Ergonomic treatment of proximal humeral fractures
ฝัง
- เผยแพร่เมื่อ 5 ม.ค. 2025
- DISRUPTIVE TECHNOLOGY IN ORTHOPAEDICS, AND ERGONOMIC ORTHOPAEDIC MANAGEMENT.
The text of the post would be rather more interesting than the video itself, and I recommend that you read the post filly before watching the video. This happened in my clinic today, and I have the patient’s permission to show her face, as her expressions play an important part in the procedure done without GA.
Today I had an overseas visitor from a developed country, who came to see me do PFO. After surgery, I did a two hour clinic, and this young lady presented to me there. She is a school girl, all of 13 years, who fell on her outstretched hand some three days ago, at school. She sustained a fracture of surgical neck of her right humerus, and the school authorities took her to a nearby orthopaedic surgeon, who advised closed reduction under GA, and fixation by multiple K-Wires. As only parents could give a consent, she was taken home. Parents panicked. Female child. Right arm. Future at stake. Lets go to a corporate hospital.
She was seen by three doctors and got her X-rays before consultant saw her. The enthusiastic surgeon informed the patient that the best treatment was surgery. He even wrote his advice. Paediatric PHILOS. He assured the parents mobilisation in two weeks after suture removal, and full functional recovery in six weeks, of course at the cost of a scar, which scared the patient no end. The additional cost was just 1.9 lakhs for surgery, imported implant and hospital expenses. The surgeons fees was less than 10% of the whole bill!
The parents had two issues. One they dis not want a scar in a female arm, especially if it was visible outside a short sleeve or sleeveless blouse. And secondly, for 1.9 lakhs they would either have to hawk the mom’s jewels, or sell some property. They did not have insurance. They went to a second corporate, and here too the opinion was the same. I don't have an idea about the exact surgical procedure, the second surgeon intended to perform, but his notes say “Open reduction, and internal fixation”. And here apart from a scar, the damages quoted were 2 lakhs.
As the patient sorrowfully came out and took a lift home, the family ruminated on how to arrange the funds. At this time, the lift operator suggested to them that they could always meet Dr L.Prakash, who treated most fractures without operation. They had collected my secretary’s number, got an appointment and saw me this morning, when the overseas surgeon was with me.
“I fully agree to the opinion of the previous surgeons! Small surgery, young child. Satisfying X-Rays, and excellent full function. Paediatric PHILOS I will recommend”
I spent the next 10 minutes explaining ergonomics to the visitor. I summarised my prison experiences of “no treatment” for most fractures, and shared my experience of studying the natural history of untreated fractures. I showed him my book on conservation, pages written so far. And then handed him my Iphone to record a video of how I managed this young lady.
The following points are shown in the video
1. Displaced fractures are painful, reduced fractures are painless.
2. Fracture patterns which are undisplacable, will stay stable after reduction despite moving the adjacent joints.
3. 0.3 % haematoma block is easy to administer. 3 ml 1% lignocaine mixed with 6 ml water makes the solution.
4. In the video I have not muted the sound during the actual reduction. You can watch the patient expressions throughout. Pain during management is less than pain at the time of sustaining injury. GA should be avoided in children at all costs.
5. See the patient expressions as she fully flexes and extends her shoulder and elbow at the last segment of the video. Thats the magic of ergonomics!
As he completed recording, the visiting professor explained “Disruptive technology in orthopaedics”
I liked the term very much. “Professor can I use this for my post and credit it to you”
“You are free to use it Dr Prakash, but don't attribute it to me. Im not a maverick like you and have to exist in the society of my peers. I simply cant afford to be unconventional”
And so, I am not mentioning the excellent videographer’ s name. The patient spent a total of 5k, and 32 minutes in my clinic.
The function at the end of the procedure speaks more than a thousand words. Now enjoy the video.
Sir .. really cool if it true she moved her arm so freely just after the treatment..
I to had humeral bone fracture and it completely took more than 5 week just to bone get adjust , heal and get some strength to work healthy,.
Sir u are crazy doc 💪😂💪
Good treatment Doctor,
I also had same fracture, and the doctor advised surgical procedure, I requested to doctor to treat without surgery. Then he treated as above.
Thank you Doctor, this will help poor people.
Please tell me where and when
@@Teja81990 two months ago, at Zaheerabad (India). Dr Kalyan Chakravarty Ortho Surgeon treated me he charged me for only bandage.
@@Teja81990 It is 8 week old fracture. My sholder ball broken completely and dislocated. Now I am on physiotherapy. I am moving my hand forward, backward and sides without pain. I am daily trying to move upward. Dr told it will take time to complete improvement. Definately I will rotate my hand in another two weeks.
