[Ortho] Comminuted fracture proximal humerus

[orthoforum на weborto.net]

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,
George Thomas