Parallel versus orthogonal plate osteosynthesis of adult distal humerus fractures: a meta-analysis of biomechanical studies

Shih, Chien-An; Su, Wei; Lin, Wei; Tai, Tai Wei

doi:10.1007/s00264-018-3937-4

Cited by 23 publications

(13 citation statements)

References 39 publications

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“…A recent meta-analysis summarizes the results of 17 biomechanical studies on the topic. The results show clear advantages with regard to axial, torsional and bending stiffness for the parallel DP method [40].…”

Section: Distal Humerusmentioning

confidence: 87%

Biomechanics of Upper Extremity Double Plating

et al. 2019

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Double plating (DP) is an established treatment modality in traumatology. For certain indications, such as open reduction and internal fixation of bicondylar tibial plateau fractures and distal humeral fractures, DP is standard of care in the clinical routine. However, the principles of DP can be transferred to other anatomic regions and indications. In the past years, DP has been brought more and more into focus. For revision cases, such as the treatment of fracture non-unions, DP seems generally useful. In anatomical locations with high torsional stress and bending forces, but also in regions with traction forces by muscles and tendons DP provides multiplanar stability and therefore seems to have biomechanical advantages. Usually two smaller implants can replace one larger implant. Thus, the number of points of fixation can be increased, the stability can be improved and soft-tissue irritations by bulky implants can be minimized. Along with the established indication and application at the distal humerus, there is biomechanical evidence in the current literature for DP of clavicle fractures and humeral shaft fractures. Furthermore, DP provides mechanical advantages in the treatment of certain proximal humeral fractures and olecranon fractures. This review of the literature summarizes the published literature on biomechanics of upper extremity DP.

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Section: Distal Humerusmentioning

confidence: 87%

Biomechanics of Upper Extremity Double Plating

et al. 2019

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“…For type C fractures, the plates are usually oriented orthogonal ("90-90") or parallel, according to surgeon preference and fracture pattern; parallel constructs may offer greater axial stiffness, axial strength, and torsional stiffness. 31,32 Older osteoporotic patients and patients with inflammatory arthropathy with severely comminuted fractures may also be treated with primary total elbow arthroplasty or nonsurgically with brief splintage followed by gradual mobilization. Although this so-called bag of bones treatment often results in radiographic malunion and/or nonunion, 33 the clinical result in the low-demand older adult patient can be surprisingly satisfactory.…”

Section: Distal Humerus Fracturesmentioning

confidence: 99%

Radiographic Evaluation of Elbow Fractures

Alidina

Souza

et al. 2021

Semin Musculoskelet Radiol

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Fractures and dislocations of the elbow are a common cause of emergency department visits each year. Radiography remains the bedrock of an initial injury assessment, and recognition of distinctive injury patterns based on fracture location, morphology, and severity, guides optimal clinical decision-making. This article reviews basic elbow anatomy, frequently seen fractures and injury patterns, and highlights how these findings influence surgical planning and patient management.

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“…Current popular fixation methods for comminuted DHFs are double plating in either parallel or orthogonal direction, which have been studied widely in both clinical and biomechanical aspects [7][8][9]. However, orthogonal plating is reported to have inadequate fixation in cases with osteoporotic and comminuted fractures, which may lead to fixation failure or non-unions [10].…”

Section: Introductionmentioning

confidence: 99%

“…However, orthogonal plating is reported to have inadequate fixation in cases with osteoporotic and comminuted fractures, which may lead to fixation failure or non-unions [10]. Recently, parallel constructs had gained more surgical popularity for treating comminuted DHFs due to the superiority over orthogonal constructs based on recent biomechanical studies [8,[11][12][13] and a biomechanical meta-analysis [9]. However, the main disadvantage of the parallel fixation is the wide soft tissue dissection [9,12].…”

Section: Introductionmentioning

confidence: 99%

Does posterior configuration have similar strength as parallel configuration for treating comminuted distal humerus fractures? A cadaveric biomechanical study

Shih

Kuan

Hsu

et al. 2021

BMC Musculoskelet Disord

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Background The posterior plating technique could be used as a clinical alternative to parallel plating for treating comminuted distal humerus fractures (DHFs) successfully with good clinical results. However, the biomechanical characteristics for posterior fixation are still unclear. The purpose of this study is to evaluate the biomechanical properties of the posterior fixation and to make comparisons between the parallel and the posterior fixation systems. Materials and methods We performed a cadaveric biomechanical testing with two posterior plating systems (a posterior two plating and a single posterior pre-contoured Y plating system) and one parallel two plating system to treat AO/OTA type-C2.3 DHFs. Among three groups, we compared construct stiffness, failure strength, and intercondylar width changes after 5000-cycle fatigue loading and failure loads and failure modes after destructive tests in both the axial compression and (sagittal) posterior bending directions. The correlations between construct failure loads and bone marrow density (BMD) were also compared. Results In axial direction, there were no significant differences in the stiffness and failure load between the posterior and the parallel constructs. However, in sagittal direction, the two-plate groups (posterior two plating and parallel plating group) had significant higher stiffness and failure loads than the one-plate group (single posterior Y plating). There was no fixation failure after 5000-cyclic loading in both directions for all groups. Positive correlation was noted between BMD and failure loads on parallel fixation. Conclusions We found that when using two plates for treating comminuted DHFs, there were no significant differences in terms of most biomechanical measurements between posterior and parallel fixation. However, the single pre-contoured posterior Y plate construct was biomechanically weaker in the sagittal plane than the parallel and the posterior two-plate constructs, although there was no fixation failure after the fatigue test for all groups regardless of the fixation methods. Level of evidence Biomechanical study

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Parallel versus orthogonal plate osteosynthesis of adult distal humerus fractures: a meta-analysis of biomechanical studies

Abstract: IA.

Cited by 23 publications

References 39 publications

Biomechanics of Upper Extremity Double Plating

Biomechanics of Upper Extremity Double Plating

Radiographic Evaluation of Elbow Fractures

Does posterior configuration have similar strength as parallel configuration for treating comminuted distal humerus fractures? A cadaveric biomechanical study

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