george.s.thomas at gmail
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Jan 19, 2008, 5:41 AM
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[Orthopod] Re: Comminuted fracture proximal humerus
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The fracture is completely displaced in the axial view. It is probably
possible to align it with the patient in the vertical position, i.e. sitting
or standing. However, I would use a locking plate for the tremendous pain
relief it offers.
I am attaching the radiographs of the mother of a doctor. She has chronic
renal failure for >10 years, diabetes mellitus and coronary artery disease.
Age 62. She was offered the options of non-surgical management in a sling
and surgery with a locking plate. She was given Tramadol for pain relief.
Five days after injury, patient requested surgery, because of pain,
inability to move without pain.
The reduction is not perfect. The patient is very small made, and it was
difficult to bring the plate proximally without impingement in abduction.
Pain relief after surgery was early and sustained.
On Jan 19, 2008 12:55 PM, Alexander Chelnokov <alex@weborto.net> wrote:
> Dear Neeraj,
>
> Saturday, January 19, 2008, 10:28:43 AM, you wrote:
>
> DNB> My questions to the house is ...
> DNB> 1. Is there any other option besides the locking plate ?? (Less
> invasive)
>
> CT scans would be useful to evaluate the head.
> Another option could be closed nailing, see an example, the surgery
> was donó 2 days ago. In common such surgeries are performed under
> regional anesthesia, not general.
> One more option can be fixation by V-shape stressed wires.
>
> DNB> 2. If he is not medically fit for surgery, then can we leave him
> DNB> alone if yes what are the chances of going it into non union?
>
> Fragments now look severely displaced.
>
> --
> Best regards,
> Alexander N. Chelnokov
> Ural Scientific Research Institute
> of Traumatology and Orthopaedics
> 7, Bankovsky str. Ekaterinburg 620014 Russia
> >
>
--
George Thomas, MBBS., D.Orth .
Orthopaedic Surgeon,
Chennai, India
Editor, Indian Journal of Medical Ethics,
www.issuesinmedicalethics.org
www.ijme.in
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