Adjunct fixation with a Kirschner wire or a plate for lateral unicondylar humeral fracture stabilization

Coggeshall, Jason D.; Lewis, Daniel D.; Iorgulescu, Alex; Kim, Stanley E.; Palm, Lindsey S.; Pozzi, Antonio

doi:10.1111/vsu.12677

Cited by 7 publications

(20 citation statements)

References 17 publications

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“…To the authors’ knowledge this is not something specifically previously reported in the literature and is possibly attributed to the stability provided by the different adjunctive fixation modalities in addition to the TCS. The supracondylar K‐wire may not completely neutralize the rotational and shear forces that the fractured condyle must withstand during the healing period, whereas adjunctive plate fixation is biomechanically superior to supplemental K‐wire, and provides increased stiffness 34 . This should reduce cyclic stress on the screw which can often lead to implant failure 26 .…”

Section: Discussionmentioning

confidence: 99%

“…The supracondylar K‐wire may not completely neutralize the rotational and shear forces that the fractured condyle must withstand during the healing period, whereas adjunctive plate fixation is biomechanically superior to supplemental K‐wire, and provides increased stiffness. 34 This should reduce cyclic stress on the screw which can often lead to implant failure. 26 BCF may therefore have not suffered complications in this study due to all but one case being stabilized with adjunctive plates.…”

Section: Discussionmentioning

confidence: 99%

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Humeral condylar fractures and fissures in the French bulldog

2022

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Objective: To report the configuration, risk factors, fixation methods and complication rates after repair of humeral condylar fractures (HCF) in French bulldogs, and report the presence of humeral intracondylar fissures (HIF) in this population as a possible predisposing factor.Study design: Retrospective clinical cohort study. Sample population: Forty-four elbows. Methods:The medical records of dogs referred between January 2012 and December 2021 were searched for French bulldogs presenting with HCF. Signalment, fracture configuration, stabilization method and complication occurrence were obtained. Postoperative radiographs were assessed for implant positioning, and computed tomography (CT) scans were assessed for the presence and size of HIF in the contralateral elbow.Results: Lateral humeral condylar fractures represented 28/44 (63.6%) of HCF in French bulldogs. Repair with a transcondylar screw (TCS) and Kirschnerwire(s) (K-wire) were 7.62 times more likely to result in a major complication (95% CI: 1.43, 21.89; p = .01) compared to other methods. All incidences (7/7) of TCS migration were within the TCS + K-wire group. A HIF was identified in 18/31 (58.1%) dogs. Older animals were not significantly less likely to have a HIF than younger animals (p = .129).Conclusions: Fracture stabilization with a TCS and K-wire(s) was associated with an increased risk of major complications and migration of the TCS. A HIF was present in the contralateral elbow of over half of the French bulldogs where CT was available.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Humeral condylar fractures and fissures in the French bulldog

2022

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“…15,18,19,[24][25][26] Failure load (N) was defined as the maximum load recorded immediately prior to a sudden decrease in sustained load, which coincided with obvious visual construct failure. 25 At completion of destructive testing, the constructs were photographed and the specifics of failure documented for each construct. Mode of failure, including the location of bone fracture, plate bending or breakage, or screw bending, breakage or pullout was also recorded for each construct.…”

Section: Specimen Preparationmentioning

confidence: 99%

Biomechanical Comparison of Two Locking Plate Constructs for the Stabilization of Feline Tibial Fractures

