22/07/2022
Case today
This was a case of a Shaft of Humerus fracture in a 64 year old. He had been operated by us in 2007 for femur fracture (I think I was just a year out of college). He sustained a fracture because of RTA and came back to us because of the faith he had on us even though he was asked to get admitted In a very popular hospital where first aid was done.
A look at Xray, he had a simple shaft of humerus fracture. But the problem he had was the fracture very close in proximity to what we call as "Big Mommy" in orthopaedics, among surgeons. For common man it's called Radial nerve. Radial nerve is a nerve which innervate the muscles used in wrist and fine hand movements. He has some sort of tingling numbness because of some minimal injury to the nerve. A bad injury would have paralysed his hand for weeks or permanently. We had couple of days to plan this as patient's blood sugar was not under control
Decided to fix the fracture through posterior approach so that we can explore the nerve too to see if there is any injury to nerve and to decompress the nerve.
When we opened up, the nerve was bang on where the fracture was, probably had some minimal injury which caused the numbness. He was so lucky to not to have a total nerve injury.
The challenge was not only to explore the nerve just enough but also to fix the fracture lying just beneath the nerve with nerve hindering proper visualization and reduction of fracture.The bone was very small too to fix a standard Locking Compression Plate. So switched over to plan B.
My theatre staffs always tell me that I give unnecessary instruments for surgery anticipating problems. For this case I had given an Old fashioned Dynamic Compression Plate, which turned out to be the right size to keep the bone opposed and to fix the fracture. Yes it was tough to visualise the fracture but we fixed it after some wishful thinking and effort.
The only thing we want is to feel satisfied when we finish operating a case every time we come out of theatre. That requires a lot of planning, some unnecessary instruments and implants too. But what's there to complain?
