Improved Implant Positioning of Cephalomedullary Nail for Trochanteric Fractures Using the Stryker ADAPT Navigation System

• Published in: Injury 2021-11, Vol.52 (11), p.3404-3407
• Main Authors: Simcox, Trevor, Tarazona, Daniel, Becker, Jacob, Ayres, Ethan, Gould, Jason
• Format: Article
• Language: English
• Subjects: Cephalomedullary nail; Computer assisted surgery; Femoral trochanteric fracture; Hip fracture; Implant cutout; Tip apex distance
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2021.07.021

•Implementation of the ADAPT system did not significantly affect operative time or amount of fluoroscopy used.•Lag screw position is superior in ADAPT group, with 10% of patients in conventional group having suboptimal anterior placement of the lag screw.•ADAPT navigation can achieve improved lag screw positioning, leading to a statistically significant reduction in TAD.•The magnitude of TAD improvement using ADAPT over conventional technique does not reach clinical significance. :Tip-apex distance (TAD) of greater than 25 mm increases the risk of cephalomedullary nail (CMN) cutout for trochanteric hip fractures. The Stryker ADAPT navigation system provides intraoperative feedback to guide implant positioning. This study compares lag screw positioning using the ADAPT to conventional methods and investigates if the use of ADAPT impacts operating room efficiency. : Retrospective review of 82 consecutive patients who underwent Stryker Gamma3 CMN for a peritrochanteric hip fracture. Study groups were assigned based on use of ADAPT navigation. Primary outcome was TAD. Secondary outcomes were lag screw position, operative time, and radiation dose. Univariate analysis of covariance was used to compare primary outcome measures, controlling for fracture classification. : 41 patients were assigned to each group. When comparing ADAPT and conventional groups mean TAD was 14.45±3.68 and 16.41±3.78 mm (p = 0.023). A higher portion of ADAPT nails (85.4% vs 63.4%, p = 0.024) were center- center within the femoral head compared to conventional methods. There were no significant differences with regards to operative time, fluoroscopy time, or radiation dose. : ADAPT navigation provides intraoperative feedback to achieve improved lag screw positioning, leading to improved TAD. The overall improvement in TAD does not likely reach clinical significance. The system requires minimal setup in the operating room, does not impact workflow, and the user interface is straight forward.