Use of 90–90 Plating for Distal Humerus Fractures

Abstract

Despite the advances made during the past quarter century in surgical technique and orthopaedic implant technology, the optimal technique for the internal fixation of intra-articular fractures of the distal humerus remains controversial. Currently, the two techniques of parallel plating and 90–90 (orthogonal or perpendicular) plating are the most widely used methods for the fixation of such fractures. However, controversy continues to surround the positioning of dual-plate fracture fixation constructs in terms of providing optimal stability. To date, neither clinical outcome nor biomechanical testing has shown either 90–90 or parallel plating to be unequivocally superior for the fixation of distal humerus fractures, and the results of the biomechanical studies of the two techniques have been different and sometimes contradictory. Both approaches have theoretical merits and both practical benefits and drawbacks for the fixation of distal humerus fractures, but in my experience 90–90 plating is best for patients with good bone quality, whereas constructs based on parallel locking plates offer some advantages for the fixation of distal humerus fractures in elderly patients with poor bone quality.

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