title: Radiation-free drill guidance in interlocking of intramedullary nails.
abstract: Intramedullary nailing is a technically demanding procedure which involves an excessive amount of x-ray acquisitions; one study lists as many as 48 to successfully complete the procedure. In this work, a novel low cost radiation-free drilling guide is designed to assist surgeons in completing the distal locking procedure without any x-ray acquisitions. Using an augmented reality fluoroscope that coregisters optical and x-ray images, we exploit solely the optical images to detect the drilling guide in order to estimate the tip position in real-time in x-ray. We tested over 200 random drill guide poses showing a mean tip-estimation error of 1.72 +/- 0.7mm which is significantly robust and accurate for the interlocking. In a preclinical study on dry bone phantom, three expert surgeons successfully completed the interlocking 56 out of 60 trials with no x-ray acquisition for guidance and an average time of 2 min.
authors.affiliation: Computer Aided Medical Procedures, TU Munich, Germany.
authors.forename: Benoit
authors.initials: B
authors.lastname: Diotte
authors.forename: Pascal
authors.initials: P
authors.lastname: Fallavollita
authors.forename: Lejing
authors.initials: L
authors.lastname: Wang
authors.forename: Simon
authors.initials: S
authors.lastname: Weidert
authors.forename: Peter-Helmut
authors.initials: PH
authors.lastname: Thaller
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Euler
authors.forename: Nassir
authors.initials: N
authors.lastname: Navab
mesh_terms: D001858:Bone Nails; D001842:Bone and Bones / Q000473:pathology*; D002138:Calibration; D003952:Diagnostic Imaging / Q000379:methods*; D004867:Equipment Design; D005471:Fluoroscopy / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods*; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D015588:Observer Variation; D055095:Optics and Photonics; D019637:Orthopedic Procedures / Q000379:methods; D019047:Phantoms, Imaging; D014741:Video Recording; D014965:X-Rays