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PubMed2002

Reconstruction of the proximal humerus after wide resection of tumours.

In 45 patients we assessed the functional results and complications for three different reconstructive procedures after resection of primary tumours of the proximal humerus. An osteoarticular allograft was used in 11, a clavicula pro humero operation in 15 and a tumour prosthesis in 19. The glenoid was resected with the proximal humerus in 25 patients. The axillary nerve was resected in 42 patients. The complication rate was lowest after reconstruction with a tumour prosthesis. The clavicula pro humero operation resulted in the most revisions. Cumulative survival rates for all the reconstructive procedures were similar. At follow-up at two years the functional results for the three reconstructive procedures were the same with a mean functional rating of 79% (Musculoskeletal Tumor Society). Excision of the glenoid had no influence on the functional result. Our findings indicate that the use of a tumour prosthesis is the most reliable limb-salvage procedure for the proximal humerus. The clavicula pro humero is an appropriate procedure if a prosthesis cannot be used.

Adult↗
PubMed2003

The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus.

The operative treatment of fractures of the proximal humerus can be complicated by poor bone quality. Our aim was to evaluate a new method which allows prediction of the bone quality of the proximal humerus from radiographs. Anteroposterior radiographs were taken of 19 human cadaver humeri. The cortical thickness was measured at two levels of the proximal humeral diaphysis. The bone mineral density (BMD) was determined for the humeral head (HH), the surgical neck (SN), the greater tuberosity (GT) and lesser tuberosity (LT) using dual-energy x-ray absorptiometry. The mean cortical thickness was 4.4 +/- 1.0 mm. Specimens aged 70 years or less had a significantly higher cortical thickness than those aged over 70 years. A significant positive correlation was found between cortical thickness and the BMD for each region of interest. The cortical thickness of the proximal diaphysis is a reliable predictor of the bone quality of the proximal humerus.

Absorptiometry, Photon↗
PubMed2001

Intermittently administered human parathyroid hormone(1-34) treatment increases intracortical bone turnover and porosity without reducing bone strength in the humerus of ovariectomized cynomolgus monkeys.

Cortical porosity in patients with hyperparathyroidism has raised the concern that intermittent parathyroid hormone (PTH) given to treat osteoporotic patients may weaken cortical bone by increasing its porosity. We hypothesized that treatment of ovariectomized (OVX) cynomolgus monkeys for up to 18 months with recombinant human PTH(1-34) [hPTH(1-34)] LY333334 would significantly increase porosity in the midshaft of the humerus but would not have a significant effect on the strength or stiffness of the humerus. We also hypothesized that withdrawal of PTH for 6 months after a 12-month treatment period would return porosity to control OVX values. OVX female cynomolgus monkeys were given once daily subcutaneous (sc) injections of recombinant hPTH(1-34) LY333334 at 1.0 microg/kg (PTH1), 5.0 microg/kg (PTH5), or 0.1 ml/kg per day of phosphate-buffered saline (OVX). Sham OVX animals (sham) were also given vehicle. After 12 months, PTH treatment was withdrawn from half of the monkeys in each treatment group (PTH1-W and PTH5-W), and they were treated for the remaining 6 months with vehicle. Double calcein labels were given before death at 18 months. After death, static and dynamic histomorphometric measurements were made intracortically and on periosteal and endocortical surfaces of sections from the middiaphysis of the left humerus. Bone mechanical properties were measured in the right humeral middiaphysis. PTH dose dependently increased intracortical porosity. However, the increased porosity did not have a significant detrimental effect on the mechanical properties of the bone. Most porosity was concentrated near the endocortical surface where its mechanical effect is small. In PTH5 monkeys, cortical area (Ct.Ar) and cortical thickness (Ct.Th) increased because of a significantly increased endocortical mineralizing surface. After withdrawal of treatment, porosity in PTH1-W animals declined to sham values, but porosity in PTH5-W animals remained significantly elevated compared with OVX and sham. We conclude that intermittently administered PTH(1-34) increases intracortical porosity in a dose-dependent manner but does not reduce the strength or stiffness of cortical bone.

