Intra-articular Distal Humerus Fractures: Parallel Versus Orthogonal Plating

Abstract

Background: Dual-plating osteosynthesis is the standard treatment for Orthopedic Trauma Association (OTA)-type 13-C distal humerus fractures. However, optimal plate position is debated. Purpose: The purpose of this study was to evaluate dual-plate positioning following intra-articular distal humerus fracture repair by comparing outcomes between patients plated in parallel and those plated orthogonally following open-reduction, internal-fixation (ORIF) of intra-articular distal humerus fractures. Methods: All OTA-type 13-C intra-articular distal humerus fractures treated operatively at our institution over a 10-year period were reviewed. Clinical outcomes and complications were compared between those plated in parallel and those plated orthogonally. Data were analyzed using independent-samples t-tests, Mann-Whitney U tests, chi-square tests, and Fisher’s exact tests. Results: A total of 69 patients met inclusion criteria. Mean follow-up among this cohort was 19.3 months; 45 (64.8%) patients had orthogonal dual plating, and 24 (35.2%) had parallel plating. Groups did not differ with respect to demographics or duration of follow-up. Clinically, there were no significant differences in time to union, elbow arc of motion at any time point, or patient Mayo Elbow Performance Index (MEPI) scores at final follow-up. Furthermore, there were no differences in complications. Conclusion: Parallel and orthogonal plating following ORIF of distal humerus fractures with modern, contoured locking compression plates had similar outcomes in this study. This study represents the largest comparative series in the literature at the time of its writing. Both techniques may be considered when deciding on dual-plating technique for treating intra-articular distal humerus fractures.

Keywords

distal humerus plating trauma elbow parallel orthogonal

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References

Atalar

Tunalı

Erşen

Kapıcıoğlu

Sağlam

Demirhan

MS.

Biomechanical comparison of orthogonal versus parallel double plating systems in intraarticular distal humerus fractures. Acta Orthop Traumatol Turc. 2017;51(1):23–28.

Bryan

Morrey

BF.

Extensive posterior approach of the elbow—a triceps-sparing approach. Clin Orthop. 1982;166:188–192.

Campbell

WC.

Incision for exposure of the elbow joint. Am J Surg. 1932;15:65–67.

Gofton

Macdermid

Patterson

Faber

King

GJ.

Functional outcome of AO type C distal humeral fractures. J Hand Surg Am. 2003;28:294–308.

Helfet

Hotchkiss

RN.

Internal fixation of the distal humerus: a biomechanical comparison of methods. J Orthop Trauma. 1990;4(3):260–264.

Henley

MB.

Intra-articular distal humeral fractures in adults. Orthop Clin North Am. 1987;18(1):11–23.

Henley

Bone

Parker

Operative management of intra-articular fractures of the distal humerus. J Orthop Trauma. 1987;1:24–35.

Holdsworth

Mossad

MM.

Fractures of the adult distal humerus. Elbow function after internal fixation. J Bone Joint Surg Br. 1990;72:362–365.

Huang

Chiu

Chuang

Chen

TH.

The results of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus: a critical analysis of the results. J Trauma. 2005;58:62–69.

10.

Jupiter

Neff

Holzach

Allgöwer

Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg Am. 1985;67:226–239.

11.

Kollias

Darcy

Reed

Rosvold

Shrive

Hildebrand

KA.

Distal humerus internal fixation: a biomechanical comparison of 90 degrees and parallel constructs. Am J Orthop. 2010;39(9):440–444.

12.

Kundel

Braun

Wieberneit

Ruter

Intraarticular distal humerus fractures. Factors affecting functional outcome. Clin Orthop Relat Res. 1996;332:200–208.

13.

Lee

Kim

Park

Choy

WS.

A comparison between orthogonal and parallel plating methods for distal humerus fractures: a prospective randomized trial. Eur J Orthop Surg. 2014;24(7):1123–1131.

14.

