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PubMed2001

Functional outcome of proximal humeral fractures.

The functional outcome of 27 patients (16 males, 11 females) with a proximal humeral fracture was evaluated using the Simple Shoulder Test. Fifteen patients were also assessed using the Constant system. The mean age of the patients was 46.3 years (range 16-90 years) and the mean follow-up was 14 months (range 6-29 months). There were ten 2-part fractures, eight minimally displaced fractures, two 3-part fractures, three 4-part fractures, three 1-part fracture-dislocations and one 3 parts fracture-dislocation. Twenty-four fractures were treated conservatively and 3 surgically. Thirteen patients (48%) regained full function on the simple shoulder test and almost all regained range of movement sufficient for activities of daily living. Six patients were not able to return to their previous job. All patients were pain free at rest and were able to sleep on the affected side comfortably, although 9 patients had pain with activity, even though most pain were mild in nature. The mean Constant scores for the fractured arm and the normal arm were 72.5 points and 91 points respectively. The strength of shoulder abduction was reduced by a mean of 34%. Although the outcome was generally satisfactory, there was nevertheless a statistically significant deterioration of function following the fracture.

Adolescent↗
PubMedDate not supplied

Comparison of percutaneous pinning with casting in supracondylar humeral fractures in children.

BACKGROUND: In Children Supracondylar fracture of humerus is one of the most common fractures in first decade of life. There are various treatment modalities for this fracture i.e. Close reduction and casting, open reduction and internal fixation, skeletal traction and Percutaneous Pinning. This study was conducted to know the outcome of Percutaneous Pinning in the management of displaced supracondylar humeral fracture in children and to compare the results with close reduction and castings and published literature. METHODS: This descriptive study was conducted in Orthopaedic department of Ayub Teaching Hospital Abbottabad and Lady Reading Hospital, Peshawar from January 2002 till December 2003 on 40 children. Patients included were of either gender with age range from 3 to 12 years with displaced supracondylar fracture presenting within 72 hours of injury. Two treatment modalities were studied for comparison. Cross k-wires fixation through each humeral condyle was done after closed reduction of fracture under image intensifier in general anesthesia. Casting/Backslab was applied after reduction of fracture without image intensifier under anesthesia or analgesia. Out come measures were according to Flynn criteria that are functional and cosmetic factor which is based on loss of elbow motion and carrying angle in degrees respectively. RESULTS: Cross percutaneous pinning gave excellent results in 13 (65%), good outcome in 4 (20%) and poor outcome in 3 (15%) patients. While patients treated with close reduction and casting showed excellent results in 4 patients (20%), good in 8 patients (40%), fair in 2 patients (10%) and poor in 6 patients (30%). CONCLUSION: Closed reduction and cross percutaneous pinning for displaced supracondylar humerus fractures in children is safe, cost and time effective method and gives stable fixation with excellent outcome as compared to close reduction and casting.

Casts, Surgical↗
PubMed1996

[A new method of osteosynthesis in proximal humeral fractures: a new internal fixation device. Apropos of 17 cases followed over more than 2 years].

