Fixation of Extra-Articular Distal Humerus Fractures Using One Locking Plate Versus Two Reconstruction Plates: A Laboratory Study

Abstract

Double-plating provides a more rigid fixation than a single-locked plate for fixation of extra-articular comminuted distal humeral fractures. This could be clinically relevant in situations with 100% comminution as seen in gun shot injuries.

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

“…It appears that some degree of cortical contact is necessary to provide adequate stability to achieve sufficient fixation with a single plate. A recent biomechanical study has shown that a locking plate placed on the lateral column with no medial buttress to prevent varus deformity provided less resistance to varus stresses compared to doubleplating [19]. This may be clinically relevant in situations with severe comminution as seen in gunshot injuries and in the absence of cortical contact between fragments.…”

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.…”

“…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.…”

“…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. …”