CARD - Computer assisted planning of hemiarthroplasty for complex fractures of the proximal humerus.

The CARD (Computer assisted research and development) team, a team of engineers and orthopaedic surgeons at the Balgrist University hospital, is specialized in computer assisted three-dimensional analysis and correction of complex deformities for several pathological orthopaedic conditions

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Corrective osteotomies of mal-united fractures are among the most demanding orthopedic procedures. Osteotomies are elective procedures scheduled in advance, providing sufficient time for careful diagnosis and operative planning. For this reason, computer-based methods have become very popular to perform complex osteotomies more precisely. However, the quantification of the deformity, the development of feasible surgical procedures as well as the transfer of the preoperative plan to the operating room are still major challenges, requiring sophisticated techniques and profound clinical expertise.

With the aid of the in-house developed software (CASPA) the pathological condition can be analysed in 3D and the surgical procedure with all necessary steps can be simulated preoperatively. The preoperative plan consist of an individual analysis of the deformity and a virtual simulation of different surgical szenarios to figure out the best solution for the individual patient. By means of 3D printer technology patient specific cutting and drill guides can be produces, which are applicable during surgery. Thereby, the preoperative plan can be realized by the orthopaedics surgeons extremely accurate as planned.

  • Goal:
    The aim of this research project is to develop a comprehensive computer-based framework for reconstruction of complex proximal humeral fractures. The project will be carried out in collaboration of the CARD team with the ETH Zurich in the course of the PhD thesis of Dr. Vlachopoulos at the Computer Vision Laboratory at the ETH under supervision of Prof. Szekely.
  • Issues:
    Treatment of comminuted fractures of the proximal humerus is demanding and the oprimal solution remains controversial. In elderly patients and if anatomical reduction of the humeral head cannot be obtained, joint replacemnt is considered as a viable and good solution. However, due to complex anatomy and intraindividual variabilty the surgical procedure is quite challenging.
  • Research:
    Semi-automatic fracture reconstruction algorithms have to be developed and the transfer to the surgery has to be tackled. Further with the obtained knowledge correction of posttraumatic deformities (mal-union after proximal humeral fractures) of the humerus shall be facilitated.
  • Phases:
    For this purpose the following steps have to be tackled/developed: 1. Computer algorithms for the analysis of the humeral anatomy in 3D and quantification of bilateral differences, since the contralateral anatomy is often considered as a reconstruction template 2. Application for preoperative planning of anatomical shoulder replacement and compensation of the bilateral differences 3. Fracture-assembling algorithms for virtual reconstruction of proximal humeral fractures 4. Design of patient specific guides for intraoperative realization
  • Budget:
    The Balgrist Foundation support this Project with an Amount of
  • Progress:

Embedment in Balgrist Research

Accurate analysis of the pathological condition, creation of feasible preoperative plans and precise instruments for the transfer to the surgery are essential to provide the best (surgical) treatment to the patient. The project is imbedded in the enlargement of the research space in close collaboration with the teams of the orthopaedics department of the Balgrist University Hospital, the CARD Team and the Computer Vision Laboratory at the ETH Zurich.

The opportunity for realtime exchance between the highly specialized orthopaedic surgeons and the team of engineers offers the best prerequesits for the ideal combination of clinical and technical expertice for real patient specific orthopaedics. The quantification of the orthopaedic prodecures in terms of accuracy evaluation is thereby a crucial step towards acchieveing the ultimative goal of best treatment of the patients.


In the last years the innovative combination of 3D preoperative plan and 3D printer technology has been adapted for several pathologies and applied for the treatment of more than > 250 complex orthopaedic procedures on almost every anatomy (forearm, humerus, pelvis, femur, tibia, foot, tumor) with promising results at the Balgrist University Hospital. One advantage is that the surgeries are performed more precisely than at the time of freehand procedures. On the other hand the technology even enabled to perform surgeries, which even in the hand of an experienced orthopaedics surgeons would not have been possible before.

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

Dr. med. Lazaros Vlachopoulos received his medical degree in 2004 from the RWTH Aachen, Germany and passed 2011 the swiss board exams in orthopedic surgery. Since January 2013 Dr. Vlachopoulos works as a researcher at the CARD team and pursuses his PhD studies at the Computer Vision Laboratory at ETH Zurich under supervision of Prof. Székely.

Patient benefit

The patients treated with this advanced technology immediately benefit from the individualized and optimal treatment of their pathological condition. The best solution for the individual patient can be figured out and the surgical procedure can be customized to the specific need of each individual patient. In addition the orthopaedic surgeons are able to illustrate the deformity to the patient with the use of 3D visualization more precisely and go through all relevant steps from the preoperative planning, the surgical procedure, the postoperative rehabilitation and the expected final result..

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