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JESS under local anesthesia: a minimally invasive technique for proximal humeral fractures

Abhay Manchanda, Satya Narayan Shukla, Abhilash Shishodiya, Vineet Kumar Gohiya.

Abstract
Background: Fractures of the proximal humerus, which account for 4% to 5 % of the total fractures,[1] are usually classified as per Neer’s classification. These fractures are treated by modalities from “just a sling” to “open reduction and internal fixation”(ORIF) by locking contoured dedicated plates for the proximal humerus, with results varying from satisfactory to good.

Objective: To propose a minimally invasive technique, of managing fractures of the proximal humerus, which can be done under local anesthesia.

Materials and Methods: Sometimes, patients with the proximal humerus fractures are not fit for general anesthesia. Moreover, the regional block may or may not always work for shoulders; hence, we operated 18 patients and fixed the fractures with the Joshi’s External Stabilization System (JESS) under local anesthesia.

Result: Of the 18 patients, all of them tolerated the procedure well except three of them, whom we supplemented with intravenous tramadol as well. While the stability with “K-wires” and “just screws” is questionable, ORIF entails a big exposure and blood loss, along with all other risks of open reduction. Moreover, all these techniques offer a debatable quality of fixation in osteoporotic fractures.

Conclusion: To combat the aforesaid issues, external fixation is in popularity for a period more than a decade now. The JESS, happens to be “today’s best option,” which we attempted performing under local anesthesia.

Key words: JESS, proximal humerus fractures, ORIF (open reduction internal fixation), K-wire, local anesthesia



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