International Orthopaedics

, Volume 43, Issue 2, pp 411–416 | Cite as

A comparative biomechanical study on different fixation techniques in the management of transverse metaphyseal-diaphyseal junction fractures of the distal humerus in children

  • Allieu Kamara
  • Xianglu Ji
  • Tianjing Liu
  • Yu Zhan
  • Jianjun Li
  • Enbo WangEmail author
Original Paper



Metaphyseal-diaphyseal junction (MDJ) fractures of the distal humerus are problematic to reduce and more susceptible to post-operative complications. This biomechanical study was designed to compare Kirschner wires (KW), lateral external fixation, and elastic stable intramedullary nails (ESIN) in simulated transverse MDJ fractures of various heights.


Sagittally oblique, transverse MDJ fractures were created in fourth-generation composite bone models at three levels: high, mid, and low fractures, respectively, and then fixed with either Kirschner wires, lateral external fixation (EF), or ESIN respectively and tested in extension, flexion, valgus, varus, internal, and external rotations.


In the high fractures, ESIN had better overall stiffness than the other techniques. In the mid groups, three crossed pinning (1-medial and 2-lateral pins) had the best overall stiffness, followed by two crossed pinning (1-medial and 1-lateral pins). In the low fractures, three crossed pinning was superior to all other techniques. Two crossed pinning and three -lateral pinning techniques yielded comparable stiffness in the low fracture model.


From a biomechanical perspective, ESIN provides the best overall stability for fractures located in the upper region of the MDJ, while percutaneous pinning is superior in stabilizing fractures of the lower region. Two lateral and one medial pins make the most stable crossed pinning construct for these fractures.


Metaphyseal-diaphyseal junction Supracondylar humeral fracture Kirschner wires Elastic stable intramedullary nails Lateral external fixation Biomechanical study 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Pediatric OrthopedicsShengjing Hospital of China Medical UniversityShenyangPeople’s Republic of China
  2. 2.Department of OrthopedicsShengjing Hospital of China Medical UniversityShenyangPeople’s Republic of China
  3. 3.College of ScienceNortheastern UniversityShenyang, Lioning ProvinceChina

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