Introduction: It has long been recognized that one of the most difficult steps of intramedullary nailing of femoral shaft fractures is distal locking - the insertion of distal interlocking screws, for which it is necessary to know the positions and orientations of the distal locking holes (DLHs) of the intramedullary nail (IMN). Complicating the process of locating and inserting the distal interlocking screws is the nail deformation with insertion [1]. Therefore, the surgeon depends heavily on intra-operative X-ray means in a conventional surgical procedure for providing precise locations and orientations of the DLHs. The desire to target accurately with as little as possible X-ray exposure has led to various attempts to develop image-based methods for recovering the positions and orientations of DLHs [2][3][4]. In this paper, we present an optimal and robust approach based on two calibrated and registered fluoroscopic images.
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