Robotic Assistant for Image-Guided Treatment of Ankle Joint Dislocations: A Feasibility Study

Trauma to the ankle is an increasingly common injury and is a major source of long-term debility [1]. Over two million ankle injuries occur each year in the United States alone [2]. Over half a million ankle injuries require surgeries [1]. Multiple studies have demon- strated accurate reduction of the distal tibiofibular joint (syndesmosis) as a critical predictor of good clinical outcome [3], [4]. Surgical manipulation of the tibia and fibula is necessary to properly align and reduce the syndesmosis space in ankle fractures involving sprains of the syndesmosis. However, current techniques of manual reduction utilizing open or percutaneous approaches have been shown to result in inaccurate reduction of the syndesmosis [3], [4]. We propose a novel system that combines intraoperative imaging based on low- dose cone-beam computed tomography (CBCT) and 3D- 2D image registration with robotic manipulation of the fibula to precisely restore its anatomical relationship with the tibial incisura. Our long-term goal is to de- velop robotic assistance with intraoperative imaging for precise reduction of the syndesmosis, while minimizing radiation exposure to the patient and the surgical staff. The focus of this study is to investigate the feasibility of the robot design and the potential clinical workflow.