StraightTrack: Towards mixed reality navigation system for percutaneous K-wire insertion

In percutaneous pelvic trauma surgery, accurate placement of Kirschner wires (K-wires) is crucial to ensure effective fracture fixation and avoid complications due to breaching the cortical bone along an unsuitable trajectory. Surgical navigation via mixed reality (MR) can help achieve precise wire placement in a low-profile form factor. Current approaches in this domain are as yet unsuitable for real-world deployment because they fall short of guaranteeing accurate visual feedback due to uncontrolled bending of the wire. To ensure accurate feedback, StraightTrack, an MR navigation system designed for percutaneous wire placement in complex anatomy, is introduced. StraightTrack features a marker body equipped with a rigid access cannula that mitigates wire bending due to interactions with soft tissue and a covered bony surface. Integrated with an optical see-through head-mounted display capable of tracking the cannula body, StraightTrack offers real-time 3D visualization and guidance without external trackers, which are prone to losing line-of-sight. In phantom experiments with two experienced orthopedic surgeons, StraightTrack improves wire placement accuracy, achieving the ideal trajectory within $5.26\pm 2.29$  mm and $2.88\pm 1.49$${}^{\circ }$, compared to over 12.08  mm and 4.07${}^{\circ }$ for comparable methods. As MR navigation systems continue to mature, StraightTrack realizes their potential for internal fracture fixation and other percutaneous orthopedic procedures.