Evolving fracture management: the role of helical plating in orthopaedic trauma surgery - a narrative review.

Purpose: This narrative review systematically compiles and analyzes existing literature on the use of helical plates in orthopaedic trauma surgery. By synthesizing data across various study types, it provides a comprehensive overview of the biomechanical characteristics, clinical outcomes, and anatomical advantages of helical plating.

Methods: A systematic search was performed using PubMed and Web of Science databases, employing defined search terms to identify relevant studies. Single case reports were excluded, while structured case series were included. Retrieved studies were categorized into five groups: simulation studies, biomechanical studies, case series, clinical comparative studies, and anatomical studies.

Results: The review identified studies from 1992 to 2023, with most of the research focusing on the femur (7 studies) and humerus (6 studies). Biomechanical studies (7) were the most common, followed by clinical case series (7), comparative studies (4), and finite element analyses (3). European institutions contributed to the majority of research, with additional studies from Asia and South America. No randomized controlled trials were found. Helical plates demonstrated comparable stability to straight plates, with distinct biomechanical advantages: superior torsional resistance in femoral fractures and improved neurovascular safety in humeral fractures.

Conclusion: Helical plates offer a viable alternative to straight plates in long bone fractures, particularly for protecting neurovascular structures. Optimal designs vary by location, with 45° helical plates recommended for humeral minimally invasive plate osteosynthesis, 180° helical plates for young patients with femoral fractures, and 90° helical plates in geriatric double plating constructs. Further high-quality research is needed to establish definitive clinical guidelines.