Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%!...

19
!"#$%&’(()*"" #$% &’$()*’$% +, -$ +./&.%.% 0*1,’$- ’,2’,%,3)$3 +, 4 $- 5 6 +, )7+$% -$% &’$()*’$%" 849 :, 2’,%,3)$3 ,3 &7’1$ ;.17+$- (73 2.(7% $ -7% <= > $ -7% ?= $@7%" 8A9 #$ 1$>7’B$ +, -$% &’$()*’$% %73 %,(*3+$’.$% $ )’$*1$).%17% +, ;$C$ ,3,’DB$ >$ %,$ 27’ ($B+$ +,%+, %* $-)*’$ ,3 2$(.,3), $@7%7%E $((.+,3),% +, )’/3%.)7 > 0,’.+$% 27’ $’1$ +, &*,D7 ,3 2$(.,3),% C7F,3 G*, .12-.($3 1$>7’ ,3,’DB$ (.3H).($" :, (-$%.&.($3 %,DI3 )’,% (’.),’.7%E -$ %.)*$(.J3 +, -$ -B3,$ +, &’$()*’$ ,- 3I1,’7 +, &’$D1,3)7% > -$ ,K.%),3(.$ 7 37 +, (712-.($(.J3 .31,+.$)$ ":, 2*,+, *).-.L$’ -$ (-$%.&.($(.J3 $-&$3*1H’.($ +, -$ MN" 8O.D*’$ 49 :$’1.,3)7 > #$))$ +,%$’’7--$’73 ,%), 1H)7+7 ,3 ;$%, $ ,%)*+.7%E ,3 +73+, -$ ,%)$;.-.+$+ .3)’B3%,($ (’,$+$ 27’ -$ 1*%(*-$)*’$ +, -7% (712$’).1.,3)7% +,- ;’$L7E %*1$+7% $ -$ ,%)$;.-.+$+ ,K),’3$8>,%7 * 7’),%.% 9 > $ -$ $-.3,$(.J3 +, 1.,1;’7 27’ ,&,()7 +, -$ D’$F,+$+E (73)’7-$;$3 -$ $-.3,$(.J3 > ,- $(7’)$1.,3)7 +, -$ &’$()*’$" P- (73)’7- +, -$ ,%)$;.-.+$+ .3)’B3%,($ 2,’1.), $(7’)$’ -$ -73D.)*+ +, -7% >,%7%E -7 (*$- -.;,’$ -$% $’).(*-$(.73,% F,(.3$% &$F7’,(.,3+7 -$ ’,0$;.-.)$(.J3 ),12’$3$ +, -$% 1.%1$%" Q7’ -7 )$3)7 -$ ,%)$;.-.+$+ .3)’B3%,($ > ,K)’B3%,($ 2,’1.),3 1.(’717F.1.,3)7% (73)’7-$+7% +,- %.).7 +, -$ &’$()*’$ &$F7’,(.,3+7 1$>7’ CUADERNO DE LA CLINICA DE TRAUMATOLOGIA Y ORTOPEDIA DEL ADULTO Tratamiento fracturas diafisarias de húmero Revision bibliografica Dr. Felipe de Pena Dr. M. Oehler Mayo 2013 [email protected]

Transcript of Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%!...

Page 1: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

!!

!

!"#$%&'(()*""!

#$%! &'$()*'$%! +,! -$! +./&.%.%!0*1,'$-! ',2',%,3)$3!+,!4! $-! 5!6!+,!)7+$%!-$%!&'$()*'$%"!849!

:,! 2',%,3)$3! ,3! &7'1$! ;.17+$-!(73!2.(7%!$!-7%!<=!>!$!-7%!?=!$@7%"!8A9!

#$! 1$>7'B$! +,! -$%! &'$()*'$%! %73!%,(*3+$'.$%! $! )'$*1$).%17%! +,!;$C$! ,3,'DB$! >$! %,$! 27'! ($B+$!+,%+,! %*! $-)*'$! ,3! 2$(.,3),!$@7%7%E! $((.+,3),%! +,! )'/3%.)7! >!0,'.+$%! 27'! $'1$! +,! &*,D7! ,3!2$(.,3),%! C7F,3! G*,! .12-.($3!1$>7'!,3,'DB$!(.3H).($"!

:,! (-$%.&.($3! %,DI3! )',%! ('.),'.7%E!-$!%.)*$(.J3!+,!-$!-B3,$!+,!&'$()*'$!,-! 3I1,'7! +,! &'$D1,3)7%! >! -$!,K.%),3(.$! 7! 37! +,! (712-.($(.J3!.31,+.$)$! ":,! 2*,+,! *).-.L$'! -$!(-$%.&.($(.J3! $-&$3*1H'.($! +,! -$!MN"!8O.D*'$!49!

!

!

:$'1.,3)7! >! #$))$! +,%$''7--$'73!,%),!1H)7+7! ,3! ;$%,! $! ,%)*+.7%E!,3!+73+,!-$!,%)$;.-.+$+!.3)'B3%,($!(',$+$! 27'! -$!1*%(*-$)*'$! +,! -7%!(712$').1.,3)7%! +,-! ;'$L7E!%*1$+7%! $! -$! ,%)$;.-.+$+!,K),'3$8>,%7! *! 7'),%.%! 9! >! $! -$!$-.3,$(.J3!+,!1.,1;'7!27'!,&,()7!+,! -$! D'$F,+$+E! (73)'7-$;$3! -$!$-.3,$(.J3! ! >! ! ,-! $(7')$1.,3)7!+,!-$!&'$()*'$"!

!

!P-! (73)'7-! +,! -$! ,%)$;.-.+$+!.3)'B3%,($! 2,'1.),! $(7')$'! -$!-73D.)*+! +,! -7%! >,%7%E! -7! (*$-!-.;,'$! -$%! $').(*-$(.73,%! F,(.3$%!&$F7',(.,3+7! -$! ',0$;.-.)$(.J3!),12'$3$! +,! -$%! 1.%1$%"! Q7'! -7!)$3)7! -$! ,%)$;.-.+$+! .3)'B3%,($! >!,K)'B3%,($! 2,'1.),3!1.('717F.1.,3)7%! (73)'7-$+7%!+,-! %.).7! +,! -$! &'$()*'$!&$F7',(.,3+7! 1$>7'!

CUADERNO DE LA CLINICA DE TRAUMATOLOGIA Y ORTOPEDIA DEL

ADULTO

Tratamiento fracturas diafisarias de húmero Revision bibliografica

Dr. Felipe de Pena Dr. M. Oehler

Mayo 2013

[email protected]

Page 2: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

F$%(*-$'.L$(.J3! >! +,2J%.)7! +,!1.3,'$-,%! $! 3.F,-! +,-! &7(7! +,!&'$()*'$! ! 2,'1.).,3+7! -$!(73%7-.+$(.J3!R44S"!

#7%! ',%*-)$+7%! 7;),3.+7%! 27'!:$'1.,3)7! +,! *3! T?6! +,!(73%7-.+$(.J3! 37! 0$3! %.+7!7;),3.+7%!27'!7)'7%!$*)7',%!%7;',!!)7+7! ,3! &'$()*'$%! )'$3%F,'%$%!1,+.7!+.&.%$'.$%E!27'!-7!G*,!,3!-7%!I-).17%! $@7%! %,! 0$! ),3+.+7! $-!)'$)$1.,3)7! G*.'I'D.(7! +,! ,%)$%!&'$()*'$%!RTS"!

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

!!!!!!!!!!!!!! !

!!!!!!!!!!O.D*'$!4"W-$%.&.($((.73!MN!!

!!!!!!!!!!!!!!!!!!X$;-$!4"!

!"&)(+()%",-../+$+.0+.()$'12+. .!"&)(+()%",-.+3-%0'#+-4.!Y!!Q$(.,3),!27-.!)'$*1$).L$+7"!Y!!O'$()*'$!!;.-$),'$-!+,!0*1,'7"!

!

Y!!O'$()*'$%!$%7(.$+$!$!&'$()*'$!!!!+,!1.,1;'7!.3&,'.7'"!Y!!O'$()*'$%!,3!0*,%7!2$)7-JD.(7"!Y!!O'$()*'$%!$%7(.$+$!$!-,%.73,%!+,-!2-,K7!;'$G*.$-"!Y!!O'$()*'$%!,K2*,%)$%"!Y!!O'$()*'$%!$%7(.$+$%!$!-,%.J3!F$%(*-$'"!YZ3($2$(.+$+!2$'$!1$3),3,'!-$!',+*((.J3!(73!7'),%.%!$3D*-$(.J3![45U!

!

Y!!W7+7!&-7)$3),"!Y!!#,%.J3!+,!-$!$'),'.$!\'$G*.$-!!!"&)(+()%",-.$,0+#)5+-4.Y!!O'$()*'$%!!)'$3%F,'%$%!(73!D'$3!+,%2-$L$1.,3)7!J%,7"8].$%)$%.%!.3.(.$-!+,-!&7(7!&'$()*'$'.79!Y!!#,%.J3!3,'F.7%$!27%)!1$3.2*-$(.J3!+,!-$!&'$()*'$!

!

