| Popis: |
Closed reduction is usually indicated in case of two-segment varus impacted proximal humeral fractures with dislocation or distal translation of the shaft. The surgeon must consider the four main anatomic and functional segments of the proximal humerus: typically the greater tuberosity is posteriorly and laterally dislocated, the diaphysis is medialized and internally rotated, the lesser tuberosity is medially dislocated, and the humeral head is free and variably dislocated. A CT scan is almost always necessary prior to performing reduction. The patient is supine and the image intensifier is contralateral to the fracture; this allows good X-ray views, and the C-arm does not get in the surgical team’s way. The procedure starts with the arm abducted at 30° with 10–15° of external rotation; the progressive abduction to 90° and more counteracts the deltoid’s action and allows the surgeon to use the acromion as a fulcrum to separate the shaft from the humeral head; a posteriorly directed force applied to the arm reduces the diaphysis under the humeral head. Longitudinal traction is not necessary. Afterward the surgeon can complete the surgery with mini-invasive percutaneous fixation. Closed reduction is a safe procedure, and the risk of neurovascular injuries is low. |
