Stability Comparison of The Screwed and Unscrewed Kirschner Wire Used in Supracondylar Humerus Fractures In Children: ANSYS 16.0 Finite Element Analysis

Year 2021, Volume: 3 Issue: 1, 1 - 6, 07.07.2021

Zafer Şen , Ferhat Sayar

https://doi.org/10.51934/jomit.943889

Abstract

Objective: Supracondylar humerus fractures are the most common surgery requiring upper extremity fractures among children. Kirschner Wire (KW) is one of the important surgical method that is smooth stainless steel pins, and is widely used in orthopedics. The aim of this study is to evaluate the stability difference in supracondylar humerus fractures of children by unscrewed and screwed KW by finite element analysis method.
Material and Methods: In this study, the computerized images of patients who were admitted to the Orthopedics and Traumatology department of a Training and Research Hospital with a diagnosis of pediatric supracondylar humerus fracture were used. A bone model was created using a layer created in the 3D Slicer program version 4.10.2. On this model, osteo-synthesis fixation was performed with Solid Works, with screwed and unscrewed K-wire mounting, divergent and crossed. Afterwards, this model was analyzed in ANSYS 16.0 finite element analysis program.
Results: All KW configuration measurements for screwed forces were found higher than unscrewed forces in both crossed and divergent torques.
Conclusion: The use of screwed K wire was found to be superior to unscrewed wire due to the more stable fixation. During surgery, the configuration of the K wire varies according to the surgeon's experience, fracture type, ulnar nerve damage risk analysis.

Keywords

Kirschner wire, supracondylar humerus fractures, finite element analysis, bone modelling

