[Ortho] Comminuted fracture proximal humerus

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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 Thomas
Chennai, India
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