Integration of the Interosseous Membrane into 3D Preoperative Planning of Forearm Osteotomies

The project aims to improve the quality of the 3D preperative planning of the forearm and to reduce possible residual limitation of the range of motion (ROM) in the postoperative situation, by analysing biomechanical information of the interosseous membrane (IOS) and translating it into patient specific operation planning. We expect that the project could add to the cutting edge research approaches employed by Balgrist CARD in the field of forearm osteotomies, by which patients could benefit from an improvement of their health and life quality.

Grant Application

Grant Application Tool access

The project is conceived as a multidisciplinary framework which collects and foresees the collaboration among 3 groups:

• Computer-Assisted Research & Development (CARD) - as executor of the project
• Laboratory for Orthopedic Biomechamics (Prof. Snedeker)
• Hand Surgery Team of the University Hospital Balgrist

The graphic depicts the multidisciplinary framework of the project.

IOM Biomechanical Simulation

The IOM Biomechanical Simulation will be developed based on the muscle simulation obtained from the HSM project, and generated on the basis of a simplified biomechanical model. The biomechnaical model will be constructed from patient specific bone motion data and static information of the IOM in a neutral position. The model will be integrated into the automatic planning framework later using patient specific information. This part of the project will performed together with the Laboratory for Orthopedic Biomechanics.

Clinical Project

In order to be able to map the constructed biomechanical model to the patient specific 3D bone information of the automatic planning a clinical project has been planned. The project is planned for manually extracting the information of bony landmarks and insertion points of the IOM along both the radius and ulna bones using CT and MRI data of healthy and and pathological forearms. After obtaining the annotation the effects of different malunions on the (stress) of the IOM will be analysed. In the next step a classification schema will be defined, identifying cases in which the ligament extension do and do not have an influence in the range of motion. This part of the project will be performed by a medical student or assistant doctor under the supervision of the CARD team and the Hand Surgery Team.

Automatic Planning Framework

Once the mapping information has been obtained the developed biomechanical model of the IOM is to be included in an existing automatic planning framework. The framework uses bone models of a patient for automatically generating a 3D corrective osteotomy planning including the osteotomy plane(s), the required reduction and the implant and screw positions. The integration of the IOM into the optimisation process of the automatic planning requires the development of new objectives and nonlinear constraints including the deformation, strength and lengthening of the IOM.

Outcome

The expected outcome of the project is an automatic framework for 3D planning of forearm osteotomies that takes into account not only the pathology of the bones but also the influence of the IOM. By doing so we can

1. Predict abnormal behavior of the IOM that could endanger the desired correction of the osteotomy procedure
2. Investigate whether the IOM have a constraining role on the proposed optimal correction
3. Predict the necessary release on th eIOM structure to achieve the expected correction

     
  • Goal:
    The project aims to improve the quality of the 3D preoperative planning of the forearm and to reduce possible residual limitation of the range of motion (ROM) in the postoperative situation.
  • Issues:
    Post-traumatic bone malunion can result in a limitation of the ROM, cause severe pain and generate functional disability.
  • Research:
    The project is a mulidiscplibary framework with 3 parts: 1. IOM Biomechanical Simulation 2. Clinical Project 3. Automatic Planning Framework
  • Phases:
    The project is split into 5 milestones: 1. Construction of the IOM model 2. Clinical project 3. Semi-automatic mapping of the IOM model to patient specific data 4. Integration of the IOM model into automatic planning 5. evaluation of the automatic planning with the integrated IOM
  • Budget:
    The Balgrist Foundation will support the project by funding the required PHD student for 1.25 years.
  • Progress:

Embedment in Balgrist research

Translation of biomechanical knowledge into the operation room is often challenging. The collaboration between the CARD team and the Laboratory of Orthopedic Biomechanics is essential to help on the fusion between biomechanical research and clinical practice about patient specific deformity between groups and to encourage easier translations from the technical field to clinical applications.

Innovation

Currently, CARD osteotomy planning can be successfully applied only to a subset of the patients because the computer assisted tools are lacking the support of simulation soft tissue structures. By offering novel computer-assisted methods resulting from this project, we expect to improve diagnosis, preoperative planning and ultimately the surgical outcome of patients with forearm pathologies.

Dr. Philipp Fürnstahl received his PhD from ETH Zurich in 2010 after working nearly four years in the field of Computer Assisted Orthopedic Surgery Planning. Thereafter, he worked in the software industry (Siemens Schweiz) as a team and project leader. Dr. Fürnstahl started leading the CARD team at the University Clinic Balgrist in June 2012.

Prof. Dr. Jess Snedeker is Extraordinarius for Orthopedic Biomechanics at the University Zürich (University Clinic Balgrist, Laboratory for Orthopedic Biomechanics) and at the Eidgenössischen Technischen Hochschule Zürich (ETHZ, Institute for Biomechanics). He has headed the research laboratory for orthopedic biomechanics since 2006.

Apart from its fundamental research on the interaction between cells and biomaterial the laboratory of Prof. Snedecker has successfully investigated clinical challenges posed by orthopedics of the shoulder, knee, hand and foot in close cooperation with leading orthopedic surgeons at the University Clinic Balgrist.

Patient benefit

We expect that more accurate and more specific surgery planning of the forearm can be done, helping to shorten treatment, care time for patients, improve their health and life and quality. An additional benefit will be the subsequent lowering of the associated treatment costs for patients and care providers.