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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

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Abstract

Background

Metaphyseal-diaphyseal junction (MDJ) fractures of the distal humerus are problematic to reduce and more susceptible to post-operative complications. This biomechanical study was designed to compare Kirschner wires (KW), lateral external fixation, and elastic stable intramedullary nails (ESIN) in simulated transverse MDJ fractures of various heights.

Method

Sagittally oblique, transverse MDJ fractures were created in fourth-generation composite bone models at three levels: high, mid, and low fractures, respectively, and then fixed with either Kirschner wires, lateral external fixation (EF), or ESIN respectively and tested in extension, flexion, valgus, varus, internal, and external rotations.

Results

In the high fractures, ESIN had better overall stiffness than the other techniques. In the mid groups, three crossed pinning (1-medial and 2-lateral pins) had the best overall stiffness, followed by two crossed pinning (1-medial and 1-lateral pins). In the low fractures, three crossed pinning was superior to all other techniques. Two crossed pinning and three -lateral pinning techniques yielded comparable stiffness in the low fracture model.

Conclusions

From a biomechanical perspective, ESIN provides the best overall stability for fractures located in the upper region of the MDJ, while percutaneous pinning is superior in stabilizing fractures of the lower region. Two lateral and one medial pins make the most stable crossed pinning construct for these fractures.

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Author notes

  1. Allieu Kamara and Xianglu Ji contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China

    Allieu Kamara, Tianjing Liu & Enbo Wang

  2. Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China

    Xianglu Ji & Jianjun Li

  3. College of Science, Northeastern University, Shenyang, Lioning Province, China

    Yu Zhan

Authors
  1. Allieu Kamara
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  2. Xianglu Ji
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  3. Tianjing Liu
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  4. Yu Zhan
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  5. Jianjun Li
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  6. Enbo Wang
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Corresponding author

Correspondence to Enbo Wang.

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Kamara, A., Ji, X., Liu, T. et al. A comparative biomechanical study on different fixation techniques in the management of transverse metaphyseal-diaphyseal junction fractures of the distal humerus in children. International Orthopaedics (SICOT) 43, 411–416 (2019). https://doi.org/10.1007/s00264-018-3968-x

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  • DOI: https://doi.org/10.1007/s00264-018-3968-x

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