title: A biomechanical evaluation of methods of distal humerus fracture fixation using locking compression plates versus conventional reconstruction plates.
abstract: OBJECTIVE
  To examine the biomechanical behavior of 2 techniques of double-plate osteosynthesis for fractures of the adult distal humerus using conventional reconstruction plates and locking compression plates.
  
  
  METHODS
  Basic science study.
  
  
  METHODS
  Experimental in vitro study.
  
  
  METHODS
  Forty fresh-frozen human distal humeri specimens.
  
  
  METHODS
  Four matched groups with 10 humeri each, median age 74 years (46-95), were created using similar bone mineral density values. Two standard configurations of double-plate osteosynthesis (dorsal or 90 degrees configuration) with either conventional reconstruction plates or locking compression plates were studied for biomechanical properties of the constructs. A fracture model with a 5-mm supracondylar osteotomy gap simulating metaphyseal comminution (AO type 13-A3.3) was used.
  
  
  METHODS
  Stiffness testing of the constructs in anterior/posterior bending, torsion, and axial compression loading. Evaluation of alterations of the bone-implant interface and failure patterns under cyclic loading and strength testing.
  
  
  RESULTS
  The study demonstrates that primary stiffness in anterior/posterior bending and torsional loading is significantly increased by using locking compression plates in a 90 degrees configuration (P < 0.05) as compared with dorsally applied plates. The differences between the different plate types are insignificant if applied in the same configuration. It is demonstrated that none of the tested implants failed under cyclic loading within the number of cycles expected for 3 months of use. The bone-implant interface is less likely to fail during strength testing with locking compression plates.
  
  
  CONCLUSIONS
  The biomechanical behavior of the osteosynthesis depends more on plate configuration than plate type. Advantages of locking compression plates are only significant if compared with dorsal plate application techniques. Nevertheless, locking compression plates are helpful supplementary tools for achieving primary stable fracture fixation. This might be of considerable clinical relevance in patients with diminished bone mineral quality or in the presence of metaphyseal comminution.
authors.affiliation: Department of Trauma and Reconstructive Surgery, University of Mainz, Mainz, Germany. Jan.Korner@ao-asif.ch
authors.forename: Jan
authors.initials: J
authors.lastname: Korner
authors.forename: Gerd
authors.initials: G
authors.lastname: Diederichs
authors.forename: Michael
authors.initials: M
authors.lastname: Arzdorf
authors.forename: Helmut
authors.initials: H
authors.lastname: Lill
authors.forename: Christoph
authors.initials: C
authors.lastname: Josten
authors.forename: Erich
authors.initials: E
authors.lastname: Schneider
authors.forename: Berend
authors.initials: B
authors.lastname: Linke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001860:Bone Plates; D004867:Equipment Design; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D006810:Humeral Fractures / Q000503:physiopathology* / Q000601:surgery*; D008422:Materials Testing; D008875:Middle Aged