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Re: Многооскольчатый перелом плеча
послал Peter Romchuk 27 Сентябрь 2003, 01:29
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Closed approximation of fragments under moderate traction by hand, then tube-like (Sarmiento type) plaster cast with forearm free and suspended on a sling. It looks somewhat like U-type cast for ankle fractures. Early (range 20") movements with forearm.
I hadn't believed in this method, until tried it on one pt; results were above all expectations.
Interesting, that alignment on X-ray pics of, say 1 month duration will be looking better than on early ones. The main principle to follow is free suspension of the humerus under its own weight without axial load.
Sleeping in semi-supine position. In 3 months you'll get united humerus with mobile shoulder and elbow. Main arguments against ORIF:
1. the rate of comminution, revealed on operation, may much exceed that on x-pics.
2. presenting hematoma is a major contributor to the healing; it will inevitably be lost during open reduction and lengthen healing time despite possible good post/op. pictures.
Regards,
Peter Romchuk, orthopedic surgeon,
Central City Hospital, Rivne, Ukraine
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