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Georg Gradl - One of the best experts on this subject based on the ideXlab platform.

  • Intramedullary Nail versus volar plate fixation of extra articular distal radius fractures two year results of a prospective randomized trial
    Injury-international Journal of The Care of The Injured, 2014
    Co-Authors: N Mielsch, Martina Wendt, Steffi S I Falk, Philip Gierer, Thomas Mittlmeier, Georg Gradl
    Abstract:

    Abstract Background Intramedullary techniques for stabilization of displaced distal radius fractures are now available. Purported benefits include limited soft tissue dissection while affording sufficient stability to allow early wrist motion. The primary null hypothesis of this randomized trial is that there is no significant difference with respect to functional outcome, pain and disability between patients treated with either 2.4-mm volar locking plate fixation or Intramedullary Nail fixation of unstable dorsally displaced extra-articular fractures of the distal radius. Methods We conducted a single-centre, parallel-group trial, with unrestricted randomization. Patients with dorsally displaced extra-articular distal radius fractures were randomized to receive volar locking plate ( n  = 72) fixation or Intramedullary Nailing ( n  = 80). The outcome was measured on the basis of the Gartland and Werley and Castaing score; the pain level; the range of wrist motion; the rate of complications; and radiographic measurements including volar tilt and ulnar variance. Clinical and radiographic assessment was performed at 8 weeks, 6 months, 1 year and 2 years after the operation. Results There were no significant differences between groups in terms of range of motion, grip strength or the level of pain during the entire follow-up period ( p  > 0.05). There was no significant difference between treatment groups with respect to volar tilt or ulnar variance ( p  > 0.05). There was no significant difference in the complication rate between groups ( p  > 0.05). Conclusions The present study supports the view that Intramedullary Nail fixation and volar plate fixation for the treatment of displaced extra-articular distal radius fractures have equivalent radiographic and functional outcomes. Level of evidence Level I therapeutic study.

Levent Eralp - One of the best experts on this subject based on the ideXlab platform.

  • fixator assisted acute femoral deformity correction and consecutive lengthening over an Intramedullary Nail
    Journal of Bone and Joint Surgery American Volume, 2009
    Co-Authors: Mehmet Kocaoglu, Levent Eralp, Erkal F Bilen, Halil Ibrahim Balci
    Abstract:

    Background: External fixators are being used frequently in standard limb-lengthening and deformity-correction procedures. Lengthening over an Intramedullary Nail has been a successful technique, and fixator-assisted Intramedullary Nailing has provided satisfactory results for the correction of selected deformities. We report a combined technique for the treatment of femoral deformities associated with shortening. Methods: Between 1997 and 2005, twenty-eight femora in twenty-five patients with a median age of twenty-seven years underwent reconstruction with an Intramedullary Nail and a unilateral fixator. The mean amount of shortening was 6.33 cm, and the mean preoperative mechanical axis deviation was 33.86 mm. Deformity correction was performed acutely and secured by the Intramedullary Nail, which was locked distally, and the same external fixator that was used for the deformity correction was utilized for lengthening. At the end of the distraction period, proximal locking screws were placed in the Intramedullary Nail and the external fixator was removed. At the time of follow-up, deformity correction and bone healing were assessed clinically and radiographically, complications were noted, and the functional results were assessed. Results: The mean duration of follow-up was forty months. The mean duration of the external fixation was 83.29 days, and the mean external fixation index was 14.98 days/cm. The mean amount of lengthening was 6.02 cm. The mean amount of mechanical axis deviation at the end of the treatment was 11.29 mm. The mean bone healing index was 36.66 days/cm. A knee flexion contracture developed in one patient and resolved after intensive rehabilitation. One patient underwent two revisions because of Schanz screw displacement secondary to cortical fracture, and four patients with minor pin-track infections were treated successfully with local wound care and oral antibiotics. Conclusions: While femoral lengthening and deformity correction can be obtained with classic methods for application of an external fixator, the long period of external fixation, patient discomfort, and plastic deformation of the regenerated bone after removal of the fixator are major disadvantages. Two techniques, fixator-assisted Nailing and lengthening over an Intramedullary Nail, were combined in this series. The duration of the external fixation was reduced compared with that required for classic treatment with an external fixator and patient comfort was increased. In addition, the Intramedullary Nail prevented fracture and deformation of the regenerated bone. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