Animals↗
PubMed2004

Changes in bone mineral density of the proximal humerus in Koreans: suture anchor in rotator cuff repair.

This study was conducted to obtain data concerning suture failure by identifying the change in bone mineral density in the proximal humerus relative to age and gender. Bone mineral density of the greater tuberosity, humeral head, and surgical neck of the proximal humerus was measured in 175 individuals (74 men and 101 women) aged >40 years. Compared to individuals in their 40s, the bone mineral density of the greater tuberosity of the humerus for women in their 70s showed a 42% decrease and in men a 43% decrease. It is therefore recommended that cadavers used for subsequent research on the fixation strength of suture anchors undergo bone mineral density analysis.

Absorptiometry, Photon↗
PubMed1999

Premature closure of the proximal physis of the humerus in a dog as a result of harvesting a cancellous bone graft.

A 5-month-old castrated male mixed-breed dog was evaluated because of lameness of the right forelimb. Physical examination revealed pain on manipulation of the right elbow joint, and radiography revealed premature closure of the distal physis of the radius with subluxation of the right elbow joint. Corrective osteotomy of the radius was performed to increase the length of the radius and establish congruity of the elbow joint. Cancellous bone was obtained from the proximal portion of the humerus and used as a graft at the osteotomy site. The dog did well after surgery. Four months after surgery, the dog again was lame on the right forelimb. Physical examination revealed instability of the right shoulder, and manipulation of that area elicited signs of pain. Radiography revealed caudomedial subluxation of the right shoulder as well as deformity of the humeral head and hypoplasia of the greater tubercle. It was presumed that these changes were associated with collection of the cancellous bone graft during the initial surgery, which resulted in premature closure of the proximal physis of the humerus. To our knowledge, this is the first report of premature closure of the proximal physis of the humerus as a result of procurement of a bone graft.

Animals↗
PubMed1999

[On the biomechanical reasons why children are liable to have fracture in supracondyle of humerus].

With the viewpoint of biomechanics in theory, this paper analyses why children are liable to have fracture in supracondyle of humerus as a result of falling to the ground with the upper limbs propping up the body while adults usually have fracture in the middle or upper part of humerus under the same condition. The focus of discussion is the change of front-inclination in the lower end of humerus in the process of bone maturity from childhood to adulthood.

Adult↗
PubMed2002

Hemiarthroplasty for complex fractures of the proximal humerus: surgical technique and results with the Atlas trimodular prosthesis.

The use of the Atlas trimodular prosthesis (Biomet, Inc., Warsaw, Indiana) to treat complex proximal humeral fractures in the acute and chronic setting is described. This prosthesis comprises an independent shaft, neck and head; its high degree of modularity allows the surgeon to match the local anatomy more precisely when sizing the prosthesis. The indications and contraindications for hemiarthroplasty for acute proximal humerus fractures are discussed, together with surgical technique for these fractures and for chronic proximal humerus fractures. Also addressed are chronic posterior fracture-dislocations and the results of arthroplasty for chronic complex fractures of the proximal humerus. Satisfactory results are dependent on proper surgical technique, compliance of the patient with rehabilitation and the absence of postoperative complications.

Arthroplasty, Replacement↗
PubMed2002

[Prenatal development of the human humerus in light of anthropometric examinations].

