Image guidance: fluoroscopic navigation.

Computer-assisted orthopaedic surgery slowly is making its way into routine orthopaedic practice. Orthopaedic trauma has long been identified as a potential impact area of this new technology. Early experience with three-dimensional (3D) image-guided surgery was promising, but this particular technique was limited by the inability to update the 3D computer model in the operating room after fracture reduction maneuvers or implant placement. Virtual fluoroscopy, or fluoroscopic navigation, became available in 1999 and has proven to be a more versatile technology for fracture treatment. Fluoroscopic navigation systems allow the surgeon to store multiple intraoperative fluoroscopic images on a computer workstation; the position of special optically-tracked surgical instruments or implants then may be virtually overlaid onto the stored images in multiple planes during implant placement. The ability to update images after fracture manipulation now has expanded the application of computer-assisted surgery to any procedures that traditionally have relied on intraoperative C-arm use. In selected applications, this technology has been shown to decrease operative time and intraoperative radiation exposure. The advantages of the new technique of fluoroscopic navigation and its current use in trauma applications will be discussed.