Skip to main content
SpringerLink
Log in

Implantology of Fractures of the Distal Humerus

  • Reference work entry
  • First Online:
Handbook of Orthopaedic Trauma Implantology

  • 23 Accesses

Abstract

Distal humerus fractures are complex and challenging to treat because of its bearing on elbow function and consequent affection of activities of daily living. This chapter discusses the indications and design features of implants that were historically used and the currently available modern plate systems. Kirschner wire fixation is adequate for pediatric supracondylar and lateral condyle fractures. Either 3.5 mm cortical screw or 4 mm cannulated cancellous screws are used to fix13-A1 fractures in the skeletally mature patients, and 13-B fractures in adults are fixed using either screws or combination of plate of screws depending on the fracture pattern. Headless compression screws help in internal fixation of fractures of the articular surface in the coronal plane. In adults, 13-A2, 13-A3, 13-C1, 13-C2, and 13-C3 fractures require the placement of two separate locking plates in either 180° configuration (parallel) or 90° configuration (perpendicular). The currently available anatomically precontoured locking plates provide angular stability with reduced chances of failure of bone implant interface. There are options for placement of locking plates on the medial, posterolateral, and lateral surfaces. Despite current biomechanical evidence favoring parallel dual plating configuration, the perpendicular dual plating is preferred for volar shear fracture patterns and the parallel dual plating is useful for internal fixation of very low fractures of distal humerus. Total elbow arthroplasty is an option in elderly, low-activity demand patients for “bag of bones” intra-articular fractures that cannot be reconstructed and stabilized adequately with internal fixation.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 1,599.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 1,599.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Galloway JD, Shymon SJ, Adams MR, Reilly MC, Sirkin MS, Hreha J, Jung MT, Madi N, Siracuse BL, Ahmed I, Vosbikian MM. Distal humerus traction radiographs: is the interobserver and intraobserver reliability comparable with computed tomography? J Orthop Trauma. 2022;36(7):e265–70. https://doi.org/10.1097/BOT.0000000000002327.

    Article  PubMed  Google Scholar 

  2. Nolan BM, Sweet SJ, Ferkel E, Udofia AA, Itamura J. The role of computed tomography in evaluating intra-articular distal humerus fractures. Am J Orthop (Belle Mead NJ). 2015;44(9):E326–30.

    PubMed  Google Scholar 

  3. Korner J, Diederichs G, Arzdorf M, Lill H, Josten C, Schneider E, Linke B. A biomechanical evaluation of methods of distal humerus fracture fixation using locking compression plates versus conventional reconstruction plates. J Orthop Trauma. 2004;18(5):286–93. https://doi.org/10.1097/00005131-200405000-00004.

    Article  PubMed  Google Scholar 

  4. Koonce RC, Baldini TH, Morgan SJ. Are conventional reconstruction plates equivalent to precontoured locking plates for distal humerus fracture fixation? A biomechanics cadaver study. Clin Biomech (Bristol, Avon). 2012;27(7):697–701. https://doi.org/10.1016/j.clinbiomech.2012.03.008.

    Article  PubMed  Google Scholar 

  5. Caravaggi P, Laratta JL, Yoon RS, De Biasio J, Ingargiola M, Frank MA, Capo JT, Liporace FA. Internal fixation of the distal humerus: a comprehensive biomechanical study evaluating current fixation techniques. J Orthop Trauma. 2014;28(4):222–6. https://doi.org/10.1097/BOT.0b013e3182a6693f.

    Article  PubMed  Google Scholar 

  6. Doğramaci Y, Esen E, Kürklü M, Kirici Y, Atahan AO, Kömürcü M. Double plate osteosynthesis provides better biomechanical stabilization than double tension band technique in distal humerus fractures. Eklem Hastalik Cerrahisi. 2010;21(1):44–9.

    PubMed  Google Scholar 

  7. Scolaro JA, Hsu JE, Svach DJ, Mehta S. Plate selection for fixation of extra-articular distal humerus fractures: a biomechanical comparison of three different implants. Injury. 2014;45(12):2040–4. https://doi.org/10.1016/j.injury.2014.08.036.