! !!"#$%"&%'&(")*+""%&$,%&-.'',&/.$)01.'2&3,&$%1402&506&'%303",&7889:;$.<$,&="4&>>&?$.#3',0"&$,%&@$00$:&!6'&,",21.A3)$4&0.'$0#',0&"/&06'&/.$)01.'2&788B&:;$)&-.$+&C344&#'%3)$4&:?')",%&'%303",&

!

& !! !

Page 3: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

! !!

6,-,7+.8"+#*9)(+:.

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

2'7K.1$-! %,! +,%FB$! ,3! $;+*((.J3!8M\]9! >! '7)$(.J3! ,K),'3$! 8^NP9!"P3)',! -$! .3%,'(.J3! +,-! 2,()7'$-!1$>7'! >! +,-)7.+,%! ,-! &'$D1,3)7!2'7K.1$-!%,!F$!,3!$+*((.J3!8M]]9!>! 27'! +,;$C7! +,! ,%)7%! ,-!&'$D1,3)7! 2'7K.1$-! %,! %.)I$! ,3!M\]!+,;.+7!$-!2,()7'$-!>!,-!;'$L7!%,!$(7')$!+,;.+7!$-!\B(,2%".

.

.

;3<,#)5%-4!

^,$-.L$'! *3$! ;I%G*,+$!;.;-.7D'/&.($! %.%),1$).L$+$E!,F$-*$3+7! ,-! )'$)$1.,3)7!&*3(.73$-E! (717! %,! ',$-.L$E! >! %*!(712-.($(.73,%! ! ,3! -$%! &'$()*'$%!+.$&.%$'.$%! ! 0*1,'$-,%! ,3! -7%!I-).17%!45!$@7%"!

=+#,$)+0.>.=?#%&%-:.

O*,3),! +,! +$)7%_! :,! *).-.L$'73!;$%,%! ,-,()'J3.($%`! Q*;! 1,+! >!X.1;7! "#$%! 2$-$;'$%! (-$F,%!&*,'73_! a*1,'$-! %0$&)! &'$()*',%E!)'$)1,3)! 7&! 0*1,'$-! %0$&)!&'$()*',%E! \'$(.3DE! G*.'*D.($-!)',$)1,3)! F,'%*%! 373! G*.'*D.($-"!#$! ;I%G*,+$! %,! -.1.)7! $! -7%!I-).17%! 45! $@7%! ,3! .+.71$! .3D-H%!7!,%2$@7-"!

.

Page 4: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

@$)#,$)%-.&,.)"(0'-)*""!

!b,)/3$-.%.%E! ,3%$>7%! (-B3.(7%!(73)'7-$+7%E! ,%)*+.7%!2'7%2,().F7%! >c7! ',)'7%2,().F7%!G*,! ,F$-I$3! ,-! )'$)$1.,3)7!&*3(.73$-! +,! -$%! &'$()*'$%!+.$&.%$'.$%! +,! 0I1,'7"!W712$'$(.J3! ,3)',! )'$)$1.,3)7!G*.'I'D.(7!>!37! !G*.'I'D.(7!+,! -$%!&'$()*'$%! +,! 0*1,'7! >! -$%!(712-.($(.73,%! +,! +.(07%!)'$)$1.,3)7%!!

@$)#,$)%-.&,.,A(0'-)*""!

P%)*+.7%! %7;',! &'$()*'$%!2$)7-JD.($E! 2$(.,3),%! d! +,! 4e!$@7%E! (712$'$(.J3! ,3)',!+.&,',3),%! 1H)7+7%! G*.'I'D.(7%E!O'$()*'$%! ,K2*,%)$%"! P%)*+.7%! ,3!.+.71$%! G*,! 37! &*,'$3! .3D-,%! 3.!,%2$@7-"!

8$#2('0%-..-,0,(()%"+&%-:.

:,! %,-,((.73$'73! ?! $')B(*-7%!!(*12-.,'73! -7%! ('.),'.7%! +,!.3(-*%.J3! E4! $')B(*-7! (73! 3.F,-! +,!,F.+,3(.$! ZZ! 8,%)*+.7%!2'7%2,().F7%! ',$-.L$+7%! ,3! *3!1.%17! (,3)'79! Ef! $')B(*-7%! (73!3.F,-! ZZZ! 8,%)*+.7%! ',)'7%2,().F7%!+,!(73)'7-!+,!($%7%9!>!*3!$').(*-7!g.F,-!Zh!8(73)'7-!+,!($%7%9"!].(07%!$')B(*-7%!,3!%*!1$>7'B$!,F$-I$3!,-!)'$)$1.,3)7! 37! G*.'I'D.(7! >! %*%!(712-.($(.73,%! $%B! (717! -$%!

(712-.($(.73,%! +,-! )'$)$1.,3)7!G*.'I'D.(7!F,'%*%!,-!37!G*.'I'D.(7"!

!

B,-($)/()*". &,. 0%-. ,-#'&)%-.)"(0')&%-:.

C:!D201%3"& E."2E')03="& F1'& =$4".$&4$& /1,)3",$43%$%& %'2E1G2& %'& 1,$&/.$)01.$& %'& 6H#'."I& J& F1'&/$)0".'2& 3,/41J',& ',& '44$& :D20'&'201%3"&'2&%'&,3='4&%'&'=3%',)3$&>>>:&

]*'$3),! AT! 1,%,%! %,! %.D*.,'73!44=! &'$()*'$%! +,! -$! +./&.%.%!0*1,'$-E! F$-7'$3+7! -$!&*3(.73$-.+$+! +,-! 071;'7! (73! ,-!),%)! +,! g,,'! "Q$'$! -$! &*3(.J3! +,-!(7+7! %,! *).-.L7! *3! D73.J1,)'7!1.+.,3+7!,-!$'(7!+,!17F.1.,3)7!>!2$'$! -$! &*,'L$!1*%(*-$'! %,!*).-.L7!*3!+.3$1J1,)'7"!

P-! V46! +,! -$%! &'$()*'$%! %,! )'$)7!7')72H+.($1,3),!>!,3!,-!',%)7!+,!-$! &'$()*'$%! ! %,! -,%! ',$-.L7!)'$)$1.,3)7! G*.'I'D.(7! >$! G*,!2',%,3)$;$3!D'$3!+,%2-$L$1.,3)7!7! ,'$3! .3,%)$;-,%"! :,! ',$-.L7! ,-!),%)! +,! g,,'! $! -$%! VE! 4AEAe!%,1$3$%! >! $-! $@7! +,! -$! -,%.J3!%.,12',! (712$'$3+7! -7%!',%*-)$+7%! (73! ,-! -$+7! 37!$&,()$+7"!

:,!+,&.3.J!-$!2%,*+7$')'7%.%!(717!-$! $*%,3(.$! +,! W$--7! J%,7! ,3! $-!

Page 5: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

1,37%! )',%! (7').($-,%! ,3!'$+.7D'$&B$%! +,! &',3),! 8O9! >!-$),'$-,%! 8Q9E! >! -$! 17F.-.+$+! +,-!&7(7!$!-$%!4e!%,1$3$%"!

6,-'0#+&%-:!

!i3! 4?6! +,! -7%! 2$(.,3),%!2',%,3)7!2%,*+7$')'7%.%! !$! -$%!4e!%,1$3$%! ",-! %(7',! +,! g,,'! %,!.3(',1,3)7! (73! ,-! (7'','! +,! -$%!%,1$3$%!--,D$3+7!$!%*!1/K.17!,3!-$! %,1$3$! 5A! $-! .D*$-! G*,! -$!&*,'L$! 1*%(*-$'"! #$! &-,K7!,K),3%.J3! +,! (7+7! 2',%,3)7! *3$!+,&.(.,3(.$!+,!f6!$-$!5A!%,1$3$%!"P-!%(7',!+,!g,,'!G*,!F$-7'$!+7-7'!>! 17F.-.+$+! $').(*-$'! &*,! 1$>7'!,3! -7%! 2$(.,3),%! G*,! ',(.;.,'73!(.'*DB$! (712$'$+7%! (73! -7%! G*,!',(.;.,'73! )'$)$1.,3)7! &*3(.73$-!82d="==49E! +,%$2$',(.,3+7! ,%)$!+.&,',3(.$! ,3! -$! ,F7-*(.J3E!2,'1$3,(.,3+7! ,3! -$%! &'$()*'$%!+,!+.$&.%$'.$%!2'7K.1$-,%"!

#7%! &$()7',%! G*,! %,! F.,'73!$%7(.$+7%! $! 2,7',%! ',%*-)$+7%!8;$C7! %(7',! +,! g,,'9!.3+,2,3+.,3),%! +,-! )'$)$1.,3)7E!&*,'73! -$! ,+$+E! %)'7j,E!2%,*+7$')'7%.%! "-$! 17F.-.+$+! +,-!(7+7!37!%,!F.7!$&,()$+$!27'!,%)7%!&$()7',%! "#$! (73%7-.+$+$(.J3!F.(.7%$!37!$&,()7! -$! &*3(.73$-.+$+!&.3$-"!

P-! I3.(7! &$()7'! .3+,2,3+.,3),!2',+.()7'! +,! 2%,*+7$')'7%.%! ,%! -$!&'$()*'$! +.$&.%$'.$! 2'7K.1$-!$%7(.$+$!$!*3!%(7',!+,!g,,'!;$C7!,3)',!-$%!V!>!4A!%,1$3$%"!

