By Rafael Orozco, J. Miquel Sales, Miquel Videla (auth.)
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Additional info for Atlas of Internal Fixation: Fractures of Long Bones. Classification, Statistical Analysis, Technique, Radiology
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. 5 mm screws (sufficient because of the size of the bone). 3 Distal section All of the measures to protect the radial nerve, common to any surgery of the humerus, must be observed. One of the advantages of the titanium plates is that there is no need to remove them, because of their tolerance, thus avoiding a second surgical procedure through fibrous tissue, a great risk for the radial nerve.
It was stabilized with a one-third tubular plate, contoured, through which the distal screws exert a lag screw effect. Following careful reduction of the several trochlear fragments, fixation and interfragmentary compression is obtained by one isolated metaphyseal screw inserted distally to the plate. This is possible because of the prevalence of cortical bone in the fragments of this area which, once reduced and compressed, will not suffer deformation and will maintain their stability even with early motion of the elbow.
The ideal implant is the titanium LC-DCP plate, of a size proportionate to that of the bone, placed in the aspect of the diaphysis that will be less likely to interfere with the blood supply of the wedge, that is to say, on the side opposite to the largest cortical surface of the wedge. We use few LC-DCP plates in fractures of other locations of the skeleton because of their cost. However, for the fractures of the humeral diaphysis we think that it is cost effective because of the advantage of being almost sure that the plate will not have to be removed.
Atlas of Internal Fixation: Fractures of Long Bones. Classification, Statistical Analysis, Technique, Radiology by Rafael Orozco, J. Miquel Sales, Miquel Videla (auth.)