References

• 1. O’hara L, Barlow J, Clarke NM. Displaced supracondylar fractures of the humerus in children: audit changes practice. The Journal of bone and joint surgery British volume. 2000;82(2):204-10.
• 2. Lamdan R, Liebergall M, Gefen A, Symanovsky N, Peleg E. Pediatric supracondylar humerus fractures: effect of bone–implant interface conditions on fracture stability. Journal of children's orthopaedics. 2013;7(6):565-9. doi: 10.1007 / s11832-013-0533-4 .
• 3. Eidelman M, Hos N, Katzman A, Bialik V. Prevention of ulnar nerve injury during fixation of supracondylar fractures in children by ‘flexion–extension cross-pinning’technique. Journal of Pediatric Orthopaedics B. 2007;16(3):221-4. doi: 10.1097 / BPB.0b013e328010b684.
• 4. Foead A, Penafort R, Saw A, Sengupta S. Comparison of two methods of percutaneous pin fixation in displaced supracondylar fractures of the humerus in children. Journal of orthopaedic surgery. 2004;12(1):76-82. doi: 10.1177 / 230949900401200114.
• 5. Davis RT, Gorczyca JT, Pugh K. Supracondylar humerus fractures in children: comparison of operative treatment methods. Clinical Orthopaedics and Related Research®. 2000;376:49-55.
• 6. Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative treatment of supracondylar fractures of the humerus in children: the consequences of pin placement. JBJS. 2001;83(5):735-40.
• 7. Kocher MS, Kasser JR, Waters PM, Bae D, Snyder BD, Hresko MT, et al. Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children: a randomized clinical trial. JBJS. 2007;89(4):706-12. doi: 10.2106 / JBJS.F.00379.
• 8. Slobogean BL, Jackman H, Tennant S, Slobogean GP, Mulpuri K. Iatrogenic ulnar nerve injury after the surgical treatment of displaced supracondylar fractures of the humerus: number needed to harm, a systematic review. Journal of Pediatric Orthopaedics. 2010;30(5):430-6. doi: 10.1097 / BPO.0b013e3181e00c0d.
• 9. Lee SS, Mahar AT, Miesen D, Newton PO. Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. Journal of Pediatric Orthopaedics. 2002;22(4):440-3.
• 10. Sankar WN, Hebela NM, Skaggs DL, Flynn JM. Loss of pin fixation in displaced supracondylar humeral fractures in children: causes and prevention. JBJS. 2007;89(4):713-7. doi: 10.2106 / JBJS.F.00076.
• 11. Zamzam MM, Bakarman KA. Treatment of displaced supracondylar humeral fractures among children: crossed versus lateral pinning. Injury. 2009;40(6):625-30. doi: 10.1016 / j.injury.2008.10.029.
• 12. Ezquerro F, Jiménez S, Pérez A, Prado M, de Diego G, Simón A. The influence of wire positioning upon the initial stability of scaphoid fractures fixed using Kirschner wires. Med Eng Phys. Temmuz 2007;29(6):652-60. doi: 10.1016 / j.medengphy.2006.08.005.
• 13. Feng C, Guo Y, Zhu Z, Zhang J, Wang Y. Biomechanical Analysis of Supracondylar Humerus Fracture Pinning for Fractures With Coronal Lateral Obliquity. J Pediatr Orthop. Mart 2012;32(2):196-200. doi: 10.1097 / BPO.0b013e318242a99a.
• 14. Bashyal RK, Dobbs MB. Complications After Pinning of Supracondylar Distal Humerus Fractures. J Pediatr Orthop. 2009;29(7):5. doi: 10.1097 / BPO.0b013e3181b768ac.
• 15. Alsamhan A, ELSingergy MM, Zamzam MM, Darwish SM. Engineering Judgment of Children Bone Fracture. Int J Biomater. 2011;2011:1-7. doi: 10.1155 / 2011/737054 .
• 16. Skaggs DL, Sankar WN, Albrektson J, Vaishnav S, Choi PD, Kay RM. How Safe Is the Operative Treatment of Gartland Type 2 Supracondylar Humerus Fractures in Children? J Pediatr Orthop. Mart 2008;28(2):139-41. doi: 10.1097 / BPO.0b013e3181653ac8 . 17. Lee KM, Chung CY, Gwon DK, Sung KH, Kim TW, Choi IH, vd. Medial and Lateral Crossed Pinning Versus Lateral Pinning for Supracondylar Fractures of the Humerus in Children: Decision Analysis. J Pediatr Orthop. 2012;32(2):131-138. doi: 10.1097 / BPO.0b013e3182471931.
• 18. Guo M, Xie Y, Su Y. Open Reduction of Neglected Supracondylar Humeral Fractures With Callus Formation in Children. J Pediatr Orthop. Eylül 2020;40(8):e703-7. doi: 10.1097 / bpo.0000000000001518 . 19. Omid R, Choi PD, Skaggs DL. Supracondylar Humeral Fractures in Children: J Bone Jt Surg-Am Vol. Mayıs 2008;90(5):1121-32. doi: 10.2106 / JBJS.G.01354 .
• 20. Gaston RG, Cates TB, Devito D, Schmitz M, Schrader T, Busch M, et al. Medial and lateral pin versus lateral-entry pin fixation for Type 3 supracondylar fractures in children: a prospective, surgeon-randomized study. Journal of Pediatric Orthopaedics. 2010;30(8):799-806. doi: 10.1097 / BPO.0b013e3181f73d59.
• 21. Lee SS, Mahar AT, Miesen D, Newton PO. Displaced Pediatric Supracondylar Humerus Fractures: Biomechanical Analysis of Percutaneous Pinning Techniques: J Pediatr Orthop. Temmuz 2002;22(4):440-3.
• 22. Ling M, Zhan S, Jiang D, Hu H, Zhang C. Where should Kirschner wires be placed when fixing patella fracture with modified tension-band wiring? A finite element analysis. J Orthop Surg. Aralık 2019;14(1):1-8. doi: 10.1186 / s13018-019-1060-x .
• 23. McKeon KE, O’Donnell JC, Bashyal R, Hou CC, Luhmann SJ, Dobbs MB, et al. Immobilization after pinning of supracondylar distal humerus fractures in children: use of the A-frame cast. Journal of Pediatric Orthopaedics. 2012;32(1):e1-e5. doi: 10.1097 / BPO.0b013e31823db1b4.