Modified pin and plate fixation for low intercondylar fractures of the humerus: biomechanical study corroborated with a case series

Jitprapaikulsarn, Surasak; Chantarapanich, Nattapon; Gromprasit, Arthit; Mahaisavariya, Chantas; Patamamongkonchai, Chawanan

doi:10.1007/s12306-022-00743-0

Cited by 4 publications

(4 citation statements)

References 33 publications

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“…This technic has shown promising clinical results and stability especially in the fixation of very distal humerus fractures 20 . Furthermore, previous FE studies have found different variations of the method to have comparable stability and stiffness to those of the conventional methods of fixation 23 . Being a newly proposed method on one hand and considering the observed clinical results on the other, it is necessary to identify key biomechanical aspects of the method to better interpret and ascertain the observed outcomes and their relation to the exact arrangement of the fixation elements.…”

Section: Discussionmentioning

confidence: 95%

“…Hakiminejad et al 22 modeled different configurations of K-wire number, diameter, and plate position to analyze their effects on fixation stiffness. Another FE study by Jitprapaikulsarn and others found their tested variation of the method to have overall comparable stability to the conventional methods except in internal rotation loading 23 . Both studies validated their models against experimental data and established criteria for judging fixation construct rigidity and reliability.…”

Section: Introductionmentioning

confidence: 94%

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Cadaveric biomechanical assessment of different configurations for a novel pin and plate fixation method in distal humerus fractures

Same,

Hakiminejad,

Nourani

et al. 2024

Sci Rep

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Use of dual pre-contoured plates has been accepted as the treatment of choice in distal humerus fractures despite challenges especially in very distal or highly fragmented fractures. Aiming to improve results in such instances, our newly proposed method uses several K-wires fixated by a small reconstruction plate. Drawing on the results of previous finite element studies, the current study aims to compare the stiffness of three clinically common variations of this method using biomechanical testing in cadaveric humeri. 24 samples were divided into three groups and fractures were simulated. Groups I and II used 1.5 mm K-wires in differing configurations while 2 mm wires were used in group III. All samples underwent compression, anterior and posterior bending, and torsional testing as well as failure testing. Our results indicated that Group III had significantly higher stiffness in flexion, extension, and torsion (p < 0.05). In failure, group III had the highest mean stiffness in anterior bending and torsion (861.2 N, 30.9 Nm). Based on previous and current results, this new Persian fixation method, especially when implemented using 2 mm K-wires, shows promise in achieving suitable stability and may be useful as an alternative approach in complex distal humerus fractures.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 94%

Cadaveric biomechanical assessment of different configurations for a novel pin and plate fixation method in distal humerus fractures

Same,

Hakiminejad,

Nourani

et al. 2024

Sci Rep

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“…Double plating of IAFs using only fixed-angle transverse screws generated lower plate stress and less fracture motion but more bone stress for most loading modes versus double plating that used variable-angle screws on the lateral side [ 39 ]. This conflicts with another study on double plating of IAFs, which demonstrated that fixed-angle transverse screws produced lower axial stiffness and strength when using parallel plates, but the trend was reversed for perpendicular plates [ 51 ].…”

Section: Resultsmentioning

confidence: 99%

Biomechanical Design Optimization of Distal Humerus Fracture Plates: A Review

Zdero,

Brzozowski,

Schemitsch

2024

BioMed Research International

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The goal of this article was to review studies on distal humerus fracture plates (DHFPs) to understand the biomechanical influence of systematically changing the plate or screw variables. The problem is that DHFPs are commonly used surgically, although complications can still occur, and it is unclear if implant configurations are always optimized using biomechanical criteria. A systematic search of the PubMed database was conducted to identify English‐language biomechanical optimization studies of DHFPs that parametrically altered plate and/or screw variables to analyze their influence on engineering performance. Intraarticular and extraarticular fracture (EAF) data were separated and organized under commonly used biomechanical outcome metrics. The results identified 52 eligible DHFP studies, which evaluated various plate and screw variables. The most common plate variables evaluated were geometry, hole type, number, and position. Fewer studies assessed screw variables, with number and angle being the most common. However, no studies examined nonmetallic materials for plates or screws, which may be of interest in future research. Also, articles used various combinations of biomechanical outcome metrics, such as interfragmentary fracture motion, bone, plate, or screw stress, number of loading cycles to failure, and overall stiffness (Os) or failure strength (Fs). However, no study evaluated the bone stress under the plate to examine bone “stress shielding,” which may impact bone health clinically. Surgeons treating intraarticular and extraarticular distal humerus fractures should seriously consider two precontoured, long, thick, locked, and parallel plates that are secured by long, thick, and plate‐to‐plate screws that are located at staggered levels along the proximal parts of the plates, as well as an extra transfracture plate screw. Also, research engineers could improve new studies by perusing recommendations in future work (e.g., studying alternative nonmetallic materials or “stress shielding”), clinical ramifications (e.g., benefits of locked plates), and study quality (e.g., experimental validation of computational studies).

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“…This study aimed to investigate biomechanical properties of different implant structures and configurations of the Persian fixation method under two different loading conditions. To date, a few studies [ 30 ] have been carried out to analyze biomechanical behavior of the pin and plate fixation method. This analysis inspects the biomechanical response of the Delta and L technique of this novel method in Y shape intra-articular fracture of distal humerus under pure compressive and anterior bending loads.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical analysis of different osteosynthesis configurations in the pin and plate fixation method for distal humerus fractures

Hakiminejad

Nourani

Ghias

et al. 2023

BMC Musculoskelet Disord

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Distal humerus fractures commonly occur in adults with low bone mineral density causing major technical challenges for orthopedic surgeons. Persian fixation method was introduced as a novel technique to stabilize small fragments in comminuted distal humerus fractures using a set of K-wires and a reconstruction plate. The present study aims to measure this technique's stiffness and stability of this technique and analyze the effect of influential parameters with numerical simulation and biomechanical testing on a cadaveric specimen. Validation of the finite element (FE) model was conducted based on results of experiments. The results indicated that Delta configuration mainly led to a higher stiffness in the case of axial loading and anterior bending compared to L configuration. Analyzing the influential factors of this technique suggests that changes in diameter and number of K-wires have a similarly significant effect on the construct stiffness while the height of plate had a slight influence. Also, the diameter of wires was the most effective parameter for implant failure, particularly in the 3-pin construct, which caused a reduction in failure risk by about 60%. The results revealed that the Persian fixation method would achieve suitable stability compared to the dual-plating technique.

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Modified pin and plate fixation for low intercondylar fractures of the humerus: biomechanical study corroborated with a case series

Cited by 4 publications

References 33 publications

Cadaveric biomechanical assessment of different configurations for a novel pin and plate fixation method in distal humerus fractures

Cadaveric biomechanical assessment of different configurations for a novel pin and plate fixation method in distal humerus fractures

Biomechanical Design Optimization of Distal Humerus Fracture Plates: A Review

Biomechanical analysis of different osteosynthesis configurations in the pin and plate fixation method for distal humerus fractures

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