Dual plating for fixation of humeral shaft fractures: A mechanical comparison of various combinations of plate lengths

Abstract

ObjectiveThe role of plate configuration was found inconclusive on the biomechanical effects of the plate size and hole number for dual plate constructions in humeral shaft fractures. The purpose of this study was to test the biomechanical stability of various dual plate constructions.MethodsTwenty-four left humeri (4th Generation Composite Humerus, Sawbones, Malmö, Sweden) with comminuted midshaft humeral fracture were used. Four groups of plate constructs were tested: laterally fixed 8-hole locking plate and screws were combined with anteriorly locking plates containing 0, 4, 6, or 8 holes in groups I, II, III, and IV, respectively. The alterations in axial, bending, and torsional angles were recorded.ResultsThere were no fixation failures during axial, bending, or torsional stiffness testing within the elastic behavior limits. Axial stiffness was highest in Group IV. Torsional stiffness, posterior-to-anterior bending stiffness, lateral-to-medial bending stiffness, and medial-to-lateral bending stiffness were lowest in Group I.ConclusionThe similar stiffness values for the 8-to-4 hole and 8-to-6 hole plate constructions indicate that the 8-to-4 hole construction is an option in young adults, while the stiffest 8-to-8 hole combination may be an option for osteoporotic patients.

Biomechanics of Upper Extremity Double Plating

“…They combined a laterally fixed 8-hole plate with a plate containing 4 or 6 holes or with another 8-hole plate placed at an angle of 90°t o the first plate. The groups with additional 4-and 6-hole plate had biomechanically comparable values, while the two 8-hole plate construction was the most stable [36]. In a finite-element study on plate location with 2 plates used to treat humeral shaft fractures, the authors evaluated altogether 5 different groups.…”

Clinical Characteristics, Mechanism, and Outcome of Humeral Shaft Fractures Sustained during Arm Wrestling in Young Men: A Retrospective Study

“…Posterior plating has biomechanical advantages because the plate is applied on the tension side of the humerus, and lateral plating is also widely used for humeral shaft fractures 24 . However, some researchers are concerned that a single plate provides inadequate fixation and is inferior to dual‐plate fixation 25,26 . The present study retrospectively analyzed the DASH scores of patients who received one of three possible plating methods for arm wrestling fractures.…”

“…24 However, some researchers are concerned that a single plate provides inadequate fixation and is inferior to dual-plate fixation. 25,26 The present study retrospectively analyzed the DASH scores of patients who received one of three possible plating methods for arm wrestling fractures. These methods included single (posterior or lateral) and dual plating (Table 3).…”

The effect of single plate and double plate application on union and functional results in humeral diaphyseal nonunions

“…Although the union time was shorter in patients who were applied the double-plate method, our union times were shorter compared to the literature. osteoporotic bones was the method that used eight lateral screws and six anterior screws for fixation (31). Therefore, in our study, this plate configuration was applied in patients who underwent double-plate fixation and early postoperative mobilization was initiated.…”

“…Murray et al, who popularized the use of the double-plate method in nonunion treatment, indicated that the double-plate method provides a stable fixation and has positive effects on fracture union (29). Biomechanical studies have shown that double-plate fixation provides more stable fixation than single-plate fixation and intramedullary nailing (30,31). One biomechanical study, which evaluated plate placement and plate length, found that the most stable fixation method for difference between the groups in terms of union time (p>0.05).…”