Skip to main content

Advertisement

Log in

Dual plate fixation on distal third diaphyseal fracture of the humerus

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Introduction

Displaced unstable distal third fractures of the humeral diaphysis are treated surgically through open reduction and internal fixation. Conventionally, surgeons prefer using long plates for secure fixation; however, we performed short plate dual plating for robust fixation that required a smaller incision and less dissection through an anterior approach. In this study, we report the results of dual plating of fractures of the humeral shaft, with radiographic evidence and clinical analysis.

Methods

This retrospective study included 29 patients with distal third diaphyseal fractures of the humerus. There were 18 men and 11 women, with an average age of 43 years, and a mean follow-up period of 21.2 months. We investigated the type of fracture, plate length, number of fixed screws, and fracture union. Range of motion, Disabilities of Arm, Shoulder, and Hand (DASH) score, and complications during follow-up were analyzed for clinical results.

Results

All fractures were classified according to AO classification. We used 4.5-mm narrow locking compression plates (LCP) and 3.5-mm LCP reconstruction plates. Fracture union was achieved in all cases during the follow-up. All patients recovered favourable elbow range of motion at final follow-up. At the final follow-up, average DASH score was 10.0, and no patient showed postoperative complications.

Conclusions

Satisfactory radiographic evidence and clinical results suggest that dual plating for distal diaphyseal humeral fractures may be considered a surgical option, with the advantages of strong fixation, less invasion of soft tissue, and early rehabilitation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Tytherleigh-Strong G, Walls N, McQueen M (1998) The epidemiology of humeral shaft fractures. J Bone Joint Surg (Br) 80:249–253

    Article  CAS  Google Scholar 

  2. Toivanen JA, Nieminen J, Laine HJ, Honkonen SE, Jarvinen MJ (2005) Functional treatment of closed humeral shaft fractures. Int Orthop 29:10–13. doi:10.1007/s00264-004-0612-8

    Article  CAS  PubMed  Google Scholar 

  3. Prasarn ML, Ahn J, Paul O, Morris EM, Kalandiak SP, Helfet DL, Lorich DG (2011) Dual plating for fractures of the distal third of the humeral shaft. J Orthop Trauma 25:57–63. doi:10.1097/BOT.0b013e3181df96a7

    Article  PubMed  Google Scholar 

  4. Jawa A, McCarty P, Doornberg J, Harris M, Ring D (2006) Extra-articular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Joint Surg Am 88:2343–2347. doi:10.2106/jbjs.f.00334

    PubMed  Google Scholar 

  5. Capo JT, Debkowska MP, Liporace F, Beutel BG, Melamed E (2014) Outcomes of distal humerus diaphyseal injuries fixed with a single-column anatomic plate. Int Orthop 38:1037–1043. doi:10.1007/s00264-013-2213-x

    Article  PubMed  Google Scholar 

  6. Lee SK, Yang DS, Chang SH, Choy WS (2016) LCP metaphyseal plate fixation for fractures of the distal third humeral shaft using brachialis splitting approach. Acta Orthop Belg 82:85–93

    PubMed  Google Scholar 

  7. Pehlivan O (2002) Functional treatment of the distal third humeral shaft fractures. Arch Orthop Trauma Surg 122:390–395. doi:10.1007/s00402-002-0403-x

    Article  PubMed  Google Scholar 

  8. Ellwein A, Lill H, Voigt C, Wirtz P, Jensen G, Katthagen JC (2015) Arthroplasty compared to internal fixation by locking plate osteosynthesis in comminuted fractures of the distal humerus. Int Orthop 39:747–754. doi:10.1007/s00264-014-2635-0

    Article  PubMed  Google Scholar 

  9. Bucholz RW, MacQueen M, Rockwood CA, Green DP (2010) Rockwood and Green’s fractures in adults, vol 1. Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia, PA

    Google Scholar 

  10. Watts A, Weinhold P, Kesler W, Dahners L (2012) A biomechanical comparison of short segment long bone fracture fixation techniques: single large fragment plate versus 2 small fragment plates. J Orthop Trauma 26:528–532. doi:10.1097/BOT.0b013e318237c12d