The study was done on 128 humeral bones (76 male and 52 female; 57 right and 71 left) obtained from 71 fetuses with C-R lengths ranging from 105 to 255 mm. Periosteum and perichondrium were exposed prior to radiography of frontal and lateral aspects using a Microphocus 401 bone X-ray apparatus. Radiographs were digitized with an analogue camera and an A/D converter for transfer to a PC computer. Nine measurements were done for each bone. Changes in proportions (structure-to-shaft ratios) during development were studied using non-linear regression analysis. The number of nutritive vessels in ossifying bone shafts were determined and indices were calculated representing sites of penetration into the humerus. The mean C-R length of the fetus when the first ossification center in the humerus appeared was 20.34 mm (21.75 mm in females and 19.0 mm in males corresponding to gestation age of 7 to 8 weeks). The length of the ossifying shaft increased proportionally to C-R length. The regression equations representing changes in the proportions of the humerus were linear in four cases: minimum anterior-posterior shaft size, minimum medial-lateral shaft size, maximum anterior-posterior condylus size, width of distal cartilage. The relative decrease in the length of the proximal and distal cartilages and their sum was regressed to three hyperbolic functions. The absolute length in mm of these cartilages increased. This change could be expressed with three exponential equations having positive fractional exponents. A single parabolic equation described the increase in the absolute and relative length of the distant chondro-osseous region. Analysis of the number of nutrient vessels, their direction and relation to surrounding structures was done in 76 humeral bones. The results are presented for pooled bones, as well as arranged by side (39 (51.3%) right, 37 (48.7%) left) and gender (54 (71%) male, 22 (29%) female). The number of nutrient foramina varied from one to three. A single nutrient foramen was found in 50%, two were disclosed in 40.85% and three in 9.2% of bones. Furthermore, 70.25% of them were located in zone IV on the anteromedial surface and the medial margin, 10.75% on the anterolateral and 15.7% on the posterior surfaces. The principal nutrient foramen contained an artery accompanied by a relatively large vein. As a rule, accessory foramina contained veins only, but in rare cases a branch of the nutrient artery was also present. All nutrient canals were directed distally. No significant differences were disclosed between right and left, male and female humeral bones as to indices representing location of the nutrient foramina.

Anthropometry↗
PubMed2005

[Closed reduction and percutaneous pinning with three Kirschner wires in children with type III displaced supracondylar fractures of the humerus].

OBJECTIVES: We evaluated the results of closed reduction and percutaneous pinning in the treatment of displaced supracondylar fractures of the humerus in children. METHODS: Sixty-one children (41 boys, 20 girls; mean age 7.6 years; range 2 to 13 years) were treated for type III displaced supracondylar fractures of the humerus within the first six hours after trauma. Initial neurologic examinations were normal. Treatment included closed reduction followed by percutaneous pinning with two lateral and one medial K-wires, the last being placed during decreased (80 to 90 degrees) elbow flexion. The ulnar nerve was examined intraoperatively, at the time of discharge, at the end of two weeks, and in the third and six months. On final examinations, the range of motion and carrying angles of both elbows were measured with a goniometer and anteroposterior and lateral radiograms of the affected elbows were examined. The results were evaluated using the clinical scoring system developed by Flynn et al. The mean hospital stay was 3.4 days (range 1 to 10 days) and the mean follow-up was 28.9 months (range 17 to 53 months). RESULTS: Iatrogenic ulnar nerve injury occurred in two patients (3.3%), which showed complete clinical improvement in three months. Union was achieved in all the patients. Superficial pin tract infections were seen in four patients (6.6%); and cubitus varus (1.6%) and myositis ossificans in two patients, respectively. Deep infection or compartment syndrome were not encountered. The results were excellent in 49 (80.3%), good in seven (11.5%), fair in two (3.3%), and poor in three patients (5%). CONCLUSION: Closed reduction and percutaneous pinning with three K-wires is an efficacious and safe procedure with a low complication rate in the treatment of type III displaced supracondylar fractures of the humerus.

Adolescent↗
PubMed1991

Use of polypropylene mesh to stabilize the "floating humerus" after total scapulectomy.

Total scapulectomy for malignant disease is a rarely performed procedure that presents a significant challenge for shoulder reconstruction. Failure to stabilize the resulting "floating humerus" may result in significant esthetic and functional problems. Current techniques of reconstruction and stabilization may yield suboptimal results and significant morbidity. We report a case of Ewing's sarcoma of the scapula, which required total scapulectomy. Polypropylene mesh was used in an attempt to prevent migration of the head of the humerus. The result was a stable shoulder with satisfactory motion and no additional morbidity. We believe that polypropylene mesh offers an advantage in shoulder reconstruction after total scapulectomy and should be considered as an option for stabilization of the humerus.

Adult↗
PubMed1990

[Centro-medullary nailing in fractures of the upper end of the humerus in children and adolescents].

