Anatomic fit of precontoured extra-articular distal humeral locking plates: a cadaveric study

BACKGROUND: Extra-articular distal humerus locking plates (EADHPs) are precontoured anatomical plates widely used to repair distal humeral extra-articular diaphyseal fractures. However, EADHPs frequently cause distal protrusion and resulting skin discomfort. The purpose of this study was to predict the occurrence of anatomic fit mismatch. We hypothesized that the smaller the humerus size, the greater the anatomic fit mismatch with EADHP. METHODS: Twenty humeri were analyzed in this study. Humeral length and distal humeral width were used as parameters of humeral size. Plate protrusion was measured between the EADHP distal tip and the distal humerus. We set the level of unacceptable EADHP anatomic fit mismatch as ≥10 mm plate protrusion. RESULTS: A significant negative linear correlation was also confirmed between humeral size and plate protrusion, with a coefficient of determination of 0.477 for humeral length and 0.814 for distal humeral width. The cutoff value of humeral length to avoid ≥10 mm plate protrusion was 293.6 mm (sensitivity, 88.9%; specificity, 81.8%) and for distal humeral width was 60.5 mm (sensitivity, 100%; specificity, 81.8%). CONCLUSIONS: Anatomic fit mismatch in distal humeral fractures after EADHP fixation has a negative linear correlation with humeral length and distal humeral width. For patients with a distal humeral width <60.5 mm, ≥10 mm plate protrusion will occur when an EADHP is used, and an alternative implant or approach should be considered.