Anti-sliding plate technique for coronal shear fractures of the distal humerus

Abstract

Purpose: The purpose of this study is to discuss the surgical strategy, technical feasibility, and clinical efficacy of coronal shear fractures of the distal humerus using the anti-sliding plate technique. Methods: Fifty-two patients (35 males and 17 females) were treated with the anti-sliding plate technique in our hospital from January 2012 to January 2017. The average age of the patients was 40.4 years. They were classified according to the Dubberley classification system and treated with the anti-sliding plate technique. The long-term functional scores represented by the Mayo Elbow Performance Index and complications were evaluated. Results: Fractures were classified as follows: 11 type-IA, 5 type-IB, 16 type-IIA, 4 type-IIB, 13 type-IIIA, and 3 type-IIIB according to the Dubberley classification system. All patients were treated with open reduction and internal fixation by the extensile lateral approach and completed a clinical and radiographic follow-up (average, 17.6 months). The average Mayo elbow performance score was 90.6 points, with 36 excellent, 11 good, and 5 fair results. The average range of movement of the elbow joint was 3°(0-15°) for extension and 136°(90-150°) for flexion. Conclusions: The anti-sliding plate technique follows basic AO principles and neutralizes the shearing force combined with lag screws and/or Kirschner wires after the anatomic reduction of the fracture. It allows for the stable internal fixation of the fracture, which is critical for early mobilization and a good functional outcome.

Biomechanical stability of complex coronal plane fracture fixation of the capitellum

“…The results of our study are in accordance with recent clinical studies that suggest plating as the treatment of choice in those complex fracture patterns [26,31]. Wang et al [31] recently evaluated the safety and efficacy of the fixation of Dubberley type B capitellar and trochlear fractures in a clinical study using posterolateral anatomic plates with support of the distal humerus.…”

“…Sen et al introduced the concept of additional fracture stabilization using an anterior placed antiglide plate following traditional AO principles by neutralizing shear forces [24]. Song et al [26] recently evaluated the technical feasibility and clinical efficacy of coronal shear fractures of the distal humerus using the anti-sliding plate technique. The authors suggest that the anti-sliding plate technique allows a stable internal fixation of the fracture, which is critical for early mobilization and a good functional outcome.…”

“…In case of comminuted and complex fractures several clinical studies have favored the use of an antiglide plate [26], or a posterolateral locking plate [31]. However, to the author's knowledge, no biomechanical studies have been performed assessing surgical treatment options in Dubberley Type-II fractures to date.…”

Coronal Shear Fractures of the Distal Humerus

“…A mini-fragment plate or a one-third tubular plate can be contoured to fit anteriorly and its distal portion is bent approximately 60° at the level of the articular surface of the capitellum in a way that it does not interfere with the radial head. The plate is secured using only the most proximal holes, while the distal portion is not fixed and helps neutralize the shear forces across the fracture site [ 19 , 25 , 71 ]. There is only one clinical study on this technique.…”

“…There is only one clinical study on this technique. Song et al [ 71 ] recently retrospectively reported on their case series of 52 patients, among whom, after a 17.6-month follow-up, 36 were scored excellent, 11 good, and five with fair results, according to the Mayo Elbow Performance Score (MEPS). All fractures were united by a one-year follow-up and three cases sustained hardware loosening or breakage without secondary fracture displacement.…”