Traumatic Humeral # Orthotic Management

Traumatic Humeral # Orthotic Management

Gord Ruder

3/15/2001

Dear List Servers,

   I have an Orthopod that refers his very unstable humeral fracture
patients to our offices for custom Shoulder, elbow, wrist orthoses. The
intent is to conservatively manage these patients with custom made orthoses
when he feels that off the self products or rigid plaster dressing is not
sufficient.

   The last patient that was seen had a complete almost perfectly transverse
fracture just distal to the spiral groove of the humerus (distal 2/3rds),
with 5mm separation, 30 degrees post/lat convex angulation. This is the
usual mal alignment in all of these types of patients managed so far - and
isn't surprising considering how the arm is positioned in the cast/sling
relative to the body. This last patient unfortunately had some radial nerve
drop out as well.

   The results to date have been good, with all patients healing without the
need of internal fixation, and often significant motor return. The challenge
is making the device in as short a time period as possible, making the
design able to accommodate the volume loss as swelling goes down, making it
modular so that the elbow ROM can be adjusted and eventually the forearm
section removed.

   My Query is this: In every case, the alignment has not been perfect,
usually less than, but up to 30 degrees. I know that a perfect alignment is
not possible, but what can be done to get as close to perfect as possible?

When the patient is being casted the injury is still fresh and quite
painfull. Incases where there is neural drop out or a fracture close to the
radial nerve, I try to minimally manipulate the bone segments.

Does anyone out there have experience with this population and do you have
any suggestions/advice regarding how aggressively you would align the
segments during casting?

thanks in advance, gord
-- --
Gordon K. Ruder C.O (c) M.Sc., B.Sc.
Clinical Orthotic Consultants, Inc.
2601 Matheson Blvd. E, Unit #10
Mississauga, Ontario, L4W-5A8
tel: 905 602-0650
fax: 905 602-0649

and/or

--
Gordon K. Ruder C.O (c) M.Sc., B.Sc.
Professor, Prosthetic & Orthotic Educational Programs,
The Sunnybrook & Women's College Health Science Centre,
c/o SCIL, 2075 Bayview Ave.,
Toronto, ON., CANADA, M4N 3M5
416-480-5783 (ph) 416-480-5975 (fax)

web page: <Email Address Redacted> target=_blank><URL Redacted><Email Address Redacted>

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