“90/90” Plating of proximal humerus fracture—a technical note

Abstract

IntroductionWhile locking plates have markedly improved fixation of proximal humerus fractures, a cohort of fractures remains difficult to treat. This cohort has been identified as fractures with marked medial comminution and varus deformity. Loss of reduction and fixation failure are the most frequently reported complications for this cohort. We report the use of an orthogonal 1/3 tubular plate to augment the proximal humerus locking plate.MethodsThe subject underwent osteosynthesis for a four-part proximal humerus fracture with medial comminution. Fixation was performed within 24 h of injury. Standard deltopectoral approach exposed the fracture. Sutures were sited to control the tuberosities and cuff. Initial reduction was held with a K-wire and augmented with a three-hole 1/3 tubular plate. Proximal humerus locking plate was sited in standard fashion including locked medial support screws. Reduction was confirmed both clinically and with intra-operative radiography.ResultsThe technique provided satisfactory results. At 6 months, the fracture had fully united with no loss of reduction. At 1 year, the patient had excellent range of motion.ConclusionThe use of a 1/3 tubular plate to augment fixation of proximal humerus fractures with medial comminution may provide a simple, reproducible, and cost-effective method to decrease loss of reduction and subsequent malunion.

Dual plate fixation of proximal humerus fractures: Retrospective review and surgical technique

“…14 Cassidy et al published a case report of a patient who sustained a four-part proximal humerus fracture, which was surgically fixed with a proximal humerus locking plate augmented with three-hole 1/3 tubular plate. 15 Interestingly they applied the 1/3 tubular plate after fracture reduction and provisional k-wire fixation but before applying the proximal humerus plate. The patient had uneventful recovery with complete union at 6 months post-operatively.…”

Corrective Open-wedge Valgus Proximal Humerus Lengthening Osteotomy. Technique and Case Series

“…3 Further stability is also achieved with medial buttress plating, acting in a similar manner as the recently described 90/90 degrees plating for proximal humeral fractures. 30 It should be noted that 3 cases are not enough to show that this technique is superior to others (including closing wedge) or that it will necessarily correct subluxation. 31 Nonetheless, it remains among the therapeutic options to consider.…”

“…Calcar screw placement in the locking plate through the graft inside the humeral head is mandatory, to enhance stability 3 . Further stability is also achieved with medial buttress plating, acting in a similar manner as the recently described 90/90 degrees plating for proximal humeral fractures 30 . It should be noted that 3 cases are not enough to show that this technique is superior to others (including closing wedge) or that it will necessarily correct subluxation 31 .…”