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

P%),!,%)*+.7!,%!*37!+,! -7%!I3.(7%!,3! +73+,! %,! F$-7'$! +,! &7'1$!&.+,+.D3$! -$! &*3(.J3!27%)! &'$()*'$!>! %,! ;*%($'73! &$()7',%E! >$! %,$!(717!-$!,+$+E!,-!).27!+,!&'$()*'$E!,3&,'1,+$+,%!(73(71.)$3),%!G*,!.3&-*>,'$3! ,3! ,-! ',%*-)$+7! &.3$-!E(73(-*>,3+7! G*,! *3! %(7',!.3&,'.7'! $! f5! 2*3)7%! ,3! -$!2',%,3(.$! +,! *3$! &'$()*'$!2'7K.1$-! +.$&.%$'.$! ! $! -$%! 4A!%,1$3$%!,%!*3!;*,3!.3+.($+7'!+,!2%,*+7$')'7%.%! "g7! ,%2,(.&.($! -7%!

Page 6: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

2$%7%!+,-!)'$)$1.,3)7!&*3(.73$-!3.!,-! ).27! +,! (.'*DB$! ',$-.L$+$! 3.! -7%!('.),'.7%! +,! ,%)$;.-.+$+! +,! -$!&'$()*'$%!

!

!

D:!D201%3"& E."2E')03="& ,3='4& >>>& %'&'=3%',)3$&',&%",%'&2'& .'$43K"& &1,&2'A13#3',0"& %'& 4$2& /.$)01.$2&%3$/32$.3$2& %'& 61#'."& 0.$0$%$2&/1,)3",$4#',0':! :,! ',$-.L7!)'$)$1.,3)7! &*3(.73$-! +,! -$%!&'$()*'$%E! G*,! (73%.%)B$! ,3! -$!(7-7($(.J3!+,!*3$!&H'*-$!,3!i!%.3!1$3.2*-$(.J3!+,!-$!&'$()*'$!>!*3$!F,L! G*,! -$%! 2$'),%! ;-$3+$%! -7!2,'1.)B$3! %,! (7-7($;$! *3! ;'$(,!

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g7! %,!2,'1.)B$! -$!($'D$!$K.$-!2$'$!,F.)$'!+,&7'1.+$+,%!$3D*-$',%!!"i3$!F,L!G*,! %,! (73%,D*B$! -$! 17F.-.+$+!(712-,)$! +,-! (7+7! %,! ',).'$;$! ,-!($;,%)'.--7! +*'$3),! -$! 1$'(0$E! %,!F7-FB$! $! (7-7($',3! ,-! +,%($3%7! >!%,! .3),3%.&.($;$! -$! 17F.-.+$+! +,-!071;'7! (73!,C,'(.(.7%!2$%.F7%!+,!&-,K.J3"!

:,! )'$)$'73! TAA! &'$()*'$%E! ,3!+73+,!,-!?56!,'$3!(,''$+$%!>!*3!A56! ,K2*,%)$%! 837! ,%2,(.&.($!D'$+7! ,3! -$! (-$%.&.($(.J3! +,!k*%).-79E! +.(07! ,%)*+.7! 2*+7!%,D*.'!,-!e?6!+,!-$%!&'$()*'$%!>!%,!-7! $)'.;*>,3! $! -$! 27;-$(.J3! ,3!

Page 7: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

,%)*+.7E!-$!(*$-!%,!,3(73)'$;$3!,3!%.)*$(.J3! +,! ($--,E! F.%)$%! ,3!.3%).)*(.73,%! *3.F,'%.)$'.$%! G*,!+,C$;$3! +,! (73(*''.'! (*$3+7! -7%!%B3)71$%!+,%$2$',(B$3"!!

!

6,-'0#+&%-:.

],-!e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

W73! ',%2,()7! $! -$! &*3(.J3! +,! -$%!$').(*-$(.73,%! ! ,-! TV6! ),3B$3!*3$!17F.-.+$+! +,-! 071;'7! $&,()$+$!,3! *3! A56! ! -$! (*$-! +.%1.3*>7! ,3!-7%! 1,%,%! %.D*.,3),E! %7-7! %,!',D.%)'7! ,-! fT6! +,! -$! 17F.-.+$+!

+,-! (7+7! +,3)'7! +,! ,%)7%! ,-! ?e6!),3B$3! 17F.-.+$+! (712-,)$! >! ,-!',%)7!*3$!+.%1.3*(.J3!G*,!.;$!+,-!A56! $-! 56E! -7%! $*)7',%! $%*1,3!G*,! $-! .D*$-! G*,! ,-! 071;'7! ,%)$!-.1.)$(.J3! +,%$2$',(,'B$! (73! ,-!).,127"!g.3D*37!+,!-7%!2$(.,3),%!&*,! ,3F.$+7! $-! &.%.7),'$2,*)$"-$%!+,%F.$(.73,%! $3D*-$',%! &*,'73!(7%1H).($1,3),! >!&*3(.73$-1,3),!$(,2)$;-,%"!

W73(-*>,! (.)$3+7! G*,! l,-! $-)7!D'$+7!+,!(73%7-.+$(.J3!>$!%,$!,3!&'$()*'$%! (,''$+$%! 7! $;.,')$%!(73&.'1$!-$!(',,3(.$! .3.(.$-!G*,!,-!17F.1.,3)7! ,3! -$! &'$()*'$! ,%!,%,3(.$-! 2$'$! -$! 7%),7D,3,%.%E! >!G*,! ,-! )'$)$1.,3)7! &*3(.73$-! +,!-$%! &'$()*'$%! +.$&.%$'.$%E! 37!',G*.,',! .3),'3$(.J3E! ,-! '.,D7! +,!2%,*+7$')'7%.%! ,%! ;$C7! >! -$!',(*2,'$(.J3! 7(*'',! ,3! *3! (7')7!2,'.7+7E!-7!(*$-!).,3,!.12-.($3(.$%!,3!,-!(7%)7!%$-*+m"!

P%),! $').(*-7! ,K2-.($! 1*>! ;.,3! ,-!1H)7+7!+,! )'$)$1.,3)7! &*3(.73$-!$%B! (717! -7%! 2$%7%! $! %,D*.'! 2,'7!).,3,! *3! D'$3! +,;,! ,3! -7%!',D.%)'7%! >$! %,$! 27'! -$! &$-)$! +,!1,+.(.J3! +,! -$! 17F.-.+$+! +,-!(7+7E!37!,K2-.($!(J17!%,!F$-7'7!-$!&*3(.J3! +,-! 071;'7! >! %,!2,'+.,'73! *3! <<6! +,! -7%!

Page 8: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

2$(.,3),%! -7! G*,! 2*+.,'$! 0$;,'!($1;.$+7!-7%!',%*-)$+7%!&.3$-,%"!

E:!D201%3"&.'0."2E')03="&%'&)",0."4&%'&)$2"I&,3='4&%'&'=3%',)3$&>L:!

i3! %7-7! (.'*C$37! ',$-.L7!)'$)$1.,3)7! &*3(.73$-! +,! -$%!&'$()*'$%! ,3! 5A! 2$(.,3),%E! G*,!&*,'$3! 1$>7',%! +,! 4V! $@7%E!&'$()*'$! +.$&.%$'.$! +,! 0*1,'7!(,''$+$! >! G*,! 37! &*,'$3! -,%.73,%!2,'.! 2'7)H%.($%! 7! ,3! 0*,%7!2$)7-JD.(7"!

:,! ',$-.L7! )'$)$1.,3)7! &*3(.73$-!,-! (*$-! (73%.%)B$!,3!*3$! &H'*-$!,3!i! G*,! %,! ',$-.L$;$! ,3! -$!,1,'D,3(.$E!(73)'7-!$!-7%!V!+B$%!>!+,2,3+.,3+7! +,-! ,%)$+7! +,! -$%!2$'),%!;-$3+$%!%,!2$%7!$!*3!;'$(,!2',&$;'.($+7! "P-! 2$(.,3),! &*,!.3%)'*.+7! ,3! $C*%)$'! ,-! ;'$(,!+*'$3),!,-!+B$!-$%!F,(,%!G*,!&*,'$!3,(,%$'.7"! :,! -,! .3+.(7! G*,! 37!+,C$'$3!,-!;'$L7!,3!*3$!$-170$+$!7!,3!*3!',%2$-+7!+,!%.--$!%.,12',!(7-D$3+7! C*3)7! $-! (*,'27! ,3! -$!1,+.+$!G*,!%,$!27%.;-,!E,F.)$3+7!-$! M\]! ,3! -$! 2'.1,'$%! A! $! f!%,1$3$%! "i3$! F,L! G*,! -7%!%B3)71$%! -7! 2,'1.).,'73! %,!(71,3LJ! (73! ,C,'(.(.7%!2,3+*-$',%! $! 3.F,-! +,-! 071;'7! >!&-,K7! ,K),3%.J3! +,-! (7+7"! M-! 1,%!%,!(71,3LJ!(73!,C,'(.(.7%!$().F7%"!#7%! ,C,'(.(.7%! $().F7%! $! 3.F,-! +,!

071;'7! &*,'73! .3%)$-$+7%! (73!%.D37%! +,! (73%7-.+$(.J3!'$+.7D'/&.($!"P-!;'$(,!&*,!',).'$+7!(73! -$! (73%7-.+$(.J3! '$+.7D'/&.($!>! (-B3.($"! ^,$-.L/3+7%,! *3!%,D*.1.,3)7!1B3.17!+,!e!1,%,%"!

