Biomechanical Analysis of Pin Placement for Pediatric Supracondylar Humerus Fractures

Gottschalk, Hilton P.; Sagoo, Daljeet; Glaser, Diana; Doan, Josh; Edmonds, Eric W.; Schlechter, John A.

doi:10.1097/bpo.0b013e318257d1cd

Cited by 46 publications

(47 citation statements)

References 20 publications

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“…When entering from the ONC, there is more pin-cortical bone contact area, rendering pins more stability. This nding was consistent with that of Gottschalk et al, [3]. The distal lower pins of the two lateral-entry con gurations (2LP, 2LD) in our model, with only a small or no ONC contact area, may have to penetrate and re-enter the bone through their course along the olecranon fossa giving them a shorter bone tunnel length and therefore less stability.…”

Section: Discussionsupporting

confidence: 91%

“…However, loss of reduction with the technique is a major concern to pediatric orthopedic surgeons. Causes of loss of reduction with pinning techniques have been attributed to pinning con guration, pin size, pin number and pin spread [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Acceptable but controversial results have been shown with multiple biomechanical studies comparing cross and divergent lateral pins [3,9,[13][14][15][16]. However, most of those studies were heterogeneous in xation details.…”

Section: Introductionmentioning

confidence: 99%

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The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model

Kamara

Liu

et al. 2020

Preprint

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Background: This study aimed at finding out the effect of exit height of pins, pin trajectory and pin number on the stability of cross and lateral pinning configurations used in the fixation of extension-type supracondylar humerus fracture (SHF) in children, through finite element analysis of a novel pediatric humerus bone model. Methods: Distal humerus model consisting of the ossific nucleus of the capitellum (ONC) and distal cartilage of a 6-year-old boy was developed via three-dimensional finite modeling. Various cross and lateral pinning fixation models with either two or three pins were simulated on an extension-type, transverse SHF and tested in six loading directions. Results: Two-cross pins and 2-lateral pins were respectively more stable in rotation and compression loadings, while 3-cross pins were the most stable in all loading directions. The cross pins exiting at the upper border of the distal metaphyseal-diaphyseal junction (MDJ) had the best stiffness among the 2-cross pins, while the lateral pins with a mid-ONC distal pin provided the best stiffness among the 2-lateral pins. A third pin however, going through the olecranon fossa led to improved stability of the 2-lateral pins in flexion, extension, internal and external rotations. Conclusion: In the fixation of extension-type, transverse supracondylar humerus fractures, 2-cross pins are only superior to 2-divergent lateral pins in rotational loadings. Two-cross pins exiting at the upper border of the MDJ provides the best stability, whereas 2-lateral pins with a distal pin going through the middle third of the ONC provides the best stability against compression forces for these fractures. Three-cross pins however offer the best stability against both compression and rotation forces. This study offers important clues in the preoperative evaluation and management of extension-type supracondylar fractures in children.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model

Kamara

Liu

et al. 2020

Preprint

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“…Previous studies have shown the miniopen technique of crossed entry pin associated with a low incidence of ulnar nerve injury [18,20,32]. Whether a third pin should be added to be more stable is controversial [19,46], but it may lead simultaneously to the increased risk of nerve injury [51,58]. Different results have been affected by the time from injury to surgery [11,21,22,33,45,47].…”

Section: Discussionmentioning

confidence: 99%

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Zhao

Wang

Zhang

2013

Clinical Orthopaedics &Amp; Related Research

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Background Closed reduction and percutaneous pin fixation is considered standard management for displaced supracondylar fractures of the humerus in children. However, controversy exists regarding whether to use an isolated lateral entry or a crossed medial and lateral pinning technique. Questions/purposes We performed a meta-analysis of randomized controlled trials (RCTs) to compare (1) the risk of iatrogenic ulnar nerve injury caused by pin fixation, (2) the quality of fracture reduction in terms of the radiographic outcomes, and (3) function in terms of criteria of Flynn et al. and elbow ROM, and other surgical complications caused by pin fixation.Methods We searched PubMed, Embase, the Cochrane Library, and other unpublished studies without language restriction. Seven RCTs involving 521 patients were included. Two authors independently assessed the methodologic quality of the included studies with use of the Detsky score. The median Detsky quality score of the included trials was 15.7 points. Dichotomous variables were presented as risk ratios (RRs) or risk difference with 95% confidence intervals (CIs) and continuous data were measured as mean differences with 95% CI. Statistical heterogeneity between studies was formally tested with standard chi-square test and I 2 statistic. For the primary objective, a funnel plot of the primary end point and Egger's test were performed to detect publication bias. Results The pooled RR suggested that iatrogenic ulnar nerve injury was higher with the crossed pinning technique than with the lateral entry technique (RR, 0.30; 95% CI,. No publication bias was further detected. There were no statistical differences in radiographic outcomes, function, and other surgical complications. No significant heterogeneity was found in these pooled results. Conclusions We conclude that the crossed pinning fixation is more at risk for iatrogenic ulnar nerve injury than the lateral pinning technique. Therefore, we recommend the lateral pinning technique for supracondylar fractures of the humerus in children.

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“…de la articulación del codo, la rehabilitación es más rápida, con recuperación completa en promedio de 8 semanas 11 . Se se consigue la alineación satisfactoria, que hace necesaria la remanipulación, aumentando el riesgo de deformidades en varo o valgo a largo plazo, que se presentan hasta en el abierta, que tiene menor incidencia de desplazamiento 12 , se indica de primera instancia en las fracturas expuestas cuando hay sospecha de lesión neurovascular, y en aquellas -llos 11 ; algunos autores, como Pretell et al 6 , indican realizar con gran angulación; ellos observaron resultados de buenos a excelentes hasta en el 95% de los casos cuando se compara la reducción abierta con la reducción cerrada únicamente en fracturas con desplazamiento severo; sin embargo, la mayoría de los autores indican iniciar con reducción cerrada y después de 2 intentos considerar la reducción abierta, pues la manipulación repetitiva puede causar rigidez y neuroapraxia 13 está indicada en la mayoría de las fracturas desde los tipos que se obtienen mejores resultados que con la reducción cerrada y la colocación de yeso 14 . No existe diferencia entre ambos métodos de reducción en cuanto a presencia de rigidez, aunque algunos estudios han reportado mayor rigidez en pacientes tratados con reducción abierta 15 .…”

Section: Fractura Humeral; Fracturas En Niños; Supracondíleaunclassified

Perfil clínico-epidemiológico de las fracturas supracondíleas de húmero en pacientes pediátricos en un hospital general regional

Barrón-Torres¹,

Sánchez-Cruz

Cruz-Melendez³

2015

Cirugía y Cirujanos

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Biomechanical Analysis of Pin Placement for Pediatric Supracondylar Humerus Fractures

Abstract: Consider a capitellar starting point for the more distally placed pin in supracondylar humerus fractures, and if the patient's size allows, a larger pin construct will provide improved stiffness with regard to rotational stresses.

Cited by 46 publications

References 20 publications

The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model

The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Perfil clínico-epidemiológico de las fracturas supracondíleas de húmero en pacientes pediátricos en un hospital general regional

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