  • distal tibial reconstruction with use of a circular external fixator and an Intramedullary Nail the combined technique
    Journal of Bone and Joint Surgery American Volume, 2007
    Co-Authors: Levent Eralp, Mehmet Kocaoglu, Nazri Mohd Yusof, Murat Bulbul
    Abstract:

    BACKGROUND: Distal tibial reconstruction with use of an external fixator when there is bone loss, limb-length discrepancy, and/or ankle instability is associated with many problems. The technique of limb-lengthening, ankle arthrodesis, and segmental transfer over an Intramedullary Nail has been introduced to overcome these problems. The present study investigates this combined technique. METHODS: Between 2002 and 2005, six patients, who ranged from seventeen to seventy years old, underwent distal tibial reconstruction and ankle arthrodesis with use of a circular external fixator and an Intramedullary Nail to treat a distal tibial defect following resection for chronic osteomyelitis or tumor or to treat a limb-length discrepancy combined with ankle instability. Functional and radiographic results were evaluated, with use of the criteria described by Paley et al., at an average follow-up of thirty-four months. RESULTS: The mean size of the bone defect in three patients was 5.3 cm (2, 7, and 7 cm), and the mean amount of the limb-shortening in four patients was 5.25 cm (range, 4 to 6 cm). The mean external fixation time was 3.5 months, and the mean external fixator index was 0.57 mo/cm. There was no recurrence of infection in the two patients with osteomyelitis. All six patients had excellent bone results, and the functional results were excellent for two patients and good for four patients. There were four complications, three of which were categorized, according to Paley, as a problem (a difficulty that occurs during lengthening and is resolved without operative intervention) and one that was categorized as an obstacle (a difficulty that occurs during lengthening and needs operative treatment). CONCLUSIONS: The combined technique is an improvement over the classic external fixation techniques of distal tibial reconstruction with ankle arthrodesis. It reduces the duration of external fixation, thus increasing patient acceptance, and it is associated with a low complication rate facilitating more rapid rehabilitation. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Distal Tibial Reconstruction with Use of a Circular External Fixator and an Intramedullary Nail. The Combined Technique” (2007;89:2218-24).

  • reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an Intramedullary Nail surgical technique
    Journal of Bone and Joint Surgery American Volume, 2007
    Co-Authors: Levent Eralp, Mehmet Kocaoglu, Haroon Rashid
    Abstract:

    BACKGROUND: Callus distraction over an Intramedullary Nail is a rarely used technique for the reconstruction of intercalary defects of the femur and tibia after radical debridement of chronic osteomyelitic foci. The aim of this study was to summarize our experience with distraction osteogenesis performed with an external fixator combined with an Intramedullary Nail for the treatment of bone defects and limb-shortening resulting from radical debridement of chronic osteomyelitis. METHODS: Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical debridement to treat a nonunion associated with chronic osteomyelitis of the tibia (seven patients) and femur (six patients). The lesions were classified, according to the Cierny-Mader classification system, as type IVA (nine) and type IVB (four). The resulting segmental defects and any limb-length discrepancy were then reconstructed with use of distraction osteogenesis over an Intramedullary Nail. Two patients required a local gastrocnemius flap. Free nonvascularized fibular grafts were added to the distraction site for augmentation of a femoral defect at the time of external fixator removal and locking of the Nail in two patients. At the time of the latest follow-up, functional and radiographic results were evaluated with use of the criteria of Paley et al. RESULTS: The mean size of the defect was 10 cm (range, 6 to 13 cm) in the femur and 7 cm (range, 5 to 10 cm) in the tibia. The mean external fixator index was 13.5 days/cm, the consolidation index was 31.7 days/cm, and the mean time to union at the docking site was nine months (range, five to sixteen months). At a mean follow-up of 47.3 months, eleven of the thirteen patients had an excellent result in terms of both bone and functional assessment. There were two recurrences of infection necessitating Nail removal. These patients underwent revision with an Ilizarov fixator. Subsequently, the infection was controlled and the nonunions healed. CONCLUSIONS: This combined method may prove to be an improvement on the classic techniques for the treatment of a nonunion of a long bone associated with chronic osteomyelitis, in terms of external fixation period and consolidation index. The earlier removal of the external fixator is associated with increased patient comfort, a decreased complication rate, and a convenient and rapid rehabilitation. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail” (2006;88:2137-45).

  • reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an Intramedullary Nail
    Journal of Bone and Joint Surgery American Volume, 2006
    Co-Authors: Mehmet Kocaoglu, Levent Eralp, Haroon Rashid, Kerem Bilsel
    Abstract:

    BACKGROUND: Callus distraction over an Intramedullary Nail is a rarely used technique for the reconstruction of intercalary defects of the femur and tibia after radical debridement of chronic osteomyelitic foci. The aim of this study was to summarize our experience with distraction osteogenesis performed with an external fixator combined with an Intramedullary Nail for the treatment of bone defects and limb-shortening resulting from radical debridement of chronic osteomyelitis. METHODS: Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical debridement to treat a nonunion associated with chronic osteomyelitis of the tibia (seven patients) and femur (six patients). The lesions were classified, according to the Cierny-Mader classification system, as type IVA (nine) and type IVB (four). The resulting segmental defects and any limb-length discrepancy were then reconstructed with use of distraction osteogenesis over an Intramedullary Nail. Two patients required a local gastrocnemius flap. Free nonvascularized fibular grafts were added to the distraction site for augmentation of a femoral defect at the time of external fixator removal and locking of the Nail in two patients. At the time of the latest follow-up, functional and radiographic results were evaluated with use of the criteria of Paley et al. RESULTS: The mean size of the defect was 10 cm (range, 6 to 13 cm) in the femur and 7 cm (range, 5 to 10 cm) in the tibia. The mean external fixator index was 13.5 days/cm, the consolidation index was 31.7 days/cm, and the mean time to union at the docking site was nine months (range, five to sixteen months). At a mean follow-up of 47.3 months, eleven of the thirteen patients had an excellent result in terms of both bone and functional assessment. There were two recurrences of infection necessitating Nail removal. These patients underwent revision with an Ilizarov fixator. Subsequently, the infection was controlled and the nonunions healed. CONCLUSIONS: This combined method may prove to be an improvement on the classic techniques for the treatment of a nonunion of a long bone associated with chronic osteomyelitis, in terms of external fixation period and consolidation index. The earlier removal of the external fixator is associated with increased patient comfort, a decreased complication rate, and a convenient and rapid rehabilitation. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail” (2006;88:[2137-45][1]). [1]: /lookup/volpage/88/2137

  • complications encountered during lengthening over an Intramedullary Nail
    Journal of Bone and Joint Surgery American Volume, 2004
    Co-Authors: Mehmet Kocaoglu, Levent Eralp, Onder Kilicoglu, Halil Burc, Mehmet Cakmak
    Abstract:

    Background: In limb-lengthening, the quest for increased patient comfort and a reduced period of external fixation has led to techniques such as lengthening over an Intramedullary Nail. The goals of this study were to investigate the rate and types of complications encountered during lengthening over an Intramedullary Nail and to identify solutions to these complications. Methods : Forty-two segments (thirty-five femora and seven tibiae) in thirty-five patients were lengthened. The mean age of the patients was 26.6 years, the mean amount lengthened was 6.3 cm (range, 2.5 to 11.5

Mehmet Kocaoglu - One of the best experts on this subject based on the ideXlab platform.

