COMPARATIVE STUDY OF PARALLEL PLATING WITH PERPENDICULAR PLATING IN DISTAL HUMERAL FRACTURES Ramachandran Govidasamy Amrut Borade Ramesh Banshiwal Dept of orthopaedics, SMS Medical college, Jaipur

Distal humeral fractures A distal humeral fracture is defined, as a fracture with an epicentre that is located within a square of lower end humerus, whose base is the distance between the epicondyles on an anteroposterior radiograph

Treatment options The treatment of distal humeral fractures aims at a painless, stable and mobile elbow joint The various modes of operative treatment crossed screws or pinning double tension banding technique minimal osteosynthesis and mobile fixation with hinged external fixators. single plating techniques, dual plating techniques (parallel and perpendicular technique) total elbow replacement

Dual plating technique Parallel plating Perpendicular plating

Perpendicular technique The 90º-90º (perpendicular) approach involves application of the Medial Distal humeral plate to the medial column and thePosterolateralDistal humeral plate to the lateral column.

Parallel technique The 180º approach (parallel) involves application of theMedial Distal humeral plate to the medial column and the Lateral Distal humeral plateto thelateral column.

Aims and Objectives To evaluate and compare the results of parallel with perpendicular plating techniques To evaluate the complications of dual plating techniques.

Study design & Study Group This prospective study will include all patients with distal humeral fractures treated by dual plating techniques in SMS medical college and who fulfill the following criteria. INCLUSION CRITERIA: Closed Intra articular fractures of distal humerus(<2weeks old) Patients consenting to study Skeletally mature. EXCLUSION CRITERIA: With vascular injuries Open fractures Old distal humeral fractures( more than 2weeks) Associated with ipsilateral ulna and radius fractures extending into elbow joint. 

Methodology Clinical history and examination Laboratory work up Radiological assessment Randomisation of study group Open reduction and internal fixation through posterior approach with Parallel plating Perpendicular plating

Contd… FOLLOW UP : Immediate post operative day: limb elevation and active finger movements 2 weeks: Remove sutures and splint, begin passive shoulder and elbow ROM. Stress elbow ROM. Active flexion, gravity extension. Active extension avoided for 6wks. 6 Weeks: Begin active extension, strengthening exercises and Xray of elbow. 3 Months: Ensure full restoration of shoulder and elbow ROM and radiological assesment. 6 Months: return to full activities / sport after clinical and radiological union. Assessment of patients with MEPS

Mayo Elbow Performance Score SECTION 1: PAIN INTENSITY None - 45 Mild - 30 Moderate - 15 Severe - 0 SECTION 2: RANGE OF MOTION Arc of motion greater than 100 - 20 Arc of motion between 50 and 100 - 15 Arc of motion less than 50 - 5

Contd… SECTION 3: STABILITY Stable - 10 Moderate instability - 5 Grossly unstable - 0 SECTION 4: FUNCTION Can comb hair - 5 Can eat food - 5 Can wear shoes - 5 Can perform hygiene - 5 Can wear shirt- 5

Contd… MAYO ELBOW SCORE IS: Score greater than 90: excellent Score 75 to 89: good Score 60 to 74: fair Score less than 60: poor

Reference articles Sang-Jin Shin, Hoon-Sang Sohn, Nam-Hoon Do; A clinical comparison of two different double plating methods for intraarticular distal humerus fractures, J Shoulder Elbow Surg (2010) 19, 2-9 Joshua M. Abzug; Phani Dantuluri; Use of orthogonal or parallel plating techniques to treat distal humerus fractures. j.hcl. Volume 26, Issue 3, August 2010, Pages 411-421 Joaquin Sanchez-Sotelo, Michael E. Torchia and Shawn W. O'Driscoll; Complex Distal Humeral Fractures: Internal Fixation with a Principle-Based Parallel-Plate Technique. Surgical Technique, J Bone Joint Surg Am. 2008;90:31-46

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