Modified pin and plate fixation for low intercondylar fractures of the humerus: biomechanical study corroborated with a case series
3
Issued Date
2023-06-01
Resource Type
ISSN
20355106
eISSN
20355114
Scopus ID
2-s2.0-85127438198
Pubmed ID
35362865
Journal Title
Musculoskeletal Surgery
Volume
107
Issue
2
Start Page
207
End Page
221
Rights Holder(s)
SCOPUS
Bibliographic Citation
Musculoskeletal Surgery Vol.107 No.2 (2023) , 207-221
Suggested Citation
Jitprapaikulsarn S., Chantarapanich N., Gromprasit A., Mahaisavariya C., Patamamongkonchai C. Modified pin and plate fixation for low intercondylar fractures of the humerus: biomechanical study corroborated with a case series. Musculoskeletal Surgery Vol.107 No.2 (2023) , 207-221. 221. doi:10.1007/s12306-022-00743-0 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/85127
Title
Modified pin and plate fixation for low intercondylar fractures of the humerus: biomechanical study corroborated with a case series
Author's Affiliation
Other Contributor(s)
Abstract
Background: Establishing fracture union of low and comminuted intercondylar fractures of the humerus is inherently challenging. The purposes of the present study were to investigate the biomechanical effectiveness of pin & plate (PP) fixation compared to other dual-plating techniques by finite element analysis, and to present a technical description as well as retrospectively review the outcomes of PP fixation in such difficult fractures. Methods: Low-level intercondylar fracture 3D models of the humerus were virtually stabilized with three fixations on lateral side including PP, lateral pre-contoured locking compression plate (L-LCP), and variable angle lateral pre-contoured locking plate (VA-L-LCP) whereas medial pre-contoured locking compression plate (M-LCP) on medial side. Loading conditions under consideration were axial compression, internal rotation, posterior bending, and valgus rotation. Regarding the clinical series, eight patients with intra-articular and comminuted fractures of the distal humerus (6 intercondylar fractures, 1 fracture-subluxation, and 1 isolated lateral condylar fracture) were operated by isolated PP fixation or combinations of PP and the other standard implants. Data were collected on fracture union, perioperative complications, and objective clinical outcomes. Results: Biomechanical results revealed the most instability of the fracture occurring under posterior bending. PP fixation presented comparable fracture stability and fragment displacement compared to other dual-plating fixations, except stress on the Kirschner wire under internal rotation which was higher than other fixations. Regarding the clinical series, fracture union was achieved in all cases with an average union time of 17 weeks (range 12–20). All except one patient had good-to-excellent MEPS results with an average Disabilities of the Arm, Shoulder, and Hand (DASH) score of 14.6 (range 0–45) and an average arc of elbow motion of 107.5 degrees (range 60–140). Conclusion: By the biomechanical performance, PP fixation is a reliable technique for fixation of low intercondylar fractures of the humerus. Supported by the clinical outcomes, the present technique could be an alternative for this particular fracture especially when severe comminution prevents the use of the standard dual plating technique.