  • fixator assisted acute femoral deformity correction and consecutive lengthening over an Intramedullary Nail
    Journal of Bone and Joint Surgery American Volume, 2009
    Co-Authors: Mehmet Kocaoglu, Levent Eralp, Erkal F Bilen, Halil Ibrahim Balci
    Abstract:

    Background: External fixators are being used frequently in standard limb-lengthening and deformity-correction procedures. Lengthening over an Intramedullary Nail has been a successful technique, and fixator-assisted Intramedullary Nailing has provided satisfactory results for the correction of selected deformities. We report a combined technique for the treatment of femoral deformities associated with shortening. Methods: Between 1997 and 2005, twenty-eight femora in twenty-five patients with a median age of twenty-seven years underwent reconstruction with an Intramedullary Nail and a unilateral fixator. The mean amount of shortening was 6.33 cm, and the mean preoperative mechanical axis deviation was 33.86 mm. Deformity correction was performed acutely and secured by the Intramedullary Nail, which was locked distally, and the same external fixator that was used for the deformity correction was utilized for lengthening. At the end of the distraction period, proximal locking screws were placed in the Intramedullary Nail and the external fixator was removed. At the time of follow-up, deformity correction and bone healing were assessed clinically and radiographically, complications were noted, and the functional results were assessed. Results: The mean duration of follow-up was forty months. The mean duration of the external fixation was 83.29 days, and the mean external fixation index was 14.98 days/cm. The mean amount of lengthening was 6.02 cm. The mean amount of mechanical axis deviation at the end of the treatment was 11.29 mm. The mean bone healing index was 36.66 days/cm. A knee flexion contracture developed in one patient and resolved after intensive rehabilitation. One patient underwent two revisions because of Schanz screw displacement secondary to cortical fracture, and four patients with minor pin-track infections were treated successfully with local wound care and oral antibiotics. Conclusions: While femoral lengthening and deformity correction can be obtained with classic methods for application of an external fixator, the long period of external fixation, patient discomfort, and plastic deformation of the regenerated bone after removal of the fixator are major disadvantages. Two techniques, fixator-assisted Nailing and lengthening over an Intramedullary Nail, were combined in this series. The duration of the external fixation was reduced compared with that required for classic treatment with an external fixator and patient comfort was increased. In addition, the Intramedullary Nail prevented fracture and deformation of the regenerated bone. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

  • distal tibial reconstruction with use of a circular external fixator and an Intramedullary Nail the combined technique
    Journal of Bone and Joint Surgery American Volume, 2007
    Co-Authors: Levent Eralp, Mehmet Kocaoglu, Nazri Mohd Yusof, Murat Bulbul
    Abstract:

    BACKGROUND: Distal tibial reconstruction with use of an external fixator when there is bone loss, limb-length discrepancy, and/or ankle instability is associated with many problems. The technique of limb-lengthening, ankle arthrodesis, and segmental transfer over an Intramedullary Nail has been introduced to overcome these problems. The present study investigates this combined technique. METHODS: Between 2002 and 2005, six patients, who ranged from seventeen to seventy years old, underwent distal tibial reconstruction and ankle arthrodesis with use of a circular external fixator and an Intramedullary Nail to treat a distal tibial defect following resection for chronic osteomyelitis or tumor or to treat a limb-length discrepancy combined with ankle instability. Functional and radiographic results were evaluated, with use of the criteria described by Paley et al., at an average follow-up of thirty-four months. RESULTS: The mean size of the bone defect in three patients was 5.3 cm (2, 7, and 7 cm), and the mean amount of the limb-shortening in four patients was 5.25 cm (range, 4 to 6 cm). The mean external fixation time was 3.5 months, and the mean external fixator index was 0.57 mo/cm. There was no recurrence of infection in the two patients with osteomyelitis. All six patients had excellent bone results, and the functional results were excellent for two patients and good for four patients. There were four complications, three of which were categorized, according to Paley, as a problem (a difficulty that occurs during lengthening and is resolved without operative intervention) and one that was categorized as an obstacle (a difficulty that occurs during lengthening and needs operative treatment). CONCLUSIONS: The combined technique is an improvement over the classic external fixation techniques of distal tibial reconstruction with ankle arthrodesis. It reduces the duration of external fixation, thus increasing patient acceptance, and it is associated with a low complication rate facilitating more rapid rehabilitation. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Distal Tibial Reconstruction with Use of a Circular External Fixator and an Intramedullary Nail. The Combined Technique” (2007;89:2218-24).

  • reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an Intramedullary Nail surgical technique
    Journal of Bone and Joint Surgery American Volume, 2007
    Co-Authors: Levent Eralp, Mehmet Kocaoglu, Haroon Rashid
    Abstract:

    BACKGROUND: Callus distraction over an Intramedullary Nail is a rarely used technique for the reconstruction of intercalary defects of the femur and tibia after radical debridement of chronic osteomyelitic foci. The aim of this study was to summarize our experience with distraction osteogenesis performed with an external fixator combined with an Intramedullary Nail for the treatment of bone defects and limb-shortening resulting from radical debridement of chronic osteomyelitis. METHODS: Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical debridement to treat a nonunion associated with chronic osteomyelitis of the tibia (seven patients) and femur (six patients). The lesions were classified, according to the Cierny-Mader classification system, as type IVA (nine) and type IVB (four). The resulting segmental defects and any limb-length discrepancy were then reconstructed with use of distraction osteogenesis over an Intramedullary Nail. Two patients required a local gastrocnemius flap. Free nonvascularized fibular grafts were added to the distraction site for augmentation of a femoral defect at the time of external fixator removal and locking of the Nail in two patients. At the time of the latest follow-up, functional and radiographic results were evaluated with use of the criteria of Paley et al. RESULTS: The mean size of the defect was 10 cm (range, 6 to 13 cm) in the femur and 7 cm (range, 5 to 10 cm) in the tibia. The mean external fixator index was 13.5 days/cm, the consolidation index was 31.7 days/cm, and the mean time to union at the docking site was nine months (range, five to sixteen months). At a mean follow-up of 47.3 months, eleven of the thirteen patients had an excellent result in terms of both bone and functional assessment. There were two recurrences of infection necessitating Nail removal. These patients underwent revision with an Ilizarov fixator. Subsequently, the infection was controlled and the nonunions healed. CONCLUSIONS: This combined method may prove to be an improvement on the classic techniques for the treatment of a nonunion of a long bone associated with chronic osteomyelitis, in terms of external fixation period and consolidation index. The earlier removal of the external fixator is associated with increased patient comfort, a decreased complication rate, and a convenient and rapid rehabilitation. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail” (2006;88:2137-45).

  • reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an Intramedullary Nail
    Journal of Bone and Joint Surgery American Volume, 2006
    Co-Authors: Mehmet Kocaoglu, Levent Eralp, Haroon Rashid, Kerem Bilsel
    Abstract:

    BACKGROUND: Callus distraction over an Intramedullary Nail is a rarely used technique for the reconstruction of intercalary defects of the femur and tibia after radical debridement of chronic osteomyelitic foci. The aim of this study was to summarize our experience with distraction osteogenesis performed with an external fixator combined with an Intramedullary Nail for the treatment of bone defects and limb-shortening resulting from radical debridement of chronic osteomyelitis. METHODS: Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical debridement to treat a nonunion associated with chronic osteomyelitis of the tibia (seven patients) and femur (six patients). The lesions were classified, according to the Cierny-Mader classification system, as type IVA (nine) and type IVB (four). The resulting segmental defects and any limb-length discrepancy were then reconstructed with use of distraction osteogenesis over an Intramedullary Nail. Two patients required a local gastrocnemius flap. Free nonvascularized fibular grafts were added to the distraction site for augmentation of a femoral defect at the time of external fixator removal and locking of the Nail in two patients. At the time of the latest follow-up, functional and radiographic results were evaluated with use of the criteria of Paley et al. RESULTS: The mean size of the defect was 10 cm (range, 6 to 13 cm) in the femur and 7 cm (range, 5 to 10 cm) in the tibia. The mean external fixator index was 13.5 days/cm, the consolidation index was 31.7 days/cm, and the mean time to union at the docking site was nine months (range, five to sixteen months). At a mean follow-up of 47.3 months, eleven of the thirteen patients had an excellent result in terms of both bone and functional assessment. There were two recurrences of infection necessitating Nail removal. These patients underwent revision with an Ilizarov fixator. Subsequently, the infection was controlled and the nonunions healed. CONCLUSIONS: This combined method may prove to be an improvement on the classic techniques for the treatment of a nonunion of a long bone associated with chronic osteomyelitis, in terms of external fixation period and consolidation index. The earlier removal of the external fixator is associated with increased patient comfort, a decreased complication rate, and a convenient and rapid rehabilitation. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail” (2006;88:[2137-45][1]). [1]: /lookup/volpage/88/2137

