• Tjalling Aurelius Sebastiaan Ingwersen, Robert Kaspar Wagner, Wouter Veenendaal, and Peter Kloen.
• Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, location AMC, Meibergdreef 9 AMC / K1 207 Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands. t.a.ingwersen@amsterdamumc.nl.
• Arch Orthop Trauma Surg. 2024 Jul 5.

IntroductionTreatment for complex olecranon fractures with metaphyseal comminution can be challenging. To improve reduction maneuvers and augment stability, we apply a small medial and/or lateral locking compression plate (LCP) prior to placing a posterior contoured 3.5 mm-2.7 mm LCP. The aim is to describe our technique and outcomes of this "orthogonal" plating technique.Material And Methods26 patients were treated with orthogonal plating. Clinical outcome variables were available for all patients at a median of 27 months (IQR 6-54), and patient-reported outcomes (Q-DASH and MEPS) for 23 patients at 38 months (IQR 18-71).ResultsAll fractures healed at a median of 2.0 months (IQR 1.5-3.8). The median elbow flexion was 120°, extension-deficit 15°, pronation 88°, and supination 85°. The median Q-DASH was 9 (IQR 0-22) and the median MEPS was 90 (IQR 80-100). Hardware was electively removed in seven patients. One patient had a late superficial infection that resolved with hardware removal and antibiotics, and one patient had two consecutive re-fractures after two hardware removals; and healed after the second revision surgery.ConclusionOrthogonal plating with a posterior LCP and a small medial and/or lateral LCP is a safe technique that leads to excellent healing rates, and good clinical and patient-reported outcomes.© 2024. The Author(s).

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