The authors report a series of 55 fractures of the upper extremity of the humerus in children and adolescents surgically treated by elastic intramedullary nailing. The place of this surgical technique is evaluated in the general treatment of these fractures, which have the prognostic always favorable. The results, with a 1 year follow-up, are all excellent or good on the functional and anatomical plan. The cases of mal union have been rare and the correction is obtained with growth. This way be explained by the capacity of remodeling of the upper humerus. The treatment of fractures of the upper extremity of the humerus is first orthopaedic in children and adolescents, but the osteosynthesis by elastic intramedullary nailing can represent a surgical method of choice in the fractures which are displaced, unstable or which need a thoraco-branchial plaster.

Adolescent↗
PubMed1986

Nonunion of the humerus. Clinical, roentgenographic, scintigraphic, and response characteristics to treatment with constant direct current stimulation of osteogenesis.

Forty-six trauma patients who had developed non-union of the humerus were evaluated from 1972 through 1981 as part of a large prospective study on nonunion. The average age of the 46 patients was 55 years. Women outnumbered men (29 women and 17 men). Seventy-one percent of the fractures occurred below the midpoint of the humerus. Inadequate immobilization and/or distraction and failure of internal fixation devices to obtain and maintain fracture fragment contiguity and stability was noted. Of the 46 patients referred, 39 were treated with constant direct current, using percutaneously inserted electrodes. Senile and disuse osteoporosis (62%), synovial pseudarthrosis (42%), obesity (20%), and osteomyelitis (5%) in this older patient population made this a difficult treatment problem. Seventeen patients' nonunions healed (46%). Electrical stimulation of nonunion of the humerus is not a panacea. Patient selection is critical.

Adult↗
PubMed1986

Supracondylar fractures of the humerus in children. Analysis at maturity of fifty-three patients treated conservatively.

From a pool of 131 supracondylar fractures of the humerus in 131 patients who were treated conservatively, all of which healed in an average time of 4.5 weeks without complications related to the treatment itself, the cases of fifty-three patients were reviewed at maturity. The average age at follow-up was twenty-six years. Nine patients had unimportant limitation of elbow motion, and slight atrophy of the musculature of the arm or forearm, or of both, was present in six patients. Arm-length discrepancy was never observed. The carrying angle remained at about the same value that had been present at the time of fracture-healing in eighteen patients, decreased in twenty-two patients, and increased in thirteen. Malrotation of the distal fragment of the fracture only rarely caused medial tilting of the fragment with consequent cubitus varus. Varus deformity was present in four patients and valgus deformity, in three. None of the patients with valgus deformity had ulnar-nerve palsy. According to our results, varus and valgus deformities of the elbow after supracondylar fractures of the humerus seem to be caused either by growth imbalance of the growth plate of the distal end of the humerus (four patients) or by malreduction of the fracture (three patients). Twelve patients in the entire pool had neurological complications at the time of the fracture. Ten of those patients fully recovered from the deficit, whereas two--one with a radial-nerve deficit and the other with ulnar-nerve involvement--still had neurological impairment at follow-up.

Adolescent↗
PubMed1984

Radiation dose rates to the proximal humerus of growing beagles injected with 239Pu.

The anatomical distribution of 239Pu in the proximal humerus was studied in four beagles injected at 90 days of age and sacrificed 7, 28, 56, and 128 days after injection, respectively. Initial deposition in each humerus was 3.1% of the injected Pu; 41% of that was retained with a net halftime of 248 days; for the remaining 59% no decrease was observed with time. Sixty-one percent of the initial deposit was concentrated in the proximal epiphysis and metaphysis. Average radiation dose rates to trabecular bone of the epiphysis, to those parts of the metaphysis that were formed before and/or after injection, and to the area corresponding to the primary and secondary spongiosa were determined by fission track autoradiography. Local dose rates within the range of 10 microns of the endosteal surface, to the marrow and to osseous tissue were calculated. Because of the rapid growth and modeling rate, surface deposits declined rapidly. In the metaphysis, bone formed after injection contained less than 1/2 the Pu concentration of bone which was present at the time of injection. At 100 days of age, bone mineralization as determined by the ash weight/wet weight ratio, and the fraction of bone volume occupied by mineralized tissue was 1/2 that seen in young adult beagles. The surface/volume ratio was twice as high as in young adult beagles. The possible effects of local radiation doses were correlated with areal densities of cells and types of cells at risk. Comparisons were made with corresponding sites from the humerus of beagles injected as young adults.