  • complications encountered during lengthening over an Intramedullary Nail
    Journal of Bone and Joint Surgery American Volume, 2004
    Co-Authors: Mehmet Kocaoglu, Levent Eralp, Onder Kilicoglu, Halil Burc, Mehmet Cakmak
    Abstract:

    Background: In limb-lengthening, the quest for increased patient comfort and a reduced period of external fixation has led to techniques such as lengthening over an Intramedullary Nail. The goals of this study were to investigate the rate and types of complications encountered during lengthening over an Intramedullary Nail and to identify solutions to these complications. Methods : Forty-two segments (thirty-five femora and seven tibiae) in thirty-five patients were lengthened. The mean age of the patients was 26.6 years, the mean amount lengthened was 6.3 cm (range, 2.5 to 11.5

M. Bielby - One of the best experts on this subject based on the ideXlab platform.

  • recovery of distal hole axis in Intramedullary Nail trajectory planning
    Proceedings of the Institution of Mechanical Engineers Part H: Journal of Engineering in Medicine, 2002
    Co-Authors: Roger W. Phillips, Attayeb Mohsen, W J Viant, J.g. Griffiths, M. Bielby
    Abstract:

    AbstractIn Intramedullary Nail (IMN) surgical operations, one of the main efforts for surgeons is to find the axes of two distal holes. Two distal holes on an IMN, which are inside the Intramedullary canal of a patient's femur, can only be seen in a lateral X-ray view. For the standard surgical procedure, the localization of the distal hole axes is a trial-and-error process which results in a long surgical time and large dose of X-ray exposure. In this paper, an algorithm to derive the three-dimensional position and orientation of the distal hole axis was developed. The algorithm first derives the Nail axis through two X-ray images. Then the distal hole axis is calculated through projecting back the hole boundary on the X-ray image from a lateral view to three-dimensional space. A least-squares method is used to determine the centres of the front hole and the back hole through iteration. The algorithm has been tested with real data and it was robust.

  • recovery of distal hole axis in Intramedullary Nail trajectory planning
    International Conference on Robotics and Automation, 2001
    Co-Authors: Roger W. Phillips, Attayeb Mohsen, W J Viant, J.g. Griffiths, M. Bielby
    Abstract:

    In Intramedullary Nail (IMN) surgical operations, one of the main efforts for surgeons is to find the axes of two distal holes. Two distal holes on an Intramedullary Nail, which are inside the Intramedullary canal of a patient's femur, can only be seen in a lateral X-ray view. For the standard surgical procedure, the localisation of the distal hole axes is a trial-and-error process which results in a long surgical time and large dose of X-ray exposure. In this paper, an algorithm to derive the 3D position and orientation of the distal hole axis was developed. The algorithm first derives the Nail axis through two X-ray images. Then the distal hole axis is calculated through projecting back the hole boundary on the X-ray image from a lateral view to the 3D space. A least squares method is used to determine the centres of the front hole and the back hole through iteration. The algorithm has been tested with real data and it was accurate and robust.

Yingze Zhang - One of the best experts on this subject based on the ideXlab platform.