    Article  PubMed  Google Scholar 

  8. Nourbakhsh A, Hirschfeld AG, Dhulipala S, Hutton W, Ganey T, Lozada L, Schlatterer D, Lourie GM. Biomechanical comparison of fixed- versus variable-angle locking screws for distal humerus comminuted fractures. Clin Orthop Surg. 2019;11(3):302–8. https://doi.org/10.4055/cios.2019.11.3.302.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shih CA, Su WR, Lin WC, Tai TW. Parallel versus orthogonal plate osteosynthesis of adult distal humerus fractures: a meta-analysis of biomechanical studies. Int Orthop. 2019;43(2):449–60. https://doi.org/10.1007/s00264-018-3937-4.

    Article  PubMed  Google Scholar 

  10. Schuster I, Korner J, Arzdorf M, Schwieger K, Diederichs G, Linke B. 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. 2008;22(2):113–20. https://doi.org/10.1097/BOT.0b013e3181632cf8.

    Article  PubMed  Google Scholar 

  11. Zalavras CG, Vercillo MT, Jun BJ, Otarodifard K, Itamura JM, Lee TQ. Biomechanical evaluation of parallel versus orthogonal plate fixation of intra-articular distal humerus fractures. J Shoulder Elb Surg. 2011;20(1):12–20. https://doi.org/10.1016/j.jse.2010.08.005.

    Article  Google Scholar 

  12. Atalar AC, Tunalı O, Erşen A, Kapıcıoğlu M, Sağlam Y, Demirhan MS. Biomechanical comparison of orthogonal versus parallel double plating systems in intraarticular distal humerus fractures. Acta Orthop Traumatol Turc. 2017;51(1):23–8. https://doi.org/10.1016/j.aott.2016.11.001.

    Article  PubMed  Google Scholar 

  13. Got C, Shuck J, Biercevicz A, Paller D, Mulcahey M, Zimmermann M, Blaine T, Green A. Biomechanical comparison of parallel versus 90-90 plating of bicolumn distal humerus fractures with intra-articular comminution. J Hand Surg Am. 2012;37(12):2512–8. https://doi.org/10.1016/j.jhsa.2012.08.042.

    Article  PubMed  Google Scholar 

  14. Borbas P, Loucas R, Loucas M, Vetter M, Hofstede S, Ernstbrunner L, Wieser K. Biomechanical stability of complex coronal plane fracture fixation of the capitellum. Arch Orthop Trauma Surg. 2022;142(11):3239–46. https://doi.org/10.1007/s00402-021-04126-1.

    Article  PubMed  Google Scholar 

  15. Yetter TR, Weatherby PJ, Somerson JS. Complications of articular distal humeral fracture fixation: a systematic review and meta-analysis. J Shoulder Elb Surg. 2021;30(8):1957–67. https://doi.org/10.1016/j.jse.2021.02.017.

    Article  Google Scholar 

  16. Haglin JM, Kugelman DN, Lott A, Belayneh R, Konda SR, Egol KA. Intra-articular distal humerus fractures: parallel versus orthogonal plating. HSS J. 2022;18(2):256–63. https://doi.org/10.1177/15563316211009810.

    Article  PubMed  Google Scholar 

  17. O’Driscoll SW. Optimizing stability in distal humeral fracture fixation. J Shoulder Elb Surg. 2005;14(1 Suppl S):186S–94S. https://doi.org/10.1016/j.jse.2004.09.033.

    Article  Google Scholar 

  18. Kokly S, Castagna A, Mohamadreza M. Modified tension band wiring in adult distal humeral fracture types A2 and C1. Arch Bone Jt Surg. 2019;7(4):325–30.

    PubMed  PubMed Central  Google Scholar 

  19. Houben PF, Bongers KJ, vd Wildenberg FA. Double tension band osteosynthesis in supra- and transcondylar humeral fractures. Injury. 1994;25(5):305–9. https://doi.org/10.1016/0020-1383(94)90241-0.

    Article  CAS  PubMed  Google Scholar 

  20. Zhao J, Wang X, Zhang Q. Surgical treatment of comminuted intra-articular fractures of the distal humerus with double tension band osteosynthesis. Orthopedics. 2000;23(5):449–52. https://doi.org/10.3928/0147-7447-20000501-13.

