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Vescio A, Carlisi G, Macrì VR, Sanzo F, Gigliotti G, Riccelli DA, Tedesco G, Mercurio M, Galasso O, Gasparini G, Jackson GR, Chahla J, Familiari F. The Effect of Fracture Patterns, Pinning Configuration, Surgeon Experience and Subspecialty on Short-Term Radiological Outcomes of Pediatric Supracondylar Humeral Fractures Treated in the Prone Position: A Case-Series. Healthcare (Basel) 2023; 11:2648. [PMID: 37830685 PMCID: PMC10573001 DOI: 10.3390/healthcare11192648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The most common treatment modality for supracondylar humerus fractures (SCHFs) in children is closed reduction and percutaneous pinning (CRPP). Nonetheless, debate persists regarding the optimal technique used. Therefore, the purpose of our study was to investigate the impact of surgeon experience, surgeon subspecialty and pin configuration on short-term radiological outcomes following CRPP of displaced SCHFs. METHODS Patients less than 14 years of age who underwent CRPP for displaced SCHFs in the prone position between January 2018 and December 2022 were analyzed. Patients were separated into subgroups based on fracture type (low vs. high sagittal), pin configuration (lateral, cross, other), number and configuration of K-wires and first operator surgical experience. The following outcome measurements were collected: postoperative Baumann angle (BA), Shaft-Condylar angle (SCA), surgical duration (SD), duration of radiation exposure (DRE) and number of clinical and radiological follow-ups (FU). RESULTS A total of 44 patients with a mean age of 6 ± 2.5 years were included in the final analysis. The mean post-operative BA and SCA were 74.8° ± 4.9° and 37.7° ± 10.2°, respectively. No significant differences were found in the post-operative Baumann's angle or SCA among the subgroups. Regarding secondary outcomes, no differences were found among each subgroup regarding SD, DRE and FUs. CONCLUSION Short-term radiological outcomes following the treatment of SCHFs treated in the prone position are not affected by fracture patterns and pinning configuration, regardless of the surgeon's years of experience or subspecialty.
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Affiliation(s)
- Andrea Vescio
- Departiment of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Pugliese Ciaccio, 88100 Catanzaro, Italy; (A.V.); (V.R.M.); (F.S.); (G.G.); (D.A.R.); (G.T.)
| | - Giovanni Carlisi
- Departiment of Orthopaedic and Trauma Surgery, Magna Graecia University, 88110 Catanzaro, Italy; (G.C.); (O.G.); (G.G.); (F.F.)
| | - Vincenzo Roberto Macrì
- Departiment of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Pugliese Ciaccio, 88100 Catanzaro, Italy; (A.V.); (V.R.M.); (F.S.); (G.G.); (D.A.R.); (G.T.)
| | - Francesco Sanzo
- Departiment of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Pugliese Ciaccio, 88100 Catanzaro, Italy; (A.V.); (V.R.M.); (F.S.); (G.G.); (D.A.R.); (G.T.)
| | - Giuseppe Gigliotti
- Departiment of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Pugliese Ciaccio, 88100 Catanzaro, Italy; (A.V.); (V.R.M.); (F.S.); (G.G.); (D.A.R.); (G.T.)
| | - Daria Anna Riccelli
- Departiment of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Pugliese Ciaccio, 88100 Catanzaro, Italy; (A.V.); (V.R.M.); (F.S.); (G.G.); (D.A.R.); (G.T.)
| | - Giuseppe Tedesco
- Departiment of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Pugliese Ciaccio, 88100 Catanzaro, Italy; (A.V.); (V.R.M.); (F.S.); (G.G.); (D.A.R.); (G.T.)
| | - Michele Mercurio
- Departiment of Orthopaedic and Trauma Surgery, Magna Graecia University, 88110 Catanzaro, Italy; (G.C.); (O.G.); (G.G.); (F.F.)
| | - Olimpio Galasso
- Departiment of Orthopaedic and Trauma Surgery, Magna Graecia University, 88110 Catanzaro, Italy; (G.C.); (O.G.); (G.G.); (F.F.)
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Giorgio Gasparini
- Departiment of Orthopaedic and Trauma Surgery, Magna Graecia University, 88110 Catanzaro, Italy; (G.C.); (O.G.); (G.G.); (F.F.)
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Garrett R. Jackson
- Department of Orthopaedic Surgery, Rush University, Chicago, IL 60612, USA; (G.R.J.); (J.C.)
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University, Chicago, IL 60612, USA; (G.R.J.); (J.C.)
| | - Filippo Familiari
- Departiment of Orthopaedic and Trauma Surgery, Magna Graecia University, 88110 Catanzaro, Italy; (G.C.); (O.G.); (G.G.); (F.F.)
