OKOJ

OKOJ, Volume 13, No. 7


Distal Humerus Fractures: Parallel Versus Orthogonal Plating

Articular fractures require stable anatomic reduction and maintenance of the congruence of the articular surface. Fractures of the distal humerus are no exception to these requirements, and surgical intervention remains the mainstay of their treatment. The current standard of care for intra-articular fractures of the distal humerus includes stabilization of both the medial and lateral columns. The manner in which bicolumnar fixation is achieved varies in terms of plate placement (parallel versus orthogonal), screw size (2.7-mm versus 3.5-mm), and the use of locking versus nonlocking plates. Although biomechanical studies suggest that parallel plating provides a more rigid construct than does orthogonal plating, these studies are varied in design and make it difficult to draw a sweeping conclusion from their data. The purpose of this article is to summarize the findings reported in the recent literature with regard to the plate fixation of distal humerus fractures, and to facilitate decision making about their management on a case-by-case basis, with emphasis on the parallel locked plating technique.

    • Keywords:
    • distal humerus fracture

    • bicolumnar fixation

    • parallel plating

    • orthogonal fixation

    • 90–90 plating

    • Subspecialty:
    • Trauma

Guest Editorial: Plating of Distal Humerus Fractures

This special issue of Orthopaedic Knowledge Online Journal focuses on plating techniques for the open reduction and internal fixation of distal humerus fractures in adults. While variations in technique exist for any surgical procedure, two distinct approaches, namely 90–90 plating and parallel plating, have evolved over the past two decades as viable options for the surgical fixation of such fractures. Available evidence does not show a significant difference in the outcomes achieved with the two techniques. These articles offer two different perspectives on the treatment of distal humerus fractures, and are intended to help the treating surgeon recognize the similarities and differences between the techniques and avoid problems.

    • Keywords:
    • distal humerus fracture

    • internal fixation

    • parallel plating

    • perpendicular plating

    • orthogonal plating

    • 90–90 plating

    • Subspecialty:
    • Trauma

    • Shoulder and Elbow

Use of 90–90 Plating for Distal Humerus Fractures

Despite the advances made during the past quarter century in surgical technique and orthopaedic implant technology, the optimal technique for the internal fixation of intra-articular fractures of the distal humerus remains controversial. Currently, the two techniques of parallel plating and 90–90 (orthogonal or perpendicular) plating are the most widely used methods for the fixation of such fractures. However, controversy continues to surround the positioning of dual-plate fracture fixation constructs in terms of providing optimal stability. To date, neither clinical outcome nor biomechanical testing has shown either 90–90 or parallel plating to be unequivocally superior for the fixation of distal humerus fractures, and the results of the biomechanical studies of the two techniques have been different and sometimes contradictory. Both approaches have theoretical merits and both practical benefits and drawbacks for the fixation of distal humerus fractures, but in my experience 90–90 plating is best for patients with good bone quality, whereas constructs based on parallel locking plates offer some advantages for the fixation of distal humerus fractures in elderly patients with poor bone quality.

    • Keywords:
    • distal humerus fracture

    • plate fixation

    • 90–90 plating

    • orthogonal plating

    • perpendicular plating

    • parallel-plate technique

    • Subspecialty:
    • Trauma

    • Shoulder and Elbow

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