Dual Plating for Fractures of the Distal Third of the Humeral Shaft

Abstract

In this study, we present a novel method for performing dual plating of extra-articular fractures of the distal third of the humerus. Since 2006, we have treated 15 such fractures with dual plates from a single posterior midline incision. In the first part of the study, we provide the surgical protocol we have used in addressing these fractures. In the second part, the charts of these patients were reviewed retrospectively to examine their clinical and radiographic outcomes. Using this technique, we have achieved an excellent union rate without significant complications while allowing early and aggressive range of motion.

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

“…Indeed, in clinical practice it is not common to place the plates and so many screws so distally in extra-articular fractures of the distal humerus. [2][3][4][5][6][7]10,11 This study suggests that under physiological loads, which are common in the immediate postoperative period, the largest displacements on the joint surface are observed on the radial condyle, and the largest displacements in the gap area are observed in the front part. This information suggests that it is necessary, regardless of whether one or two plates are being placed, to achieve greater stability in the radial column area, which was also confirmed in clinical practice.…”

“…This information suggests that it is necessary, regardless of whether one or two plates are being placed, to achieve greater stability in the radial column area, which was also confirmed in clinical practice. 2,4 The significance of lateral column stabilization is all the greater if we know that in the case of osteoporosis in the distal humerus region, it is most pronounced in the posterolateral segment. 28,29 Moreover, it was found that the cortex in the medial column region is substantially stronger in comparison with the lateral column, both in the supra-and infracondylar region of the distal humerus.…”

“…Although there is still some controversy regarding the treatment of extra-articular distal humerus fractures, many surgeons recommend surgery with plates and screws, [1][2][3][4][5][6][7] while others give precedence to functional bracing, even in the case of a radial nerve lesion. 8,9 Robinson et al 1 reported a better healing response in operated patients with an extra-articular metaphyseal fracture of the distal humerus compared to patients treated non-operatively.…”

Humeral shaft fractures

“…These holes utilize smaller screws with greater thread density and often permit use of compression or locking screws. In the distal-third of the humerus, "90-90" degree dual plating with a malleable lateral reduction plate and a more stout posterolateral extraarticular plate has been shown to lead to good alignment and union [31]. When plating fractures with far cortex bone loss or severe osteopenia, placement of a cortical strut allograft can be considered to augment the far cortex and provide purchase for the screws at that level [32].…”

Influence of Gap Shape on Biomechanical Properties of Extra-Articular Distal Humeral Fracture – A Finite Element Study

“…It is often diffi cult to obtain rigid fi xation in distal fractures of humeral diaphysis without compromising the elbow 8 . However, fi xation of these fractures remains a challenge due to the restricted space for instrumentation at the distal segment and the need to maintain repair integrity under a large range of motion and low to moderate loading 9 .…”