george.s.thomas at gmail
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Jan 19, 2008, 6:00 PM
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[Orthopod] Re: Comminuted fracture proximal humerus
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Dear Alex,
>>I agree that this reduction is not perfect. The gap may later result
> with nonunion. Such or even better reduction can be reached without site
> opening as you mentioned. Locking plates are positioned as less
> invasive, why so long incision was - even longer than plate?
In the proximal humerus, the locking plate is generally introduced through
an open incision of the type that I have used. The complex muscle
attachments at the proximal end of the humerus, make it difficult to
position the plate without opening.
>
>
> >>You would use locking plate in the discussed case because it is somewhat
> better comparatively to locked nail? Or just because you get accustomed
> to use plates, or proximal humeral nails are not available around, or
> because of some other reason?
Proximal humerus nails are available in India
The reason I prefer the locking plate for proximal humerus fractures is that
the rotator cuff muscles have to be reattached, and that is possible with
the plate and not the nail. I am not sure if they are detached in the
present case. If they are not, then the nail is certainly a less invasive
option.
Best regards,
>
>
> Pls compare wound size visible at x-rays of your example with ones after
> typical closed nailing of the proximal humerus.
>
> ___
> 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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