锁骨骨折的固定盘治疗经验分享课件.ppt

Line AB is superior border to inferior border of articular surface C is center of head CD is perpendicular to AB EF shaft Sum of distance of each screw to articular surface divided by # of screws no correlation to cut out 7 months 2 months Analysis and Efficacy and Failure in Proximal Humerus Fractures Treated With Locking PlatesAgudelo et al Nov/Dec JOT 2007 Multi center (5) over nealy 5 years Approaches varied (DP and AL) Implants varied 136 pts with follow up Varus malreduction defined as head-shaft angle of 120 degrees Analysis and Efficacy and Failure in Proximal Humerus Fractures Treated With Locking PlatesAgudelo et al Nov/Dec JOT 2007 Statistically significant association b/w loss of fixation and varus malreduction (120°) 30.4% when head –shaft angle 120° 11% when head –shaft angle ≥ 120° Endosteal Implants Assist in indirect reduction of medial cloumn Provide mechanical support for medial column and humeral head Fibular allograft of 6cm Inserted thru lateral fx into shaft Push screw thru plate Incorporates in 6 – 12 weeks 5 years 42 patients over 42 fx 3 radiographic failures 7.1429% vs 36% Any takers for a follow up study? The Geisinger Experience Insert Graft Between Tuberosities at this Step Alternative Use of Allograft Conclusions Position so you can get images then drape Know both approaches Avoid dissection of bicipital groove If medial column comminuted use allograft strut Avoid varus （head –shaft angle≥120°) Place inferior head screws Take home messages Leave internal amputations for SAVAGES… Let’s remember that we are Orthopaedic Surgeons !!! Mighell states that ORIF is generally indicated for persons younger than 40 years in an effort to save the head and avoid prosthetic replacement. In fracture-dislocations with complete denuding of all attached soft tissues are usually managed with hemiarthroplasty regardless of patient age Plate slid under axillary nerve and 8 mm distal to rtc insertion , centered on GT After latex found that no v