ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Orthopedics
This article is part of the Research TopicPediatric Trauma and Critical Care: From Basic to ClinicView all 10 articles
Clinical Study of Modular External Fixator for Distal Humeral Metaphyseal-Diaphyseal Junction Fractures in Children
Provisionally accepted
Shuzhen Deng1
Zhaoqiang Chen1
Zhongli Zhang1
ZHE FU1Huaguo Zhao2Jin Cao2Dan Wu2
Jingyu Zhang1
Yongcheng Hu1*- 1Tianjin Hospital, Tianjin, China
- 2Ningbo No 6 Hospital, Ningbo, China
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Background: This study evaluated the clinical efficacy of closed reduction with modular external fixation for pediatric distal humeral metaphyseal-diaphyseal junction (MDJ) fractures. Methods: We retrospectively analyzed 45 pediatric patients (mean age 7.87±5.03 years) treated from January 2020 to December 2024. Patients were divided into "linear" (n=18, two half-pins/one rod) and "triangular" (n=27, four half-pins/three rods) configuration groups based on external fixator configuration. Outcomes included fracture healing time, radiographic parameters (Baumann angle, shaft-condylar angle), Flynn elbow scores, and complications. Fracture line height (The vertical distance from the highest point of the fracture line to the upper edge of the olecranon fossa) was retrospectively measured to analyze configuration selection. Results: The mean operative time was 42.8±12.3 min in the "linear" group and 46.5±17.9 min in the "triangular" group. All fractures healed satisfactorily. Healing time (11.0±2.6 weeks vs. 10.2±3.2weeks), final Baumann angles (72.80±3.71° vs. 73.81±7.40°), and shaft-condylar angles (39.38±8.32° vs. 35.51±7.67°) showed no significant differences between groups (P>0.05). Excellent-to-good Flynn scores were achieved in 94.44% (linear) vs. 92.31% (triangular) of patients, with no statistically significant difference (P>0.05). Complications included pin tract infections (7 vs. 11 cases) and fixation loosening (2 cases each). The average fracture line height was significantly lower in the "linear" configuration group (17.51±3.35 mm) compared to the "triangular" group (28.02±7.93 mm). Conclusions: Modular external fixation demonstrated promising outcomes for pediatric distal humeral MDJ fractures, providing a minimally invasive treatment option with favorable functional recovery, and no second surgery is required to remove the internal fixation device. Low-position MDJ fractures (< 20mm) with a linear configuration can be sufficiently stabilized with K-wires, and the "triangular" configuration is more suitable for high-level fractures (≥20mm).
Keywords: Closed reduction, Distal humeral fracture, External fixation configuration, Metaphyseal-diaphyseal junction, Modular external fixator, Pediatric fracture
Received: 20 Dec 2025; Accepted: 13 Jan 2026.
Copyright: © 2026 Deng, Chen, Zhang, FU, Zhao, Cao, Wu, Zhang and Hu. 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: Yongcheng Hu
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