Locking and Non-locking Constructs Achieve Similar Radiographic and Clinical Outcomes for Internal Fixation of Intra-articular Distal Humerus Fractures

Marschall Berkes, MD
Hospital for Special Surgery

Grant Garrigues, MD
Duke University Medical Center

John Solic, MD
Duke University Medical Center

Nathan Van Zeeland, MD
Hand and Upper Extremity Center of Northeast Wisconsin, LTD.

Nader Shourbaji, MD
Emory University Medical Center

Kim Brouwer, MS
Department of Orthopedic Surgery, Yawkey Center for Outpatient Care, Massachusetts General Hospital

Jesse Jupiter, MD
Department of Orthopedic Surgery, Yawkey Center for Outpatient Care, Massachusetts General Hospital

David Ruch, MD
Duke University Medical Center

William Obremskey, MD, MPH
Vanderbilt University


Abstract

Background 
Locking plates have been used increasingly for the management of distal humerus fractures. Studies that compare patient-centered outcomes between locking and non-locking fixation for distal humerus fractures are lacking.

Questions/Purposes 
The purposes of this study were to (1) determine whether locking plates offered superior fixation compared with non-locking plates for distal humerus fractures, (2) determine whether the use of locking plates was associated with fewer complications, and (3) determine whether locking plate use resulted in superior radiographic outcome compared with non-locking plates. Lastly, another aim was to determine the average cost difference associated with locking plate use versus non-locking plate use for distal humerus fracture fixation.

Patients and Method 
Demographic, clinical, and radiographic data including loss of fixation, range of motion, rate of infection, nonunion and reoperation, as well as measures of fixation were collected retrospectively and compared on 96 patients with surgically treated AO type 13C distal humerus fractures (65 locking, 31 non-locking) at 6-week and 6-month follow-up. Average costs of locking and non-locking constructs were calculated and compared.

Results 
Three in 96 (3.1%) of all cases experienced loss of fixation, with no difference between the two groups. There was no difference between locking and non-locking groups with regard to the rate of nonunion, infection, and reoperation at 6 weeks and 6 months. On average, locking plate constructs were 348% more expensive than non-locking constructs.

Conclusion 
While there are some significant differences in radiographic parameters and cost between locking and non-locking constructs for internal fixation of intra-articular distal humerus fractures, there were no statistically significant differences in clinical outcome.

This article appears in HSS Journal: Volume 7, Number 3.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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