Optimizing the 3D Plate Shape for Proximal Humerus Fractures

Marilyn Keller, Marcell Krall, James Smith, Hans Clement, Alexander M. Kerner,
Andreas Gradischar, Ute Schäfer, Michael J. Black, Annelie Weinberg, Sergi Pujades 

MICCAI 2023
[Paper] [Supplementary] [Poster]
[Code]

Abstract

To treat bone fractures, implant manufacturers produce 2D anatomically contoured plates. Unfortunately, existing plates only fit a limited segment of the population and/or require manual bending during surgery. Patient-specific implants would provide major benefits such as reducing surgery time and improving treatment outcomes but they are still rare in clinical practice.

In this work, we propose a patient-specific design for the long helical 2D PHILOS (Proximal Humeral Internal Locking System) plate, used to treat humerus shaft fractures. Our method automatically creates a custom plate from a CT scan of a patient's bone. We start by designing an optimal plate on a template bone and, with an anatomy-aware registration method, we transfer this optimal design to any bone. In addition, for an arbitrary bone, our method assesses if a given plate is fit for surgery by automatically positioning it on the bone. We use this process to generate a compact set of plate shapes capable of fitting the bones within a given population.

This plate set can be pre-printed in advance and readily available, removing the fabrication time between the fracture occurrence and the surgery. Extensive experiments on ex-vivo arms and 3D-printed bones show that the generated plate shapes (personalized and plate-set) faithfully match the individual bone anatomy and are suitable for clinical practice.

Acknowledgments

This work was supported by the project CAMed (COMET K- Project 871132) which is funded by the Austrian Federal Ministry of Transport, Innovation and Technology (BMVIT) and the Austrian Federal Ministry for Digital and Economic Affairs (BMDW) and the Styrian Business Promotion Agency (SFG). Michael J. Black (MJB) has received research gift funds from Adobe, Intel, Nvidia, Meta/Facebook, and Amazon. MJB has financial interests in Amazon, Datagen Technologies, and Meshcapade GmbH. MJB’s research was performed solely at MPI. The authors thank the International Max Planck Research School for Intelligent Systems for supporting Marilyn Keller. Sergi Pujades' work was funded by the ANR SEMBA project. For the scanned humerus dataset, we acknowledge Dr. Brian Corner, Dr. Jeff Hudson who did the scanning, and the Cleveland Museum of Natural History Physical Anthropology Dept for access to the Hamann-Todd human skeletal collection. We also thank Anja Gieringer for the bone CT scans and Karoline Seibert at Hofer GmbH & Co KG, Fürstenfeld, Austria for the 3D printing of bones and plates.

Citation

@inproceedings{Keller:humerusplate:2023,
  title = {Optimizing the {3D} Plate Shape for Proximal Humerus Fractures},
  author = {Keller, Marilyn and Krall, Marcell and Smith, James and Clement, Hans and Kerner, Alexander M. 
            and Gradischar, Andreas and Sch{\"a}fer, Ute and Black, Michael J and Weinberg, Annelie and Pujades, Sergi},
  booktitle = {International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI)},
  pages = {487--496},
  month = oct,
  year = {2023},
}