.

6,-'0#+&%-4.

#$! (73%7-.+$(.J381,+.$! +,! 4A!%,1$3$%9!%,!2'7+*C7!,3!ff!+,!fT!2$(.,3),%! 8T=69E! -$! +,%&7'1.+$+!$3D*-$'! 37! ($*%7! -.1.)$(.73,%!&*3(.73$-,%! ,3! -7%! 2$(.,3),%! ":,!',$-.L7!(.'*DB$!,3!5!2$(.,3),%!G*,!$!-$%!4=!%,1$3$%!2,'1$3,(B$3!%.3!%.D37%! +,! (73%7-.+$(.J3E!',$-.L/3+7%,! 7%),7%B3),%.%! (73!2-$($E!)7'3.--7%!>!$27'),!+,!0*,%7!$*)7-7D7! "#$! -7($-.L$(.J3! +,! -$!&'$()*'$! ,'$! +.$&.%$'.$! 2'7K.1$-!(73! *3! &'$D1,3)7! ,3! $-$! +,!1$'.27%$!,3!f!+,!,%)7%!2$(.,3),%!"X7+$%! -$%! -,%.73,%! '$+.$-,%!$%7(.$+$%!',(*2,'$'73!%*! &*3(.J3!$!-7%!<!1,%,%!"!

P-! $*)7'! (73(-*>,! G*,! ,-!1H)7+7!+,! )'$)$1.,3)7! (,''$+7! +,! -$%!&'$()*'$%! +.$&.%$'.$%! +,! 0*1,'7!%.D*,! ,%)$3+7! F.D,3),! >! G*,!$%7(.$! *3! $-)7! B3+.(,! +,!(73%7-.+$(.J3E! -$! $3D*-$(.J3! ,3!F$'7! ,%! -$! (712-.($(.J3! 1/%!&',(*,3),! 2,'7! 37! ).,3,!

Page 9: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

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

].(07! ,%)*+.7! &*,! ',$-.L$+7! 27'!*3! %7-7! (.'*C$37! *).-.L$3+7! -$!1.%1$! )H(3.($! (73! .3+.($(.73,%!(-$'$%E! -7!G*,! -7!0$(,!&*,'),!2,'7!).,3,! *3! 3I1,'7! (0.(7! +,!2$(.,3),%"! g7! ,%)$;-,(,! ($+$!(*$3)7! (73)'7-$'! >! %7-.(.)$'!'$+.7D'$&B$%!$-!2$(.,3),"!

!!

F:!D201%3"&.'0."2E')03="&,3='4&>>>&%'&'=3%',)3$& F1'& )"#E$.$& '4&0.$0$#3',0"& F13.H.A3)"& ='.212&0.$0$#3',0"& /1,)3",$4& ',& 4"& F1'&.'/3'.'&$4&03'#E"&%'&)",2"43%$)3M,I&E2'1%"$.0."232I& )",2"43%$)3M,&=3)3"2$I& /1,)3",$43%$%& J&)"#E43)$)3",'2&%'&%3/'.',0'2&03E"2&%'& /.$)01.$2& %3$/32$.3$2& %'&6H#'.":! #7%! ('.),'.7%! +,!',$-.L$(.J3! +,! (.'*DB$! %73! -7%!,K2*,%)7%! ,3! -$! )$;-$! 3*1,'7! 4!":,! )71$'73! +7%! D'*27%! +,!+.&,',3),%!(,3)'7!07%2.)$-$'.7%E!,-!2'.1,'!D'*27!+,!e<!2$(.,3),%!&*,!)'$)$+7! ,3! &7'1$! 37! G*.'I'D.($!(7-7(/3+7%,! ,3! *3$! 2'.1,'$!.3%)$3(.$! *3! &H'*-$! ,3! i! $! -$!%,1$3$! %,! -,%! (7-7(7! *3! ;'$(,!2',&$;'.($+7E! %,! -,%! .3+.(7!17F.1.,3)7%! 2$%.F7%! (*$3+7! ,-!+7-7'! -7! 2,'1.).,'$! >! $().F7%! *3$!F,L!G*,!%,!F.%*$-.L$;$3!%.D37%!+,!(73%7-.+$(.J3!,3!-$!^n"!

P-! %,D*3+7! D'*27! &*,! )'$)$+7!G*.'I'D.($1,3),! E+,! *3! )7)$-! +,!45=! 2$(.,3),%! E$! TA! 2$(.,3),%! %,!-,!(7-7(7!*3$!2-$($!;-7G*,$+$!f"5!11! >! $-! ',%)7! *3$! 2-$($! 37!;-7G*,$+$! ":,! F$-7'7! ,-!27'(,3)$C,! +,! (73%7-.+$(.J3! E!',)$'+7! +,! -$! 1.%1$!E2%,*+7$')'7%.%! E(73%7-.+$(.J3!F.(.7%$! E-,%.73,%! 3,'F.7%$%! ,!.3&,((.J3! ,3! -7%! A! D'*27%! ":,!

Page 10: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

+,&.3.J! -$! (73%7-.+$(.J3! (717! -$!2',%,3(.$! +,! ($--7! J%,7! ,3! +7%!2'7>,((.73,%! '$+.7D'/&.($%! >! -$!(73%7-.+$(.J3! F.(.7%$! (717! *3$!$3D*-$(.J3! [A=U! ,3! (*$-G*.,'!2-$37!E%,!+7(*1,3)7!-$!17F.-.+$+!+,! -$! $').(*-$(.J3! +,-! (7+7! >!071;'7"!

6,-'0#+&%-:.

:,! ',$-.L7! *3! %,D*.1.,3)7! +,! V!1,%,%! 2'71,+.7! "P-! ).,127! +,!(73%7-.+$(.J3! &*,!2$',(.+7!,3! -7%!A! D'*27%! (73!*3!2'71,+.7!+,!<$!44! 1,%,%! ,3! ,-! D'*27! G*,! 37!',(.;.J! (.'*DB$! (73)'$! <! $! 4?!1,%,%! "-$!17F.-.+$+! +,-! (7+7! &*,!.D*$-! ,3! -7%! +7%! D'*27%! E%.3!($1;.7%!,3!-$!%.)*$(.J3!-$;7'$-!"!

P-! B3+.(,! +,! 2%,*+7$')'7%.%! ! &*,!1$>7'! ,3! ,-! D'*27! )'$)$+7!7')72H+.($1,3),! (73! *3!27'(,3)$C,! +,! A="e6! F,'%*%!V"?6"#$! (73%7-.+$(.J3! F.(.7%$! &*,!1$>7'! ,3! ,-! 2'.1,'! D'*27! "P-!B3+.(,! +,! .3&,((.J3! &*,! +,! <EA6!!,3! ,-! 2'.1,'! D'*27! ,3! &'$()*'$%!27'!0,'.+$!+,!;$-$!>!+,!fEA!6!,3!,-! %,D*3+7! D'*27! E-$%! -,%.73,%!%,(*3+$'.$%! +,-! 3,'F.7! '$+.$-!&*,'73! F.%)$%! +,%2*H%! +,! -$!1$3.2*-$(.J3! +,! *3$! &'$()*'$!(,''$+$! )'$)$+$! &*3(.73$-1,3),!,3! *3! TE56! >! ,3! -$! (.'*DB$! AE?6E!

)7+7%! -7%! 2$(.,3),%! ',(*2,'$'73!-$!&*3(.J3!2',F.$!"!

P-! $*)7'! (73(-*>,! G*,! $*3G*,! ,-!)'$)$1.,3)7! +,! ,-,((.J3! ,3! -$!1$>7'B$! +,! -$%! &'$()*'$%! +,!0*1,'7! ,%! 7')72H+.(7! %,!,F.+,3(.$3! B3+.(,%! +,!2%,*+7$')'7%.%! +,! *3! A<6! 37!,F.+,3(.$+7%! ,3! -$! -.),'$)*'$! ,!B3+.(,%! +,! (73%7-.+$(.J3! F.(.7%$!1/%! ,-,F$+7%! G*,! -7%! 2*;-.($+7%!27'!:$'1.,3)7!,)!$-"!

#$! &*3(.J3! &*,! %.1.-$'! ,3! -7%! +7%!D'*27%E! -$! (73%7-.+$(.J3! F.(.7%$!&*,!1$>7'!,3!,-!D'*27!)'$)$+7!%.3!(.'*DB$! %.3! .12-.($3(.$%! ,3! -$!&*3(.J3"!

#$%! &$--$%! ,3! ,-! )'$)$1.,3)7!&*3(.73$-! %,! -$%! $)'.;*>,! $! G*,!(.,')7%! (.'*C$37%! 0$3! 2,'+.+7! ,-!$'),! +,! )'$)$'! ,%)$%! &'$()*'$%! +,!,%),! 17+7! 7! G*,! ,-! 2$(.,3),! 37!)7-,',! +.(07! )'$)$1.,3)7! 0,(07!G*,! 37! 0$! %.+7! ',&,'.+7! ,3! -$!;.;-.7D'$&B$!"!

o*,+$!27'!,%)*+.$'! %.! -$!2-$($!+,!(712',%.J3! 2*,+,! %*%).)*.'! $-!)'$)$1.,3)7!&*3(.73$-!,3!-$!,'$!+,!-$! 7%),7%B3),%.%! 1B3.1$1,3),!!.3F$%.F$E!2,'7!37!,%!,-!7;C,).F7!+,!+.(07!,%)*+.7"!

