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Locking versus non-locking plates in fixation of extra-articular distal humerus fracture: a randomized controlled study

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Abstract

Introduction

Studies have shown that the use of nonlocking (reconstruction) plates in fixing distal humerus fractures may not yield stable fixation which therefore requires long immobilization and suboptimal functional results. There are reports showing that locking plates are biomechanically superior to nonlocking plates. The aim of this study was to compare elbow functional outcomes between locking and nonlocking plates in fixation of distal humerus fractures.

Methods

A single-centre, randomized control study was conducted at an academic level 1 trauma centre. A total of 60 patients with type 13-A fracture (AO/OTA classification) were randomized into two equal groups, locking plates group, and nonlocking plates group. The primary outcome measure was the Mayo elbow performance score (MEPS) at one year. Secondary outcomes measures were elbow flexion/extension arc, union, operative time, and complications (e.g., infection, heterotrophic ossification).

Results

The Mayo Elbow Performance Score (MEPS) at one year was 88 ± 10.1 in locking plates group and 75.8 ± 12.8 in nonlocking plates group. The difference was found to be statically significant (P value = 0.01). Elbow flexion/extension arc of motion at one year was 116° ± 15° in locking plates group and 113° ± 28° in nonlocking plates. The difference was not found to be statistically significant (P value = 0.17).

Conclusion

Both implants yield similar results, with locking plates showing slightly better clinical scores.

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References

  1. Huang TL, Chiu FY, Chuang TY, Chen TH (2005) The results of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus. J Trauma 58(1):62–69

    Article  Google Scholar 

  2. Sodergard J, Sandelin J, Bostman O (1992) Postoperative complications of distal humeral fractures. 27/96 adults followed up for 6 (2-10) years. Acta Orthop Scand 63(1):85–89

    Article  CAS  Google Scholar 

  3. Jacobson SR, Glisson RR, Urbaniak JR (1997) Comparison of distal humerus fracture fixation: a biomechanical study. J South Orthop Assoc 6(4):241–249

    CAS  PubMed  Google Scholar 

  4. Self J, Viegas SF, Buford WL Jr, Patterson RM (1995) A comparison of double-plate fixation methods for complex distal humerus fractures. J Shoulder Elbow Surg 4(1 Pt 1):10–16

    Article  CAS  Google Scholar 

  5. Schuster I, Korner J, Arzdorf M, Schwieger K, Diederichs G, Linke B (2008) Mechanical comparison in cadaver specimens of three different 90-degree double-plate osteosyntheses for simulated C2-type distal humerus fractures with varying bone densities. J Orthop Trauma 22(2):113–120

    Article  Google Scholar 

  6. Reising K, Hauschild O, Strohm PC, Suedkamp NP (2009) Stabilisation of articular fractures of the distal humerus: early experience with a novel perpendicular plate system. Injury 40(6):611–617

    Article  CAS  Google Scholar 

  7. Caravaggi P, Laratta JL, Yoon RS, De Biasio J, Ingargiola M, Frank MA, Capo JT, Liporace FA (2014) Internal fixation of the distal humerus: a comprehensive biomechanical study evaluating current fixation techniques. J Orthop Trauma 28(4):222–226

    Article  Google Scholar 

  8. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF (2018) Fracture and dislocation classification compendium. J Orthop Trauma 32(Supplement 1):S1–S170

    Article  Google Scholar 

  9. Schildhauer TA, Nork SE, Mills WJ, Henley MB (2003) Extensor mechanism-sparing paratricipital posterior approach to the distal humerus. J Orthop Trauma 17(5):374–378

    Article  Google Scholar 

  10. Cusick MC, Bonnaig NS, Azar FM, Mauck BM, Smith RA, Throckmorton TW (2014) Accuracy and reliability of the Mayo Elbow Performance Score. J Hand Surg Am 9(6):1146–1150

    Article  Google Scholar 

  11. Greiner S, Haas NP, Bail HJ (2008) Outcome after open reduction and angular stable internal fixation for supra-intercondylar fractures of the distal humerus: preliminary results with the LCP distal humerus system. Arch Orthop Trauma Surg 128(7):723–729

    Article  CAS  Google Scholar 

  12. Valone LC, Waites C, Tartarilla AB et al (2019) Functional elbow range of motion in children and adolescents [published online ahead of print]. J Pediatr Orthop. https://doi.org/10.1097/BPO.0000000000001467

  13. O’Driscoll SW (2005) Optimizing stability in distal humeral fracture fixation. J Shoulder Elbow Surg 14(1 Suppl S):186–194

    Article  Google Scholar 

  14. Horne G (1980) Supracondylar fractures of the humerus in adults. J Trauma 20(1):71–74

    Article  CAS  Google Scholar 

  15. Aslam N, Willett K (2004) Functional outcome following internal fixation of intraarticular fractures of the distal humerus (AO type C). Acta Orthop Belg 70(2):118–122

    PubMed  Google Scholar 

  16. Pajarinen J, Bjorkenheim JM (2002) Operative treatment of type C inter-condylar fractures of the distal humerus: results after a mean follow- up of 2 years in a series of 18 patients. J Shoulder Elbow Surg 11(1):48–52

    Article  Google Scholar 

  17. Patela J, Motwania G, Shaha H, Daveshwar R (2017) Outcome after internal fixation of intraarticular distal humerus (AO type B & C) fractures: preliminary results with anatomical distal humerus LCP system. J Clin Orthop Trauma 8(1):63–67

    Article  Google Scholar 

  18. Lee JK, Choi YS, Sim YS, Choi DC, Han SH (2017) Dual plate fixation on distal third diaphyseal fracture of the humerus. Int Orthop 41(8):1655–1661

    Article  Google Scholar 

  19. Kaiser T, Brunner A, Hohendorff B, Ulmar B, Babst R (2011) Treatment of supra- and intra-articular fractures of the distal humerus with the LCP distal humerus plate: a 2-year follow-up. J Shoulder Elbow Surg 20(2):206–212

    Article  Google Scholar 

  20. Zdravkovic V, Jost B (2018) Rounded data have a high potential for false comparative statistical results as shown with elbow arc of motion. J Shoulder Elbow Surg 27(2):276–228

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, P. O 11559, Egypt

    Sherif Galal, Yasser Mattar, Alaa Mohy Eldin Solyman & Mostafa Ezzat

  2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA

    Sherif Galal

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  1. Sherif Galal
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  2. Yasser Mattar
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  3. Alaa Mohy Eldin Solyman
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  4. Mostafa Ezzat
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Correspondence to Sherif Galal.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Level of evidence: Level I, Therapeutic study

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Galal, S., Mattar, Y., Solyman, A.M.E. et al. Locking versus non-locking plates in fixation of extra-articular distal humerus fracture: a randomized controlled study. International Orthopaedics (SICOT) 44, 2761–2767 (2020). https://doi.org/10.1007/s00264-020-04770-z

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  • DOI: https://doi.org/10.1007/s00264-020-04770-z

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