Comparative analysis of accuracy and safety in guided versus freehand lateral-to-medial humeral transcondylar drilling.

Experienced surgeons can safely perform freehand humeral transcondylar drilling using anatomical landmarks.

This ex vivo study compared four humeral transcondylar drilling techniques in 48 canine cadavers (96 elbows) to evaluate accuracy and safety. Techniques evaluated included universal aiming device (UAD), fluoroscopy-assisted drilling (FAD), 3D-printed patient-specific drill guides (3D-PDG), and freehand drilling (FHD) performed by board-certified surgeons. All drilled tunnels were compared to an optimal drilling axis using CT imaging. Results demonstrated that freehand drilling was the fastest technique with zero joint infringement, outperforming all guided methods. UAD had the highest complication rate (26.1% joint infringement), followed by 3D-PDG (21.7%) and FAD (4.2%). Most complications resulted from excessive craniocaudal or proximodistal angulation exceeding 10 degrees. The study concluded that experienced surgeons can reliably perform freehand humeral condylar drilling using anatomical landmarks with satisfactory accuracy and safety. However, guided techniques require design modifications, enhanced surgeon training, and operator experience to improve outcomes and reduce joint infringement.

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