P%),! ,%)*+.7! 37! ,3(*,3)'$!+.&,',3(.$!,3)',!,-!)'$)$1.,3)7!37!

Page 11: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

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g7!,%2,(.&.($!;.,3!,-! %,D*.1.,3)7!,3!3.3D*37! +,! -7%! +7%! 1H)7+7%!82$%$C,! $-! ;'$(,! E2-$($%! *).-.L$+$%!E(712-.($(.73,%! $! -$'D7! 2-$L79E>!%.D*,!(73(-*>,3+7!G*,!,-!1H)7+7!37! G*.'I'D.(7! ,%! $2'72.$+7! 2$'$!-$! 1$>7'B$! +,! -$%! &'$()*'$%! +,!0*1,'7!+.$&.%$'.$%"!

G:! P%)*+.7! 2'7%2,().F7! 3.F,-! +,!,F.+,3(.$! ZZ!+73+,!%,! )'$)$'73!T<!2$(.,3),%! (73! &'$()*'$%! (,''$+$%!+,! 0*1,'7! G*,! 37! )*F.,'$3!.3+.($(.J3! $;%7-*)$! 3.! ',-$).F$! +,!(.'*DB$! 8X$;-$! 49"#7%! 7;C,).F7%! +,!,%),! ,%)*+.7! ,'$3! ,F$-*$'! ,-!)'$)$1.,3)7! &*3(.73$-! ,3!&'$()*'$%! (,''$+$%! +.$&.%$'.$%! +,!0*1,'7"!

:,! $2-.(7! ;'$(,! ! 2',&$;'.($+7! ,3!-$! *3.+$+! +,! ,1,'D,3(.$! >! %,!(73)'7-7! ,-! 2$(.,3),! $! -7%! 5! +B$%!!2$'$! F,'! %.! ,-! 2$(.,3),! %,!,3(73)'$;$! &$1.-.$'.L$+7! (73! ,-!)'$)$1.,3)7"! P-! 2'JK.17! (73)'7-!%,! ',$-.L7! $! -$%! e! %,1$3$%!+73+,!%,! ,F$-*J! (-B3.($! >!'$+.7-JD.($1,3),! $-! 2$(.,3),! ":.!37!%,!F.%*$-.L$;$!($--7!J%,7!,3! -$!'$+.7D'$&B$! $-! 2$(.,3),! %,! -,!',$-.L$;$! (.'*DB$! E+,! (73).3*$'!(73! ,-! )'$)$1.,3)7! 7')72H+.(7! %,!(73)'7-$;$! A! %,1$3$%! +,%2*H%! >!%,!',).'$;$!,-!;'$(,!*3$!F,L!G*,!-$!&'$()*'$! ,%)*F.,'$! (73%7-.+$+$!"Z31,+.$)$1,3),! +,%2*H%! +,! -$!(7-7($(.J3! +,-! ;'$(,! %,!(71,3L$;$! (73! ,C,'(.(.7%! +,!17F.-.+$+! +,-! 071;'7! >! (7+7!,%)$3+7! 2'70.;.+7! -$! '7)$(.J3!,K),'3$!0$%)$!-$%!e!%,1$3$%"!

6,-'0#+&%-.

],! -7%! T<! 2$(.,3),%! ?A! 8??69!(73%7-.+$'73! %.3! 2'7;-,1$%E! -$!(73%7-.+$(.J3! F.(.7%$! 37! ,K(,+.J!-7%! A=U! ,3! 3.3DI3! 2-$37! E%,!(73%)$)$'73! %,.%! -,%.73,%! '$+.$-,%!>! A4! 2$(.,3),%! 8<<69! &*,'73!.3),'F,3.+7%! G*.'I'D.($1,3),827'!&$--$! +,! )'$)$1.,3)7! &*3(.73$-9!*%$3+7! 2-$($! ,3! 44! 2$(.,3),%!E(-$F7! .3)'$1,+*-$'! ,3! e! >! (-$F7!1$%! ($;-,%! ,3! ! 7)'7%! f"P-! ).,127!

Page 12: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

1,+.7! +,%+,! -$! &'$()*'$! 0$%)$! -$!(.'*DB$! &*,! +,! ?A! +B$%! "W73!',%2,()7! $! -$! (73%7-.+$(.J3! ;$C7!)'$)$1.,3)7! 7')72H+.(7! 0*;.,'73!+.&,',3(.$%! %.D3.&.($).F$%!+,2,3+.,3+7! +,-! -*D$'! ,3! +73+,!$%.,3)$! -$! &'$()*'$! E-$%! &'$()*'$%!+.$&.%$'.$%! 2'7K.1$-,%!(73%7-.+$'73! 1,37%! G*,! -$%!1,+.7! +.$&.%$'.$%! 82d==49>! -$%! +,!),'(.7! +.%)$-82d==59E%.3!+.&,',3(.$%! ,3)',! -$%! +,! ),'(.7!1,+.7! >! +.%)$-82d=?59"P-! I3.(7!&$()7'! 2',+.()7'! ,3(73)'$+7! +,!(73%7-.+$(.J3! &*,! -$! -7($-.L$(.J3!+,!-$%!&'$()*'$%!"!

P-! $*)7'! (73(-*>,! G*,! ,-!)'$)$1.,3)7! 37! G*.'I'D.(7! +,! -$%!&'$()*'$%! +,! 0*1,'7! ,%! *3!1H)7+7! %,D*'7! >! ,&.($L! 2$'$! -$%!&'$()*'$%! 1,+.7! +.$&.%$'.$%! >! +,!),'(.7! +.%)$-! (73%.D*.,3+7! *3$!(73%7-.+$(.J3!+,-! V<6E!1/%!+,! -$!1.)$+! +,! -$%! &'$()*'$%! +,! ),'(.7!2'7K.1$-! &$--7! ,3! (73%7-.+$'! >! %,!-7! $)'.;*>,3! $! -$! $3$)71B$! +,!+.(0$! L73$! >$! G*,! %,! .3%,')$! ,-!+,-)7.+,%! >! 2,()7'$-! 1$>7'!($*%$3+7!+.%)'$((.J3!+,-! &7(7"! :,!(',,! G*,! -$%! &'$()*'$%! 1,+.7!+.$&.%$'.$%! %73! -$%! G*,! 2',%,3)$3!1/%! 2'7;-,1$%! 2$'$! (73%7-.+$'!;$C7! )'$)$1.,3)7! 37! G*.'I'D.(7E!-7%! ',%*-)$+7%! +,! ,%),! ,%)*+.7!.3+.($3! G*,! *3! V?6! +,! -$%!

&'$()*'$%! (73%7-.+$'73! %.3!2'7;-,1$%"!

#$!(7-$;7'$(.J3!+,-!2$(.,3),!,%!-$!2.,+'$! $3D*-$'! +,-! )'$)$1.,3)7!&*3(.73$-E! 2$(.,3),%! G*,! 37!(772,'$3! ).,3,3! 1*(07! 1/%!'.,%D7!+,!&$--$%"!

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

P-! )'$)$1.,3)7! 37! G*.'I'D.(7! +,!-$%! &'$()*'$%! +.&.%$'.$%E! +,;,!(71,3L$'!(73!-$!(7-7($(.J3!+,!*3!;'$(,! 2',&$;'.($+7! ,3! ,-!171,3)7!+,!-$!-,%.J3E!%.,3+7!,%)$!*3$! ,K(,-,3),! $-),'3$).F$! 2$'$! ,-!)'$)$1.,3)7! +,! -$%! &'$()*'$%! +,!),'(.7!1,+.7!>!+.%)$-!%.3! ),3,'!,3!

Page 13: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

(*,3)$! -$! (73&.D*'$(.J3! +,! -$!&'$()*'$"!

P3!,%),!$')B(*-7!%,!$2-.($!*3!;'$(,!,3! ,-! 171,3)7! +,! -$! &'$()*'$!%$-),/3+7%,! ,-! 2$%7! +,! -$!(7-7($(.J3! +,! -$! &H'*-$! ,3! i! %.3!),3,'! 1$-7%! ',%*-)$+7%E! 2,'7! %.3!--,D$'!$!-7%!27'(,3)$C,%!7;),3.+7%!27'! :$'1.,3)7"! :,! ',2.),! ,-!(73(,2)7! +,! G*,! -$%! &'$()*'$%! +,!),'(.7!2'7K.1$-!).,3,3! !1/%!&$--$%!,3! -$! (73%7-.+$(.J3! "g7! 0$;-$! +,!-7%!',%*-)$+7%!>c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

H:D201%3"& ,3='4& >>>& %'& '=3%',)3$&I%",%'& 2'& )"#E$.$,& 4"2&.'2140$%"2& %'4& 0.$0$#3',0"&F13.H.A3)"& ='.212& 0.$0$#3',0"& ,"&F13.H.A3)"& %'& 4$2& /.$)01.$2&#'%3"&

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

:,! ,-.D.,'73! &'$()*'$%! (,''$+$%!).27! 4A! MAE! M<E! \A! ,3! 2$(.,3),%!1$>7',%! $! 4e! $@7%! G*,!(71,3L$'$3! %*! )'$)$1.,3)7!+,3)'7!+,!-7%!?!+B$%!27%),'.7',%!$!-$! &'$()*'$! >! ,3! -7%! (*$-,%! %,!2*+.,'$! ,-,D.'! *3! 2'7)7(7-7! +,!)'$)$1.,3)7"!o*,+$3+7! $! ('.),'.7!+,-! 1,+.(7! ,-! )'$)$1.,3)7! $!',$-.L$'"! :,! %.D*.,'73! -7%!2'.3(.2.7%! ,K2*,%)7%! 27'!:$'1.,3)7! 2$'$! -$%! &'$()*'$%! 37!G*.'I'D.($%! >! %,! (7-7(7! *3! (-$F7!.3)'$1,+*-$'! +,! 0I1,'7!2$'$! -$%!G*.'I'D.($%"!!

