Biomechanical comparison of anatomical plating systems for comminuted distal humeral fractures

Abstract

Purpose Six different mono-axial and poly-axial distal humeral plating systems with an anatomical plate design were compared. The aim of the biomechanical tests was to examine differences regarding system stiffness, median fatigue limit, and failure mechanisms. Methods Different configurations of two double plate fixation systems by two manufacturers for the treatment of complex distal humeral fractures (AO/OTA type C2.3) were biomechanically tested in a physiologically relevant setup. Results The 180°Stryker configuration presented itself as the system with the highest stiffness, being significantly stiffer (p < 0.001) than every system other than the poly-axial 180°aap system (p = 0.378). For the median fatigue limit the 180°S tryker and poly-axial aap systems were ranked first and second. The failure mechanism for all 90°systems was a fatigue breakage of the posterolateral plate. The 180°aap systems demonstrated breakage of the most distal screws of the lateral plate. The 180°Stryker system demonstrated screw breakage on both the medial and lateral plates. Discussion Breakage of the posterolateral plate as a failure mechanism for the 90°systems was expected. The 180°s ystems demonstrated a higher stiffness compared to the 90°c onstructs for the axial loading. In conclusion, both poly-axial anatomical plating systems provide sufficient stability in this scenario, and the 180°configurations demonstrated superior stiffness.

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

“…Successful treatment for comminuted DHFs requires bicolumnar fixation with sufficient biomechanical stability [7,8] to allow early elbow range of motion and avoid post-operative complications such as non-union and implant failure [4][5][6]. Although several studies had found that parallel plating can provide good clinical results and is biomechanical superior to orthogonal plating in osteoporotic fracture [1,22], it is associated with a greater extent of soft tissue dissection in the distal humerus [11,12] a higher HO formation rate [23,24], and greater difficulty in contouring and applying the lateral plates [19]. Posterior two-plate fixation is considered to be an alternative technique [17] that also has good functional outcomes, high union rates, and low complication rates in c-type DHFs [16].…”

“…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].…”

“…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 – 13 ] and a biomechanical meta-analysis [ 9 ]. However, the main disadvantage of the parallel fixation is the wide soft tissue dissection [ 9 , 12 ].…”

Elbow hemiarthroplasty versus open reduction and internal fixation for AO/OTA type 13 C2 and C3 fractures of distal humerus in patients aged 50 years or above: a randomized controlled trial

“…Despite the evolution of surgical implants and techniques, AO/OTA type 13 C2 and C3 fractures of the distal humerus still pose a surgical challenge. Open reduction and internal fixation (ORIF) is often preferred as the first choice of treatment, but the results vary and are sometimes disappointing, especially in elderly patients [10,25,29]. The success of ORIF depends on correct reduction of the fracture, reconstruction of the articular surface, and the stability and rigidity of the fixation [12].…”

The column procedure preserves elbow stability on biomechanical testing

“…Protocols involving extensive arthrolysis, radial head excision and temporary external fixation have been elaborated [22,23]. Due to the complexity of elbow injuries, optimal treatment of their sequelae varies among different centres according to the individual experience [23][24][25].…”