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
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Bai H, Lu Q, Liang X, Wang X, Yang Y, Wang H, Wang J, Jie Q. Finite element analysis of Kirschner wire fixation for lateral condyle fracture in children in the sagittal plane. Front Pediatr 2023; 11:1210493. [PMID: 37554152 PMCID: PMC10405918 DOI: 10.3389/fped.2023.1210493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE This study aims to find the optimal arrangement of the Kirschner wire (K-wire) in the sagittal plane for fixation of a pediatric lateral condylar humeral fracture (Milch type II) by using finite element analysis (FEA). METHODS A model of lateral condyle fracture in a 6-year-old boy was developed, and an XYZ coordinate system was established based on this model. The YZ plane was defined as the sagittal plane to investigate the impact of the angle formed by the first and second K-wires on stability. Two configurations were studied for each angle: parallel and divergent. Evaluation indicators included the maximum displacement of the fracture fragment and the maximum von Mises stress in the pins and bone. RESULTS The model with a -60° angle showed the best performance in both evaluation indicators. The parallel and divergent pin configurations had different performances in each group. The displacement results for negative angles were similar, and this result was better than those for positive angles. CONCLUSION We successfully created a model of pediatric lateral condyle humerus fracture (Milch type II) and performed K-wire fixation with varying sagittal plane configurations, combined with FEA. Our findings demonstrate that the angle of -60° between the two pins in the sagittal plane provided the highest level of stability, with divergent configurations proving superior to parallel pinning at this angle.
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Affiliation(s)
- Huanan Bai
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Shaanxi, China
- School of Medicine, Medical College of Yan'an University, Yan'an, China
| | - Qingda Lu
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Shaanxi, China
| | - Xiaoju Liang
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Shaanxi, China
| | - Xiaoming Wang
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Shaanxi, China
| | - Yating Yang
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Shaanxi, China
| | - Huan Wang
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Shaanxi, China
| | - Jiaju Wang
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Shaanxi, China
| | - Qiang Jie
- Pediatric Orthopaedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Shaanxi, China
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Jeon S, Ahn W, Oh J, Chung J, Choi J, Lee S. Finite element analyses of lateral condyle fracture fixation in paediatrics regarding configuration of Kirschner-wire. BMC Musculoskelet Disord 2022; 23:940. [PMID: 36307784 PMCID: PMC9615206 DOI: 10.1186/s12891-022-05897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/19/2022] [Indexed: 11/12/2022] Open
Abstract
Background This study aimed to discover the most stable outcome among different Kirschner-wire (K-wire) configurations for fixation of a lateral condyle fracture (Milch type II) in different loads of stress by using finite element analyses (FEA). Methods The right humerus of a 6-year-old boy with a lateral condyle fracture (Milch type II), was modelled with a computer aided engineering. Using FEA, peak von Mises stress and stiffness were evaluated first for a single K-wire fixation by varying the angle (0, 5, 10, 15, 20, 25, 30 degrees). Then, based on the single K-wire result, assessment of peak von Mises stress and stiffness were evaluated via FEA for two- or three-wire fixation under various configurations (two convergent, two parallel, three divergent). Results Single K-wire fixation by 5 and 25 degrees had the lowest peak von Mises stress. The fracture site showed higher stiffness at 0, 5 and 15 degrees. Considering the collected results and clinical situation, 5 degree K-wire was selected for the FEA of multiple K-wire fixation. For multiple K-wire fixation, three divergent (5–20-35 degrees) K-wires showed better stability, both in peak von Mises stress and stiffness, than any two-K-wire configurations. Among two K-wire fixations, two divergent (5–50 degrees) K-wires provided the lowest von Mises stress in varus and valgus while two divergent (5–65 degrees) K-wires showed better results in flexion, extension, internal and external rotation, and both configurations showed similar results in stiffness. Conclusions We successfully created a paediatric lateral condyle fracture (Milch type II) model which was used to conduct FEA on different K-wire configurations to achieve stability of the fracture. Our results show that an initial K-wire inserted at 5 degrees, followed by the insertion of a second divergent wire at either 45 or 60 degrees provides the most stability in two K-wire fixations in this type of fracture repair. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05897-3.
