Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 5, pp 623–628 | Cite as

The effect of humeral-fenestration diameter in Outerbridge–Kashiwagi arthroplasty on failure load of the distal humerus: a cadaveric biomechanical study

  • Chih-Kai Hong
  • Ming-Long Yeh
  • I-Ming Jou
  • Cheng-Li Lin
  • Chih-Hsun Chang
  • Chih-Hung Chang
  • Wei-Ren SuEmail author
Orthopaedic Surgery



Outerbridge–Kashiwagi ulnohumeral arthroplasty is an effective method in treating elbow osteoarthritis; however, distal humerus fracture after surgery can become a critical issue. A previous biomechanical study has shown that the failure load of the distal humerus decreases after a fenestration, but the size of the fenestration hole has not yet been discussed.

Materials and methods

32 fresh-frozen cadaveric distal humeri were obtained. Two drill sizes were chosen for fenestration: 12 and 15 mm in diameter. Two directions of force were applied with a materials testing machine for biomechanical testing: 5° flexion for axial loading and 75° flexion for anterior–posterior (AP) loading. Each specimen randomly received one of the two fenestration sizes, and force directions. All specimens were loaded to failure at a rate of 2 mm/min.


The failure loads of the 12 and 15 mm groups were not significantly different in either axial loading(3886 ± 1271 N vs 4286 ± 901 N) or AP loading(2303 ± 803 N vs 1897 ± 357 N). All specimens loaded with axial force failed via the fenestration holes; however, during AP loading, some specimens failed through the fenestration holes, while others at diaphysis (p = 0.28).


The failure load of distal humeri did not differ significantly after fenestration of 12 or 15 mm. The clinical relevance is that as the risk of distal humerus fracture is not exacerbated, a larger-size fenestration hole could be of help to improve the effectiveness of this surgical procedure.


Outerbridge–Kashiwagi Ulnohumeral arthroplasty Fenestration Distal humerus 



There is no funding source.

Compliance with ethical standards

Conflict of interest

Chih-Kai Hong, Ming-Long Yeh, I-Ming Jou, Cheng-Li Lin, Chih-Hsun Chang, Chih-Hung Chang, and Wei-Ren Su declare that they have no conflict of interest.

Ethical approval

This article was granted an exemption from the institutional review board (IRB) in a medical center.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Chih-Kai Hong
    • 1
  • Ming-Long Yeh
    • 2
    • 3
  • I-Ming Jou
    • 4
  • Cheng-Li Lin
    • 1
    • 3
  • Chih-Hsun Chang
    • 1
  • Chih-Hung Chang
    • 5
    • 6
  • Wei-Ren Su
    • 1
    • 3
    • 7
    Email author
  1. 1.Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
  2. 2.Department of Biomedical EngineeringNational Cheng Kung UniversityTainanTaiwan
  3. 3.Medical Device Innovation CenterNational Cheng Kung UniversityTainanTaiwan
  4. 4.Department of Orthopedics, E-Da HospitalI-Shou UniversityKaohsiungTaiwan
  5. 5.Department of Orthopaedic SurgeryFar Eastern Memorial HospitalNew Taipei CityTaiwan
  6. 6.Graduate School of Biotechnology and BioengineeringYuan Ze UniversityTaoyuanTaiwan
  7. 7.Medical Device R&D Core LaboratoryNational Cheng Kung University HospitalTainanTaiwan

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