International Orthopaedics

, Volume 43, Issue 2, pp 449–460 | Cite as

Parallel versus orthogonal plate osteosynthesis of adult distal humerus fractures: a meta-analysis of biomechanical studies

  • Chien-An Shih
  • Wei-Ren Su
  • Wei-Chin Lin
  • Tai-Wei TaiEmail author
Original Paper



There are two widely used distal humerus fracture (DHF) fixation methods with either orthogonal or parallel double-plate osteosynthesis. However, biomechanical studies have shown inconsistent results on which technique is more effective. We performed a meta-analysis to compare these two fixation methods for adult DHF fixation.


We searched the literature for entries discussing the biomechanical testing of orthogonal and parallel fixation techniques for DHFs. We then performed a meta-analysis of the following biomechanical outcome measures: axial/sagittal/coronal/torsional stiffness, load to failure, and torque to failure.


Seventeen studies comparing both constructs were included. The parallel configuration exhibited greater mechanical strength with respect to axial stiffness/load to failure, torsional stiffness, and posterior bending load to failure than the orthogonal constructs. Subgroup analysis revealed that parallel constructs also had higher torsional stiffness in supracondylar fractures.


This meta-analysis shows that parallel constructs provide greater axial stiffness, axial strength, and torsional stiffness than orthogonal plate for DHF fixation. A subgroup analysis revealed that parallel constructs had better torsional stiffness in supracondylar fracture fixation.

Level of evidence



Biomechanical study Distal humeral fracture Fracture fixation Meta-analysis Parallel Orthogonal 



We would like to show our gratitude to Ka-Wai Tam for sharing his pearls of wisdom with us during the research course. We would also like to thank Chih-Kai Hong for his excellent assistance in collecting data for this meta-analysis.

Author contribution

CAS, WCL, WRS, and TWT: study conception and design

CAS and WCL: acquisition of data

CAS, WRS, WCL, TWT: analysis and interpretation of data

CAS and TWT: drafting of the article

All authors have read and approved the final submitted manuscript.

Funding information

No funding was received.

Compliance with ethical standards

Conflict of interest


Supplementary material

264_2018_3937_MOESM1_ESM.doc (20 kb)
Table 1, S Search strategy for this meta-analysis (DOC 20 kb)
264_2018_3937_MOESM2_ESM.docx (16 kb)
Table 2, S Quality of methodology (DOCX 15 kb)
264_2018_3937_MOESM3_ESM.doc (66 kb)
ESM 1 (DOC 65 kb)


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Chien-An Shih
    • 1
    • 2
    • 3
  • Wei-Ren Su
    • 1
    • 2
    • 4
  • Wei-Chin Lin
    • 1
  • Tai-Wei Tai
    • 1
    • 2
    Email author
  1. 1.Department of Orthopedics, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
  2. 2.Medical Device R & D Core LaboratoryNational Cheng Kung University HospitalTainanTaiwan
  3. 3.Department of Biomedical EngineeringNational Cheng Kung UniversityTainanTaiwan
  4. 4.Medical Innovation CenterNational Cheng Kung UniversityTainanTaiwan

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