Distal Humerus Fractures: Parallel Versus Orthogonal Plating

Abstract

Articular fractures require stable anatomic reduction and maintenance of the congruence of the articular surface. Fractures of the distal humerus are no exception to these requirements, and surgical intervention remains the mainstay of their treatment. The current standard of care for intra-articular fractures of the distal humerus includes stabilization of both the medial and lateral columns. The manner in which bicolumnar fixation is achieved varies in terms of plate placement (parallel versus orthogonal), screw size (2.7-mm versus 3.5-mm), and the use of locking versus nonlocking plates. Although biomechanical studies suggest that parallel plating provides a more rigid construct than does orthogonal plating, these studies are varied in design and make it difficult to draw a sweeping conclusion from their data. The purpose of this article is to summarize the findings reported in the recent literature with regard to the plate fixation of distal humerus fractures, and to facilitate decision making about their management on a case-by-case basis, with emphasis on the parallel locked plating technique.

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