title: Intra-operative augmented reality in distal locking.
abstract: OBJECTIVE
  To design an augmented reality solution that assists surgeons during the distal locking of intramedullary nailing procedures.
  
  
  METHODS
  Traditionally, the procedure is performed under X-ray guidance and requires a significant amount of time and radiation exposure. To absolve these complications, we propose video guidance that allows surgeons to achieve both the down-the-beam position of the intramedullary nail and its subsequent locking. For the down-the-beam position, the IM nail pose in X-ray is calculated using a 2D/3D registration scheme and later related to the patient leg pose which is calculated using video-tracked AR markers. For the distal locking, surgeons use an augmented radiolucent drill in which its tip position is detected and tracked in real-time under video guidance.
  
  
  RESULTS
  To evaluate the feasibility of our solution, we performed a preclinical study on dry bone phantom with the participation of four clinicians.
  
  
  RESULTS
  Participants achieved 100 % success rate in the down-the beam positioning and 93 % success rate in distal locking using only two X-ray images in 100 s.
  
  
  CONCLUSIONS
  We confirmed that intra-operative navigation using augmented reality provides an alternative way to perform distal locking in a safe and timely manner.
authors: Chair for Computer Aided Medical Procedures, Technische Univ. Munchen, Munich, Germany.
authors: Roberto
authors: R
authors: Londei
authors: Marco
authors: M
authors: Esposito
authors: Benoit
authors: B
authors: Diotte
authors: Simon
authors: S
authors: Weidert
authors: Ekkehard
authors: E
authors: Euler
authors: Peter
authors: P
authors: Thaller
authors: Nassir
authors: N
authors: Navab
authors: Pascal
authors: P
authors: Fallavollita
mesh_terms: D000465:Algorithms; D001858:Bone Nails; D001842:Bone and Bones / Q000473:pathology*; D003196:Computer Graphics; D003198:Computer Simulation; D004867:Equipment Design; D005471:Fluoroscopy / Q000295:instrumentation* / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007432:Intraoperative Period; D019637:Orthopedic Procedures; D019047:Phantoms, Imaging; D015203:Reproducibility of Results; D014741:Video Recording; D014965:X-Rays