Finding the canal: A novel technique for identifying and instrumenting ulnar canals during total elbow arthroplasty

Instrumentation of the ulnar canal during primary or revision total elbow arthroplasty can be difficult in cases of deformity, a problem aggravated when utilizing a triceps-on approach. The proximal geometry is complex and may be violated if attention is not paid to the proper orientation of the canal leading to stress risers, fracture, and early implant failure. To avoid these complications, it is necessary to accurately identify the intramedullary canal in a reliable way to avoid eccentric reaming and violation of the ulnar cortex. We recently utilized a novel technique to identify the appropriate entry site for the preparation of the ulna in those with very small medullary canals or distorted proximal ulnar articulations. The initial step utilizes a drill bit through the olecranon and into the ulnar canal. A guidewire is then placed and then excavated using a burr to identify the entry point and orientation of the canal. This technique can be employed to correctly identify the entry point of the canal and avoid perforation of the ulnar cortex and allow for accurate placement of the ulnar component.