PURPOSE OF THE STUDY: The authors describe a new internal fixation device, and report on 17 proximal humeral fractures managed with this technique. MATERIAL AND METHODS: The fracture patterns, using Neer's classification were: 9 displaced three-part fractures, 4 displaced four-part fractures and 4 interior fracture dislocations (mean age of the patients: 70 years). The device is a two-part titanium device. The humeral component has a long vertical stem cemented in the humeral shaft; and a short proximal portion set at an angle of 135 degrees on the stem, with a neck and a Morse taper cone. The other part is a crown-shaped stapple, whose base is a perforated disk with a central Morse taper socket. The rim of the crown has five prongs which, together with the central socket, are impacted in the cancellous bone of the humeral head. The taper of the humeral component is inserted into the central socket of the stapple to provide fracture fixation. Tuberosities are reattached to the shaft with non absorbable sutures. RESULTS: Mean follow-up was 29 months. The global ratings were as follows: 4 excellent results, 6 good results, 4 fair results, 3 poor results. Mean active forward flexion: 100 degrees, and mean active external rotation 22 degrees. After exclusion of the 4 fracture-dislocations, the global rating became: 4 excellent results, 5 good results, 3 fair results, 1 poor result. Mean active forward flexion: 110 degrees and mean active external rotation: 31.5 degrees. There were no case of avascular necrosis in 13 patients. Complications requiring surgery occurred in one case: an upper protrusion of the stapple which required replacement of the stapple by a prosthetic humeral head. Other complications included: 2 asymptomatic partial protrusions of the stapple, 2 complete and two partial avascular necrosis in fracture-dislocations. DISCUSSION: Except for the fracture-dislocations our device confers several major benefits. The humeral head is preserved. Typical problems associated with joint replacement (dislocations, loosening, glenoid degeneration) are avoided. Humeral head conservation enhances healing of the tuberosities. Fixation could always be obtained, regardless of the complexity of the fracture pattern. An hemiarthroplasty (e.g. in case of avascular necrosis) is possible by the modular design of the device.

Adult↗
PubMedDate not supplied

Open reduction of displaced pediatric supracondylar humeral fractures through the anterior cubital approach.

The authors performed a retrospective review of the anterior cubital approach, an alternative exposure for displaced pediatric supracondylar fractures. Anatomic structures that hinder reduction, such as the brachialis muscle or joint capsule, and neurovascular tissues can be identified easily with this approach. Sixty-one children with displaced supracondylar humeral fractures were treated surgically with Kirschner wires using the anterior cubital approach between January 1996 and August 2002. The cohort comprised 35 boys and 26 girls with a mean age of 8.7 years (range 3-13 years). Mean follow-up was 3.5 years (range 1-6 years). Preoperatively 13 children (21.3%) had a neurovascular insufficiency that required an exploration during the operation. All patients were reduced completely with full anatomic position. On follow-up, no patient had any scar formation or deformity or experienced any restricted motion. The authors conclude that the anterior cubital approach is very effective and is an option for the treatment of pediatric supracondylar humerus fractures without serious complications.

Adolescent↗
PubMed2005

Interference Kirschner wires augment distal humeral fracture fixation in the elderly.

OBJECTIVES: This study was designed to compare the biomechanical stability of a two-plate distal humerus fixation with and without Kirschner-wire (K-wire) augmentation of supracondylar osteotomies. DESIGN: Ex vivo paired cadaveric study. SETTING: Biomechanical laboratory. MATERIALS: : Five pairs of fresh, elderly cadaveric humeri. INTERVENTION: Two 3.5-mm reconstruction plates were used to stabilize each humerus. This fixation model was selected solely to evaluate the effect of K-wire augmentation. Augmentation consisted of 2 K-wires placed in both the medial and lateral columns of the humerus to interdigitate with the plate screws. A posteriorly directed load was cyclically applied to the distal fragment for 5000 cycles or until failure, and osteotomy site motion was tracked optically. MAIN OUTCOME MEASUREMENTS: Fixation survival was defined as 5000 cycles or the number of cycles until osteotomy site motion reached >2 mm. RESULTS: K-wire augmented fixations survived significantly more cycles than did controls (4410 +/- 875 vs. 1114 +/- 2182, respectively; paired t test, P < 0.05). CONCLUSIONS: Augmentation with K-wires may decrease the incidence of loss of fixation in distal humeral fractures.

Age Factors↗
PubMed1992

Displaced supracondylar humeral fractures in children. A comparison of results and costs in patients treated by skeletal traction versus percutaneous pinning.

