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Single-screw Fixation of Adolescent Salter-II Proximal Humeral Fractures

Biomechanical Analysis of the “One Pass Door Lock” Technique

Miller, Mark Carl PhD*,†; Redman, Christopher N. MD; Mistovich, R. Justin MD§; Muriuki, Muturi PhD; Sangimino, Mark J. MD*

Journal of Pediatric Orthopaedics: September 2017 - Volume 37 - Issue 6 - p e342–e346
doi: 10.1097/BPO.0000000000001038

Background: Pin fixation of Salter-II proximal humeral fractures in adolescents approaching skeletal maturity has potential complications that can be avoided with single-screw fixation. However, the strength of screw fixation relative to parallel and diverging pin fixation is unknown. To compare the biomechanical fixation strength between these fixation modalities, we used synthetic composite humeri, and then compared these results in composite bone with cadaveric humeri specimens.

Methods: Parallel pinning, divergent pinning, and single-screw fixation repairs were performed on synthetic composite humeri with simulated fractures. Six specimens of each type were tested in axial loading and other 6 were tested in torsion. Five pair of cadaveric humeri were tested with diverging pins and single screws for comparison.

Results: Single-screw fixation was statistically stronger than pin fixation in axial and torsional loading in both composite and actual bone. There was no statistical difference between composite and cadaveric bone specimens.

Conclusion: Single-screw fixation can offer greater stability to adolescent Salter-II fractures than traditional pinning.

Clinical Relevance: Single-screw fixation should be considered as a viable alternative to percutaneous pin fixation in transitional patients with little expected remaining growth.

*Allegheny General Hospital

Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA

Children’s Medical Center of Dallas, Dallas, TX

§University Hospitals of Cleveland, Cleveland, OH

Hines Veterans Administration Hospital, Hines, IL

M.C.M.: designed the testing protocol, analyzed the data, wrote the Methods, Results and Discussion. C.N.R.: performed simulated surgical repairs, wrote part of the Introduction. R.J.M.: constructed templates and molds for testing, wrote part of the Introduction and Discussion. M.M.: performed biomechanical testing, collated results, assisted in the experimental design, created figures. M.J.S.: created the groupings in the experimental design, oversaw all simulated surgical repairs, rewrote and edited the Introduction and Methods.

No external support was received for this work.

The authors declare no conflicts of interest.

Reprints: Mark Carl Miller, PhD, 10th Floor, S. Tower, 320 E. North Avenue, Pittsburgh, PA 15212. E-mail:

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.