Locking and Non-locking Constructs Achieve Similar Radiographic and Clinical Outcomes for Internal Fixation of Intra-articular Distal Humerus Fractures

Abstract

Background: Locking plates have been used increasingly for the management of distal humerus fractures. Studies that compare patient-centered outcomes between locking and non-locking fixation for distal humerus fractures are lacking. Questions/Purposes: The purposes of this study were to (1) determine whether locking plates offered superior fixation compared with non-locking plates for distal humerus fractures, (2) determine whether the use of locking plates was associated with fewer complications, and (3) determine whether locking plate use resulted in superior radiographic outcome compared with non-locking plates. Lastly, another aim was to determine the average cost difference associated with locking plate use versus non-locking plate use for distal humerus fracture fixation. Patients and Method: Demographic, clinical, and radiographic data including loss of fixation, range of motion, rate of infection, nonunion and reoperation, as well as measures of fixation were collected retrospectively and compared on 96 patients with surgically treated AO type 13C distal humerus fractures (65 locking, 31 non-locking) at 6-week and 6-month follow-up. Average costs of locking and non-locking constructs were calculated and compared. Results: Three in 96 (3.1%) of all cases experienced loss of fixation, with no difference between the two groups. There was no difference between locking and nonlocking groups with regard to the rate of nonunion, infection, and reoperation at 6 weeks and 6 months. On average, locking plate constructs were 348% more expensive than non-locking constructs. Conclusion: While there are some significant differences in radiographic parameters and cost between locking and non-locking constructs for internal fixation of intra-articular distal humerus fractures, there were no statistically significant differences in clinical outcome.

Pre-contoured locking plates vs. conventional reconstruction plates in AO type C distal humerus fractures: A prospective randomized study

“…A comparison of non-locking and locking plate constructs in biomechanical study has been done by Komer et al In which they found that the stiffness of the construct was no different if arranged in the same configuration [9] . Another study by the same group compared orthogonal constructs using conventional reconstruction plates, locking cornpression plates, and precontoured distal humerus locking plates in cadaveric specimens of varymg bone mineral densities and they concluded that fixation with either locking or nonlocking plates is acceptable in patients with good bone mineral density, but locking plates could prove to be more effective 111 patients with lower bone mineral density [10] .…”

Predictors of reoperation after internal fixation of intra-articular distal humerus fractures

“…19,25 In one study, use of locking plate fixation (n = 65) compared to unlocked constructs (n = 31) was shown to be no different with regard to rates of reoperation. 26…”

Evaluation of Results of Intercondylar Fracture of Humerus in Adults Treated by Various Surgical Modalities

“…The biomechanical evidence leading to this conclusion resembles that for parallel plating, in that locking screws create a stiffer construct in some but not all testing environments 13 . Clinically, however, Berkes et.al 14 retrospectively reviewed 96 AO type 13C distal humerus fractures, of which 65 underwent plate fixation with locking screws and 31 with non locking screws, and found no difference in the two groups in rates of non union, infection and re operation. The critical factors for successful outcome remain those advocated earlier by Cassebaum 15 .…”