    Article  PubMed  Google Scholar 

  11. Kim SJ, Lee SH, Son H, Lee BG (2016) Surgical result of plate osteosynthesis using a locking plate system through an anterior humeral approach for distal shaft fracture of the humerus that occurred during a throwing motion. Int Orthop 40:1489–1494. doi:10.1007/s00264-015-2895-3

    Article  PubMed  Google Scholar 

  12. Adams J, Coonse G (1948) Complete rigid internal fixation by double plating fractures of long bones. Proc Inst Med Chic 17:98

    CAS  PubMed  Google Scholar 

  13. Metikala S, Bhogadi P (2015) Orthogonal double plating and autologous bone grafting of postoperative humeral shaft nonunion–a rare case report and review of literature. J Orthop Case Rep 5:50–53. doi:10.13107/jocr.2250-0685.345

    PubMed  PubMed Central  Google Scholar 

  14. Kosmopoulos V, Nana AD (2014) Dual plating of humeral shaft fractures: orthogonal plates biomechanically outperform side-by-side plates. Clin Orthop Relat Res 472:1310–1317. doi:10.1007/s11999-013-3379-7

    Article  PubMed  Google Scholar 

  15. Choi S, Kang H, Bang H (2014) Technical tips: dualplate fixation technique for comminuted proximal humerus fractures. Injury 45:1280–1282. doi:10.1016/j.injury.2014.04.029

    Article  PubMed  Google Scholar 

  16. Mast J, Jakob R, Ganz R (1989) Planning and reduction technique in fracture surgery. Springer-Verlag, Berlin, New York

    Book  Google Scholar 

  17. Archdeacon MT, Wyrick JD (2006) Reduction plating for provisional fracture fixation. J Orthop Trauma 20:206–211

    Article  PubMed  Google Scholar 

  18. Kosmopoulos V, Luedke C, Nana AD (2015) Dual small fragment plating improves screw-to-screw load sharing for mid-diaphyseal humeral fracture fixation: a finite element study. Technol Health Care 23:83–92. doi:10.3233/THC-140875

    Article  PubMed  Google Scholar 

  19. Ji F, Tong D, Tang H, Cai X, Zhang Q, Li J, Wang Q (2009) Minimally invasive percutaneous plate osteosynthesis (MIPPO) technique applied in the treatment of humeral shaft distal fractures through a lateral approach. Int Orthop 33:543–547

    Article  PubMed  Google Scholar 

  20. An Z, Zeng B, He X, Chen Q, Hu S (2010) Plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique. Int Orthop 34:131–135

    Article  PubMed  Google Scholar 

  21. Yin P, Zhang L, Mao Z, Zhao Y, Zhang Q, Tao S, Liang X, Zhang H, Lv H, Li T, Tang P (2014) Comparison of lateral and posterior surgical approach in management of extra-articular distal humeral shaft fractures. Injury 45:1121–1125. doi:10.1016/j.injury.2014.02.034

    Article  PubMed  Google Scholar 

  22. Levy JC, Kalandiak SP, Hutson JJ, Zych G (2005) An alternative method of osteosynthesis for distal humeral shaft fractures. J Orthop Trauma 19:43–47

    Article  PubMed  Google Scholar 

  23. Patel R, Neu CP, Curtiss S, Fyhrie DP, Yoo B (2011) Crutch weightbearing on comminuted humeral shaft fractures: a biomechanical comparison of large versus small fragment fixation for humeral shaft fractures. J Orthop Trauma 25:300–305

    Article  PubMed  Google Scholar 

  24. Chao TC, Chou WY, Chung JC, Hsu CJ (2005) Humeral shaft fractures treated by dynamic compression plates, ender nails and interlocking nails. Int Orthop 29:88–91. doi:10.1007/s00264-004-0620-8

    Article  PubMed  PubMed Central  Google Scholar 

  25. Spitzer AB, Davidovitch RI, Egol KA (2009) Use of a “hybrid” locking plate for complex metaphyseal fractures and nonunions about the humerus. Injury 40:240–244. doi:10.1016/j.injury.2008.07.019

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Soo-Hong Han.

Ethics declarations

Conflict of interest

The authors declare they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, JK., Choi, YS., Sim, YS. et al. Dual plate fixation on distal third diaphyseal fracture of the humerus. International Orthopaedics (SICOT) 41, 1655–1661 (2017). https://doi.org/10.1007/s00264-016-3355-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-016-3355-4

Keywords

Navigation