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Closed Reduction Principles

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Simple and Complex Fractures of the Humerus

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Abstract

Closed reduction is usually indicated in case of two-segment varus impacted proximal humeral fractures with dislocation or distal translation of the shaft. The surgeon must consider the four main anatomic and functional segments of the proximal humerus: typically the greater tuberosity is posteriorly and laterally dislocated, the diaphysis is medialized and internally rotated, the lesser tuberosity is medially dislocated, and the humeral head is free and variably dislocated. A CT scan is almost always necessary prior to performing reduction. The patient is supine and the image intensifier is contralateral to the fracture; this allows good X-ray views, and the C-arm does not get in the surgical team’s way. The procedure starts with the arm abducted at 30° with 10–15° of external rotation; the progressive abduction to 90° and more counteracts the deltoid’s action and allows the surgeon to use the acromion as a fulcrum to separate the shaft from the humeral head; a posteriorly directed force applied to the arm reduces the diaphysis under the humeral head. Longitudinal traction is not necessary. Afterward the surgeon can complete the surgery with mini-invasive percutaneous fixation. Closed reduction is a safe procedure, and the risk of neurovascular injuries is low.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, University of Turin Medical School, Mauriziano-Umberto I Hospital, Largo Turati 62, Turin, 10128, Italy

    Marco Assom

  2. Department of Orthopaedics and Traumatology, University of Turin Medical School, CTO-Maria Adelaide Hospital, Via Zuretti 29, Turin, 10126, Italy

    Enrico Bellato

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  1. Marco Assom
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  2. Enrico Bellato
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Correspondence to Enrico Bellato .

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Editors and Affiliations

  1. Department of Orthopaedics and Traumatology, CTO Hospital Turin, Turin, Italy

    Filippo Castoldi

  2. Department of Orthopaedics and Traumatology, Mauriziano-Umberto I Hospital, Turin, Italy

    Davide Blonna

  3. Department of Orthopaedics and Traumatology, Mauriziano-Umberto I Hospital, Turin, Italy

    Marco Assom

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Assom, M., Bellato, E. (2015). Closed Reduction Principles. In: Castoldi, F., Blonna, D., Assom, M. (eds) Simple and Complex Fractures of the Humerus. Springer, Milano. https://doi.org/10.1007/978-88-470-5307-6_4

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  • DOI: https://doi.org/10.1007/978-88-470-5307-6_4

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  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5306-9

  • Online ISBN: 978-88-470-5307-6

  • eBook Packages: MedicineMedicine (R0)

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