Effects of Orthogonal Vs Parallel Plating on Fracture Healing for the Management of Intra-Articular Distal Humerus Fracture

Objective: To compare the radiological and functional outcomes of orthogonal (90–90) versus parallel plating techniques in the operative management of intra-articular distal humerus fractures. Methods: This prospective cohort study was conducted at the Orthopedics Department of Combined Military Hospital Rawalpindi, enrolling 80 adult patients with AO/OTA type C intra-articular distal humerus fractures during the period from October 2024 to March 2025. Patients were managed with either orthogonal (n=40) or parallel (n=40) dual plating based on surgeon preference and fracture morphology. Postoperative follow-up included clinical and radiographic assessments at 6 weeks, 3 months, and 6 months. Functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS), range of motion (ROM), and radiological union on standard AP and lateral views. Complications such as non-union, implant loosening, and ulnar neuropathy were recorded. Results: At final follow-up, fracture union was achieved in 95% of patients in both groups. The mean MEPS score was slightly higher in the parallel plating group (89.6 ± 6.2) compared to the orthogonal group (85.7 ± 7.4), though not statistically significant (p=0.062). Elbow ROM was comparable between groups. Implant-related complications were observed more in the orthogonal group (12.5%) than in the parallel group (5%), but the difference was not statistically significant. Conclusion: Both orthogonal and parallel plating configurations result in comparable fracture union rates and functional outcomes in the management of intra-articular distal humerus fractures. Parallel plating may offer a marginal advantage in elbow function and fewer implant-related complications, but both methods remain viable and effective depending on fracture pattern and surgeon experience.