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 Table of Contents    
LETTER TO EDITOR  
Year : 2013  |  Volume : 47  |  Issue : 5  |  Page : 534-535
Author's reply


Department of Orthopaedics, HOSMAT Hospital, Bangalore, Karnataka, India

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Date of Web Publication17-Sep-2013
 

How to cite this article:
Kumar M N, Ravindranath V P, Ravishankar M R. Author's reply. Indian J Orthop 2013;47:534-5

How to cite this URL:
Kumar M N, Ravindranath V P, Ravishankar M R. Author's reply. Indian J Orthop [serial online] 2013 [cited 2019 Dec 11];47:534-5. Available from: http://www.ijoonline.com/text.asp?2013/47/5/534/118220
Sir,

We are happy to note that our article has been read with keen interest by our peers. [1],[2] Our responses to the questions raised are as follows:

Regarding the citation of Ring et al., in our article, the duration of 5-192 months can be found in the article by Ring, Perry and Jupiter. [3] This is reference no. 1 in the bibliography. However, it has been wrongly mentioned as reference no. 3 in the body of the article. We request the readers to kindly refer to the first reference.

Regarding the issue of "working length" of the plate, we did not believe that reduced working length minimizes implant failure. Smith et al., have stated that few screws can be missed in the middle of the plate to increase the working length. [4] They have stated so in the context of minimally invasive plating of comminuted fractures using locking compression plate (LCP) as a "bridging plate." However, we have used the LCP in a different context, i.e., nonunion of the humerus. In long standing nonunions following previous failed internal fixation, bone farther away from the fracture site is also likely to be compromised due to stress shielding from the plate, previous screw holes, cortical thinning from a nail and disuse osteoporosis. If the bone segment farther away from the plate can afford reliable screw purchase, it may be possible to omit a few screws in the middle. However, this is rarely the case in previously treated nonunions of humerus. This necessitated the use of almost all screw holes in the plate.

Surgical management should aim toward achieving bony union by tailoring the approach to the confronting pathology.

 
   References Top

1.Biraris SR, Sonawane DV, Patil HG, Nemade PS. Outcome of locking compression plates in humeral shaft nonunions. Indian J Orthop 2013;47:534.   Back to cited text no. 1
  Medknow Journal  
2.Kumar MN, Ravindranath VP, Ravishankar M. Outcome of locking compression plates in humeral shaft nonunions. Indian J Orthop 2013;47:150-5.  Back to cited text no. 2
  Medknow Journal  
3.Ring D, Perey BH, Jupiter JB. The functional outcome of operative treatment of ununited fractures of the humeral diaphysis in older patients. J Bone Joint Surg Am 1999;81:177-90.  Back to cited text no. 3
[PUBMED]    
4.Smith WR, Ziran BH, Anglen JO, Stahel PF. Locking plates: Tips and tricks. J Bone Joint Surg Am 2007;89:2298-307.  Back to cited text no. 4
[PUBMED]    

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Correspondence Address:
M N Kumar
Department of Orthopaedics, HOSMAT Hospital, McGrath Road, Bangalore 560 025, Karnataka
India
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Source of Support: None, Conflict of Interest: None


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