![]() ![]() To effectively manage distal humerus MDJ fractures, special attention must be paid to the characteristics of the fracture lines. 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. The incidence of loss of reduction with the gold standard percutaneous pinning technique alone has been reported to be as high as 18%, and most of the cases would require secondary management or may develop into unwanted complications, which may pose a significant burden on both patient and caregiver. ![]() One of the most common complications following management of displaced SHF is loss of reduction. However, complications still occur after using the current treatment modalities available for typical supracondylar humerus fractures (SHFs). Management is mainly directed towards restoring bone healing as well as managing fracture-related complications, in order to restore a cosmetically normal and functional limb to the child. 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.ĭistal humerus metaphyseal-diaphyseal junction (MDJ) region fracture in children is a complex fracture which requires accurate management by a trained pediatric orthopedic surgeon. 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. 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. 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. 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 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. Stiffness values in flexion, extension, valgus, varus, internal, and external rotations for each fixation technique were calculated. 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). ![]() Loss of reduction is relatively higher in MDJ fractures treated with classical supracondylar humerus fractures (SHFs) fixation techniques. 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. ![]()
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