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Letters to the Editor to:

Scientific Articles:
Iván F. Rubel, Peter Kloen, Deirdre Campbell, Mark Schwartz, Alan Liew, Elizabeth Myers, and David L. Helfet
Open Reduction and Internal Fixation of Humeral Nonunions : A Biomechanical and Clinical Study
J Bone Joint Surg Am 2002; 84: 1315-1322 [Abstract] [Full text] [PDF]
*Letters to the Editor: Submit a response to this article

Electronic letters published:

[Read Letter to the Editor] Dr. Helfet responds to Dr. Sharma
DAVID L. HELFET, Ivan F. Rubel, Peter Kloen, Deirdre Campbell, Mark Schwartz, Alan LIew and Elizabeth Myers   (28 August 2003)
[Read Letter to the Editor] Additional plate on medial side or lateral side of humerus?
Ashwini Sharma, Roop Singh, Narender K Magu   (25 August 2003)

Dr. Helfet responds to Dr. Sharma 28 August 2003
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DAVID L. HELFET,
MD
Hospital for Special Surgery,
Ivan F. Rubel, Peter Kloen, Deirdre Campbell, Mark Schwartz, Alan LIew and Elizabeth Myers

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Re: Dr. Helfet responds to Dr. Sharma

helfetd{at}hss.edu DAVID L. HELFET, et al.

Dear Dr. Sharma:

In answer to you questions:

1. Yes, the recon plate can be placed on either side.

2. The number of screws depends on bone quality and length of segment.

3. The second plate is used if there is micromotion when the construct with one plate is stressed.

David L. Helfet, MD
Additional plate on medial side or lateral side of humerus? 25 August 2003
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Ashwini Sharma,
Senior Resident
PGIMS, Rohtak,
Roop Singh, Narender K Magu

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Re: Additional plate on medial side or lateral side of humerus?

ashvinisharma{at}rediffmail.com Ashwini Sharma, et al.

OPEN REDUCTION AND INTERNAL FIXATION OF HUMERAL NONUNIONS

A BIOMECHANICAL AND CLINICAL STUDY Sir, We read with interest the article in August, 2002 issue by Rubel et al titled “Open reduction and internal fixation of humeral nonunions-a biomechanical and clinical study”

We would ask the authors to comment on three questions. 1.In their clinical study,the authors have augmented the fixation achieved by a 4.5 mm limited contact dynamic compression plate using a lateral 3.5 mm reconstruction plate. Yet the figure labeled Fig 3-C shows a 3.5 mm recon plate on the medial (ulnar) side of humerus. Can the recon plate be placed on either side?

2. In their biomechanical study they have used two additional screws on either side of the fracture site. Fig 3-C and 3-D show one screw through the distal fragment. How many screws, at the minimum, should be placed in the distal fragment to provide stability?

3.In both cases in which the preoperative radiographs show little deformity, (figures 2-A, 2-B, 3-A, 3-B) is it necessary to use a 3.5 mm recon plate and the additional exposure that applying it entails?