Patient-specific Guides Improve the Accuracy and Safety of Transcondylar Screw Placement—A Cadaveric Study in the Canine Humerus

Abstract

Objectives

The goal of this study was to compare the accuracy and safety of a transcondylar screw (TCS) placed using a 3D-printed patient-specific guide (PSG) or a generic aiming device (AD). We hypothesized that PSG is more accurate (i.e., positioning and orientation closer to the optimal trajectory) and safer (reduced incidence of joint violation) than the AD.

Methods

A total of seven pairs of forelimbs were allocated to PSG and AD groups. After CT scanning, the optimal TCS orientation was planned in silico by a surgical specialist, and guides were printed. Using the PSG or AD, a 2.5-mm drill hole was drilled from medial to lateral across the humeral condyle. The positioning of the “planned” and “achieved” drill holes was defined on postoperative CT. The accuracy of TCS positioning and the risk of joint penetration were then calculated for the two groups.

Results

Positioning of the entry and exit holes was significantly more accurate in the PSG group. Differences in screw angulation were not significantly different between groups. Despite the presence of an outlier (caused by incomplete seating of the PSG against the bone), 7 out of 7 screws positioned with PSG were “safe,” while 3 out of 7 from the AD group would have violated the joint.

Conclusion

Our data confirm the technical superiority of PSG over the AD for placement of a TCS in the humeral condyle.

Keywords

computed tomography - surgical accuracy - elbow - dog - humeral intracondylar fissure - patient-specific guide

Authors' Contribution

J.T.K. and M.J.A. were involved in the study design and analysis of data. They performed all procedures together. B.O. designed and produced the guides used in the study and planned all surgeries. All authors contributed to the final manuscript.

Publikationsverlauf

Eingereicht: 24. Juli 2024

Angenommen: 03. Januar 2025

Artikel online veröffentlicht:
11. Februar 2025

• References

• 1 Moores AP. Humeral intracondylar fissure in dogs. Vet Clin North Am Small Anim Pract 2021; 51 (02) 421-437
• 2 Strohmeier UW, Harris KP. Humeral intracondylar fissures in French bulldogs. Vet Rec 2021; 189 (11) e504
• 3 Chase D, Sul R, Solano M, Calvo I, Joslyn S, Farrell M. Short- and long-term outcome after transcondylar screw placement to treat humeral intracondylar fissure in dogs. Vet Surg 2019; 48 (03) 299-308
• 4 Carrera I, Hammond GJC, Sullivan M. Computed tomographic features of incomplete ossification of the canine humeral condyle. Vet Surg 2008; 37 (03) 226-231
• 5 Serrano Crehuet T, de Linares Tuduri P, Biskup J. Biomechanical comparison of humeral condyles with experimental intracondylar fissures immobilized with a transcondylar positional or a lag screw: an ex-vivo study in dogs. Vet Surg 2021; 50 (07) 1443-1448
• 6 Perry KL, Bruce M, Woods S, Davies C, Heaps LA, Arthurs GI. Effect of fixation method on postoperative complication rates after surgical stabilization of lateral humeral condylar fractures in dogs. Vet Surg 2015; 44 (02) 246-255
• 7 McCarthy J, Woods S, Mosley JR. Long-term outcome following management of canine humeral intracondylar fissure using a medial approach and a cannulated drill system. Vet Rec 2020; 186 (15) 490-490
• 8 Hattersley R, McKee M, O'Neill T. et al. Postoperative complications after surgical management of incomplete ossification of the humeral condyle in dogs. Vet Surg 2011; 40 (06) 728-733
• 9 Carwardine D, Mather A, Schofield I. et al. Medial versus lateral transcondylar screw placement for canine humeral intracondylar fissures: a randomized clinical trial. Vet Surg 2024; 53 (02) 264-276
• 10 Potamopoulou M, Brown G, Whitelock R. Correlation between the insertion side of a transcondylar screw for the surgical management of humeral intracondylar fissures in dogs and the incidence of postoperative surgical site infection. Vet Comp Orthop Traumatol 2023; 36 (06) 311-316
• 11 Grand JGR. Percutaneous screw fixation of incomplete ossification of the humeral condyle in three dogs (four elbows). J Am Anim Hosp Assoc 2017; 53 (01) 45-51
• 12 Pardo M, Morris AP, Frazzica F, Barnes DM. Accuracy of medial-to-lateral transcondylar screw placement using an aiming device and preoperative computer tomography planning for the treatment of humeral intracondylar fissure. Vet Surg 2021; 50 (06) 1218-1226
• 13 Carwardine D, Burton NJ, Knowles TG, Barthelemy N, Parsons KJ. Outcomes, complications and risk factors following fluoroscopically guided transcondylar screw placement for humeral intracondylar fissure. J Small Anim Pract 2021; 62 (10) 895-902
• 14 Carwardine DR, Gosling MJ, Burton NJ, O'Malley FL, Parsons KJ. Three-dimensional-printed patient-specific osteotomy guides, repositioning guides and titanium plates for acute correction of antebrachial limb deformities in dogs. Vet Comp Orthop Traumatol 2021; 34 (01) 43-52
• 15 Townsend A, Guevar J, Oxley B, Hetzel S, Bleedorn J. Comparison of three-dimensional printed patient-specific guides versus freehand approach for radial osteotomies in normal dogs: ex vivo model. Vet Surg 2024; 53 (02) 234-242
• 16 Roh YH, Cho CW, Ryu CH, Lee JH, Jeong SM, Lee HB. Comparison between novice and experienced surgeons performing corrective osteotomy with patient-specific guides in dogs based on resulting position accuracy. Vet Sci 2021; 8 (03) 40
• 17 Yu Y, Kang J, Kim N, Heo S. Accuracy of a patient-specific 3D-printed drill guide for placement of bicortical screws in atlantoaxial ventral stabilization in dogs. PLoS One 2022; 17 (08) e0272336
• 18 Easter TG, Bilmont A, Pink J, Oxley B. Accuracy of three-dimensional printed patient-specific drill guides for treatment of canine humeral intracondylar fissure. Vet Surg 2020; 49 (02) 363-372
• 19 Barnes DM, Morris AP, Anderson AA. Defining a safe corridor for transcondylar screw insertion across the canine humeral condyle: a comparison of medial and lateral surgical approaches. Vet Surg 2014; 43 (08) 1020-1031
• 20 Walton MB, Crystal E, Morrison S. et al. A humeral intracondylar repair system for the management of humeral intracondylar fissure and humeral condylar fracture. J Small Anim Pract 2020; 61 (12) 757-765