BACKGROUND: Double-plate fixation is the gold standard for extra-articular distal humerus fractures, but it carries a substantial risk of postoperative ulnar neuropathy. Fixation using a single posterolateral plate with a medial cannulated screw may reduce ulnar neuropathy while maintaining fracture stability. This study aimed to compare the clinical outcomes of single-plate-with-medial-screw fixation versus double-plate fixation for extra-articular distal humerus fractures. MATERIALS AND METHODS: Fifty-six patients who underwent surgery for extra-articular distal humerus fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association AO/OTA classification A2 or A3) between January 2018 and August 2024 were divided into a double-plate group and a single-plate-with-medial-screw group. We conducted a retrospective, nonrandomized comparative study. The double-plate fixation was used in 30 patients from January 2018 to October 2021, while the single-plate fixation with a medial screw was used in 26 patients from November 2021 to August 2024. All surgeries were performed using a posterior paratricipital approach. Bony union, radiographic healing, and loss of reduction were evaluated. Postoperative pain scores (visual analog scale at 2 days after the operation), operative time (minutes), elbow range of motion, elbow function (Mayo Elbow Performance Score MEPS), and the presence of postoperative ulnar neuropathy were compared between the two groups. RESULTS: The double-plate fixation and single-plate fixation with a medial screw were performed in 30 and 26 patients, respectively. The mean age was 54.8 ± 19 (range, 17-85) years, and the mean follow-up duration was 18.2 ± 6.5 (range, 12-38) months. All fractures achieved solid osseous union at final follow-up. No significant differences were observed between the groups in terms of postoperative pain score, range of motion, and MEPS (all p > 0.05). However, the operative time was shorter for the single-plate-with-medial-screw group than that for the double-plate group (112.5 ± 25.7 versus 172.2 ± 35.2 min, p < 0.05), and the operative time was significantly associated with the fixation method (p < 0.05). In addition, postoperative ulnar neuropathy occurred less frequently with the single-plate-with-medial-screw group than with the double-plate group (8% versus 37%, p = 0.013). CONCLUSIONS: Both double-plate and single-plate-with-medial-screw fixation showed comparable union rates and functional outcomes in extra-articular distal humerus fractures. However, single-plate fixation with a medial screw required a shorter operative time and was associated with a lower incidence of postoperative ulnar neuropathy than double-plate fixation. Level of evidence Level III, retrospective comparative study.
Jung et al. (Fri,) studied this question.