By Rafael Orozco, J. Miquel Sales, Miquel Videla (auth.)
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Extra info for Atlas of Internal Fixation: Fractures of Long Bones. Classification, Statistical Analysis, Technique, Radiology
Fixation is indicated because of the difficult reduction and stabilization by bloodless methods. The most proximal fractures require some kind of internal fixation with screws into the humeral head. The distal fractures, depending on their Ievel, will need a straight plate or a reconstruction plate, placed either in the posterior or in the lateral aspect of the diaphysis and reaching the distal humeral zone. In the oblique fractures, one interfragmentary lag screw must be placed whenever possible (it was not possible in the case illustrated in the upper part of the page ).
These are fractures with a very bad prognosis because of the high risk of avascular necrosis of the humeral head, quite frequent in young patients. All fractures of the anatomical neck will completely interrupt the epiphyseal blood supply, thus its survival will depend on the revascularization coming from the metaphyseal environment. Impacted fractures should not be disimpacted. The worse prognosis corresponds to the fractures associated with a gleno-humeral dislocation. Intricate attempts at surgery give unacceptable results.
3 (distal) means that they will usually require anatomic reduction and stable internal fixation. It is essential to follow the principles of interfragmentary compression with lag screws (preferably through the plate) and to neutralize the fracture site with a plate of a size proportionate to that of the bone. 3 subgroup. In this segment, the cortices are quite hard and the screws will have an excellent hold. In the case illustrated in the upper part of the page, the interfragmentary compression was performed with lag screws through the plate.
Atlas of Internal Fixation: Fractures of Long Bones. Classification, Statistical Analysis, Technique, Radiology by Rafael Orozco, J. Miquel Sales, Miquel Videla (auth.)