Arch Hand Microsurg.  2025 Mar;30(1):86-94. 10.12790/ahm.24.0044.

The feasibility of anterior plate fixation in distal-third humeral shaft fractures: a retrospective case series

• Kim KT
• Kim SJ
• Shim JW

• KMID: 2565473
• DOI: http://doi.org/10.12790/ahm.24.0044

Abstract

Purpose
The surgical approaches and types of implants used for the fixation of distal-third humerus shaft fractures remain a matter of debate. We examined fracture patterns and evaluated the feasibility of plate fixation via an anterior approach.
Methods
We conducted a retrospective study of 22 patients who underwent surgical treatment for distal-third humerus fractures from 2019 to 2023, with a minimum follow-up period of 6 months for all included patients. An anterolateral approach was used to perform open reduction and internal fixation. The minimum cortical width required for screw fixation at the most proximal part of the distal fragment was set at 10 mm.
Results
The mean age of the patients was 38 years. Simple spiral and wedge fractures were predominant (86.3%). The distal fragment fracture line distribution was, on average, 30 mm (4–50 mm) to 101 mm (57–145 mm) from the coronoid fossa proximal margin. The mean distance sufficient to achieve bicortical purchase, engaging both the near and far cortices, was 61 mm (36–96 mm). An anterolateral approach was used in 18 patients based on computed tomography measurements of approximately 50 mm. An average of eight cortices were fixed in the distal fragment. All patients achieved bone union within 12 weeks without complications (mean, 12.69±2.43 weeks).
Conclusion
Stable fixation was achieved with an anterior straight plate when 50 mm of the distal fragment was secured from the coronoid fossa’s proximal margin, with both cortices measuring at least 10 mm in width.

Keyword

Humeral fractures; Surgical procedures; Radial neuropathy; Fracture fixation

Figure

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  Fig. 1. Distance from the proximal margin of the coronoid fossa to the most distal (a) and proximal (b) points of the fracture in the distal fragment.

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  Fig. 2. Axial computed tomography scans using the most proximal point where both cortices were at least 10 mm apart were analyzed to determine the feasibility of screw fixation in both cortices. This location was then correlated on the coronal plane, and the distance from the proximal margin of the coronoid fossa to this point was measured.

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  Fig. 3. A 35-year-old male patient with a spiral wedge fragment fracture (A, preoperative; B, postoperative). The distance from the proximal margin of the coronoid fossa to the most distal fracture line was 4 mm, and that to the most proximal fracture line was 63 mm. Fixation was achieved using four lag screws and a metaphyseal plate.

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  Fig. 4. A 23-year-old female patient with a bending wedge fragment fracture (A, preoperative; B, postoperative). The distance from the proximal margin of the coronoid fossa to the most distal fracture line was 28 mm, and that to the most proximal fracture line was 72 mm. Fixation was achieved using three lag screws and a metaphyseal plate.

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  Fig. 5. The metaphyseal locking compression plate (LCP) can accommodate three 3.5-mm screws and one 4.5-mm cortical screw within 50 mm (A). (B) The LCP can accommodate three 4.5-mm screws or 5.0-mm locking screws.

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  Fig. 6. The proximal portion of the PHILOS plate (DePuy Synthes, Paoli, PA, USA) is designed to fit the anatomical shape of the humerus with greater tuberosity. When the plate is applied to the humerus shaft it will float approximately 3 to 4 mm above it, even when considering the anterior angulation of the distal humerus.

Reference

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