A comparative biomechanical study on different fixation techniques in the management of transverse metaphyseal-diaphyseal junction fractures of the distal humerus in children

Kamara, Allieu; Ji, Xianglu; Liu, Tianjing; Zhan, Yu; Li, Jianjun; Wang, Enbo

doi:10.1007/s00264-018-3968-x

Cited by 20 publications

(21 citation statements)

References 22 publications

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“…Pins that crossed within the MDJ region would have their centre of rotation brought closer to the fracture line, also making them less stable. Similar observation was made with cross pins in a previous biomechanical study conducted with composite bones using varying fracture heights of metaphyseal-diaphyseal fracture of the humerus [21].…”

Section: Discussionsupporting

confidence: 83%

The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model

Kamara

Liu

et al. 2020

Preprint

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Background: This study aimed at finding out the effect of exit height of pins, pin trajectory and pin number on the stability of cross and lateral pinning configurations used in the fixation of extension-type supracondylar humerus fracture (SHF) in children, through finite element analysis of a novel pediatric humerus bone model. Methods: Distal humerus model consisting of the ossific nucleus of the capitellum (ONC) and distal cartilage of a 6-year-old boy was developed via three-dimensional finite modeling. Various cross and lateral pinning fixation models with either two or three pins were simulated on an extension-type, transverse SHF and tested in six loading directions. Results: Two-cross pins and 2-lateral pins were respectively more stable in rotation and compression loadings, while 3-cross pins were the most stable in all loading directions. The cross pins exiting at the upper border of the distal metaphyseal-diaphyseal junction (MDJ) had the best stiffness among the 2-cross pins, while the lateral pins with a mid-ONC distal pin provided the best stiffness among the 2-lateral pins. A third pin however, going through the olecranon fossa led to improved stability of the 2-lateral pins in flexion, extension, internal and external rotations. Conclusion: In the fixation of extension-type, transverse supracondylar humerus fractures, 2-cross pins are only superior to 2-divergent lateral pins in rotational loadings. Two-cross pins exiting at the upper border of the MDJ provides the best stability, whereas 2-lateral pins with a distal pin going through the middle third of the ONC provides the best stability against compression forces for these fractures. Three-cross pins however offer the best stability against both compression and rotation forces. This study offers important clues in the preoperative evaluation and management of extension-type supracondylar fractures in children.

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Section: Discussionsupporting

confidence: 83%

The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model

Kamara

Liu

et al. 2020

Preprint

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“…In a previous biomechanical study conducted with composite bone models [12], K-wires were found to be superior to both ESIN and EF in stabilizing transverse fractures that are located in the lower MDJ region. Other fracture patterns such as fractures with coronal obliquity were however not investigated in that study.…”

Section: Discussionmentioning

confidence: 84%

“…This reconstructed surface humerus model was then imported into SolidWorks 2016 edition (Dassautt Systemes-Simula, France) in international graphic interactive standard (IGES) format, for solid model generation and fracture and fixation simulations. Before fracture simulation, the distal MDJ region was determined as previously described [7,12]. Three different distal humerus MDJ fracture patterns including transverse, medial oblique, and lateral oblique fractures were simulated in the coronal plane.…”

Section: Fracture and Fixation Simulationsmentioning

confidence: 99%

“…The medial oblique fracture started at the lateral edge above the olecranon fossa and exited proximally medially, while the lateral oblique fracture started at the medial edge above the olecranon fossa and exited proximally laterally. The fractures were then fixated with K-wires, lateral external fixation system (EF), and elastic stable intramedullary nails (ESIN) as previously described [8,12]. All K-wires had a diameter of 2.0 mm.…”

Section: Fracture and Fixation Simulationsmentioning

confidence: 99%

“…In a previous biomechanical study, we compared the stability of Kirschner wires (K-wires), ESIN and EF in various heights distal humerus MDJ fractures using composite bone models [12]. Fractures located in the upper half of the distal MDJ region were found to be more stable with ESIN, while fractures located in the lower half were more stable with K-wires.…”

Section: Introductionmentioning

confidence: 99%

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Mechanical stability study of three techniques used in the fixation of transverse and oblique metaphyseal-diaphyseal junction fractures of the distal humerus in children: a finite element analysis