Hottmann

Johnson

Banks

et al. 2019

Vet Comp Orthop Traumatol

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Objectives The aim of this study was to compare the biomechanical characteristics of locking compression plate (LCP) and conical coupling plate (CCP) constructs for the stabilization of experimentally induced gap fractures in cat tibiae. Materials and Methods Pelvic limbs were harvested from eight cat cadavers. Paired tibiae were stripped of all soft tissues, and randomly assigned to the LCP or CCP stabilization group. An eight-hole 2.7 mm LCP or a six-hole 2.5 mm CCP was applied to the medial surface of each tibia. A 1-cm segment of the tibia was excised centrally beneath the plate. The specimens were potted, then tested in non-destructive four-point craniocaudal and mediolateral bending, followed by non-destructive axial compression. Each construct was subsequently loaded to failure in axial compression. Bending and axial stiffness, yield load and failure load were calculated for each specimen. Results The LCP constructs were significantly stiffer than the CCP constructs when subjected to non-destructive bending and axial loading. Craniocaudal bending stiffness was significantly greater than mediolateral bending stiffness for both constructs. Yield load and failure load were significantly greater for LCP constructs compared with CCP constructs. Clinical Significance LCP may be a more suitable implant for stabilizing complex diaphyseal tibial fractures in cats. Additional supplemental fixation should be considered when using CCP to stabilize unreconstructed diaphyseal tibial fractures in cats. Further clinical investigation of both implants is recommended.

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“…More recently, the stability of this construct has been brought into question by the frequency of implant‐related complications when K‐wires are used to stabilise the epicondylar ridge fracture compared to when bone plates are used 5,6 . This concern was supported by cadaveric studies showing that stiffness, yield load and load to failure are all greater when bone plates rather than K‐wires are used in conjunction with a transcondylar bone screw 7 . As a result of these observations, recommendations have gravitated towards the use of epicondylar bone plates rather than K‐wires or pins, in combination with transcondylar bone screws, to manage these patients, 8 including when such fractures are treated in puppies 9 .…”

Section: Introductionmentioning

confidence: 99%

“…5,6 This concern was supported by cadaveric studies showing that stiffness, yield load and load to failure are all greater when bone plates rather than K-wires are used in conjunction with a transcondylar bone screw. 7 As a result of these observations, recommendations have gravitated towards the use of epicondylar bone plates rather than K-wires or pins, in combination with transcondylar bone screws, to manage these patients, 8 including when such fractures are treated in puppies. 9 However, little attention has been directed at whether these recommendations are appropriate across the entire spectrum of patients treated for these fractures and, in particular, whether there might be a different approach to the management of puppies compared with adult dogs.…”

Section: Introductionmentioning

confidence: 99%

Humeral unicondylar fractures in immature dogs treated using a bone screw and Kirschner wire

Butterworth¹

2022

Veterinary Record

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Background: To investigate the incidence of implant-related complications when humeral unicondylar fractures in immature dogs are stabilised with a transcondylar bone screw and epicondylar Kirschner wire (K-wire)/pin. Methods: Records of cases treated by the author in this clinic over a 10-year period were screened for those involving humeral condylar fractures. These were then reduced to include those patients who were less than 7 months of age with unicondylar fractures and follow-up radiographs. Results: Thirty fractures in 29 dogs met the inclusion criteria. All of these had been stabilised with a transcondylar bone screw and epicondylar Kwire. Fracture healing was documented in all dogs. Surgical site infection was not recorded. Implant-related major complications were reported in four (13%) dogs and successfully treated by either implant removal or replacement. Short-term outcome was judged as excellent in 23 out of 30 and good in seven out of 30 of these fractures. Conclusion:The use of a transcondylar bone screw in combination with an epicondylar K-wire is an appropriate fixation method for humeral unicondylar fractures seen in puppies less than 7 months of age.

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Adjunct fixation with a Kirschner wire or a plate for lateral unicondylar humeral fracture stabilization

Abstract: Our results support the recommendation for adjunct fixation of comminuted lateral unicondylar humeral fractures with an epicondylar plate.

Cited by 7 publications

References 17 publications

Humeral condylar fractures and fissures in the French bulldog

Humeral condylar fractures and fissures in the French bulldog

Biomechanical Comparison of Two Locking Plate Constructs for the Stabilization of Feline Tibial Fractures

Humeral unicondylar fractures in immature dogs treated using a bone screw and Kirschner wire

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