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Precise lag screw placement with ADAPT for Gamma3 during cephalomedullary nailing

Message from Dr. Mitchell Kuhl | St. Cloud Orthopedics

More than 115,000 hip fractures occur in the United States annually1, costing $4.7 billion.2 Many of these fractures are treated today with a cephalomedullary nail with traditional instrumentation.

Stryker has developed ADAPT, a computer assisted surgery system designed to for use in Gamma3 surgery, to enhance the outcomes with this procedure. The system assists with implant alignment, lag screw length determination, lag screw positioning and distal targeting. A previous generation of this software has been available since 2012, and in my institution, we have utilized ADAPT for more than 250 cases.

To better understand the impact of the ADAPT system at our facility we compared 123 consecutive cases using ADAPT with the previous 126 consecutive cases without the use of ADAPT.3 Patients in this study represented a typical hip fracture population; the median age was 84 years and 66% were female. The groups were subdivided into stable and unstable fractures. The demographics of all groups were noted to be equivalent.

Precise lag screw placement, including a lower and less variable tip-apex distance, was found compared to conventional cases. No postoperative cut-outs occurred when ADAPT was utilized, and the potential risk for cut-out was decreased in the ADAPT cases vs. the conventional cases.

Radiation exposure is also a risk associated with cephalomedullary nailing and can adversely affect not only the patient but the surgeon and operating room staff. With the use of ADAPT, we found that radiation time was significantly shorter for the stable fracture group and all cases combined.

One concern with the addition of the ADAPT system is that it may increase the complexity and the operative time for the procedure. However, in our study, we found that the use of ADAPT decreased the operative time in the stable fracture group and had no significant effect on the unstable fracture group and all cases combined.


OTA 2017 poster:
Precise lag screw placement with the use of a novel computer assisted surgery system during cephalomedullary nailing.