Orthogonal versus parallel plating in pediatric distal humeral fractures: a systematic review and meta-analysis

This systematic review and meta-analysis compared orthogonal and parallel plating techniques for these fractures, focusing on functional recovery, complication rates, and biomechanical stability.

A comprehensive literature search was conducted on January 25, 2025, across PubMed, EMBASE, Europe PMC, and Scopus. Studies involving pediatric patients (aged 0-18 years) with distal humeral fractures treated using orthogonal or parallel plating were included. Eligible studies reported outcomes such as Mayo Elbow Performance Score (MEPS), range of motion (ROM), union time, and non-union rate. Two independent reviewers extracted data, and study quality was assessed using the Cochrane risk of bias (RoB) tool version 2.0. Statistical analyses were performed using a random-effects model in RStudio.

From an initial pool of 659 records, five studies (three randomized controlled trials [RCTs] and two cohort studies) met the inclusion criteria. Meta-analyses revealed no significant differences between orthogonal and parallel plating in MEPS (SMD - 0.25, p = 0.07), ROM (SMD - 0.15, p = 0.27), flexion range (SMD - 0.11, p = 0.46), non-union rate (RR 1.01, p = 0.99), union time (RR 1.01, p = 0.99), or surgical duration (SMD 0.06, p = 0.74). However, orthogonal plating showed a statistically significant advantage in extension range (SMD 0.45, p = 0.005). The risk of bias was minimal, and the certainty of evidence was rated as high.

Both orthogonal and parallel plating techniques demonstrated comparable efficacy in managing pediatric distal humeral fractures, with no significant differences in most outcomes. Orthogonal plating exhibited a slight advantage in extension range, though its clinical relevance requires further investigation.