A Biomechanical Evaluation of Methods of Distal Humerus Fracture Fixation Using Locking Compression Plates Versus Conventional Reconstruction Plates

Abstract

The biomechanical behavior of the osteosynthesis depends more on plate configuration than plate type. Advantages of locking compression plates are only significant if compared with dorsal plate application techniques. Nevertheless, locking compression plates are helpful supplementary tools for achieving primary stable fracture fixation. This might be of considerable clinical relevance in patients with diminished bone mineral quality or in the presence of metaphyseal comminution.

Comparative study of three models of extra-articular distal humerus fracture osteosynthesis using the finite element method on an osteoporotic computational model

“…11,[13][14][15][16][17][18] No study to date has addressed the issue of biomechanical stability on the transition of the distal humeral diaphysis into the distal segment of the humerus.…”

“…Those studies are very uneven: with regard to the number and types of models, methods and load directions, methods and precision of displacements measurements, and thus the conclusions derived from them are hardly mutually comparable. 11,[13][14][15][16][17][18] Using the finite element method, attempts were made to find the optimal plate configuration which would improve its biomechanical properties, taking into account the specific anatomy of the distal humerus.…”

“…9 No prospective randomized studies have been published on their outcomes, and the majority of the studies carried out were retrospective and involved a small number of patients. [10][11][12][13][14][15][16][17][18][19][20][21][22][23] Hence it is not possible to draw conclusions from them on the ideal configuration of the implant for stabilization of distal humerus fractures. …”

Outcomes of distal humerus diaphyseal injuries fixed with a single-column anatomic plate

“…Double-plating techniques using two 3.5-mm plates in orthogonal (90-90) or parallel (180°) patterns are generally accepted. Standard singleplating techniques typically fail to achieve adequate stabilisation [6][7][8]. Yet despite good functional results, nonunions and infections do occur with double-plating techniques [8,9].…”

“…In a biomechanical study, Korner et al demonstrated that both two standard reconstruction plates and two pre-contoured locking plates provide adequate fixation in an extra-articular distal humerus model [7]. They showed, however, that the locking plate construct provided enhanced stiffness against anterior-posterior bending and torsional loads.…”