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Modified pin and plate fixation for low intercondylar fractures of the humerus: biomechanical study corroborated with a case series

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MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

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.

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Availability of data and materials

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

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Acknowledgements

The authors thank Prof. Banchong Mahaisavariya, Faculty of Medicine, Siriraj Hospital, Mahidol University and Prof. Theerachai Apivatthakakul, Faculty of Medicine, Chiangmai University, Thailand for manuscript edition and preparation.

Funding

There was no source of funding for this research.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Buddhachinaraj Hospital, Phitsanulok, Thailand

    S. Jitprapaikulsarn, A. Gromprasit & C. Patamamongkonchai

  2. Department of Mechanical Engineering, Faculty of Engineering at Sriracha, Kasetsart University, Sriracha, Chonburi, Thailand

    N. Chantarapanich

  3. Golden Jubilee Medical Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

    C. Mahaisavariya

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  1. S. Jitprapaikulsarn
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  2. N. Chantarapanich
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  5. C. Patamamongkonchai
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Contributions

SJ and NC were involved in drafting and revising the manuscript for content, including the medical writing for the content, the study concept and design, the analysis and interpretation of the data, as well as the acquisition of the data. AG, CM, and CP were involved in revising the manuscript for content as well as the analysis and interpretation of the data.

Corresponding author

Correspondence to N. Chantarapanich.

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Conflict of interest

S. Jitprapaikulsarn, N. Chantarapanich, A. Gromprasit, C. Mahaisavariya, and C Patamamongkonchai declare that they have no conflict of interest.

Ethical approval

This study has been approved by the ethical committees of Buddhachinaraj Hospital in accordance with the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in all figures.

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Jitprapaikulsarn, S., Chantarapanich, N., Gromprasit, A. et al. Modified pin and plate fixation for low intercondylar fractures of the humerus: biomechanical study corroborated with a case series. Musculoskelet Surg 107, 207–221 (2023). https://doi.org/10.1007/s12306-022-00743-0

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  • DOI: https://doi.org/10.1007/s12306-022-00743-0

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