Wang et al., "Application of additional medial plate
in treatment of proximal humeral fractures with unstable medial column: A finite element study and clinical practice," Medicine (United States), vol.
Augmentation techniques, such as an IM cortical strut graft, a second medial plate
, or both can be added mainly for mechanical purposes [3, 4, 6, 7].
* Difficulties were experienced in few initial cases especially in fractures reduction proper medial plate
placement and good bicortical screw purchase:
The lower end of the posterior border of the medial plate
appears to be con- tinued as a slender, curved or hook-like process termed as pterygoid hamulus (hamular process, pterygoideus hamulus, pterygoid hooklet).7
Stachyotis is similar to Rhabdocosma Meyrick, 1935 (Ypsolophidae) in the shape of the pleural lobes but differs from the latter in the male genitalia: processes on uncus in addition to socii present in Stachyotis, absent in Rhabdocosma; gnathos acuminate medially, up-curved in Stachyotis, with linguiform medial plate
in Rhabdocosma; and saccus longer in Stachyotis than in Rhabdocosma.
In one, the middle piece is formed by fusion of upper pair of nuclei and medial plate
of middle pair of nuclei.
Trunk scales with a very narrow smooth medial plate
Decision was made to leave the medial plate
in situ because it was not affecting his clinical progress and posed further surgical risk to be removed.
One patient had failed fixation who had started early manual labour without surgeon's advise, he was again operated with re-osteosynthesis with additional medial plate
and bone graft & recovered fully.
Scales small (measured length up to 1.0 mm); crown of trunk scales elongate, with relatively long posterior portion, with higher medial plate
and downstepped lateral areas; median plate bent down, with short, shallow notch anteriorly, smooth and flat or slightly raised posteriorly; lateral crown areas with one to two longitudinal ridges of different height; usually one spine, rarely up to five, very short, anterior to ridges; lateral ridges joined behind and below posterior point of medial plate
; base wider than crown, anterior spur directed either vertically, or anteriorly and downwards; pulp depression large, with rows of openings of dentine canals; pulp canal present; dentine canals proximally expanded and distally narrow.
In a biomechanical study of internal fixation of the distal humerus, Helfet and Hotchkiss (5) found that double-plate construction with the two plates at right angles, a medial plate
on the medial column and a posterior plate on the lateral column, provided the strongest fixation regardless of whether the plate was a one-third tubular or a 3.5 mm reconstruction plate.