A paradigm shift in the surgical reconstruction of extra-articular distal humeral fractures: single-column plating.
OBJECTIVE
The study aimed (1) to examine if there are equivalent results in terms of union, alignment and elbow functionally comparing single- to dual-column plating of AO/OTA 13A2 and A3 distal humeral fractures and (2) if there are more implant-related complications in patients managed with bicolumnar plating compared to single-column plate fixation.


METHODS
This was a multi-centred retrospective comparative study.


METHODS
The study was conducted at two academic level 1 trauma centres.


METHODS
A total of 105 patients were identified to have surgical management of extra-articular distal humeral fractures Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 13A2 and AO/OTA 13A3).


METHODS
Patients were treated with traditional dual-column plating or a single-column posterolateral small-fragment pre-contoured locking plate used as a neutralisation device with at least five screws in the short distal segment.


METHODS
The patients' elbow functionality was assessed in terms of range of motion, union and alignment. In addition, the rate of complications between the groups including radial nerve palsy, implant-related complications (painful prominence and/or ulnar nerve neuritis) and elbow stiffness were compared.


RESULTS
Patients treated with single-column plating had similar union rates and alignment. However, single-column plating resulted in a significantly better range of motion with less complications.


CONCLUSIONS
The current study suggests that exposure/instrumentation of only the lateral column is a reliable and preferred technique. This technique allows for comparable union rates and alignment with increased elbow functionality and decreased number of complications.
University of Pittsburgh Medical Center, Department of Orthopaedic Surgery, Pittsburgh, PA, USA.
Gregory M
GM
Meloy
Matthew A
MA
Mormino
Peter A
PA
Siska
Ivan S
IS
Tarkin
D000328:Adult; D057929:Arthroplasty, Replacement, Elbow; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000503:physiopathology / Q000601:surgery*; D007049:Iatrogenic Disease / Q000517:prevention & control*; D008297:Male; D011826:Radial Nerve; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome; D017769:Ulnar Nerve Compression Syndromes / Q000517:prevention & control*
Distal humeral fracture; Dual-column plating; Extra-articular; Single-column plating