FRACTURES OF THE SURGICAL NECK AND EPIPHYSEAL SEPARATIONS OF UPPER END OF HUMERUS

¹ Orthopaedic and Traumatic Clinic of the Employees' Hospital Tennessee Coal, Iron and Railroad Company

1. In the marked displacement of the surgical neck fractures and epiphyseal separations of upper end of humerus, reduction by closed method is often very difficult.

2. Majority of such injuries could be reduced by the closed method with aid of the portable fluoroscope; and a fair trial at the closed method should always be attempted before open reduction is carried out.

3. Careful study of all shoulder injuries should be made by roentgen ray and physical examination done before any procedure whatever is carried out.

4. Patient should be given anaesthetic in bed, and reduction followed by traction and abduction frame which is attached to bed. Frequent check with roentgen ray should always be made.

5. When doing manipulations under closed method, great care should be exercised to prevent further injury to blood vessels, nerves and muscles.

6. In the epiphyseal separations of the upper end of the humerus, right angle abduction of arm to body and ninety degrees of external rotation should be used. Forty-five degrees of abduction and ninety degrees external rotation is all that is necessary in the surgical neck fractures. Some form of removable abduction splint should be applied immediately after patient is allowed out of bed.

7. No foreign fixation material such as metal plate, nails, bone pegs, etc., should be necessary if proper reduction and continuous traction is carried out.

8. All forms of splints should be permanently removed as early as possible, active and passive motion with radiant light, diathermy and hot baths should be carried out from earliest date possible. The above method has diminished period of convalescence as much as twenty per cent.

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