Srpski arhiv za celokupno lekarstvo 2011 Volume 139, Issue 5-6, Pages: 370-375
https://doi.org/10.2298/SARH1106370G
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External fixation in the treatment of shooting proximal humeral fracture with bone defect: A case report
Golubović Zoran (Ortopedsko-traumatološka klinika, Klinički centar, Niš)
Vukašinović Zoran (Medicinski fakultet, Beograd + Institut za ortopedsko-hirurške bolesti „Banjica”, Beograd)
Stanić Vojkan (Vojnomedicinska akademija, Beograd)
Stojanović Saša (Ortopedsko-traumatološka klinika, Klinički centar, Niš)
Stojiljković Predrag (Ortopedsko-traumatološka klinika, Klinički centar, Niš)
Stojiljković Danilo (Medicinski fakultet, Niš)
Golubović Ivan (Ortopedsko-traumatološka klinika, Klinički centar, Niš)
Micić Ivan (Ortopedsko-traumatološka klinika, Klinički centar, Niš)
Radovanović Zoran (Medicinski fakultet, Niš)
Kostić Igor (Ortopedsko-traumatološka klinika, Klinički centar, Niš)
Višnjić Aleksandar (Medicinski fakultet, Niš)
Najman Stevo (Medicinski fakultet, Niš)
Introduction. Shooting injuries of shoulder with destruction of proximal
humerus are rare and severe orthopaedic injuries. Case Outline. A 74-year-old
patient was wounded at close range by a shotgun. He was wounded in the left
shoulder and suffered a massive defect of the proximal humerus and soft
tissue. The neurocirculatory finding of the injury extremity was normal.
After a short resuscitation, x-ray of the thorax and the left shoulder
registered a complet destruction of humeral head. After the primary treatment
of the wound under general endotracheal anesthesia, the shoulder was
stabilized with an external fixator type Mitkovic, with convergent
orientation of the pins, where two pins were placed in the neck of scapula
and two in the humeral shaft, because the left scapular acromion was
fractured by shotgun projectiles. Conclusion. After radical wound
debridement, external fixation is the method of choice for shoulder
stabilisation in shooting injury of shoulder with bone defect. If this is not
possible, pins of the left external skeletal fixator should be placed into
the coracoid process and acromion. The pins can be also placed into the
humeral shaft, as done in the presented case, and by which a good stability
of the injured proximal humerus, easy approach to the wound for bandaging and
reconstructive surgery can be achieved.
Keywords: shooting fracture, proximal humerus destruction, external fixation, humeral shaft
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