ArticleJSES reviews, reports, and techniques2026
A novel radiological classification of the distal humerus: morphometric analysis across two European populations.
Article in JSES reviews, reports, and techniques, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Total elbow arthroplasty (TEA) utilization is projected to increase substantially, with revision TEA expected to outnumber primary procedures by 2050. Aseptic loosening remains the most common indication for TEA revision. This study aimed to develop and validate a novel morphometric classification system for the distal humerus to optimize pre-operative planning and implant selection. Methods: A retrospective analysis of 300 anteroposterior elbow radiographs from patients in Spain (n = 138) and Germany (n = 162) was conducted. The morphometric index was calculated as the ratio of medullary canal widths at 120 mm and 35 mm from the lateral epicondyle. Methodology follows the validated percentile-based approach introduced by Citak et al, adapted here to the context of distal humeral morphology. Percentile-based classification thresholds were established: type A (≤25th percentile, ≤0.239), type B (25th-75th percentile, 0.239-0.336), and type C (>75th percentile, >0.336). Interobserver and intraobserver reliability were assessed. Statistical analyses included analysis of variance (ANOVA), Results: The morphometric index ranged from 0.134 to 0.523 (mean 0.29 ± 0.07). Classification yielded type A: 75 cases (25%), type B: 150 cases (50%), and type C: 75 cases (25%). Interobserver reliability was excellent (r = 0.873, Conclusion: This novel morphometric classification system demonstrates excellent reliability and reveals significant population-based and sex-related variations in distal humeral anatomy. These findings support the clinical relevance of population-specific morphometric considerations in TEA planning and implant design.
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