a surgical instrument configured to operate on an anatomical structure, wherein the surgical instrument comprises a distal end and a proximal end spaced proximally from the distal end;

an image sensor that is attached to the surgical instrument, wherein the image sensor is configured to detect an orientation of at least one fiducial marker relative to the image sensor, and the image sensor is configured to generate image sensor data that is based on the orientation of the at least one fiducial marker detected by the image sensor, wherein a distalmost portion of the image sensor is disposed closer to the proximal end than the distal end;

a processor;

a memory in communication with the processor, the memory having stored therein instructions that, upon execution of the processor, cause the processor to 1) receive X-ray image data representing the at least one fiducial marker and representation of the anatomical structure and/or an implant, 2) determine, based on the X-ray image data, a trajectory, relative to the at least one fiducial marker and relative to the anatomical structure and/or the implant, wherein the trajectory extends toward the anatomical structure and/or the implant, and 3) determine an orientation of the surgical instrument relative to the trajectory based on the image sensor data; and

a display coupled to the processor wherein the display is configured to display a representation of the orientation of the surgical instrument relative to the trajectory.