Dual tension band wiring for adolescent supracondylar fractures of the humerus: mechanical assessment and a clinical series

Abstract

Background: The optimal fixation technique of adolescent supracondylar fractures of the humerus (A-SCFH) remains inconclusive. To prove the efficacy of Dual Tension Band Wiring (DTBW), the mechanical performance was compared to the other pinning constructs, i.e., Lateral Divergent Pining (LDP), Cross Pining (CP) and Dual CP. The clinical outcomes of the DTBW in A-SCFH were retrospectively described. Methods: Bone specimens with a supracondylar fracture acquired from computed tomography images of a patient were fabricated using a three-dimensional printing technique. The fracture was stabilized with pining techniques to create those four constructs. Each of constructs was mechanically tested under posterior bending, medial bending, lateral bending, and torsion. Maximum force, displacement at maximum force, maximum torque, rotational displacement at maximum torque, and construct stiffness were collected and calculated from the result of mechanical test. For the case series, 15 A-SCFH was operated on the DTBW. The reviewed data included time to union, perioperative complications, arc of elbow motion, Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. Results: The DTBW revealed a greater maximum force, and construct stiffness compared to the other constructs in most of the loading conditions. According to the case series, all fractures were consolidated with a mean union time of 7.2 weeks (range 6–10). By MEPS, all patients were determined to be good-to-excellent. The mean arc of elbow motion was 130 degrees (range 120–140) with a mean DASH score of 7.9 (range 2.5–17.5). Conclusion: By mechanical performance and clinical outcomes, the DTBW can be an effective and reliable technique in management of A-SCFH.