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Atlas of Internal Fixation: Fractures of Long Bones. by Rafael Orozco, J. Miquel Sales, Miquel Videla (auth.)

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

Sample text

If it is possible to hold on to a big fragment, it must be fixed with a lag screw. The addition of autologaus cancellous bone graft is essential. At the Ievel of the middle third of the diaphysis it is permissible to try Hackethal's intramedullary nailing, assuming a proportion of failures that will have to be salvaged by the standard procedure: interfragmentary compression with a lag screw and a neutralization plate of the LC-DCP type. The Ionger and the more fragmented the wedge, the better are the conditions for healing.

3 ). Since these are articular fractures, anatomic reduction is mandatory. The prevalence of cortical bone in this segment allows internal fixations "ad minimum". One screw, weil placed with biomechanical sense, may be enough to obtain stability of the fragment. 3 case corresponds to a multiple injury patient and, because of the poor quality of the preoperative X-rays, the fracture could only be adequately classified at surgery. The fracture line that ascends through the metaphysis must be anatomically reduced.

The surgical technique is usually difficult and an osteotomy of the olecranon may be required to allow exposure for the reduction and internal fixation. The radial and median nerves are always present in this area and the humeral artery is an added risk. The reduction of the articular surface must be meticulous and stable; small areas of bone loss must be substituted by autologous cancellous bone graft. arge and small fragment techniques in order to combine them adequately. Surgery of the distal humerus is difficult and requires good quality X-rays for detailed preoperative planning.

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