Computed Tomography-Based Humeral Templating for Uncemented Elbow Arthroplasty.

Abstract

Intramedullary (IM) screw insertion into the distal humerus provides fixation for a novel, uncemented elbow arthroplasty. A multitude of screw sizes is required to accommodate variable humeral morphology. The goal of this study was to use computed tomography (CT) for IM screw sizing and to validate this templating by inserting screws into three-dimensionally (3D) printed models. Computed tomography humerus scans for 30 patients were reformatted in the plane of the distal IM canal. Screw size was templated by measuring the canal diameter at 3 locations corresponding to the lengths of the screws being tested. Interrater and intrarater reliabilities of the measurements were assessed. Three-dimensional models of 5 humeri were printed, and IM screws were placed to achieve a secure endosteal fit. We identified combinations of body components and IM screw length and diameter for all patients to seat this uncemented elbow arthroplasty. The measurements and screw width determinations were reliable. Canal diameter correlated with age but was unrelated to sex. Screws were inserted into five 3D-printed models which matched the templates and demonstrated mechanical and radiographic evidence of secure fit. This study characterizes distal humerus anatomy in the context of IM screw fixation. Humerus CT scans of 30 patients were able to be templated, and validation via implantation of IM screws into 3D models was successful. Computed tomography templating will allow surgeons to predict the optimal screw size prior to implantation. A broad range of screw lengths and diameters is critical for implantation of this novel elbow arthroplasty.