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Journal of Children's Orthopaedics

Published in:

01-12-2013 | Technical Note

Pediatric supracondylar humerus fractures: effect of bone–implant interface conditions on fracture stability

Authors: Ron Lamdan, Meir Liebergall, Amit Gefen, Naum Symanovsky, Eran Peleg

Published in: Journal of Children's Orthopaedics | Issue 6/2013

Abstract

Background

Closed reduction and percutaneous fixation with Kirschner wires (KWs) is the standard of care of pediatric supra-condylar humerus fractures (SCHFs). Failure modes leading to loss of reduction are not clear and have not been quantified. Multiple factors may weaken the KW–bone interface bonding conditions. To the best of our knowledge, the possible effect of this decrease on different KW configurations and fracture stability has never been studied.

Purpose

To investigate the effect of bone–KW friction conditions on SCHF post-operative mechanical stability and to formulate clinical guidelines for KW configuration under different conditions.

Methods

Finite element-based model of a fixated SCHF was used to simulate structure stability for two lateral divergent versus crossed lateral and medial KW configurations under varying KW–bone friction conditions.

Results

Finite element simulations demonstrated that crossed KWs provide superior stability compared with the divergent configuration when KW–bone bonding is compromised. When KW–bone bonding conditions are adequate, crossed and divergent KW configurations provide similar, sufficient fracture stability.

Conclusions

Under normal bone–implant interface conditions, the two diverging lateral KW configuration offers satisfactory mechanical stability and may be the preferred choice of SCHF fixation. When KW–bone bonding is suboptimal, as when one or more of the lateral KWs are re-drilled, addition of a medial KW should be considered in order to improve stability despite risk to ulnar nerve.

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Title: Pediatric supracondylar humerus fractures: effect of bone–implant interface conditions on fracture stability
Authors: Ron Lamdan
Meir Liebergall
Amit Gefen
Naum Symanovsky
Eran Peleg
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: Journal of Children's Orthopaedics / Issue 6/2013
Print ISSN: 1863-2521
Electronic ISSN: 1863-2548
DOI: https://doi.org/10.1007/s11832-013-0533-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pediatric supracondylar humerus fractures: effect of bone–implant interface conditions on fracture stability

Abstract

Background

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Purpose

Methods

Results

Conclusions

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