O'Driscoll synthesizes biomechanical literature to define two governing principles and eight specific technical objectives for distal humeral fracture fixation — challenging the standard AO/ASIF 90°/90° perpendicular plate construct and proposing parallel sagittal-plane plating with interdigitating screws as the mechanically superior strategy.
When fixing a comminuted or osteoporotic distal humeral fracture, place both plates in the sagittal plane (posterolateral and posteromedial), maximize the number and length of screws in the distal fragments so they interdigitate across the midline, and ensure the construct is stiff enough to allow immediate active motion — if the lateral plate is posterior and screws are short, expect lateral column pullout under everyday varus loading.
O'Driscoll synthesizes biomechanical literature to define two governing principles and eight specific technical objectives for distal humeral fracture fixation — challenging the standard AO/ASIF 90°/90° perpendicular plate construct and proposing parallel sagittal-plane plating with interdigitating screws as the mechanically superior strategy.
When fixing a comminuted or osteoporotic distal humeral fracture, place both plates in the sagittal plane (posterolateral and posteromedial), maximize the number and length of screws in the distal fragments so they interdigitate across the midline, and ensure the construct is stiff enough to allow immediate active motion — if the lateral plate is posterior and screws are short, expect lateral column pullout under everyday varus loading.