SERGIO - NEW CASE - "DELAYED" HUMERUS BRIDGE PLATE ...

[Sergio Rowinski]

My dear indiaorth friends, hello. 

This is, indeed, a very nice case. 

I am absolutely happy to (finally) post this case. 

 I waited - yes, I waited - 07 (seven) months to post this case, here. 

This case is like that "Challenging distal humerus bridge plate" case, that I posted in 

July/2013 - a case that shall be posted only when FINISHED... 

On that case, I waited 3 months to post it; now, in this present one, I waited 07 months ...

This case is absolutely beautiful, because of many things : 

_________________________________________

FIRST, this case shows that

orthopedics is based much more in principles and concepts than in simple "guidelines" ...

When many "juniors", here in Indiaorth, 

in many different cases, have asked for "guidelines", I have 

insistently asked them to think about PRINCIPLES and CONCEPTS, first...  

_____________________________________________________

SECOND, this case shows how WIDE and AMPLE can be the indications for 

anterior bridge plating, in humerus. 

______________________________________________________

And THIRD, this case is lovely because, with it, I have literally PUSHED 

THE LIMITS (mine, at least) ...

I have, with this case, done my first bridge plate to treat a complex humerus DELAYED union ...

______________________________________________________

So : 

62 y old lady, non smoker, had a proximal methaphyseal/diaphyseal complex

spiral humerus fracture, right side, in August/2013. No neuro deficits.  

She was treated by other team (hip team), conservatively, in my public hospital.

Anyway, after 12 weeks of conservative management, there was : 

• no bone healing, radiographically
  
• pain, clinically 
  

So, on December 2013, one of the HIP guys called me on phone, and said : 

"I am booking a complex humerus non-union for you, next week. We tried to treat it conservatively, but it has gone to a NON-UNION.

You will have to open that, refresh bony ends, put a lot of graft and plate it. Be prepared!!!!", he said ...

___________________________

On the day of surgery, I examined that arm, 

clinically, and under dynamic C-arm evaluation ...

Well ... NOT frank mobility ...

Indeed, there was mobility - but not much ... Discrete mobility ...

It was (still) a DELAYED union ...

Bone was asking for stability to heal ...

And ?????????

And, a DELAYED union means a situation in which bone still CAN GO TO UNION. 

In tibias, what to do a with a delayed union, in shaft,  in conservative treatment ??????

Give patient a PTB and ask him to DISCHARGE and walk !!!!!!!!!

 

I have seen that all my residency...

But, in upper limb, it's not like this. 

____________________________________

So ?????????

Well, as I always tell my residents, 

"X-ray speak. You just have to listen..."

And, that X-ray was indeed SHOUTING ...

Just asking for stability to go to UNION ...

So, 

immediately before putting sterile drapes, I changed plans ...

I would not 

• open all that
• refresh bony ends 
  
• put a lot of graft
  
• and plate, with a long PHILOS 
  

as programmed... 

I would just give bone just what it needed ...

And the rest is the rest ...

16 photos attached ... Sorry for the "NOT-THE-BEST" photos quality ...

Indiaorth accepts until 1 MEGA per mail ...

This is case is dedicated to my bahut friend VMI ...

--

Dr Sergio Rowinski

Orthopedic Surgeon

Shoulder & Elbow Surgery

São Paulo, Brazil

[Dr.Vishwanath Iyer]

Sergio,
Very good case. More important is
understanding the reason for the delayed union. Congratulations. I do not know the reason for dedicating case to me. I would have done exactly the same. I too would have only stabilised it without B G, in my own way
V M I

V M Iyer
B106, Kumaradhara, N G V, ,
Bangalore, , 500047
9742399481 7620853362

--
You received this message because you are subscribed to the Orthopod Mailing List.
To post to this group, send email to orth...@googlegroups.com
To unsubscribe from this group, send email to orthopod-u...@googlegroups.com
For more options, visit this group at http://groups.google.com/group/orthopod?hl=en
---
Powered by Orthogate
Improving orthopaedic care, education, and research using Internet technologies
http://www.orthogate.org
---
You received this message because you are subscribed to the Google Groups "Orthopod" group.
To unsubscribe from this group and stop receiving emails from it, send an email to orthopod+u...@googlegroups.com.
For more options, visit https://groups.google.com/d/optout.

[Dr Minoo Patel]

Dear Sergio,

What did you do (or not do) with the radial nerve? (at the lateral inter-muscular septum)

MIPO or open?

For MIPO if the lateral plate goes this low the suggestion is to have an twist to plate the distal 1/3 of the plate anteriorly.

Regards

Minoo Patel

 

Dr Minoo Patel MBBS, MS, FRACS, Ph.D.

Orthopaedic Surgeon ǀ Senior Lecturer Monash University ǀ Research Fellow Melbourne University

Chairman, Australian Orthopaedic Association Research Foundation

 

Shoulder, Elbow and Upper Limb Surgery  ǀ  Limb Lengthening, Deformities and Reconstruction

 

Suite 5.7. The Epworth Centre, 32 Erin St, Richmond. VIC  3121

Ph: 03 9429 8084    Fax: 03 94294045       Mobile: 0418 418 728

Email: minoo...@bigpond.com    ǀ  Email: man...@limblengthening.com.au

                   

Shoulder, Elbow & Hand Clinics

 

 

 

 

--

[prasoon anand]

Sergio, what has happened to you favorite (  now mine too  )  saying : Believe in God , but do not forget to lock your Car " !

Any ways , just joking !

Thanks for sharing this wonderful case .

Regards , 

--

Prasoon Anand

MS (Orth), ( yr 2005 )

Consultant ( Orthopedics)

Tata Motors Hospital

Jamshedpur

Mob: +919031080137

[prasoon anand]

Thanks dr Minoo Patel ,

This is really very useful tips .