Outcome analysis of extraarticular distal humerus locking plate for fresh fractures of humerus shaft


  • Anand Saurabh Department of Orthopaedics, IMS BHU, Varanasi, U. P., India
  • Abhijeet Kunwar Department of Orthopaedics, IMS BHU, Varanasi, U. P., India
  • G. N. Khare Department of Orthopaedics, IMS BHU, Varanasi, U. P., India
  • Shubhashu Shekhar Department of Orthopaedics, IMS BHU, Varanasi, U. P., India
  • Anil Kumar Rai Department of Orthopaedics, IMS BHU, Varanasi, U. P., India
  • Vishal Verma Department of Orthopaedics, IMS BHU, Varanasi, U. P., India




Distal humerus fracture, Plate osteosynthesis, Extra-articular


Background: The complex anatomy of distal humerus with proximity of radial nerve make the exposure and fixation of these fractures difficult. The standard technique of plate osteosynthesis consider at least eight cortices hold in both distal and proximal ends. Obeying these principles becomes difficult in distal humerus fractures. These difficulties have been overcome with the use of anatomical extra-articular distal humerus plate which has more hole density in the distal part with 3.5 mm screws for greater hold in distal part.

Methods: A prospective study was carried out at Institute of Medical Sciences BHU Trauma Centre for 19 cases of distal third fracture excluding open fractures of patients between 18-68 years who attended our OPD or Emergency from June 2017 to July 2019. All patients were operated with the triceps-reflecting modified posterior approach. Regular follow-up was done to evaluate elbow functionality, fracture union, secondary displacement, non-union, implant failure and any complications; Mayo Elbow Performance score (MEPS) was used for the final functional assessment.

Results: Fourteen 73.6% male and 5 (26.3%) female patients with mean age 41 years constituted the study group, who had an average follow-up of 17.1 months. Preoperatively one patient had radial nerve palsy (neuropraxia) who recovered completely 3 months after surgery. Overall, 18 (94.7%) patients were adjudged to have complete radiological union within 14 weeks; Mean flexion achieved was 134±11.5 (range 90–140). Average MEPS at the latest follow-up was 94.7±7.5.

Conclusions: Extra-articular fractures of distal humerus can be satisfactorily treated with the use of single anatomically pre-contoured locking compression plate with excellent elbow functional range of motion and union rates.


Stewart MJ, Hundley JM, Tennessee M. Fractures of the humerus: a comparative study in methods of treatment. J Bone Joint Surg Am. 1955;37(4):11.

Sarmiento A, Horowitch A. Functional bracing for comminuted extra-articular fractures of the distal third of the humerus. J Bone Joint Surg Br. 1990;72(2):283-7.

Ring D, Harris M, Doornberg J, McCarty P, Jawa A. Extraarticular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Joint Surg Am. 2006;88(11):2343-7.

McKee MD. Fractures of the shaft of the humerus. In: Bucholz RW, Heckman JD, Court-Brown CM (eds) Rockwood and green’s fractures in adults. Lippincott Williams and Wilkins, Philadelphia; 2006:1117-1159.

Ali E, Griffiths D, Obi N, Strong TG, Rensburg VL. Nonoperative treatment of humeral shaft fractures revisited. J Shoulder Elbow Surg. 2015;24:210-4.

Jawa A, McCarty P, Doornberg J, Harris M, Ring D. Extra-articular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Joint Surg Am. 2006;88:2343-7.

Paris H, Tropiano P, D’orval CB. Fractures of the shaft of the humerus: systematic plate fixation. Anatomic and functional results in 156 cases and a review of the literature. Rev Chir Orthop Reparatrice Appar Mot. 2000;86(4):346-59.

Yang Q, Wang F, Wang Q, Gao W, Huang J, Wu X, et al. Surgical treatment of adult extra-articular distal humeral diaphyseal fractures using an oblique metaphyseal locking compression plate via a posterior approach. Med Princ Pract. 2012;21:40-5.

Spitzer AB, Davidovitch RI, Egol KA. Use of a “hybrid” locking plate for complex metaphyseal fractures and non-unions about the humerus. Injury. 2009;40:240-4.

Saragaglia D, Rouchy RC, Mercier N. Fractures of the distal humerus operated on using the Lambda® plate: Report of 75 cases at 9.5 years follow-up. Orthop Traumatol Surg Res. 2013;99:707-12.

Levy JC, Kalandiak SP, Hutson JJ, Zych G. An alternative method of osteosynthesis for distal humeral shaft fractures. J Orthop Trauma. 2005;19:43-7.

Meinberg E, Agel J, Roberts C. Fracture and dislocation classification compendium. J Orthop Trauma. 2018;32:1-10.

Morrey BF, An KN, Chao EYS. Functional evaluation of the elbow. In Morrey BF ed. The Elbow and Its Disorders, 2nd ed. Philadelphia: WB Saunders; 1993:86-89.

Fjalestad T, Stromsoe K, Salvesen P, Rostad B. Functional results of braced humeral diaphyseal fractures: Why do 38% lose external rotation of the shoulder? Arch Orthop Trauma Surg. 2000;120:281-5.

Gosler MW, Testroote M, Morrenhof JW, Janzing HM. Surgical versus non-surgical interventions for treating humeral shaft fractures in adults. Cochrane Database Syst Rev. 2012;1:CD008832.

Pickering RM, Crenshaw AHJ, Zinar DM. Intramedullary nailing of humeral shaft fractures. Instr course Lect. 2002;51:271-8.

Moran MC. Modified lateral approach to the distal humerus for internal fixation. Clin Orthop Relat Res. 1997;(340):190-7.

Sharaby M, Elhawary A. A simple technique for double plating of extraarticular distal humeral shaft fractures. Acta Orthop Belg. 2012;78:708-13.

Prasarn ML, Ahn J, Paul O, Morris EM, Kalandiak SP, Helfet DL, et al. Dual plating for fractures of the distal third of the humeral shaft. J Orthop Trauma. 2011;25:57-63.

Scolaro JA, Voleti P, Makani A. Surgical fixation of extra-articular distal humerus fractures with a posterolateral plate through a triceps-reflecting technique. J Shoulder Elbow Surg. 2014;23(2):251-7.

Gerwin M, Hotchkiss RN, Weiland AJ. Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve. J Bone Joint Surg Am. 1996;78(11):1690-5.

Trikha V, Agrawal P, Das S, Gaba S, Kumar A. Functional outcome of extra-articular distal humerus fracture fixation using a single locking plate: A retrospective study. J Orthop Surg (Hong Kong). 2017;25(3):2309499017727948.

Jain D, Goyal GS, Garg R, Mahindra P, Yamin M, Selhi HS. Outcome of anatomic locking plate in extraarticular distal humeral shaft fractures. Indian J Orthop. 2017;51(1):86-92.






Original Research Articles