title: Computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails: a preliminary report on clinical application.
abstract: OBJECTIVE
  To evaluate the clinical feasibility and effect of the computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails.
  
  
  METHODS
  The hardware components of the system included a PC computer with a monitor, auto mechanical stereotactical localization cubic frame, foot holder and localization operative apparatus. Special navigation software can be used for registration of X-ray fluoroscopic images and real-time controlling navigation of tools. Twenty-one cases of close tibial and fibular fractures were treated with closed intramedullary nailing, 6 of which involved in middle third, 12 in middle and lower third, 3 in lower third. C-arm alignment and registration time, fluoroscopic time and drilling time involved in the locking procedure were recorded. The size of unreamed or reamed tibial nails ranged from 8/300-11/330.
  
  
  RESULTS
  All distal holes except 1 were locked successfully. In 9 of 41 locked holes (21.95%), the drill bit touched the canal of locking hole without damage of the nail and clinical consequences. The fluoroscopy time per pair of screws was 2.23+/-0.31 s.
  
  
  CONCLUSIONS
  The computer-assisted auto-frame navigation system for distal locking is well designed, easy to operate and do not need additional instruments during the procedure. The developed system enables the physician to precisely navigate surgical instruments throughout the anatomy using just a few computer-calibrated radiographic images. The total time of X-ray exposure per procedure can be significantly reduced.
authors.affiliation: Department of Orthopaedics and Traumatology, Jishuitan Hospital, Beijing 100035, China. DrW-JQ1997@163.com
authors.forename: Jun-qiang
authors.initials: JQ
authors.lastname: Wang
authors.forename: Chun-peng
authors.initials: CP
authors.lastname: Zhao
authors.forename: Man-yi
authors.initials: MY
authors.lastname: Wang
authors.forename: Yong-gong
authors.initials: YG
authors.lastname: Su
authors.forename: Lei
authors.initials: L
authors.lastname: Hu
authors.forename: Lei
authors.initials: L
authors.lastname: Sun
authors.forename: Li-dan
authors.initials: LD
authors.lastname: Zhang
authors.forename: Wen-yong
authors.initials: WY
authors.lastname: Liu
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.forename: Yi-fei
authors.initials: YF
authors.lastname: Gao
authors.forename: Tian-miao
authors.initials: TM
authors.lastname: Wang
mesh_terms: D000328:Adult; D001858:Bone Nails; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D025321:Surgery, Computer-Assisted; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome