Radiation-free methods for navigated screw placement in slipped capital femoral epiphysis surgery

  • Bamshad Azizi KoutenaeiEmail author
  • Javad Fotouhi
  • Farshid Alambeigi
  • Emmanuel Wilson
  • Ozgur Guler
  • Mathew Oetgen
  • Kevin Cleary
  • Nassir Navab
Original Article



For orthopedic procedures, surgeons utilize intra-operative medical images such as fluoroscopy to plan screw placement and accurately position the guide wire with the intended trajectory. The number of fluoroscopic images needed depends on the complexity of the case and skill of the surgeon. Since more fluoroscopic images lead to more exposure and higher radiation dose for both surgeon and patient, a solution that decreases the number of fluoroscopic images would be an improvement in clinical care.


This article describes and compares three different novel navigation methods and techniques for screw placement using an attachable Inertial Measurement Unit device or a robotic arm. These methods provide projection and visualization of the surgical tool trajectory during the slipped capital femoral epiphysis procedure.


These techniques resulted in faster and more efficient preoperative calibration and set up times compared to other intra-operative navigation systems in our phantom study. We conducted an experiment using 120 model bones to measure the accuracy of the methods.


As conclusion, these approaches have the potential to improve accuracy of surgical tool navigation and decrease the number of required X-ray images without any change in the clinical workflow. The results also show 65% decrease in total error compared to the conventional manual approach.


Slipped capital femoral epiphysis (SCFE) Computer-assisted orthopedic surgery Computer-aided intervention Inertial measurement unit 



This research was internally funded by the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Health System.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

Supplementary material 1 (MP4 5836 kb)


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Copyright information

© CARS 2019

Authors and Affiliations

  1. 1.Chair for Computer Aided Medical Procedures and Augmented Reality, Department of InformaticsTechnical University of Munich (TUM)MunichGermany
  2. 2.Sheikh Zayed Institute for Pediatric Surgical InnovationChildren’s National Health SystemWashingtonUSA
  3. 3.Laboratory for Computational Sensing and RoboticsJohns Hopkins UniversityBaltimoreUSA
  4. 4.E-Kare IncFairfaxUSA

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