Comparison of Single-Plate and Double-Plate Osteosynthesis with Locking Plate Fixation for Distal Humeral Fracture in Older Adults

Background: Management of transcondylar fracture of the humerus in older adults remains a challenging issue in trauma surgery. Both single- and double-plate fixation are used, and the best procedure is yet to be determined. This retrospective study evaluated and compared the clinical and radiological outcomes of single- and double-plate fixation for transcondylar humeral fracture. Methods: This study included older adults (age >65 years) with transcondylar fractures of the humerus (AO/OTA 13A2-3; transverse, transmetaphyseal fracture) treated at our hospital between 2002 and 2019. The patients were divided into two groups based on the fixation procedures they underwent, namely, single (group S) or double (group D) locking plate osteosynthesis. Postoperative outcomes were investigated. Results: Group S and group D comprised 11 (11 women) and 17 (2 men; 15 women) patients, respectively. In group S, the elbow was immobilized in a long-arm cast or splints for 2 weeks to prevent early displacement of fracture. Residual numbness of the ulnar digits was observed in two patients in group S and in nine patients in group D. No significant difference was noted between the two groups in the ratio of loss of reduction, loosening of the medial screw, ulnar nerve disturbance, or clinical outcomes. The ratio of elbow contracture significantly differed between 2 groups. The elbow flexion angle was significantly lower in group S. Conclusions: Open reduction and internal fixation with a double plate appears to be the optimal choice for early postoperative mobilization and maintenance of flexion and arc of the elbow joint.