Dual plate fixation on distal third diaphyseal fracture of the humerus

Lee, Jun-Ku; Choi, Yong Kee; Sim, Yu Fan; Choi, Dae-Sung; Han, Soo-Hong

doi:10.1007/s00264-016-3355-4

Cited by 17 publications

(5 citation statements)

References 22 publications

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“…Choi et al 14 introduced a dual plate fixation technique for comminuted proximal humerus fractures. Lee et al 1 and Prasarn et al 15 described that satisfactory outcomes were achieved from dual plate fixation of distal diaphyseal humeral fractures. However, in some patients with smaller Journal of Orthopaedic Surgery 27 (2) humeri, the diaphyseal shaft length and/or diameter available for fixation are limited, consequently making it difficult to use large fragment plates.…”

Section: Discussionmentioning

confidence: 99%

“…17 By contrast, dual plate fixation can be performed with a smaller incision and less working length than one large fragment plate. 1 Especially partial release of the deltoid insertion is inevitable in anterolateral plating. Although no statistical difference in clinical outcomes was detected, partial release can be the source of postoperative shoulder pain or abduction weakness.…”

Section: Discussionmentioning

confidence: 99%

“…The humeral shaft is the region just proximal to the supracondylar ridge and immediately distal to the surgical neck. 1 Humeral shaft fractures typically occur with direct or indirect trauma and account for approximately 3% of all orthopedic injuries. 2,3 Internal fixation with a single large fragment plate is the conventional strategy for surgical management of humeral shaft fractures.…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of dual 3.5-mm locking compression plate fixation for humeral shaft fractures: Comparison with single 4.5-mm locking compression plate fixation

Seo

Heo

Yang

et al. 2019

J Orthop Surg (Hong Kong)

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Background: Recently, several in vitro biomechanical studies that used dual small locking plate fixation for humeral shaft fractures have investigated. However, in vivo studies about dual plate fixation for humeral shaft fractures are limited. The purpose of our study was to report the outcomes of dual small plating for humeral shaft fractures in comparison with those of single large fragment plating. Methods: Sixty consecutive patients who underwent an open reduction internal fixation for humeral shaft fractures at our institution from September 2014 to December 2017 were included. Single 4.5-mm locking compression plate (LCP) fixation was used in the first 40 cases, and dual 3.5-mm LCP fixation was used in the final 20 consecutive cases. Data were collected to define patient characteristics, injury mechanism, clinical outcomes, time to surgery, operative time, estimated blood loss, and complications. Using simple radiography during the follow-up period (6, 12, 24, and 52 weeks after surgery), the shoulder and elbow joint ranges of motion (ROM) were also evaluated. Results: Demographic data, time to surgery, surgical time, and estimated blood loss had no significant differences between the two groups. No significant differences were observed in nonunion rate and union rate 3 months after surgery. However, two patients (5%) in the single 4.5-mm LCP fixation group showed metal failure and breakage. No significant differences were found in postoperative shoulder and elbow ROM. Three patients (7.5%) in the single plating group and one patient (5%) in the dual plating group developed radial nerve palsy after surgery. No vascular injury and deep infection were observed in either group. Conclusion: For diaphyseal humeral fractures, dual 3.5-mm LCP fixation to the humerus is a possible treatment choice. This method showed satisfactory union rate, ROM, and complication rate, without increasing surgical time, in comparison with the conventional single 4.5-mm LCP fixation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of dual 3.5-mm locking compression plate fixation for humeral shaft fractures: Comparison with single 4.5-mm locking compression plate fixation

Seo

Heo

Yang

et al. 2019

J Orthop Surg (Hong Kong)

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“…Therefore, to reduce the complications of such fractures, the stability of the distal fracture needs to be xed by at least three or four screws, for which it is obvious that only a double plate can facilitate. Some physicians believe that this kind of fracture should be treated with double plates [6,7]. The approaches for treating distal third diaphyseal fractures of the humerus have been reported using anterior [8], anterolateral [9], and posterior [10] approaches, each of which has both advantages and disadvantages.…”

