Basic scienceBiomechanical evaluation of parallel versus orthogonal plate fixation of intra-articular distal humerus fractures
Section snippets
Study design
Fourteen pairs of fresh-frozen cadaver upper extremities (28 total specimens) were used for the current study. Each pair of left and right elbows was a matched pair harvested from the same donor. The mean donor age was 84 years (range, 60-97) and 12 of 14 donors were older than 70 years. A low T-type intra-articular distal humerus fracture with a metaphyseal defect was created, and the right or left elbow of each matched pair was randomly chosen for fixation with either orthogonal or parallel
Varus loading
Parallel plate constructs were characterized by significantly higher stiffness compared to the orthogonal constructs during all phases of cyclic loading under a varus moment (repeated measures ANOVA: F-ratio = 17.7, P = .002). The detailed results are presented in Table I and Figure 6.
Macroscopic evaluation demonstrated screw loosening in all (7/7) posterior plates of the orthogonal construct (Figure 7), but in none of the lateral plates of the parallel construct; the difference was significant
Discussion
Stable fixation of distal humerus fractures plays a critical role in avoiding the complications of nonunion, failure of fixation, and stiffness of the elbow.8, 12, 13, 15, 20, 22, 23, 26, 27 However, optimal configuration of dual plate constructs for fixation of distal humerus fractures remains controversial and biomechanical studies have reported conflicting results.4, 10, 14, 30, 31, 32, 33
Helfet and Hotchkiss10 concluded in one of the early biomechanical studies that an orthogonal plate
Conclusions
Parallel plating for fixation of an intra-articular distal humerus fracture with a metaphyseal defect demonstrates higher stiffness and lower rate of implant loosening compared to orthogonal plating in varus cyclic loading, higher ultimate torque in varus loading to failure, and higher ultimate load in axial/sagittal loading to failure. Parallel plating appears to be preferable for fixation of such fractures. Further research is needed to clarify the biomechanical properties of these plate
Disclaimer
Dr Itamura is a speaker for Acumed LLC. (Hillsboro, OR) and has received financial payments or other benefits. The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. No outside funding or grants were received that assisted this study. IRB approval was not required.
Implants for this study were donated by Acumed (Hillsboro,
References (33)
- et al.
Elbow anatomy and structural biomechanics
Clin Sports Med
(2004) - et al.
Elbow joint force predictions for some strenuous isometric actions
J Biomech
(1980) - et al.
Muscles across the elbow joint: a biomechanical analysis
J Biomech
(1981) - et al.
Functional outcome of AO type C distal humeral fractures
J Hand Surg [Am]
(2003) Supracondylar fractures of the elbow: open reduction, internal fixation
Hand Clin
(2004)- et al.
Management of the smashed distal humerus
Orthop Clin North Am
(2002) - et al.
Fractures of the distal humerus
Orthop Clin North Am
(2000) - et al.
Complex fractures of the distal humerus and their complications
J Shoulder Elbow Surg
(1999) - et al.
Biomechanical comparison of two different periarticular plating systems for stabilization of complex distal humerus fractures
Clin Biomech (Bristol, Avon)
(2006) - et al.
A comparison of double-plate fixation methods for complex distal humerus fractures
J Shoulder Elbow Surg
(1995)
A biomechanical comparison of plate configuration in distal humerus fractures
J Orthop Trauma
Assessment of bone quality in the proximal humerus by measurement of the contralateral site: a cadaveric analyze
Arch Orthop Trauma Surg
Surgical treatment of intra-articular fractures of the distal part of the humerus. Functional outcome after twelve to thirty years
J Bone Joint Surg Am
A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65
J Orthop Trauma
Intraarticular fractures of the distal humerus in the adult
Clin Orthop Relat Res
Internal fixation of the distal humerus: a biomechanical comparison of methods
J Orthop Trauma
Cited by (70)
Adjunctive intraosseous wiring fixation technique for the comminuted distal humeral fractures
2023, JSES Reviews, Reports, and TechniquesManagement of Bicondylar Distal Humerus Fractures
2023, Operative Techniques in OrthopaedicsControversies in the Management of Bicolumnar Fractures of the Distal Humerus
2023, Journal of Hand Surgery