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Pelvic fractures are amongst the most challenging orthopaedic trauma injuries with a high risk of massive bleeding, and are potentially life-threatening. The Chinese University of Hong Kong (CUHK)’s Faculty of Medicine (CU Medicine) has introduced a novel orthopaedic robotic surgical system and successfully performed the first robotic‑assisted pelvic fracture reduction and fixation minimally-invasive surgery in Hong Kong. The CUHK orthopaedics team has successfully completed three cases at the Prince of Wales Hospital since June this year. Clinical results demonstrated that the novel procedure yields minimal intraoperative blood loss and improved fracture reduction quality with small surgical incisions, and a promising recovery trajectory. It provides a safe and precise treatment option for geriatric and severely injured patients, turning a new page in trauma care in Hong Kong.

Professor Patrick Yung Shu-hang, S.H. Ho Professor of Orthopaedics and Sports Medicine and Chairman of the Department of Orthopaedics and Traumatology at CU Medicine, stated, “We are deeply grateful for the generous donation that brought this advanced orthopaedic robotic surgical system to CUHK. Following the Memorandum of Understanding (MoUs) signed last year with our robotic innovation partner and Beijing Jishuitan Hospital, the National Orthopaedic Medical Center, we have also established a vital framework for ongoing collaborations. Our team looks forward to driving the development of next-generation, artificial intelligence (AI)-integrated robotic technologies.”

Pelvic fractures are critical orthopaedic injuries – Fragility fractures carry a one-year mortality rate of approximately 15%

Pelvic fractures are among the most challenging and potentially life-threatening injuries in orthopaedic trauma. Due to the rapidly ageing population, fragility fractures of the pelvis have also become increasingly common. Operating on these fractures is a highly complex, skill-dependent procedure due to the close proximity of critical neurovascular structures. The main goals of treatment are early mobilisation and pain relief. Conventional open surgeries are known to carry inherent risks of significant blood loss and soft tissue complications. Many frail elderly patients cannot tolerate major surgery, and rely on non-surgical treatments. However, the resulting long-term immobilisation can trigger severe complications, including pneumonia, pressure ulcers, and deep vein thrombosis. Data shows that the one-year mortality rate for such patients reaches approximately 15%.

Dr Ronald Wong Man-yeung, Clinical Associate Professor in the Department of Orthopaedics and Traumatology at CU Medicine, said, “By introducing an advanced orthopaedic robotic system, we can typically perform safe, precise and minimally invasive robotic-assisted pelvic fracture reduction, paving the way for fixation. This advancement is especially meaningful for geriatric patients. Because many face multiple health conditions and have limited physiological reserves, prolonged and invasive surgeries carry high risks. Minimising surgical trauma allows us to significantly reduce complications. It is a safe and efficient treatment option for high-risk patients.”

Enhancing surgical precision with advanced orthopaedic robotics

Preoperative planning utilises three-dimensional CT scans to map out fracture reduction and fixation strategies for the patient. In the surgical procedure, the robotic system uses real-time 3D navigation data to help guide the active robotic arm during the realignment of the fracture. Furthermore, it delivers reproducible outcomes by utilising an automated process. This closed approach provides a minimally invasive alternative to conventional techniques, while aiming to enhance surgical precision and optimise patient recovery.

The CUHK orthopaedic team successfully treated its first pelvic fracture case in Hong Kong using surgical robotic technology in June this year. Since then, the orthopaedic team has completed three cases with minimal surgical blood loss and trauma. The novel surgery had minimal surgical trauma, with patients experiencing an intraoperative blood loss of only 10 to 20 milliliters. While open procedures can result in up to one liter of blood loss, this innovative approach reduces bleeding substantially by up to 90%. Additionally, the transition from traditional incisions exceeding 10 centimeters with extensive dissection to minimally invasive wounds under two centimeters drastically minimises soft tissue trauma. This reduction in surgical trauma lowers post-operative pain and decreases the overall risk of infection. The initial post-operative recovery for these patients is promising.

Dr Ronald Wong added, “The robotic-assisted system is designed to support high precision in fracture reduction and fixation through a minimally invasive approach, aiming to minimise surgical trauma and blood loss. This marks a major step forward in the field of orthopaedic trauma and demonstrates how cutting-edge technology aids in addressing long-standing surgical challenges.”

The robotic system has received medical device clearance from the National Medical Products Administration (NMPA) for managing pelvic and long bone fractures, and it is also listed in the Medical Device Administrative Control System (MDACS). Building on this milestone, the team is also developing new AI models to instantly compute the optimal screw tract configurations for complex fracture fixations.

Dr Chui Chun-sing, Assistant Professor, Department of Orthopaedics and Traumatology, CU Medicine, said, “The position, combination and number of screws are critical to surgical success. Poor placement can damage neurovascular structures or cause screw loosening, which may lead to fracture displacement. Conversely, excessive screw usage inflicts unnecessary tissue trauma, while insufficient fixation compromises stability. AI can generate optimal insertion trajectory plans rapidly, accelerating the pre-operative planning phase. Ultimately, this technology has the potential to enhance surgical efficiency, precision, and safety.”

Cross-border collaborative partnerships to drive future orthopaedic trauma care

The CUHK team is currently collaborating closely with their robotic innovation partner and Beijing Jishuitan Hospital, the National Orthopaedic Medical Center. The CUHK team aims to develop next-generation, AI-integrated surgical technologies, contributing to clinical standards that can benefit patients worldwide. To solidify Hong Kong’s role in translational medicine, CUHK has also recently filed two US provisional patents for these core intelligent technologies to safeguard our local academic innovations.

Professor Patrick Yung remarked, “Our department is proud to establish major cross-border research initiatives. We believe that deep synergy between Hong Kong and the Chinese mainland is essential to transforming orthopaedic care. By merging clinical research with cutting-edge technology, we are committed to developing advanced techniques that elevate patient outcomes worldwide.”