• Caio Zamboni, Bruno L Carmo, Leonardo V M Moraes, José O S Hungria, Marcelo T Mercadante, and Patricia M M B Fucs.
• Trauma Surgery Group of Santa Casa de São Paulo, Brazil; Orthopaedics and Traumatology Department of Irmandade da Santa Casa de Misericóridia de São Paulo, Brazil. Electronic address: contato@drzamboni.com.br.
• Injury. 2019 Dec 1; 50 (12): 2247-2251.

IntroductionThe emergence of minimally invasive techniques has expanded the use of plates and improved their safety for the repair of humeral diaphyseal fractures with proximal extension. In this study, we aimed to determine the best contouring method for long locking plates in the repair of humeral fractures using this approach.Patients And MethodsComparative observations were performed between helical and spiral modelling in plastic models to identify which shape best fits the contours of the humerus. To determine the best shape, we attempted to assess the torsion required for the plate to settle laterally in the greater tuberosity and anteriorly in the diaphyseal region of the humerus. After establishing the best approach, we transferred the method to two anatomical specimens and confirmed the viability of the method and pathways. Additionally, to confirm the clinical applicability of the method, we applied the method in ten patients.ResultsAfter placing the plates in the bone models, it was found that the helical plate was more distant from the bone. On the other hand, the spiral plate achieved better accommodation along the contours of the humerus. The amount of twist was tested at 50°, 70° and 90°. When the plate was twisted at 70°, it maintained contact with the greater tuberosity proximally and the anterior cortical diaphyseal region. Eight patients completed the follow-up. Radiographic consolidation and good functional outcomes were achieved in all patients.ConclusionsSpiral modelling at 70° allows anatomical accommodation at the greater tuberosity proximally and in the diaphyseal region.Copyright © 2019. Published by Elsevier Ltd.

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