:,! *).-.L7! ,-! %(7',! +,! W73%)$3)!2$'$! ,F$-*$'! -$! &*3(.J3! 27%)!)'$)$1.,3)7E! ,-! (*$-! ,F$-I$E! -$!

Page 14: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

17F.-.+$+! >! &*,'L$E! +7-7'! ,3! -$%!$().F.+$+,%! +.$'.$%! >! +*'$3),! ,-!%*,@7"!

6,-'0#+&%-.

]*'$3),!*3!2,'.7+7!+,!!f!$@7%!%,!.3(-*>7! *3! )7)$-! +,! fe! 2$(.,3),%E!4f!37!72,'$+7%!>!<<!72,'$+7%!+,!A=! 07%2.)$-,%! +.&,',3),%! 8M*%)'.$E!a*3D'B$!>!a7-$3+$9!"P-!2$)'J3!1/%!&',(*,3),! +,! &'$()*'$! 4A! M<!)'$3%F,'%$! 1,+.7! +.$&.%$'.$"! W73!*3!%,D*.1.,3)7!+,-!V46!$-!$@7!,3!,-!D'*27!37!72,'$)7'.7!>!*3!?T!6!,3!-$%!)'$)$+$%!G*.'I'D.($1,3),"!

#$! (73%7-.+$(.J3! %,! +.7! ,3! 44!2$(.,3),%!+,-!D'*27!37!G*.'I'D.(7E!72)/3+7%,!,3!<!2$(.,3),%!G*,!37!2',%,3)$;$3!($--7!$!-$%!V!%,1$3$%!27'! ',$-.L$'%,! )'$)$1.,3)7!G*.'I'D.(7"!],3)'7!+,-!7)'7!D'*27!*3! VT6! -7D'7! -$! (73%7-.+$(.J3! $-!$@7!+,-!)'$)$1.,3)7"!

W73! ',%2,()7! $! -7%! ',%*-)$+7%!&*3(.73$-,%!-7%!2$(.,3),%!)'$)$+7%!G*.'I'D.($1,3),! 2',%,3)$3!1$>7'! '$3D7! +,! 17F.-.+$+! ,3! -$!$').(*-$(.J3! +,-! 071;'7! $! -$%! e!%,1$3$%! +,! -$! (.'*DB$! -$! (*$-! %,!,12$',C$! $-! $@7! (73! ,-! D'*27! +,!-7%! 2$(.,3),%! 37! 72,'$+7%"! #$!17F.-.+$+! +,-! (7+7! 7;)*F7!',%*-)$+7%! %.1.-$',%! $! -7%!$3),'.7',%! "g7! %,! ,3(73)'$'7%!

+.&,',3(.$%!,3! -7%!+7%!D'*27%!(73!',%2,()7! $-! +7-7'! $! 3.F,-! +,-!071;'7"! M-! $@7! )7+7%! -7%!2$(.,3),%! G*,! )'$;$C$;$3!F7-F.,'73! $! %*%! )$',$%! %.3!+.&,',3(.$%!,3)',!D'*27%"!

g7! 0*;7! (712-.($(.73,%! ,3! ,-!D'*27! 37! 72,'$+7E! %.! %,!,F.+,3(.$'73! *3! 456! +,!(712-.($(.73,%! (73! -$! (.'*DB$!(717!%,'!'7)*'$!+,!-$!,K)',1.+$+!2'7K.1$-! (73! -$! .3%,'(.J3! +,-!(-$F7E! -,%.J3!!+,-!1$3D*.)7!+,!-7%!(7')7%! '7)$+7',%E! 2,'+.+$! +,-!)7'3.--7! +.%)$-! +,! ;-7G*,7E!.3&,((.J3! %*2,'&.(.$-! +,! -$! 0,'.+$!G*.'I'D.($"! #$! %$).%&$((.J3! +,-!2$(.,3),! &*,! %.1.-$'! ,3! -7%! A!D'*27%"!

P-! )'$)$1.,3)7! G*.'I'D.(7! (73!,3(-$F$+7! .3)'$1,+*-$'! ',%*-)$!,3! *3! 1H)7+7! ,&,().F7! ,3! ,-!)'$)$1.,3)7! (73! *3$! F*,-)$! $! -$%!$().F.+$+,%! ',(',$).F$%! 1/%!'/2.+7! G*,! ,-! )'$)$1.,3)7! 37!G*.'I'D.(7E! 2,'7! $-! $@7! -$!&*3(.73$-.+$+! ,%! .D*$-! "P-!)'$)$1.,3)7! G*.'I'D.(7! ',G*.,',!1/%! +B$%! +,! .3),'3$(.J3! >! 2*,+,!+,%$''7--$'! (712-.($(.73,%!+,'.F$+$%!+,-!1.%17"!

W73(-*>,3! G*,! ,-! )'$)$1.,3)7! 37!G*.'I'D.(7! %.D*,! %.,3+7! *3!1H)7+7!,&.($LE!F.$;-,E!(73!1,37%!

Page 15: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

(7%)7%! ,3! ,-! 1$3,C7! +,! -$%!&'$()*'$%! +.$&.%$'.$%! +,! 0*1,'7! >!%.!%,!+,;,!($1;.$'!$-!)'$)$1.,3)7!G*.'I'D.(7! -7%! ',%*-)$+7%!&*3(.73$-,%! %.D*,3! %.,3+7! 1*>!;*,37%"! :,! +,;,'B$3! ',$-.L$'!,%)*+.7%! '$3+71.L$+7%! ,3! ,-!&*)*'7! 2$'$! %,D*.'! D$'$3).L$3+7!G*,! ,-! )'$)$1.,3)7! 37! G*.'I'D.(7!%.D*,!%.,3+7!-$!1,C7'!72(.J3!2$'$!,%)$%!&'$()*'$%"!

].(07! ,%)*+.7! 2',%,3)$! ! 27($!($3).+$+! +,! 2$(.,3),%E! 37! %,!,%)$;-,(,! *3! 2'7)7(7-7! (-$'7! ,3!(*$3)7! $! (J17! ',$-.L$'! ,-!)'$)$1.,3)7! 37! G*.'I'D.(7! E-$!F,3)$C$!G*,! ).,3,! %73! -7%!;*,37%!',%*-)$+7%! ,3! 2$(.,3),%! )'$)$+7%!,3! +.&,',3),%! 07%2.)$-,%! >! 27'!+.&,',3),%! (.'*C$37%! G*,! ,%! *37!+,! -7%! 2'7;-,1$%! G*,! 2*,+,!--,F$'! $! -$! &$--$! $-! )'$)$1.,3)7!37!G*.'I'D.(7!"!

I:! D201%3"& .'0."2E')03="& ,3='4& %'&'=3%',)3$& >>>& ',& %",%'& 2'& .'$43K"&1,&.'4'=$#3',0"&%'&78&$N"2&%'&4$2&/.$)01.$2& %3$/32$.3$2& %'& 6O#'."&F1'& E.'2',0$<$,& 1,$& 4'23M,& %'4&,'.=3"& .$%3$4:! P-! 7;C,).F7! &*,!,F$-*$'! ,-! ).,127! +,!',(*2,'$(.J3! +,! -$! -,%.J3!3,'F.7%$E! $%B! (717! ,-! ).,127! +,!(73%7-.+$(.J3! >! %.! %,! +,;,! 7! 37!',$-.L$'! ,K2-7'$(.J3! +,-! 3,'F.7!

$&,()$+7! ,3! ,-! 171,3)7! +,! -$!&'$()*'$"! W.,3)7! *3! &'$()*'$%!&*,'73! 1$3,C$+$%!7')72H+.($1,3),!>!$!4e!&'$()*'$%!$;.,')$%! ).27! 4EAE! %,! -,%! ',$-.L7!&.C$(.J3! ,K),'3$! >! -$F$+7!G*.'I'D.(7"! g7! %,! ,K2-7'7!G*.'I'D.($1,3),!3.3DI3!3,'F.7!,3!,-!171,3)7!+,!-$!&'$()*'$!>!+.(07!,%)*+.7! &*,! ',$-.L$+7! ,3! *3! %7-7!(,3)'7! ,3! ;$%,! $! -7%! ',D.%)'7%!1H+.(7%"!

