Abstract
Purpose
The ideal surgical treatment of extra-articular distal-third diaphyseal humeral fractures is controversial in terms of the surgical approach and plate position. The aim of this study was to compare the clinical and radiological outcomes between anterior and posterior plating methods for extra-articular distal-third diaphyseal humeral fractures.
Methods
Twenty-four patients were treated with anterior plating with modified placement of the proximal humeral internal locking system (PHILOS) plate, and 22 patients were treated with posterior plating of the extra-articular distal humerus plate (EADHP). Patient demographics, the fracture configuration, the number of screws in the distal fragment, the operation time, and the time to union were analyzed. The range of elbow motion, Mayo elbow performance score (MEPS), plate-related symptoms, and complications were evaluated at the final follow-up.
Results
There were no statistically significant differences in the demographic data between the two groups. The mean operation time for anterior plating (108.2 ± 24.5 min) was significantly shorter than that for posterior plating (144.2 ± 29.5 minutes, p < 0.001). The average number of screws used in the distal humeral fragment was significantly higher with anterior plating (5.7 ± 0.7) than with posterior plating (4.8 ± 0.5, p < 0.001). No patients in the anterior plating group had plate-related symptoms, while 17 patients in the posterior plating group (77%) had discomfort or cosmetic problems related to the plate (p < 0.001). Plate removal was performed upon patient request in nine patients of the posterior plating (52.9%) and four (17%) in anterior plating (p = 0.040). Nonunion occurred in one patient who underwent anterior plating, and one patient who underwent posterior plating had post-operative radial nerve palsy. There were no significant differences in the MEPS or elbow range of motion between the two surgical methods.
Conclusion
Both anterior and posterior plating provide satisfactory clinical and radiologic outcomes for extra-articular distal-third diaphyseal humeral fractures. Despite the satisfactory outcomes, however, posterior plating is highly associated with plate-related complaints, which might be one of the considerations when the surgical method is selected for extra-articular distal-third diaphyseal humeral fractures.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Sang-Jin Shin, Ji-Woong Kwak, and Hoon-Sang Sohn. The first draft of the manuscript was written by Hoon-Sang Sohn and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The manuscript has been read and approved by all authors, and each author believes that the manuscript represents honest work. The institutional review board of Wonju Severance Christian Hospital approved this study (IRB no: CR320187).
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Level of evidence: III, therapeutic
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Shin, SJ., Kwak, JW. & Sohn, HS. Comparison between anterior and posterior plating systems in extra-articular distal-third diaphyseal humeral fractures. International Orthopaedics (SICOT) 46, 2119–2126 (2022). https://doi.org/10.1007/s00264-022-05435-9
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DOI: https://doi.org/10.1007/s00264-022-05435-9