"90/90" Plating of proximal humerus fracture-a technical note

Area of Science:

• Orthopedic surgery
• Traumatology
• Biomechanical fixation

Background:

• Proximal humerus fractures with medial comminution and varus deformity present fixation challenges.
• Locking plates have improved outcomes but complications persist in this cohort.
• Loss of reduction and fixation failure are common in these complex fractures.

Observation:

• A novel technique using an orthogonal 1/3 tubular plate to augment a standard proximal humerus locking plate was applied.
• Osteosynthesis was performed within 24 hours of injury for a four-part fracture with medial comminution.
• Reduction was maintained with K-wire and a 1/3 tubular plate before definitive locking plate fixation.

Findings:

• The augmented fixation technique demonstrated satisfactory results at 6 months with complete fracture union and no loss of reduction.
• Excellent range of motion was achieved at 1 year post-operatively.
• The combined approach provided stable fixation for a complex fracture pattern.

Implications:

• Augmenting proximal humerus locking plates with a 1/3 tubular plate offers a simple and reproducible solution.
• This method may decrease the incidence of malunion and fixation failure in challenging fractures.
• The technique presents a potentially cost-effective strategy for managing complex proximal humerus fractures.