ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Orthopedics
Volume 13 - 2025 | doi: 10.3389/fped.2025.1640764
This article is part of the Research TopicFractures and Deformities of the Extremities in Children and Adolescents: Etiology, Diagnosis, and Treatment: 2025View all articles
Fixation for Metaphyseal-diaphyseal Junction Noncomminuted Fracture of the distal humerus in children: K-wire or ESIN, how to decide?
Provisionally accepted
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
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The metaphyseal-diaphyseal junction (MDJ) fracture of the distal humerus has posed significant difficulty clinically, as the increased height of the distal fragmant makes it hard for Kirschner wires to reach the proximal fragment. Our previous study provided suggestions for the choice of fixation in metaphyseal-diaphyseal junction (MDJ) fracture of the distal humerus according to the location of the fracture line based on biomechanical analysis. This study went on to testify an advanced suggestions in clinical patients.Normal elbow X-rays were measured to get a normal reference value to define the location of the fracture. A ratio of c' (the diameter of humeral shaft at the most proximal point of the fracture line)/d (the diameter of humeral shaft at distal humerus) was used to define the location of the fracture and guide the selection of fixation.According to our previous research, the ratio of c'/d was used to define the location of the fracture. Eighty-nine patients with MDJ fractures were included. For patients with high MDJ fracture elastic stable intramedullary nails (ESIN) were selected and for those with low MDJ fractures Kirschner wires were used. The short-term outcome was assessed using the Flynn criteria.The c/d ratio of 1.2 was finally used to define the high or low location of the fracture.All the 89 MDJ fractures healed uneventfully. 73 of them were fixed with lateral or crossed pinning and 84.9% of them were ranked as excellent. 16 cases were fixed with ESIN and 81.3% were excellent. There were no significant difference between the outcomes of the groups.ESINs were used for fractures in the higher part of the MDJ region, defined as c'/d<1.2. Three lateral divergent or crossed pins were used for fractures in the lower part of the MDJ region with c'/d ≥1.2. This strategy, as recommended by our previous biomechanical research, has been demonstrated to be practical in clinical practice.
Keywords: metaphyseal-diaphyseal junction fracture, closed reduction and percutaneous pinning, Elastic stable intramedullary nail, External fixator, Humerus, pediatric. Level of Evidence: Level III Retrospective Cohort Study
Received: 04 Jun 2025; Accepted: 07 Jul 2025.
Copyright: © 2025 Li, Liu, Li, Zhang, Li, Liwei and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Enbo Wang, Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
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