Radiation-free drill guidance in interlocking of intramedullary nails

Med Image Comput Comput Assist Interv. 2012;15(Pt 1):18-25. doi: 10.1007/978-3-642-33415-3_3.

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.

MeSH terms

  • Bone Nails
  • Bone and Bones / pathology*
  • Calibration
  • Diagnostic Imaging / methods*
  • Equipment Design
  • Fluoroscopy / methods
  • Fracture Fixation, Intramedullary / instrumentation*
  • Fracture Fixation, Intramedullary / methods*
  • Fractures, Bone / therapy*
  • Humans
  • Observer Variation
  • Optics and Photonics
  • Orthopedic Procedures / methods
  • Phantoms, Imaging*
  • Video Recording
  • X-Rays