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Computer assisted imaging systems are rarely used for fracture treatment and foot surgery. We introduce a new system for image based guidance in traumatology.We included 20 patients with a fracture of the fifth metatarsal. They were randomized on admission into two groups. Ten patients in the metatarsal group were operated conventionally and ten were operated with the assistance of a new image guidance system. This system is based on 2D-fluoro images which are acquired with a conventional c-arm and are transferred to the system workstation. After detecting marked tools, it can be used to display trajectories for K-wire guidance in the c-arm shot.The average duration of surgery in the image-guided group was 12.7 minutes. In the conventional treated group, it was 17 minutes. The average duration of radiation was 18 seconds in the image-guided group vs. 32.4 seconds in the conventional group. 1.6 trials were necessary to position the K-wire for image-guided procedures in comparison to 2.7 trials in the conventional group.Image-based guidance systems can be used for indications, were hitherto existing navigation systems are limited due to their dependence on fixed reference devices. Image-guided systems can be integrated into existing workflows and can reduce the malpositioning of guidewires. Copyright © 2012 John Wiley & Sons, Ltd.