Complex Distal Humeral Fractures: Internal Fixation with a Principle-Based Parallel-Plate Technique

Abstract

Stable fixation and a high rate of union of complex distal humeral fractures can be achieved when a principle-based surgical technique that maximizes fixation in the distal segments and stability at the supracondylar level is employed. The early stability achieved with this technique permits intensive rehabilitation to restore elbow motion.

Use of Orthogonal or Parallel Plating Techniques to Treat Distal Humerus Fractures

“…Lastly, the screws should lock together by interdigitation, creating a "fixed-angle" structure and linking the columns together. (27) With regard to fixation of the plates, the plates should be applied allowing for compression of both columns at the supracondylar level. Lastly, the plates chosen must have enough strength and stiffness to resist breaking or bending before union occurs at the supracondylar level.…”

“…Lastly, the plates chosen must have enough strength and stiffness to resist breaking or bending before union occurs at the supracondylar level. (27) It was the Mayo clinic group's belief that following these technical objectives would allow the parallel plating technique to link both columns of the distal humerus, thus providing the structural stability necessary for fracture healing. The interdigitation of the distal screws is likened to a keystone of an arch, being the structural link necessary for adequate fixation.…”

“…The interdigitation of the distal screws is likened to a keystone of an arch, being the structural link necessary for adequate fixation. (27) Thus, fixation of the bone fragments relies on the stability of the hardware construct rather than on screw purchase in the bone. (23) Biomechanical Anaylsis:…”

“…If during the reduction missing bone is encountered, one should understand that the anterior aspect of the distal part of the humerus is the critical area that needs to be restored to allow for a functional joint. (27) The posterior aspect of the articular surface of the distal humerus is a less critical region. In addition, the medial half of the trochlea is vital to ensure stability of the elbow articulation.…”

“…It can be reconstructed with either the lateral half of the trochlea or the capitellum. (27) Once the articular surface is anatomically reduced, the plates are placed along the medial and lateral columns of the distal humerus. One-third tubular plates are not strong enough for fixation of these fractures and therefore, the precountered distal humerus plates are currently favored.…”