:,! ',$-.L7! &H'*-$! ,3! i! ,3!,1,'D,3(.$%! -$! (*$-! %,! 1$3)*F7!+*'$3),!<! %,1$3$%E!>!+,%2*H%! %,!2$%7!$!*3!!;'$(,!2',&$;'.($+7!(73!17F.-.L$(.J3! ),12'$3$! +,! -$%!$').(*-$(.73,%!$+>$(,3),%"!

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

Page 16: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

(73%7-.+$(.J3! +,! -$! &'$()*'$! $! -$%!V!%,1$3$%"!

6,-'0#+&%-.

:,! ',$-.L7! *3! %,D*.1.,3)7!2'71,+.7!+,!e!$@7%!(73%7-.+$3+7!-$%! 44?! &'$()*'$%! ,3! *3! '$3D7! +,!+,! ?! $! 4A! %,1$3$%! -$%! )'$)$+$%!&*3(.73$-1,3),! >! ,3)',! V! >! 4e!%,1$3$%! -$%! )'$)$+$%!G*.'I'D.($1,3),"!

#$!',(*2,'$(.J3!,%273)$3,$!+,!-$!&*3(.J3!+,-! 3,'F.7! '$+.$-! %,!+.7! $!-$%! e! %,1$3$%! ,3! 4=4! &'$()*'$%!E%.,3+7! ,%)$! )7)$-! $! -$%! 4?!%,1$3$%! 8<! >! ?=! %,1$3$%9":,.%!2$(.,3),%! 37! ',(*2,'$'73! %*!&*3(.J3! 27'! -7! G*,! %,! 2'7(,+.J! $!-$! ',F.%.J3! G*.'I'D.($! ,3! A!2$(.,3),%! 2',%,3)$3+7! *3$!-$(,'$(.J3! +,-! 3,'F.7! '$+.$-!E+.(0$%! &'$()*'$%! &*,'73! )'$)$+$%!7')72H+.($1,3),! >! 37! %,!,3(73)'J!,-!3,'F.7!$)'$2$+7!,3!,-!($--7! +,! &'$()*'$! "P3! ,-! ',%)7! +,!-7%! 2$(.,3),%! %,! ',$-.L7! *3$!)'$3%27%.(.J3!1*%(*-7),3+.37%$!$!-7%!A!$@7%!+,!-$!-,%.J3!"!

P-! %.D37! +,! X.3,-! %,! 2',%,3)7!(717! *3! ;*,3! 2',+.()7'! +,! -$!',(*2,'$(.J3!3,'F.7%$! ,-! (*$-! &*,!,F.+,3),!,3!-$%!4=4!&'$()*'$%!G*,!',(*2,'$'73! %*! &*3(.J3! "P-! $*)7'!(73(-*>,! G*,! ,-! T56! +,! -$%!

-,%.73,%! 3,'F.7%$%! $%7(.$+$%! $!*3$! &'$()*'$! +,! 0*1,'7! %,!',(*2,'$3! ,%273)/3,$1,3),E! >!37! +,;,! ',$-.L$'%,! ,K2-7'$(.J3!),12'$3$!+,!-$!-,%.J3!3,'F.7%$!>$!G*,!37!%,!0$!+,17%)'$+7!1,C7'B$!&*3(.73$-! (73! +.(07!2'7(,+.1.,3)7"! :,! +,;,! ',$-.L$'!*3! ,%)*+.7! ,-H()'.(7! $! -$%! 4=!%,1$3$%!+,! -$! -,%.J3E! #$!1$>7'B$!+,! -$! ;.;-.7D'$&B$! +.%273.;-,!$(73%,C$!G*,!+,!37!',(*2,'$'%,!-$!-,%.J3! %,! +,;,'B$! ',$-.L$'! -$!,K2-7'$(.J3! +,3)'7! +,! -7%! f! $! e!1,%,%!27%),'.7',%!$!-$!-,%.J3"!

],(.+.17%! .3(-*.'! ,%),! $').(*-7! >$!G*,! ,3! 3*,%)'7! %,'F.(.7! %,! 0$3!+$+7!+.%(*%.73,%!%7;',!%.!-$!-,%.J3!3,'F.7%$! ,%! *3$! .3+.($(.J3!',-$).F$! 2$'$! -$! (.'*DB$! 7! %.! %,!+,;,! ,K2-7'$'! +.(0$! -,%.J3! ,3!$D*+7E! $*3G*,! ,%),! ,%)*+.7!2',%,3)$! *3! 3.F,-! +,! ,F.+,3(.$!;$C7! G*,+$! (-$'7! ,-! ;*,3!',%*-)$+7! ;$C7! )'$)$1.,3)7!&*3(.73$-! >! -$! ',(*2,'$(.J3! +,!($%.! -$! )7)$-.+$+! +,! -$%! -,%.73,%!3,'F.7%$%"!

.

.

B)-('-)*":.

P-!)'$)$1.,3)7!37!G*.'I'D.(7!%.D*,!%.,3+7!,-!1H)7+7!+,! )'$)$1.,3)7!

Page 17: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

+,! -$! 1$>7'B$! +,! -$%! &'$()*'$%!(,''$+$%! +.$&.%$'.$%! +,! 0*1,'7!E$*3G*,! 37! (73%).)*>,! *3$!2$3$(,$! E+,! %,'! $2-.($+7! ,3!&7'1$!(7'',()$!>!(73!(7-$;7'$(.J3!+,-! 2$(.,3),E! %,! 2*,+,3!1$3,C$'!$-!1,37%!*3!T=6!+,! -$%! &'$()*'$%!+.$&.%$'.$%! R4=S"#7%! ;*,37%!^,%*-)$+7%! 7;),3.+7%! 27'!:$'1.,3)7!>!(7-$;7'$+7',%!(73!*3!27'(,3)$C,! +,! (73%7-.+$(.J3! +,!*3!T?6!37!0$3!%.+7!7;),3.+7%!,3!7)'7%! ,%)*+.7%! 27'! -7! G*,! ,K.%),!(.,')$! (73)'7F,'%.$! (73! ',%2,()7!$-! )'$)$1.,3)7! +,! ,%)$%! &'$()*'$%!RTS"!

P3! 3*,%)'$! ',F.%.J3! %,!,3(73)'$'73! 27(7%! $')B(*-7%E! G*,!,F$-*$'$3! ,-! )'$)$1.,3)7!&*3(.73$-! ,3! -7%! I-).17%! 4=!$@7%E!,3! %*! 1$>7'B$! 2',%,3)$'73! *3!3.F,-! +,! ,F.+,3(.$! ).27! ZZZ! (73! *3!D'$+7! +,! ',(71,3+$(.J3! ).27!\8,F.+,3(.$! '$L73$;-,9EG*,! %.D*,!27%.(.73$3+7! $-! )'$)$1.,3)7! 37!G*.'I'D.(7! (717! 1H)7+7! +,!,-,((.J3!+,!2'.1,'$!-B3,$"!

#7%! 1,C7',%! ',%*-)$+7%! %,!7;)*F.,'73! (*$3+7! %,! ',$-.L7! *3!2'7)7(7-7! %.%),1$).L$+7! +,!)'$)$1.,3)7E! (71,3L$3+7! (73!*3$! &H'*-$! ,3! iE! 2$%$3+7! $! *3!\'$(,! 2',&$;'.($+7! >! $D',D$3+7!,C,'(.(.7%! +,! 17F.-.+$+!2$*-$).3$1,3),"!

g*,%)'$! ',F.%.J3! 1*,%)'$! G*,! ,-!%.).7! +,! &'$()*'$! 2*,+,! .3&-*.'! ,3!-$! (73%7-.+$(.J3E! +7%! $')B(*-7%!,F.+,3(.$;$3E! -$! 1$>7'! &$--$! +,!

(73%7-.+$(.J3! ,3! &'$()*'$%! +,!),'(.7! +.$&.%$'.7! 2'7K.1$-!$)'.;*.;-,! $! (73%.+,'$(.73,%!$3$)J1.($%! >! *).-.L$+$%! (717!&$()7'!2',+.()7'!.3+,2,3+.,3),!+,!-$! ,+$+E! %,K7E! 1,($3.%17E!)'$*1/).(7! >! &*3(.J3! 2',F.$! R4E<E!5S"!

#$! &*3(.73$-.+$+! $-! $@7! +,! -$!&'$()*'$! ,%! -$! 1.%1$E! ,3! ,-!)'$)$1.,3)7!37!G*.'I'D.(7!G*,!,3!,-! G*.'I'D.(7E! $%B! (717! ,-! D'$+7!+,! $(,2)$(.J3! 27'! 2$'),! +,-!2$(.,3),"!

P-! D'$+7! +,! $3D*-$(.J3! ,3!(*$-G*.,'$! +,! -7%! 2-$37%! G*,! 37!,K(,+$!-7%!!A5!$!<=U!%,!F.7!G*,!37!$&,()$;$3! -$! &*3(.J3! +,! -$%!$').(*-$(.73,%E! -7! G*,! (73(*,'+$!(73! -7%! ',%*-)$+7%! +,! :$'1.,3)7!RAS"!