Section: Introductionsmentioning

confidence: 99%

Modified medial minimally invasive plate osteosynthesis techniques for the treatment of distal third diaphyseal fracture of humerus using a double plate technique

Lin

et al. 2023

Preprint

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Purpose The surgical approach and the placement of plates for the treatment of distal third diaphyseal fracture of the humerus are controversial. The aim of this retrospective study was to evaluate the clinical and radiographic outcomes when modified medial minimally invasive plate osteosynthesis (MIPO) techniques for the treatment of distal third diaphyseal fracture of the humerus using a double plate technique were performed.Methods A total of 20 patients with a distal third diaphyseal fracture of the humerus were selectd from our hospital. Patients were seen between January 2017 and May 2019. They were treated with a modified medial approach combined with MIPO techniques using a double plate technique. Patient demographics, operation time, bleeding volume, union time, complication, the mean fracture length(FL) and distal cortical length (DCL), and the number of screws in the distal fragment were analyzed. The function of the shoulder and elbow were evaluated using Neer's assessment of the shoulder and Mayo's assessment of the elbow.Results The FL was 57.7 ± 7.7mm and the DCL 39.1 ± 5.2mm. The mean operative time was 88.3 ± 12.6min (range 60-110min). The mean blood loss on surgical treatment was 47.8 ± 10.6ml(range 30-60ml). Bone healing was observed in all patients from 10 to 14 weeks (average 11.9 ± 1.8) and there were no complications recorded. All the patients had good function of both the shoulder and elbow. The maximum flexibility of the elbow ranged from 130° to 145° (average 138.5 ± 4.9°) with maximum flexibility straightness 0° to 5° (average 2.2 ± 1.5°). The Mayo elbow joint function score was 80–100 (average 92.7 ± 5.1). The Neer shoulder joint function score was from 85–100 (average 93.6 ± 3.5).Conclusion The modified medial approach had the advantages of no iatrogenic radial nerve nor ulnar nerve injuries. The anterior and the medial side plate were fixed perpendicular to the distal humerus and can offer higher stability at the same time producing better shoulder and elbow joint function.

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“…These features aim at rigid stability to allow early mobilization as well as adequate stiffness to stimulate fracture healing [5]. The preferred plating techniques for comminuted distal humeral fractures include the Mayo clinic configuration (180°between plates) with parallel plate fixation and medial and lateral plate positioning as well as the AO/ASIF configuration (90°angle between plates) with perpendicular plate fixation and medial and postero-lateral plate positioning [3,[6][7][8][9]. Parallel orientation of the plates seemed biomechanically superior [10], but for the translation to the clinical setting the soft tissue envelope and Patrick A. Varady and Christian von Rüden contributed equally to this work.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of anatomical plating systems for comminuted distal humeral fractures

Varady

Rüden

Greinwald

et al. 2017

International Orthopaedics (SICOT)

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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.

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Dual plate fixation on distal third diaphyseal fracture of the humerus

Abstract: Satisfactory radiographic evidence and clinical results suggest that dual plating for distal diaphyseal humeral fractures may be considered a surgical option, with the advantages of strong fixation, less invasion of soft tissue, and early rehabilitation.

Cited by 17 publications

References 22 publications

Clinical outcomes of dual 3.5-mm locking compression plate fixation for humeral shaft fractures: Comparison with single 4.5-mm locking compression plate fixation

Clinical outcomes of dual 3.5-mm locking compression plate fixation for humeral shaft fractures: Comparison with single 4.5-mm locking compression plate fixation

Modified medial minimally invasive plate osteosynthesis techniques for the treatment of distal third diaphyseal fracture of humerus using a double plate technique

Biomechanical comparison of anatomical plating systems for comminuted distal humeral fractures

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