@@SrinivasReddy-wn7hy thanks a lot , I will not opt for surgery then.
@@SrinivasReddy-wn7hy can you lift your hand without any help.
Hello sir my father humerus head neck fracture , and humerus shaft fracture
How can it be cured without surgery
How can i contact you
Could you suggest something on phone call ???
Please reply sir
No muestra radiografía de control, así mismo no cumple con el principio de inmovilizar las articulaciones proximal y distal no muestra el resultado radiografico
Sir, can you please add the post reduction x Ray
Doctor what will be treatment for ABC in right hand of 7 years old boy
I had this same injury how is she moving it
What did you do, I am unable to sleep since days
Excited to see post reduction x ray n further follow up...
Reduction requires a general anesthesia . isn't it right ?
Life is beautiful not at all
@@iaos.org.in.youtube 😂😂 best reply
For this type of fracture, you should fix elbow with shoulder.
Soo brave girl.
Бедная Девочька ( ,пускай у неё всё будет хорошо
Does children need OR/ORIF with GA if they have a fracture or dislocation since they move alot and don't let you touch them during the close reduction procedure. Respected Sir I had a discussion with a senior and he told me tht they usually perform GA with OR for fractures in children ususally since its painful for the kid. Is my senior right? Shouldn't be Open reduction less used since growing child has excellent remodeling and healing of bones and close reduction with local Anesthesia should be prefered. What are your views on that. Will be very thankful of you if you can answer my ambiguity.
Your senior is wrong and unethical. children seldom need GA or metal or surgery
they remodel so well. Child is not a miniature adult!
God bless you dear
Address
Can displaced proximal humerus fracture treated conservatively if it was so severe
Every proximal humeral fracture can be managed without surgery with excellent results
@@iaos.org.in.youtube even with a displaced humerus break can it still heal naturally with no surgery doc? Thank you
@@ericsenecal9203 of course. humerus fracture seldom needs surgery!
@@iaos.org.in.youtube awesome to hear doc I feel like the bone will heal better naturally
Sir which medicine are you injecting in her arm
Any reference for treatment at Delhi for my mother 78 yrs old.
What do you mean by ergonomic?
saved money
🎉
Sir aap address de diye same problem hame bhi he
very useful sir. Since the cast is very close to skin, will removal with power cutter be a bit risky?
G Palani my nurse uses hand saw and patience
It uses vibration so it does not cut skin
Hello sir my grandmother 70 years old had this type of situation today... but in the x-ray there is no cracks found anywhere...but doctor sed that shoulder is fractured need do surgery So I'll send u the x-ray could you please explain what is happened actually... I'll send u the x-ray with your permission
Thank u
Sir post procedure X-ray
same problem
Sir, my mother in law, who is about 60 years old and a diabetic, has been ailing from right humerus head fracture afer falling at balcony yesterday night. I had to take her to nearby orthopaedic surgeon today morning, who suggested surgery after observing her x ray. Now, she does not agree to operate but prefer to adopt some other means except plustering and surgery. Could you,sir suggest me some way so that we can meet you or use your technique here in our home at Howrah, west bengal?
th-cam.com/video/EqBg80cb_7Y/w-d-xo.html
my online consultation fees is Rs 2500. If you can afford, +91 9791020615 whatsapp message only!
How can I contact you sir
bahut khub
Sir I want to talk to you
Thanks
Life is beautiful you an orthopaedic Surgeon?
Life is beautiful +91 9791020615 whatsapp and I’ll add you to an academic group if you are a surgeon
Good
Post reduction x-ray sir
Dear Doctor, my father in law had a neck of humerus fracture few days back. Can we please consult you... Kindly provide your number sir.....
1431KRISHNA1 +91 9791020615 WhatsApp
That poor girl
Post reduction x ray........ Janaaab.....
😇
Sir great job.. BUT cast lagaya Aapne lekin stocinet pe Coten yaa softroll kyu nahi lagaya .. Patient ko brister or hiting kaa chance bohat rehta hai .. dairect stockinet pe cast lagane se....
you must learn modern ergonomic methods. blisters never happen! unpadded casts are modern methods. We are rewriting orthopaedic methods
Its weong way sir … according to me she should take rest at the place of moving her shoulder up and down
No rest. She united in 3 weeks
👌🙏🙏🙏
😄😄
Wash!!
Surgery is not successful sir because she is htaking help left hand to lift right hand
Sir post procedure X-ray