#$! &'$()*'$! $%7(.$+$! $! *3$! -,%.J3!+,-! 3,'F.7! '$+.$-! ).,3,! $-)7%!B3+.(,%! +,! (73%7-.+$(.J3! >!',(*2,'$(.J3! +,! -$! &*3(.J3! ;$C7!)'$)$1.,3)7! 7')72H+.(7E! 37!%.,3+7!,%)$!*3$!.3+.($(.J3!2$'$!-$!(.'*DB$! 3.! 2$'$! -$! ,K2-7'$(.J3!),12'$3$!+,-!3,'F.7"!R?S"!

],!-$!',F.%.J3!%,!+,%2',3+,!G*,!,-!)'$)$1.,3)7! 37! G*.'I'D.(7! %.D*,!%.,3+7! *3! 1H)7+7! ,&.($L! ,3! ,-!)'$)$1.,3)7! +,! -$%! &'$()*'$%!+.$&.%$'.$! +,! 0*1,'7"! :,! +,;,!%,-,((.73$'!1*>!;.,3!,-!2$(.,3),E!37! %7-7! 27'! ,-! ).27! +,! &'$()*'$! %.!37! 27'! ,-! D'$+7! +,! (712'71.%7!+,!,%),!(73!,-!)'$)$1.,3)7E!G*,!%,!

Page 18: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

+,;,! ',$-.L$'!%.%),1$).L$+$1,3),E! (73!(73)'7-,%! %,1$3$-,%! >! (73! *3!$+,(*$+7! 2'7D'$1$! +,! ,C,'(.(.7%!7)7'D$+7%! 27'! ,-! (.'*C$37! 8-$!&.%.7),'$2.$! 37! 17%)'7! 1,C7',%!',%*-)$+7%!&*3(.73$-,%!R4S9"!

#7%! 1,C7',%! ',%*-)$+7%! %,!7;)*F.,'73! ',$-.L$3+7! *3$! &H'*-$!,3! i! ,3! ,-! 171,3)7! +,! -$!&'$()*'$! 8%.3! 1$3.2*-$(.J3! +,! -$!1.%1$9E! -$! (*$-! %,! +,C$! 27'! ,-!2,'.7+7! $D*+7! 8A! %,1$3$%9!2$%$3+7! +,%2*H%! $! *3! ;'$(,!2',&$;'.($+7! ,-! (*$-! %,! +,;,!$C*%)$'! 2,'.J+.($1,3),! >!$D',D$3+7!,C,'(.(.7%!+,!17F.-.+$+!2$%.F$E! 17F.-.+$+! $().F$! (73!%.D37%!+,! (73%7-.+$(.J3! (-B3.(7%! >!'$+.7D'/&.(7%"! g7! G*,+$! (-$'7!(*$3+7! $;7')$'! ,-! )'$)$1.,3)7!7')72H+.(7! 2$'$! $-D*37%! $*)7',%!%,! +,;,!2$%$'! $! -$%! V! %,1$3$%! %.!37! 0$>! %.D37%! (-B3.(7%! 3.!'$+.7D'/&.(7%!R<! EeS!>!2$'$!7)'7%!$!-$%!e!%,1$3$%!R5S"!

#$! (73%7-.+$(.J3! F.(.7%$! &*,! -$!(712-.($(.J3! 1$%! F.%)$! %.3!.12-.($3(.$%!,3!-$!&*3(.J3!3.!,3!-$!,%)H).($"!

:,! 3,(,%.)$3! ,%)*+.7%! (73!1$>7'!3.F,-! +,! ,F.+,3(.$! 2$'$! %,D*.'!,F$-*$3+7! -$! F.D,3(.$! +,! +.(07!)'$)$1.,3)7!2,'7!G*,+$!(-$'7!G*,!,%!*3!1H)7+7!,&,().F7E! (73!;$C$%!(712-.($(.73,%!>!+,!;$C7!(7%)7"!

!

!

J)30)%1$+K2+:.

4"! \'7$+;,3)! b"^"E! P-.L$;,)0! p.--E! b(o*,,3! b"b"!Q',+.().73! 7&! 7*)(71,%! $&),'! 0*1,'$-! +.$20>%$-!&'$()*',"! Z3C*'>E! Z3)"! q"! ($',! .3C*',+! f4! 8A=4=9! 5?Ar5??"!

A"!:$'1.,3)7!M"E!s$D7'%j>!!q"\"!E!s>(0!!k"M"!E#$))$!#"#"E!W$22%! W"M"""O*3().73$-! \'$(.3D! &7'! )0,! )',$)1,3)! 7&!&'$()*',%! 7&! )0,! a*1,'$-! ].$20>%.%"! X0,! C7*'3$-! 7&!;73,!C7.3)!$3+!%*'D,'>!hN#"!VArME!gN"!f!MQ^Z#!A==="!

<"^*)D,'%! b$'.C3! $3+! ^.3D! ]$F.+! "X',$)1,3)! 7&!].$20>%,$-! O'$()*',%! 7&! )0,! a*1,'*%! i%.3D! $!O*3(.73$-! ;'$(,"q"! N')072! X'$*1$! "h7-*1,! A=!Eg*1;,'!T!N()7;,'!A==e!E5T?re=4"!

f"! M3)73>! ],3$'+! q'"E! b]`! q*%).3! P"! ^.(0$'+%E! b]`!p.--.$1!X"!N;',1%j,>E!b]E!bQa`!b.(0$,-!W"!X*(j,'E!b]`!b$'j!O-7>+E!b]`!k',D!M"!a,'L7DE!b]".N*)(71,!7&!g7372,'$).F,!F%!N2,'$).F,!X',$)1,3)!7&!a*1,'$-!:0$&)! O'$()*',%_! M! ^,)'7%2,().F,! :)*+>! 7&! A4<!Q$).,3)%!"N')072,+.(%!EMD*%)!A=4=!tF7-*1,!<<!tZ%%*,!V"!

5"X7.F$3,3!!q"M"u"!Eg.,1.3,3!q"!E#$.3,!a"!q"!Ea73j73,3!!:"P"E! b"! q"! q$'F.3,3"! O*3().73$-! )'$)1,3)! 7&! (-7%,+!0*1,'$-! %0$&)! ! &'$()*',%"! Z3),'3$).73$-! 7')072,+.(%!8:ZWNX9!8A==59!AT_!4=r4<"!

e"!b.++,3+7'2!q"!q"!F$3E!"!u$L$(%$>!!OE#.(0),30$03!Q"E!!^,33,'! g"E! "! \$;%)! ^"E! ! b,-(0,'! k! ""! N*)(71,%!&7--7v.3D!72,'$).F,!$3+!373r72,'$).F,!1$3$D,1,3)!7&! 0*1,'$-! 1.+%0$&)! &'$()*',%_! $! 2'7%2,().F,E!7;%,'F$).73$-! (707')! %)*+>! ! 7&! f?! 2$).,3)%"! "#$! %!&$'#('!"()$*!+#$*!,-.//0!123-425-67!

!!?"!b$'j7!\*1;$%.',F.(E!M-,j%$3+$'!#,%.,w!!h,%3$!\*1;$%.',F.,w!E!k7'$3!W!7;,-C.,E!ZF$3! b.-7%%,F.(,E! a,3'>! ]*%0$3! P"! M)j.3%73"! X0,!1$3$D,1,3)! 7&! 0*1,'$-! %0$&)! &'$()*',%! v.)0!$%%7(.$),+!'$+.$-!3,'F,!2$-%>_!$!',F.,v!7&!44?!($%,%"!M'(0!N')072!X'$*1$!:*'D!8A=4=9!4<=_54Tt5AA!!

V"! P&)0.1.7%! Q$2$%7*-.%! E! k,7'D.7%! Z"! ]'7%7%E!M)0$3$%.7%! g"! h,'F,'.+.%E! ].73.%.7%! M-,K$3+'7%!h,',))$%"! O*3().73$-! ;'$(.3D! 7&! 0*1,'$-! %0$&)!&'$()*',%"! M! ',F.,v! 7&! (-.3.($-! %)*+.,%"! Z3C*'>E! Z3)"! q"!W$',!Z3C*',+!f4!8A=4=9!,A4t,A?"!

T":2.D*,-! M3+',! ^! E:),&&3,'! ^7;,')! q""a*1,'$-! :0$&)!&'$()*',%"!W*''!^,F!b*%(*-7%j,-,)!b,%!8A=4A9!5_4??t4V<"!

4=":$'1.,3)7! M"E! p$++,--! q"E-$))$! #""].$20>%,$-!a*1,'$-! O'$()*',%!X',$)1,3)!N2).73%"!&8"! %9:;<=>! 9?!@9<"!A!%9B<&!+:;C";D!E!%@%+F9;CG9>:H"!41I=!E!<:H@";!/.!E!9J&9@";!-../F!!!

Page 19: Fracturas de humero - clitoa.fmed.edu.uy fc... · $+,(*$+7!2'7d'$1$!+,!,c,'(.(.7%! 7)7'd$+7%!27'!,-!(.'*c$37!8-$! &.%.7),'$2.$!37!17%)'7!1,c7',%!!! 5??"!!!!!

44":$'1.,3)7! M"E-$))$! #"#"X0,! 373G*.'*D.($-!)',$)1,3)! 7&! )0,! &'$()*',%! .3! (73),127'$'>!7')072,+.(%! A+$! ,+.((.73! b$(! k'$v! a.--! b,+.($-!A==?!W$2),'%!4EA<!)7!!ff!"!

!

!

!

!

.

.

!

!