Holographic computing as a navigation system for humeral osteotomies

Purpose : Surgical navigation using holograms displayed via mixed reality glasses is already applied in orthopaedic procedures, particularly in shoulder and knee surgeries. Could this system be applied to long bone deformity correction? This study aims to employ this technology for the navigation of humeral osteotomies and evaluate its accuracy and reproducibility. Methods : A holographic software integrated with MRTK 2 (Microsoft, Redmond), USA was developed for Microsoft Hololens 2. Using 3D Builder, trackers were designed for mixed reality recognition, enabling spatial modification analysis. On fifteen humerus phantoms, an engineer performed navigated derotation osteotomies. Subsequently, a trainee and a pediatric orthopedic specialist each completed five osteotomies. CT scans measured the orientation achieved. The error, defined as the difference between planned and achieved orientation, was statistically analyzed for both manual and navigated techniques. Results : The average error of the navigated system was 1.73º (SD: 2.63), with statistically significant differences (p<0.05). In addition, the holographic computing system showed accuracy regardless of the osteotomy magnitude. In contrast, the freehand technique presented an average error of 14.2º (SD: 18.86) for the resident surgeon and 4.6º (SD: 17.56) for the specialist, with no statistically significant differences between them. The manual system presented lower precision and greater unpredictability compared to the navigated system. Conclusions : Surgical navigation based on holographic computing improves the accuracy of derotation osteotomy. Its accessibility and simplicity make it a promising technique for future surgical navigation systems.