Letsch

Schmit-Neuerburg

Sturmer

Walz

Intraarticular fractures of the distal humerus. Surgical treatment and results. Clin Orthop Relat Res. 1989;241:238–244.

15.

McKee

Jupiter

JB.

A contemporary approach to the management of complex fractures of the distal humerus and their sequelae. Hand Clin. 1994;10:479–494.

16.

McKee

Jupiter

Toh

Wilson

Colton

Karras

KK.

Reconstruction after malunion and nonunion of intra-articular fractures of the distal humerus. Methods and results in 13 adults. J Bone Joint Surg Br. 1994;76:614–621.

17.

McKee

Kim

Kebaish

Stephen

Kreder

Schemitsch

EH.

Functional outcome after open supracondylar fractures of the humerus—the effect of the surgical approach. J Bone Joint Surg Am. 2000;82:646–651.

18.

McKee

Wilson

Winston

Schemitsch

Richards

RR.

Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg Am. 2000;82(12):1701–1707.

19.

Morrey

. Functional evaluation of the elbow. In: Morrey

, ed. The Elbow and Its Disorders. 3rd ed. Philadelphia, PA: W.B. Saunders; 2000:82.

20.

O’Driscoll

SW.

Optimizing stability in distal humeral fracture fixation. J Shoulder Elbow Surg. 2005;14(suppl 1):186S–194S.

21.

O’Driscoll

SW.

The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and non-unions. Orthop Clin North Am. 2000;31:91–101.

22.

Pajarinen

Bjorkenheim

JM.

Operative treatment of type C intercondylar fractures of the distal humerus: results after a mean follow-up of 2 years in a series of 18 patients. J Shoulder Elbow Surg. 2002;11:48–52.

23.

Ring

Jupiter

JB.

Fractures of the distal humerus. Orthop Clin North Am. 2000;31:103–113.

24.

Sanchez-Sotelo

Torchia

O’Driscoll

SW.

Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique. J Bone Joint Surg Am. 2007;89:961–969.

25.

Shih

Lin

Tai

TW.

Parallel versus orthogonal plate osteosynthesis of adult distal humerus fractures: a meta-analysis of biomechanical studies. Int Orthop. 2019;43(2):449–460.

26.

Shin

Sohn

NH.

A clinical comparison of two different double plating methods for intraarticular distal humerus fractures. J Shoulder Elbow Surg. 2010;19(1):2–9.

27.

Sodergard

Sandelin

Bostman

Postoperative complications of distal humeral fractures. 27/96 adults followed up for 6 (2-10) years. Acta Orthop Scand. 1992;63:85–89.

28.

Stoffel

Cunneen

Morgan

Nicholls

Stachowiak

Comparative stability of perpendicular versus parallel double-locking plating systems in osteoporotic comminuted distal humerus fractures. J Orthop Res. 2008;26:778–784.

29.

Taylor

Owen

Benfield

Wayne

Boardman

ND.

Parallel plating of simulated distal humerus fractures demonstrates increased stiffness relative to orthogonal plating with a distal humerus locking plate system. J Orthop Trauma. 2016;30(4):118–122.

30.

Van Gorder

. Surgical approach in supracondylar “T” fractures of the humerus requiring open reduction. J Bone Joint Surg Am. 1940;22:278–292.

31.

Waddell

Hatch

Richards

RR.

Supracondylar fractures of the humerus: results of surgical treatment. J Trauma. 1988;28:1615–1621.

32.

Wang

Liu

A comparison between perpendicular and parallel plating methods for distal humerus fractures: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2020;99(23):e19602.

33.

Wildburger

Mahring

Hofer

HP.

Supraintercondylar fractures of the distal humerus: results of internal fixation. J Orthop Trauma. 1991;5:301–307.

34.

Zalavras

Vercillo

Jun

Otarodifard

Itamura

Lee

TQ.

Biomechanical evaluation of parallel versus orthogonal plate fixation of intra-articular distal humerus fractures. J Shoulder Elbow Surg. 2011;20:12–20.