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Zainal Abidin NA, Ramlee MH, Ab Rashid AM, Ng BW, Gan HS, Abdul Kadir MR. Biomechanical effects of cross-pin's diameter in reconstruction of anterior cruciate ligament - A specific case study via finite element analysis. Injury 2022; 53:2424-2436. [PMID: 35641332 DOI: 10.1016/j.injury.2022.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/09/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
For anterior cruciate ligament reconstruction (ACL-R), one of the crucial aspects of treatment is the fixator selection that could provide initial graft fixation post-operatively. Literature on biomechanical stabilities of different sizes of fixators as femoral graft fixation is limited. Therefore, this study aims to analyse the influence of different diameters of cross-pins on the stability of graft fixations after ACL-R via finite element analysis (FEA). In the methodology, three-dimensional (3D) models of three different diameters of cross-pins were developed, of which anterior tibial loads (ATL) were applied onto the tibia. From the findings, the cross-pin with a smaller diameter (4 mm) provided optimum stability than larger diameter cross-pins, whereby it demonstrated acceptable stresses at the fixators (both cross-pin and interference screw) with a different percentage of 28%, while the stresses at the corresponding bones were favourable for osseointegration to occur. Besides, the strains of the knee joint with 4 mm diameter cross-pin were also superior in providing a good biomechanical environment for bone healing, while the recorded strain values at fixators were comparable with a larger diameter of cross-pins without being inferior in terms of deformation. To conclude, the cross-pin with 4 mm diameter depicted the best biomechanical aspects in graft fixation for ACL-R since it allows better assistance for the osseointegration process and can minimise the possibility of the breakage and migration of fixators. This study is not only useful for medical surgeons to justify their choices of pin diameter to treat patients, but also for researchers to conduct future studies.
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Affiliation(s)
- Nur Afikah Zainal Abidin
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia; Department of Orthopaedics, Hospital Pakar Kanak-Kanak, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Muhammad Hanif Ramlee
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia; Department of Orthopaedics, Hospital Pakar Kanak-Kanak, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Amir Mustakim Ab Rashid
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia; Department of Orthopaedics, Hospital Pakar Kanak-Kanak, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Bing Wui Ng
- Department of Orthopaedics, Hospital Pakar Kanak-Kanak, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Hong Seng Gan
- Department of Data Science, Universiti Malaysia Kelantan, 16100 UMK City Campus, Pengkalan Chepa, Kelantan, Malaysia
| | - Mohammed Rafiq Abdul Kadir
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia; Sports Innovation and Technology Centre (SITC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia
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Pavone V, Vescio A, Accadbled F, Andreacchio A, Wirth T, Testa G, Canavese F. Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society. J Child Orthop 2022; 16:208-219. [PMID: 35800655 PMCID: PMC9254020 DOI: 10.1177/18632521221106379] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/19/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the current trends in the treatment of supracondylar humerus fractures as well as the preferred post-operative follow-up protocol among members of the European Paediatric Orthopaedic Society. METHODS The survey was composed by four main domains and 26 items: (1) surgeon information (3 items); (2) treatment (8 items); (3) post-operative treatment (3 items); and (4) factors influencing the outcome (12 items). All active members of European Paediatric Orthopaedic Society were invited by email to answer an electronic questionnaire. RESULTS The survey was submitted to 397 European Paediatric Orthopaedic Society active members; 184 members answered (46.3%) the questionnaire. Among respondents, 64.1% declared >10 years of experience and 55.4% declared to treat >20 supracondylar humerus fractures per year. Closed reduction, percutaneous pinning, and supine position were the preferred treatment option for Gartland type II and III supracondylar humerus fractures by 79.9%, 95.5%, and 84.8% of respondents, respectively. Supracondylar humerus fractures are treated within 24 h from trauma by 33.2% of respondents. Pins are removed 4 weeks from index procedure by 58.2% of respondents. Fracture type (72.3%), surgeon experience, and (71.2%) are of "crucial importance" for expected outcome of supracondylar humerus fractures treatment. CONCLUSION Surgeon experience, type of fracture, treatment modality, and pins configuration were considered the main factors potentially influencing the outcome of supracondylar humerus fractures. European Paediatric Orthopaedic Society members agreed on the treatment modality of Gartland type II and III supracondylar humerus fractures, patient positioning, and timing of hardware removal. Other important issues such as timing of surgery, pins configuration, surgical approach, and post-operative protocol are still debated. LEVEL OF EVIDENCE level II.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and
Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University
Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy,Vito Pavone, Department of General Surgery
and Medical Surgical Specialties, Section of Orthopaedics and Traumatology,
University Hospital Policlinico-Vittorio Emanuele, University of Catania, Via
Santa Sofia 78, 95123 Catania, Italy.
| | - Andrea Vescio
- Department of General Surgery and
Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University
Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Franck Accadbled
- Pediatric Orthopaedic Department,
Purpan Hospital, Toulouse University Centre, Toulouse, France
| | - Antonio Andreacchio
- Pediatric Orthopedic Surgery
Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Thomas Wirth
- Orthopaedic Department, Olga Hospital,
Stuttgart, Germany
| | - Gianluca Testa
- Department of General Surgery and
Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University
Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Federico Canavese
- Department of Pediatric Orthopedic
Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lille, France
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