NEW CASE - HUMERUS ANTERIOR BRIDGE PLATE - 19 Y GIRL

[Sergio Rowinski]

My dear friends, this is one more example of HUMERUS ANTERIOR BRIDGE PLATING - in a more demanding fracture ...

I am now with about 35 to 40 cases done. This 19 years old girl had a fracture, at home. Could be treated conservatively - but, with 2 small incisions, she was moving the next day. 

As I say, once surgeon goes through the "learning curve", this technique is : 

• safe 
• very versatile 
• have very reasonable cosmesis 
• keeps rotator cuff out of the game ... 

15 photos attached ...

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Dr Sergio Rowinski

Orthopedic Surgeon

Shoulder & Elbow Surgery

São Paulo, Brazil

[Alexander Chelnokov]

Hi

2013/4/15 Sergio Rowinski <raul...@gmail.com>

My dear friends, this is one more example of HUMERUS ANTERIOR BRIDGE PLATING - in a more demanding fracture ...

For such and more distal fractures antegrade nailing is a good option. Insertion point is lower than the cuff. 

Attached is a pre-, post-op and 2 month follow-up.

--
Best regards,
 Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia

[Dr.Vishwanath Iyer]

Wow! Alex,

Good demonstration. Greetings..

Vishu

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Dr Vishwanath M Iyer
 919742399481
917620853362
103, Railway lines,Solapur.413001
91 217 2317597/2316783  

[Rohit Shah]

will you pl send the details of the approach which may decrease the LEARNING CURVE

*ROHIT SHAH*

PROF OF ORTHOPAEDICS
SMT N.H.L.MUNICIPAL MEDICAL COLLEGE ELLISBRIDGE AHMEDABAD
INDIA
91 79 26403772 RESIDENCE
O94260 69317 MOBILE
rohi...@gmail.com

[Sunil Kumar]

Sergio and Alexander

As I learn  from your  posts a FRACTURE HUMERUS  BRIDGE PLATING Good Stability

AND    Nailing   also works

So  can I  beat it!     --nailing still adopted  by many  still,  all over places

On Mon, Apr 15, 2013 at 1:29 PM, Dr.Vishwanath Iyer <drvish...@gmail.com> wrote:

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sunilsrivastava

[Jose M Palomo]

 

    1.- Great, Sergio ! Great, Alexander !

    2.- Rohit, the “details of the approach which may decrease the learning curve” are ... that very curve. Doing a handfull of them, actually.

    3.- Sunil, nailing also works ... when it works. I could show you very bad cases of nailed humeral shaft fractures.

    4.-There must be, Alexander, some reasonable explanation as to how you reached such a nice healing with such an unstable fixation.

 

    Jose M Palomo

    Hospital General Castelló

    Spain

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Dr Vishwanath M Iyer
919742399481
917620853362
103, Railway lines,Solapur.413001
91 217 2317597/2316783  

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sunilsrivastava

[Manuel Becerra]

pearls:

  perform a slight traction with the arm abducted some 60o to avoid varus

  premould the plate with a plastic bone model, so you can slide it very easily

  In diaphyseal fx tne incision are anterior, in distal fx the distal incision is lateral

  place 2 or 3 screws proximal and 2 or 3 distally

  In transverse or short oblique fx an antero-medial incision can be made at fx level in order to control the reduction with the finger

 

good luck

 

MB

 

 

[Alexander Chelnokov]

Hi

2013/4/15 Dr.Vishwanath Iyer <drvish...@gmail.com>

Wow! Alex,

Good demonstration. Greetings..

Sergio's case looks very interesting.  It looks like length was not restored and it resulted with AP translation. 

Was the plate inserted down- or upwards? Any concerns about radial nerve? THX for case!

[Alexander Chelnokov]

Hi 

2013/4/15 Jose M Palomo <jmpa...@comcas.es>

     3.- Sunil, nailing also works ... when it works. I could show you very bad cases of nailed humeral shaft fractures.

 Most of them must be upper third spiral ones i guess. Distal third are less problematic.

 

   4.-There must be, Alexander, some reasonable explanation as to how you reached such a nice healing with such an unstable fixation.

As we all know Sarmiento brace provides very nice healing with nothing about stable fixation, so the presented nailing techniques (and Sergio's case of plating as well) can be perceived as internal Sarmiento brace...

 

[Manuel Becerra]

 

pearls:

  perform a slight traction and place the arm abducted some 60o to avoid varus

  premould the plate with a plastic bone model, ( or use a sterile bone model)  so you can slide it very easily.  this is the key step in distal or proximal fractures since  the plate has to be twisted in order to adapt it exactly to the bone or use it as a tool to reduce the fx

  In diaphyseal fx tne incisions are anterior, in distal fx the distal incision is lateral (There is a high risk of injuring the radial or musculocutaneous nerves if the distal      incision is volar since the screws are inserted from lateral)

  place 2 or 3 screws proximally and 2 or 3 distally

[Jose M Palomo]

 

    Well, yes indeed. They were mainly proximal half ones.

 

    As regarding to Sarmiento’s – I have adapted hundreds of arm, forearm, QTB and PTB braces casts and braces – yes, ... but not always. As a matter of fact, I will operate next Friday a delayed union of a middle third short oblique humeral shaft fracture treated by means of a brace for three and a half months.

    So maybe your humeral nail, quite more than Sergio’s plate, “can be perceived as internal brace” but I would have suffered quite a thrill should any of my staffs decide using that procedure.

    Do you actually either allow any kind of ROM movement – shoulder and/or elbow - or rather keep the arm in a sling and swathe for some time ?

 

 

   Jose M Palomo

    Hospital General Castelló

    Spain

From: Alexander Chelnokov

Subject: Re: [Orthopod] NEW CASE - HUMERUS ANTERIOR BRIDGE PLATE - 19 Y GIRL

[Sunil Kumar]

Thanks

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