et al. 2020

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Background: Management of distal humerus metaphyseal-diaphyseal junction (MDJ) region fractures can be very challenging mainly because of the higher location and characteristics of the fracture lines. Loss of reduction is relatively higher in MDJ fractures treated with classical supracondylar humerus fractures (SHFs) fixation techniques. Methods: Three different fracture patterns including transverse, medial oblique and lateral oblique fractures were computationally simulated in the coronal plane in the distal MDJ region of a pediatric humerus and fixated with Kirschner Wires (K-wires), elastic stable intramedullary nails (ESIN), and lateral external fixation system (EF). Stiffness values in flexion, extension, valgus, varus, internal, and external rotations for each fixation technique were calculated. Results: In the transverse fracture model, 3C (1-medial, 2-lateral K-wires) had the best stiffness in flexion, varus, internal, and external rotations, while 3L (3-divergent lateral K-wires) was the most stable in extension and valgus. In the medial oblique fracture model, EF had the best stiffness in flexion, extension, valgus, and varus loadings, while the best stiffness in internal and external rotations was generated by 3MC (2-medial, 1-lateral K-wires). In the lateral oblique fracture model, 3C (1-medial, 2-lateral K-wires) had the best stiffness in flexion and internal and external rotations, while ESIN had the best stiffness in extension and valgus and varus loadings. Conclusion: The best stability against translational forces in lateral oblique, medial oblique, and transverse MDJ fractures would be provided by ESIN, EF, and K-wires, respectively. K-wires are however superior to both ESIN and EF in stabilizing all three fracture types against torsional forces, with both 2-crossed and 3-crossed K-wires having comparable stability. Depending on the fracture pattern, a 3-crossed configuration with either 2-divergent lateral and 1-medial K-wires or 2-medial and 1-lateral K-wires may offer the best stability.

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Technik und Biomechanik der Bohr-Draht(Kirschner-Draht)-Osteosynthese bei Kindern

Slongo

2020

Oper Orthop Traumatol

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Zusammenfassung Operationsziel Sichere und stabile Fixierung metaphysärer sowie epiphysärer Frakturen (Salter-Harris I–IV) mittels korrekter Bohrdraht(Kirschner[K]-Draht)-Osteosynthese, in der Folge als K‑Draht-Osteosynthese (OS) bezeichnet. Indikationen Gemäß der AO(Arbeitsgemeinschaft für Osteosynthesefragen)-Kinderklassifikation der langen Röhrenknochen (AO Pediatric Comprehensive Classification of Long-Bone Fractures [PCCF]) alle Salter-Harris- und metaphysären Frakturen sowie Frakturen des Fuß- und Handskelettes, unabhängig von der Repositionsart, geschlossen oder offen, sofern eine Adaptationsosteosynthese eine hinreichende Stabilität zulässt. Eine K‑Draht-OS erfordert immer eine zusätzliche Fixierung/Ruhigstellung in einem Gipsverband. Kontraindikationen Alle diaphysären Frakturen, sofern ein K‑Draht nicht im Sinne der Markraumschienung verwendet wird. Nicht korrekt reponierte respektive nicht reponierbare Frakturen. Operationstechnik Nach geschlossener oder offener, möglichst anatomischer Reposition werden unter Durchleuchtungskontrolle 1, 2, gelegentlich 3 K-Drähte pro Fragment eingebracht. Wichtig ist dabei, dass die K‑Drähte das zu fixierende Fragment sowie das Hauptfragment (Metaphyse) optimal fassen. Es muss daher möglich sein, mit dem Durchleuchtungsgerät eine streng seitliche sowie korrekte anteroposteriore Aufnahme machen zu können. Dabei ist darauf zu achten, dass man das Gerät in die entsprechende Ebene schwenken kann. Ein Drehen der Extremität sollte auf ein Minimum beschränkt werden. Durch eine zusätzliche Manipulation zwecks Durchleuchtung könnten die zuvor optimal reponierten Fragmente erneut dislozieren. Dies wiederum kann zu einer schlechten K‑Draht-Fixierung führen. Je nach Morphologie der Fraktur, Größe der Fragmente und Lokalisation der Fraktur (Humerus, Unterarm, Femur oder Tibia, Hand oder Fuß) muss die K‑Draht-Technik angepasst werden. Diese kann sein: monolateral gekreuzt, monolateral divergierend auf- oder absteigend oder die häufigste angewendete aufsteigend gekreuzte Technik. Die K‑Drähte werden in der Regel über Hautniveau belassen und umgebogen. Somit können sie ohne erneute Narkose in der Ambulanz entfernt werden. Man muss sich bewusst sein, dass der K‑Draht weder eine Kompressions- noch eine Neutralisations-OS ist, sondern immer nur eine Adaptation. Daher braucht eine K‑Draht-OS immer eine zusätzliche Ruhigstellung mittels Gips oder konfektionierter Schiene. Weiterbehandlung Ruhigstellung im Gipsverband für 4 bis 5 Wochen abhängig vom Alter. Ergebnisse Bei technisch optimal durchgeführter Fixation und korrekter Indikation für eine K‑Draht-OS sowie adäquater Nachbehandlung sind die Ergebnisse sehr gut bis gut.

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A comparative biomechanical study on different fixation techniques in the management of transverse metaphyseal-diaphyseal junction fractures of the distal humerus in children

Cited by 20 publications

References 22 publications

The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model

The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model

Mechanical stability study of three techniques used in the fixation of transverse and oblique metaphyseal-diaphyseal junction fractures of the distal humerus in children: a finite element analysis

Technik und Biomechanik der Bohr-Draht(Kirschner-Draht)-Osteosynthese bei Kindern

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