FRACAS: A system for computer-aided image-guided long bone fracture surgery

Leo Joskowicz*, Charles Milgrom, Ariel Simkin, Lana Tockus, Ziv Yaniv

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

166 Scopus citations


This article describes FRACAS, a computer-integrated orthopedic system for assisting surgeons in performing closed medullary nailing of long bone fractures. FRACAS's goal is to reduce the surgeon's cumulative exposure to radiation and surgical complications associated with alignment and positioning errors of bone fragments, nail insertion, and distal screw locking. It replaces uncorrelated, static fluoroscopic images with a virtual reality display of three-dimensional bone models created from preoperative computed tomography and tracked intraoperatively in real time. Fluoroscopic images are used to register the bone models to the intraoperative situation and to verify that the registration is maintained. This article describes the system concept, software prototypes of preoperative modules (modeling, nail selection, and visualization), intraoperative modules (fluoroscopic image processing and tracking), and preliminary in vitro experimental results to date. Our experiments suggest that the modeling, nail selection, and visualization modules yield adequate results and that fluoroscopic image processing with submillimetric accuracy is practically feasible on clinical images.

Original languageAmerican English
Pages (from-to)271-288
Number of pages18
JournalComputer Aided Surgery
Issue number6
StatePublished - 1998

Bibliographical note

Funding Information:
Leo Joskowicz was supported by a Guastalla Faculty Fellowship and a grant from the Israel Ministry of Industry and Trade-IZMEL Consortium on Image-Guided Therapy, and, together with Charles Milgrom, by Equipment Grant 906 1/98 from the Israel Academy of Sciences and Humanities. Lana Tockus was supported by a Silicon Graphics Biomedical (now Biomedicom) grant. The authors also acknowledge the contribution of students Ofri Sa-dowski and Guy Leshem, who recently joined the project.


  • Computer-aided orthopedic surgery
  • Fluoroscopic image processing
  • Long bone fracture reduction
  • Trauma


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