Is pin configuration the only factor causing loss of reduction in the management of pediatric type III supracondylar fractures?

Reisoğlu, Ali; Kazımoğlu, Cemal; Hanay, Emre; Ağuş, Haluk

doi:10.1016/j.aott.2016.11.003

Cited by 38 publications

(36 citation statements)

References 24 publications

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“…Pin configuration and pin spread along the fracture line among other factors have been said to be associated with loss of reduction in the management of SHFs [2][3][4][5]. To effectively manage distal humerus MDJ fractures, special attention must be paid to the characteristics of the fracture lines.…”

Section: Introductionmentioning

confidence: 99%

Mechanical stability study of three techniques used in the fixation of transverse and oblique metaphyseal-diaphyseal junction fractures of the distal humerus in children: a finite element analysis

et al. 2020

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Background: 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. Methods: Three 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. Results: In 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. Conclusion: The 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.

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Section: Introductionmentioning

confidence: 99%

Mechanical stability study of three techniques used in the fixation of transverse and oblique metaphyseal-diaphyseal junction fractures of the distal humerus in children: a finite element analysis

et al. 2020

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“…It had been reported that proper pin spread at the fracture site could in uence the stability of pins [5]. In our cross pinning con gurations, the best stiffness was achieved when both pins exited around the upper border of the metaphyseal-diaphyseal junction (MDJ).…”

Section: Discussionmentioning

confidence: 79%

“…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%

“…Many authors have however advocated for the lateral-only pins due to the risk of ulnar nerve injury with medially placed pins [10,11]. However, the use of cross pins may be inevitable in some cases, such as in medially oblique fractures, high fractures or fractures with medial comminution, which may have a higher incidence of loss of reduction in clinical practice [5]. Cross pins are also preferred by many surgeons because of its torsional stability, an important factor considered in the prevention of cubital varus [12].…”

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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“…The other 35 patients underwent cross-pinning from lateral/proximal to medial/distal direction. Optimal placement of lateral pins alone with at least 2 mm of divergence at fracture site maybe difficult in proximally located and/or medially comminuted fractures (19,20). Ulnar nerve injury can be a catastrophic complication of pinning of pediatric supracondylar fracture, thus any efforts should be made to avoid it.…”

Section: Discussionmentioning

confidence: 99%

The Outcome of Closed Reduction and Total Lateral Entry Crossed Pin Fixation of Unstable Type III Pediatric Supracondylar Humerus Fractures

Aslani¹,

Navali²,

Baghdadi³

et al. 2016

J Orthop Spine Trauma

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Background: Supracondylar humerus fracture is the most common elbow fracture in children. While closed reduction and percutaneous pining is the standard treatment method, the ideal pin arrangement is controversial. Objectives: The current study aimed at evaluating the outcome of the closed lateral cross-pinning to treat displaced supracondylar humeral fractures. Patients and method: After closed parallel lateral pin fixation, reduction was unstable in 35 patients, who underwent cross-pinning from lateral entry point. The mean follow-up period was 6 months and all patients were evaluated for the loss of reduction, iatrogenic ulnar nerve injury, and elbow range of motion. Results: The mean age of the patients was 7 years. All fractures were type III according to the Gartland classification. There was no case of reduction loss or iatrogenic ulnar nerve injury. Elbow range of motion was full. Two patients had malreduction. Conclusions: Although medial and lateral cross-pinning has the highest stability of pinning techniques, the risk of iatrogenic ulnar nerve injury is significant. Total lateral entry cross-pin fixation method of pediatric supracondylar humerus fractures has similar results to the conventional cross-pin methods regarding the fixation stability, but with lower ulnar nerve injury cases.

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Is pin configuration the only factor causing loss of reduction in the management of pediatric type III supracondylar fractures?

Cited by 38 publications

References 24 publications

Mechanical stability study of three techniques used in the fixation of transverse and oblique metaphyseal-diaphyseal junction fractures of the distal humerus in children: a finite element analysis

Mechanical stability study of three techniques used in the fixation of transverse and oblique metaphyseal-diaphyseal junction fractures of the distal humerus in children: a finite element analysis

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 Outcome of Closed Reduction and Total Lateral Entry Crossed Pin Fixation of Unstable Type III Pediatric Supracondylar Humerus Fractures

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