A Comparative Study of Perpendicular Versus Parallel Plate Fixation in Distal Humerus Fractures

Abstract

Dr. Pranavkumar Jagdishbhai Pandya and Dr. Sudhirkumar Rawat

Background: Intra-articular distal humerus fractures are complex injuries requiring stable fixation to permit early mobilization and prevent elbow stiffness. Dual-plate fixation using either perpendicular (orthogonal) or parallel configuration is commonly employed, but the optimal plate orientation remains debated.

Objectives: To compare functional and radiological outcomes of perpendicular versus parallel plate fixation in adult intra- articular distal humerus fractures.

Methods: This prospective comparative observational study was conducted at a tertiary care teaching hospital in India. Forty adult patients with AO/OTA type 13-C distal humerus fractures were included and divided into two groups: perpendicular plating (n=20) and parallel plating (n=20). Patients underwent standardized surgical fixation followed by early mobilization. Outcomes assessed included elbow range of motion, Mayo Elbow Performance Score (MEPS), time to radiological union, and postoperative complications over a minimum follow-up of six months. Statistical analysis was performed with significance set at p<0.05.

Results: Baseline demographic and fracture characteristics were comparable between groups. Most fractures in both groups achieved radiological union within 12–16 weeks. Parallel plating showed a slightly greater mean elbow arc of motion (118° vs 110°) and a higher proportion of excellent MEPS outcomes (45% vs 35%). Complication rates were low and similar, with elbow stiffness being the most common complication.

Conclusion: Both perpendicular and parallel plating techniques are effective for distal humerus fractures. Parallel plating offers a modest functional advantage in selected cases, while overall outcomes depend primarily on fracture characteristics, surgical execution, and rehabilitation.

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