Clinical outcome and treatment cost were compared in 65 children treated by either percutaneous pinning or skeletal traction for displaced supracondylar humeral fractures. Clinical outcome was evaluated by loss of elbow motion and change in carrying angle. Results of treatment were basically equivalent in the two groups and were satisfactory in 90% or more. To determine treatment cost, the authors analyzed factors that vary according to the type of therapy. Cost of treatment was lowest in those who had percutaneous pinning and subsequent pin removal in the office. Compared to this group, the cost of treatment increased by 23% in those who had percutaneous pinning and removal of the pins as a surgical procedure, by 117% in those treated by traction with the olecranon pin inserted in the emergency room, and by 142% in those treated by traction with the olecranon pin inserted in the operating room.

Bone Nails↗
PubMed1987

[First results after the use of a Y-plate for the stabilization of supradiacondylar humeral fractures].

A new implant for the stabilisation of supra- and diacondylar fractures of the humerus is assessed. If compared with other implants this y-shaped plate has a considerably better stability. Due to different diameters of the holes 4.5 mm screws may be used for the long part, 3.5 mm screws for the branches of the plate, which in most cases allow good stabilisation and early mobilisation of the limb. Out of twelve patients, operated since 1981, ten were reexamined for follow-up after a mean of 34.1 months. All of the fractures stabilised with the y-plate were healed with normal osseous consolidation. According to the scheme of Cassebaum, the result was excellent in five, good in four and unsatisfactory in one patient. For each of the two available types of plates the dimensions proved to be sufficient with respect to the branches. However, for cases with fractures continuing into the humeral shaft, an additional type with a longer mainpart would seem desirable.

Adolescent↗
PubMed1987

Proximal humeral fractures. Late results in relation to classification and treatment.

One hundred and eighty-eight proximal humeral fractures were reviewed retrospectively in relation to the Neer classification and the treatment given. The displacement criteria were found to have prognostic significance. Minimally displaced fractures had excellent outcome, whereas the results following any treatment of the displaced fractures were unsatisfactory in about one half of the cases. The indications for closed or open treatment can only be defined by prospective studies, and the methods of treatment should be improved.

Adult↗
PubMed1992

[Primary humerus head replacement in dislocated proximal humeral fracture. Indications, technique, results].

Displaced three- and four-part fractures of the humeral head detached from their blood supply are at high risk for a poor functional outcome after internal fixation. Primary prosthetic replacement can restore the pretraumatic anatomy, and early function is possible. Head replacement within 2 weeks after trauma, reapproximation of the tuberosities, and reconstruction of the rotator cuff tear establishes early stability and good functional results in up to 80%.

Aged↗
PubMed1995

Delayed high median neuropathy after supracondylar humeral fracture. A case report and review of the literature.

Compression neuropathy of the median nerve around the elbow is an uncommon yet well-recognized clinical entity. Acute compression can occur after trauma to the elbow, whereas prolonged compression neuropathy usually involves compression under a normal or aberrant anatomic structure. The authors present a case of severe median nerve compression neuropathy above the elbow that occurred several months after a supracondylar humeral fracture in a previously asymptomatic adolescent with aberrant soft tissue anatomy.

Child↗
PubMed1990

Susceptibility to tourniquet-induced radial palsy in the presence of previous humeral fracture.

The purpose of this article is to present a potential hazard that may be encountered when using a pneumatic tourniquet during hand surgery, even when applied with the appropriate pressure and for the correct amount of time. Two of our patients developed complete radial nerve paralysis after hand surgery in which the pneumatic tourniquet was used. The tourniquet had a manometer between the cuff and the pump, which allowed for pressure control. The tourniquet time for patient 1 was 45 minutes and for patient 2 65 minutes, and the pressure was 250 mm Hg in both. Both patients had a history of humeral fracture on the paralyzed side.

Adult↗
PubMed1998

Shoulder hemiarthroplasty for proximal humeral fractures.

Shoulder hemiarthroplasty is a well-accepted surgical procedure for the treatment of specific subtypes of proximal humeral fractures, including four-part fractures, three-part fractures associated with severe osteopenia, head-splitting and severe articular impression fractures. Careful patient assessment and meticulous surgical technique are essential to prevent complications. The results are satisfactory in approximately 80% of cases. The results are better in younger patients and in acute versus chronic fractures. There are a significant number of complications that are related to technical details of the procedure. Careful placement of the prosthesis and secure reattachment of the tuberosities to the shaft reduce the chance of complication following surgery. Good to excellent results in terms of range of motion and pain relief can be expected in most patients.

