Abstract
Anterior to posterior (AP) pinning is the recommended sagittal pin configuration in divergent lateral entry coronal pinning of pediatrics supracondylar fractures. However, there was still a lack of evidence regarding alternative sagittal pins configurations. We aimed to compare the construct stiffness of alternative sagittal pin configurations by using synthetic bone models. Sixty synthetic pediatric humeri were osteotomized to create a supracondylar fracture. After the fracture reduction, all specimens were fixed in the coronal plane with divergent lateral entry pin configurations in four different patterns in the sagittal plane: AP, crossed, divergent and parallel sagittal pin configuration. Each configuration was tested with five loading patterns. The AP sagittal pin had significantly lower construct stiffness than the divergent (p = 0.003) and the parallel sagittal pin configuration (p = 0.005) in external rotation loading tests. The divergent sagittal pin had the highest construct stiffness in extension, valgus, and external rotation loads, but the parallel sagittal pin had lower construct stiffness under extension load than the divergent and crossed sagittal pin configurations. The divergent sagittal pin configuration provides greater construct stiffness than other sagittal pin configurations due to the maximal pin spreading distance at the fracture site and the pin angle lock mechanism.
Highlights
Supracondylar fractures of the distal humerus are the most common fractures in children, with the peak incidence at age 4–7 years [1]
We considered two pins with divergent lateral entry to be the most appropriate configuration in the coronal plane because the crossed medial-lateral pin configuration is associated with a higher risk of iatrogenic ulnar nerve injury [6,7,9,21,23]
Four different pin configurations were chosen for study: the Anterior to posterior (AP) sagittal pin configuration [2,3,1,2,3], the crossed sagittal pin configuration [2,3,4,], the divergent sagittal pin configuration [3,], and parallel sagittal pin configuration [3,2]
Summary
Supracondylar fractures of the distal humerus are the most common fractures in children, with the peak incidence at age 4–7 years [1]. Many treatment methods have been described, e.g., closed reduction with a long-arm cast, skin traction, axial skeletal traction, and flexible nailing. In the 1940s, publication on closed reduction and percutaneous pinning [2] described the currently preferred surgical treatment for displaced supracondylar fractures [3,4,5,6]. The crossed medial-lateral and lateral entry pin configuration in the coronal plane have been favored as an effective pinning technique [7,8,9,10,11,12,13,14]. We considered two pins with divergent lateral entry to be the most appropriate configuration in the coronal plane because the crossed medial-lateral pin configuration is associated with a higher risk of iatrogenic ulnar nerve injury [6,7,9,21,23]
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