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Re: Comminuted fracture proximal humerus
Alexander Chelnokov 21 Январь 2008, 22:17
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Dear Neeraj,
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 done 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.
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Re: Comminuted fracture proximal humerus
George Thomas 21 Январь 2008, 22:33
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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.
George Tomas
Chennai, India
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Re: Comminuted fracture proximal humerus
Отправитель: Alexander Chelnokov 21 Январь 2008, 22:38
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George Thomas пишет:
> 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
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?
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?
Pls compare wound size visible at x-rays of your example with ones after typical closed nailing of the proximal humerus.
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Re: Comminuted fracture proximal humerus
Отправитель: George Thomas 21 Январь 2008, 22:46
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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,
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