title: Biomechanical testing of pin configurations in supracondylar humeral fractures: the effect of medial column comminution.
abstract: OBJECTIVE
  We measured biomechanical stability in simulated supracondylar humeral fractures fixed with each of 6 pin configurations, 2 with associated medial comminution, and developed a technique for reproducible pin placement and divergence.
  
  
  METHODS
  A transverse supracondylar osteotomy was performed on 36 biomechanical humerus models. Of these, 24 (4 groups of 6 specimens each) were fixed with pins in 1 of 4 lateral entry configurations. The remaining 12 (2 groups of 6 specimens each) had a 30-degree medial wedge removed from the distal humerus and were fixed with 1 of 2 configurations. Half of each group was tested under axial rotation and the other half under varus bending. The distal humerus was divided into 4 equal regions from lateral to medial (1-4). Lateral entry pins were inserted through regions 1-3, whereas the medial pin was inserted through region 4.
  
  
  RESULTS
  Without comminution, 3 widely spaced, divergent lateral entry pins resulted in higher torsional stiffness (0.36 Nm/degree) than 2 pins in adjacent regions (P < 0.055), but similar to 2 pins in nonadjacent regions (P = 0.57). Three lateral entry pins had higher bending stiffness (79.6 N/mm) than 2 pins, which ranged from 46.7 N/mm (P < 0.01) to 62.5 N/mm (P = 0.21). With comminution, adding a third medial entry pin increased torsional stiffness (0.13-0.24 Nm/degree, P < 0.01) and increased bending stiffness (38.7-44.7 N/mm, P = 0.10).
  
  
  CONCLUSIONS
  For fractures without medial column comminution, fixation using 3 lateral entry pins may provide the greatest combination of torsional and bending stiffness. With medial comminution, adding a third medial pin increased torsional stiffness (P < 0.01) and bending stiffness (P = 0.10).
authors.affiliation: Los Angeles Orthopaedic Hospital, Los Angeles, CA 90007, USA. msilva@laoh.ucla.edu
authors.forename: Mauricio
authors.initials: M
authors.lastname: Silva
authors.forename: Ashleen R
authors.initials: AR
authors.lastname: Knutsen
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Kalma
authors.forename: Sean L
authors.initials: SL
authors.lastname: Borkowski
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Bernthal
authors.forename: Hillard T
authors.initials: HT
authors.lastname: Spencer
authors.forename: Sophia N
authors.initials: SN
authors.lastname: Sangiorgio
authors.forename: Edward
authors.initials: E
authors.lastname: Ebramzadeh
mesh_terms: D001696:Biomechanical Phenomena; D001858:Bone Nails; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008953:Models, Anatomic; D000092464:Elbow Injuries