Biomechanical comparison of two different periarticular plating systems for stabilization of complex distal humerus fractures

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.…”

“…Computational simulations were performed with loads on the specific part of the articular segment of the distal humerus, distally from the gap, following the principles from the latest biomechanical studies dealing with distal humerus fractures 14,[16][17][18] , with the radial column being loaded with 60%, and the ulnar column with 40% of the total load. The load and humerus positions were as follows: Axial load or anterior deflection in which the upper arm was placed at a flexion angle of about 5° in relation to the longitudinal axis of the humeral diaphysis ( Figure 2a); Bending or posterior deflection with the upper arm flexed at a 75° angle in relation to the longitudinal axis of the humeral diaphysis ( Figure 2b); Lateral or varus load in which the load is applied laterally on the radial condylar, with the humerus placed horizontally (Figure 2c).…”

“…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].…”