Aging↗
PubMedDate not supplied

Replacement of the proximal humerus with a ceramic prosthesis: a preliminary report.

Insertion of a multicomponent ceramic prosthesis with extracortical fixation to the conically reamed shaft of the humerus was performed in 7 patients after resection of 4 malignant and 3 benign tumors of the proximal humerus. The length of the replacement ranged from 9 to 18 cm. Fixation was secure in all but one patient, who sustained a fracture through the proximal humerus. Subluxation occurred in 3 patients but posed no difficulty, except in one patient who required revision for a dislocation. Functionally, little active motion is achieved, but the implant provides a spacer to permit efficient use of the hand and elbow. No patient has had local recurrence of the tumor. One patient died one year postoperatively from an unrelated second primary cancer. Although the preliminary results are encouraging, further investigations are necessary on the mechanical aspects of the cone fixation principle and of the techniques of shoulder muscle reconstruction to improve the function of the prosthetic joint.

Adult↗
PubMed1981

[The two columns of the lower end of the humerus].

The anatomical examination of the distal end of the human humerus brings new perspectives. The lower extremity of the humerus is considered as a structure with two diverging columns that prolong the diaphysis and flank the trochlear mass articulate with the ulna. Two series of dry humeruses, one of 100, and the other 20 permitted a study with measurements of the posterior width of the columns, their antero-posterior dimensions, the angle that they form with the posterior longitudinal axis of the diaphysis. Dry bones, radiographs, and direct tracing were used. The second series of bones was used for cross-sections in several planes, and for perforations of the fossae. Lastly, graded cuts of frozen elbows were done. These methods showed the two columns to be completely different. The outer column is thick, quadrangular, bulky, convex at the back, wide, almost vertical; in front it bears the condyle, while a lateral facet appears on its distal part; this column is articulated with the radius and extends itself to the thumb column. The inner column is fusiform, narrow, oval on cross-sections; it is a column which supports the trochlea and the muscles, two roles played also by the outer column.

Anthropometry↗
PubMed1975

Distal humerus in hominoid evolution.

Multivariate analysis of 16 measurements of the distal humerus in samples of hominoids, cercopithecoids, Tertiary hominoid fossils, and early hominids shows the following results: (1) there is a substantial and functionally interpretable difference between the distal humerus of cercopithecoids and hominoids (excluding Hylobates); (2) the Tertiary hominoid fossils resemble the cercopithecoids more than the hominoids although they are in some ways intermediate; (3) the hominid fossil from Kanapoi resembles Homo sapiens very closely; (4) the Kromdraai humerus is intermediate in shape between Pan and other hominoids; and (5) the large fossil hominid from East Rudolf (KNM-ER 739) is unique among the hominoids.

Animals↗
PubMed1993

Parosteal (juxtacortical) chondrosarcoma of the humerus associated with regional lymph node metastasis. A case report.

Recurring parosteal (juxtacortical) chondrosarcoma of the humerus occurred in a 79-year-old man. Roentgenograms of the left humerus showed minimal cortical irregularity and a large soft tissue mass without calcification or periosteal reaction. Magnetic resonance imaging (MRI) showed a multilobular tumor of high intensity (T2-weighted imaging) without marrow involvement. During the left shoulder disarticulation an enlarged axillary lymph nodes was discovered and removed. Macroscopic examination of the disarticulated humerus showed a large yellow parosteal mass, which looked like cartilage, completely surrounding the humeral shaft. The marrow cavity was almost normal except for a small erosion at the site of the olecranon fossa. The histologic diagnosis of the mass was Grade 2 chondrosarcoma of parosteal (juxtacortical or periosteal) origin associated with regional lymph node metastasis. The features that made this case unique were a long history of the tumor (for 32 years), minimal cortical destruction of the bone by the tumor, and regional lymph node metastasis. This case illustrates the differential diagnosis of the parosteal chondrosarcoma from periosteal osteosarcoma and extraskeletal myxoid chondrosarcoma.

Aged↗