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Robot-assisted navigation combined with a double reverse traction reduction frame for retrograde intramedullary nailing of extra-articular distal femoral fractures: a retrospective comparative cohort study

Year: 2026

Type: article

Abstract: Objective To compare the perioperative, radiographic, and functional outcomes associated with an integrated surgical workflow combining robot-assisted navigation with a double reverse traction reduction frame vs. conventional manual traction. Methods This retrospective comparative cohort study was conducted on 58 patients (AO/OTA 33-A1 or 33-A2) with distal femoral fractures treated between January 2021 and December 2024. Patients were divided into a robot-assisted double reverse traction reduction group (RDR group, n = 26) and a conventional manual traction group (CMT group, n = 32). All patients underwent retrograde intramedullary nailing. The RDR group received robot-assisted guidewire positioning combined with continuous traction-frame-assisted fracture reduction, whereas the CMT group underwent conventional manual traction reduction. Perioperative parameters, radiographic outcomes, functional scores, and complications were analyzed. Results The groups were similar in the measured baseline demographic and fracture characteristics, including AO/OTA subtype. Compared with the CMT group, the RDR group showed significantly reduced operative time, decreased intraoperative blood loss, fewer fluoroscopic acquisitions, smaller residual coronal and sagittal angulation, and shorter fracture healing time. At the 12-month follow-up, knee flexion angle and Hospital for Special Surgery (HSS) knee score were significantly higher in the RDR group. No significant difference in complication rates was observed between groups. Conclusion In this retrospective comparative cohort, the integrated workflow was associated with shorter operative time, lower intraoperative blood loss, fewer fluoroscopic acquisitions, improved postoperative alignment, and better 12-month knee function compared with conventional manual traction.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1929866