[Dislocation of the head of the humerus in subcapital fractures].
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In the treatment of non-impacted fractures of the upper end of the humerus, the tendency of many surgeons is to use nailing with the fracture site closed, from the supra-olecranon fossa. This would seem to merit certain criticisms. Following reduction of the fracture, we use Ender elastic nails and two modified nails of a smaller calibre, one inserted via the epicondyle and the other via the epitrochlea. The technique of this ascending bipolar nailing using elastic nails is carried out in a horizontal supine position, which facilitates manoeuvres of reduction and facilitates anaesthesia. Apart from non-impacted fractures of the upper end of the humerus, other indications exist.
Capitellum fractures are exceedingly rare. The five observations reported herein show that the clinical aspect is often discrete, necessitating a detailed radiographic study, especially with the elbow seen in profile. As the spontaneous evolution of this type of fracture presents a poor prognosis, surgical reduction of the fracture is immediately indicated and systematic osteosynthesis guarantees a satisfactory functional result.
In four missed posterior shoulder dislocations, a trial of closed reduction was successful, but severe instability required further therapy. The glenohumeral joints were immobilized by 3 to 4 percutaneously inserted threaded pins. Removal of the pins after 4 to 6 weeks was followed by physiotherapy. After a follow-up of 4 to 42 months, the functional results of this simple procedure are good and there is no recurrence. Bending of the ends of the pins, a very careful follow-up to deal with pin migration, and adequate prevention of subsequent convulsions in epileptic patients are mandatory.