Acute Disease↗
PubMedDate not supplied

Management of proximal humeral fractures.

The understanding of early controlled range of motion adapted to the stability of the fracture is crucial in postfracture shoulder therapy. The diagnosis and management of proximal humeral fractures have been reviewed. In addition, the aspects of therapy and the pertinent rehabilitation protocols are outlined. Although this article outlines standard treatment approaches, the specific therapy should be individualized to the patient's goals and abilities, and continuous communication between all persons involved in the patient's care is essential for achieving the best possible outcome.

Exercise Therapy↗
PubMed2000

[Treatment outcome after primary hemi-alloarthroplasty in dislocated humeral head fractures].

Humeral head fractures often lead to a high complication rate because of vulnerable vascularization of the humeral head, pretraumatical soft tissue lesions and osteoporotic bone. Compared with open reduction and internal fixation primary hemiarthroplasty seems to be an encouraging alternative treatment in case of dislocated and comminuted fractures. To evaluate our results following primary hemiarthroplasty we examined the outcome of 27 patients treated between November 1993 and May 1997 by primary hemiarthroplasty (15 Neer II, 12 Aequalis) in our institution within two weeks after trauma. The average patient follow-up was 3.5 years. Postoperatively more than 80% of the patients reported no pain. Excellent or good results with abduction over 90 degrees, low or moderate loss of power and low restraint in activities of all day living were achieved in about 50% of patients. The results according to the criteria of the Constant-Score depended on the intensity of the rehabilitation programme with an average outcome of 65 points. Maybe in the future functional results can be improved by a more aggressive rehabilitation and stronger rotator cuff refixation.

Aged↗
PubMed2001

Surgical treatment of distal intraarticular humeral fractures in adults.

We reviewed 17 patients with distal intraarticular humeral type C fractures, treated by open reduction and internal fixation, followed by an early rehabilitation programme. The results, as judged by the criteria of Jupiter, were excellent in ten, good in five and fair in two. Non-union of the olecranon osteotomy occurred in one patient.

Activities of Daily Living↗
PubMed2000

Percutaneous fixation of proximal humeral fractures.

The purpose of the current study is to evaluate the technique of closed reduction and percutaneous pinning of proximal humeral fractures and to determine whether this technique provides enough stability to permit early active range of motion and subsequent fracture healing. Fractures were classified according to Neer et al and were included if the surgical or anatomic neck were angulated greater than 45 degrees, separation between fragments was greater than 1 cm, or the greater tuberosity was displaced more than 0.5 cm. There were 21 Type II, 16 Type III, and four Type IV fractures. Fractures were pinned using distally threaded Dynamic Hip Screw guide pins, 2-mm Kirschner wires, or 2.5-mm distally threaded Schantz pins. Patients were evaluated for union rates and motion. Assessment was made using the Modified American Shoulder and Elbow Surgeons Form. Thirty-six patients with 37 fractures were available for review with followup averaging 40 months (range, 12-68 months). All patients with Neer Type IV fractures did not respond to fixation and three had avascular necrosis develop, irrespective of the type of pin used. In the remaining 33 patients with Neer Type II and Type III fractures, a union rate of 94% was observed at an average of 2.6 months. All patients had good functional results. In the current series, there were no failures using Schantz pins. There was a 20% failure rate with Dynamic Hip Screw pins (2% if the patients with Type IV fractures were excluded) and a 100% failure rate with Kirschner wires. Stable fixation with early motion and subsequently good results can be obtained using percutaneous fixation in patients with Type II and Type III fractures; however, terminally threaded pins must be used and smooth Kirschner wires must be avoided. Percutaneous fixation cannot be recommended in patients with Type IV fractures.

Adult↗