    Article  CAS  PubMed  Google Scholar 

  21. Jung SW, Kang SH, Jeong M, Lim HS. Triangular fixation technique for bicolumn restoration in treatment of distal humerus intercondylar fracture. Clin Orthop Surg. 2016;8(1):9–18. https://doi.org/10.4055/cios.2016.8.1.9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Holdsworth BG. Humerus: distal. In: Reudi TP, Murphy WM, editors. AO principles of fracture management. Stuttgart/New York: Thieme; 2000. p. 307–21.

    Google Scholar 

  23. Hessmann MH, Ring DC. Humerus, distal. In: Reudi TP, Buckley RE, Moran CG, editors. AO principles of fracture management. Stuttgart/New York: Thieme; 2007. p. 609–25.

    Google Scholar 

  24. Ring DC. Humerus, distal. In: Buckley RE, Moran CG, Apivatthakakul T, editors. AO principles of fracture management. Stuttgart/New York: Thieme; 2017. p. 623–36.

    Google Scholar 

  25. Helfet DL, Hotchkiss RN. Internal fixation of the distal humerus: a biomechanical comparison of methods. J Orthop Trauma. 1990;4(3):260–4. https://doi.org/10.1097/00005131-199004030-00004.

    Article  CAS  PubMed  Google Scholar 

  26. Frattini M, Soncini G, Corradi M, Panno B, Tocco S, Pogliacomi F. Mid-term results of complex distal humeral fractures. Musculoskelet Surg. 2011;95(3):205–13. https://doi.org/10.1007/s12306-011-0132-9.

    Article  PubMed  Google Scholar 

  27. Saragaglia D, Rouchy RC, Mercier N. Fractures of the distal humerus operated on using the Lambda® plate: report of 75 cases at 9.5 years follow-up. Orthop Traumatol Surg Res. 2013;99(6):707–12. https://doi.org/10.1016/j.otsr.2013.04.007.

    Article  CAS  PubMed  Google Scholar 

  28. Scolaro JA, Voleti P, Makani A, Namdari S, Mirza A, Mehta S. Surgical fixation of extra-articular distal humerus fractures with a posterolateral plate through a triceps-reflecting technique. J Shoulder Elb Surg. 2014;23(2):251–7. https://doi.org/10.1016/j.jse.2013.09.020.

    Article  Google Scholar 

  29. Trikha V, Agrawal P, Das S, Gaba S, Kumar A. Functional outcome of extra-articular distal humerus fracture fixation using a single locking plate: a retrospective study. J Orthop Surg (Hong Kong). 2017;25(3):2309499017727948. https://doi.org/10.1177/2309499017727948.

    Article  PubMed  Google Scholar 

  30. Jung HS, Won YS, Choi YS, Lee JS. Risk factors for hardware-related complications after extra-articular distal humerus fracture fixation using an anatomical locking plate. Eur J Trauma Emerg Surg. 2023;49(1):125–31. https://doi.org/10.1007/s00068-022-02064-0.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Parul University, Vadodara, India

    Karthik Vishwanathan

Authors
  1. Karthik Vishwanathan
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. NH Narayana Superspeciality and Multispeciality Hospitals, Howrah, West Bengal, India

    Arindam Banerjee

  2. Technical University of Munich, Munich, Germany

    Peter Biberthaler

  3. Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India

    Saseendar Shanmugasundaram

Section Editor information

  1. Department of Orthopaedics, Apollo Gleneagles Hospitals, Kolkata, India

    Ravi Ganesh Bharadwaj

  2. Sri Dhaatri Orthopaedic, Maternity & Gynaecology Center, Vijayawada, India

    Srinivas B. S. Kambhampati

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Singapore Pte Ltd.

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Vishwanathan, K. (2023). Implantology of Fractures of the Distal Humerus. In: Banerjee, A., Biberthaler, P., Shanmugasundaram, S. (eds) Handbook of Orthopaedic Trauma Implantology. Springer, Singapore. https://doi.org/10.1007/978-981-19-7540-0_69

Download citation

  • DOI: https://doi.org/10.1007/978-981-19-7540-0_69

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-7539-4

  • Online ISBN: 978-981-19-7540-0

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation