25岁患者摔伤后就诊于北美某诊所，告知没事，肌肉拉伤，去做康复吧，三周后发现完蛋了，何去何从？？？
结果是美好的，教训是深刻的，老外总结了以下五点，都是患者的血和泪换来的。
#1: Examine your patients. And unless you have radiographic vision, you need x-rays to rule out fractures.
#2: At 3 weeks out, this is a terrible injury to fix. The shaft has been digging in the proximal humerus creating a defect. In an older person this may need a fibular strut. (in a young person with good bone usually don’t need a strut)
#3: There’s also a greater tuberosity fragment that’s displaced. You need to fix that reliably to give her good function.
#4: Make sure you are properly reduced, as in no varus. Also make sure you have good calcar screws. To prevent intra articular screws I typically drill to the subchondral bone and take 2-4mm off. Remember locking screws may not be in the joint at the time of surgery, but if the head collapses the locking screws will end up in the joint.
#5: Early range of motion is key! Don’t immobilize more than 2 weeks.
最后，这个钢板是北京积水潭郑州医院执行院长査晔军老师的师父MCKEE（快刀英雄谱之Mckee肱骨远端骨折七部曲）等发明的。
