg, Germany
3Department of Orthopaedics, Scott & White Memorial Hospital, Temple, TX, USA
4University of Illinois College of Medicine, Peoria, IL, USA
5Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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BMC Musculoskeletal Disorders 2014, 15:189  doi:10.1186/1471-2474-15-189

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Received: 1 November 2013
Accepted: 14 May 2014
Published: 30 May 2014
© 2014 Regling et al.; licensee BioMed Central Ltd. 
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.



The importance of the tip-apex distance (TAD) to predict the cut-out risk of fixed angle hip implants has been widely discussed in the scientific literature. Intra-operative determination of TAD is difficult and can be hampered by image quality, body habitus, and image projection. The purpose of this paper is to evaluate, through a cadaveric study, a novel computer assisted surgery system (ADAPT), which is intended for intraoperative optimisation of lag screw positioning during antegrade femoral nailing. A 3D measure for optimal lag screw position, the tip-to-head-surface distance (TSD), is introduced.
La importancia de la distancia de la punta del ápice (TAD) para predecir el riesgo de desconexión de los implantes de cadera ángulo fijo ha sido ampliamente discutido en la literatura científica. Determinación intraoperatoria de TAD es difícil y puede verse obstaculizada por la calidad de imagen, hábito corporal, y la proyección de imagen. El propósito de este trabajo es evaluar, a través de un estudio de cadáver, un nuevo sistema de cirugía asistida por ordenador (ADAPT), que está diseñado para la optimización del posicionamiento intraoperatorio tornillo de tracción durante el enclavado femoral anterógrado. Una medida para la posición 3D tirafondo óptima, la distancia de punta a la cabeza en la superficie (TSD), se introduce.

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