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Re: Многооскольчатый перелом плеча
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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Re: Многооскольчатый перелом плеча
Len Funk 27 Сентябрь 2003, 01:31
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Do you have any pictures of this technique to show us?
Len
Lennard Funk
Consultant Shoulder & Upper Limb Surgeon
Honorary Clinical Lecturer
www.sportsmedclinic.com
www.shoulderdoc.co.uk
www.orthoteers.co.uk
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Re: Многооскольчатый перелом плеча
Rajesh 27 Сентябрь 2003, 01:39
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Good technique.
One problem I have occassionally seen in cast treatment(not this technique) of humerus #s is the risk of a sharp spike of bone piercing through the skin at some stage or other and going unnoticed until cast is taken off. Any experience of this and how would you try to avoid such a problem? (serial ultrasound ??)
thanks
rajesh
Dr.K.R.Rajesh,MS,DipNB,FRCS,FRCS(Orth)
Consultant Orthopaedic surgeon
Lords Hospital & Cosmopolitan Hospital
Trivandrum
India.
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