Corrective cold ablation robot-guided laser osteotomies in wrist surgery: do we get what we planned? - A cadaver study.

PURPOSE: The purpose of this study is to evaluate the accuracy of a cold ablation robot-guided laser osteotome in pre-clinical cadaver tests, performing shortening and lengthening osteotomies on the ulna and radius.

METHODS

The osteotomies were performed using CARLO®, a miniaturised ablation laser. A total of 12 corrective laser osteotomies were performed on the distal metaphysis of the radius and ulna. These were planned on a 3D CT model specific to each patient prior to surgery. Pre- and postoperative CT scans were taken to compare the virtual surgical planning with the postoperative results and to demonstrate the accuracy of the cutting path.

RESULTS

Accuracy measurements of the actual cutting path compared to the planned cut showed a mean deviation of 2.11 ± 0.73 mm in the osteotomies of the radii and 1.66 ± 0.29 mm on the ulnae. After fixation the radii revealed an average lengthening of 4.36 ± 0.58 mm (planned: 4.00 mm), while radial inclination was corrected by 10.55 ° ±1.02 (planned: 10.00 °). The ulnae showed an average shortening of 3.05 ± 0.28 mm (planned: 3.00 mm).

CONCLUSION

First cadaveric tests showed promising results concerning the resulting corrections of one and two plane osteotomies in wrist and forearm surgery. Compared to previously published results on corrective osteotomies of the radius and ulna, the resulting corrections were highly precise, matching the accuracy of current techniques. Future steps are stability testing of the osteosynthesis followed by certification and first use in patients.

LEVEL OF EVIDENCE: Therapeutic, Level 5.