Abstract
BackgroundManagement 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.MethodsThree 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.ResultsIn 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.ConclusionThe 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.
Highlights
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
In the transverse fracture model, the Three-crossed pins (3C) (1-medial, 2lateral Kirschner Wires (K-wires)) configuration had the best stiffness in flexion, varus, internal, and external rotations, while the 3divergent lateral K-wires (3L) (3-divergent lateral K-wires) configuration was the most stable in extension and valgus (Table 2)
In the medial oblique fracture model, external fixation system (EF) had the best stiffness in flexion, extension, valgus, and varus loadings, while the best stiffness in internal and external rotations was generated by Three-crossed pins (3MC) (2-medial, 1-lateral K-wires)
Summary
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. Distal humerus metaphyseal-diaphyseal junction (MDJ) region fracture in children is a complex fracture which requires accurate management by a trained pediatric orthopedic surgeon. Adequate stability cannot be guaranteed even if fixation is achieved, due to the small cortical bone of the proximal fragment available for pin purchase. These “supra-olecranon fossa” fractures are shown to have a higher incidence of post-op complications than the classical “trans-olecranon” types [6, 7]. A comparative study of these techniques in these fractures with varying characteristics, using a pediatric humerus model is still lacking in the literature
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