SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
We discuss four cases of bone cyst in the proximal humerus, in two boys aged 8 and 9, and two girls aged 2 and 5. Differentiation between a solitary and an aneurysmatic bone cyst can be difficult. The bone cyst in the proximal humerus is mostly benign. In one case (the 2-year-old girl) a malignancy, a telangiectatic osteosarcoma, was observed after 2-5 years follow-up. Humerus resection was performed.
Fourteen shoulders in 14 patients with minimally displaced fractures of the greater tuberosity of the proximal humerus were evaluated, at an average of 3 years, 7 months (range: 1 year to 6 years, 1 month) after the operation. For comparison this portion of the proximal humerus was measured using 100 Korean adult cadaveric humeri. The results of these preliminary studies suggest that the patients presenting with a one-part fracture of the greater tuberosity of the proximal humerus should be evaluated individually. In most patients in whom the displacement of the fragment is less than 5 mm, good results can be obtained with non-operative treatment. If the displacement of the fragment is more than 5 mm in young active patients, and more than 3 mm in individuals (especially athletes and heavy laborers) involved in overhead activity, the fragment should be mobilized, repaired, and fixed into its original bed or slightly inferolaterally.
BACKGROUND: Fixed-angle implants are being increasingly used in surgery of fractures of the proximal humerus. The aim of this retrospective investigation was to evaluate the outcome after fracture reduction utilizing a fixed-angle plate (Königsee). MATERIALS AND METHODS: Between January 2003 and April 2004, 58 patients were operated, 52 of whom received a fixed-angle implant; 46 cases were harvested for a follow-up examination. Each patient was re examined clinically and radiologically at least 6 and 18 months after surgery. The functional outcome was evaluated using the Constant Score and the Simple Shoulder Test. The results were compared to results of other investigations. RESULTS: The mean patient age was 68.8 years (34-94 years). Fractures were classified using the Neer Classification: 12 were classified as two-part, 25 as three-part, and 9 as four-part fractures. Three of the three-part and four of the four-part fractures were rated as luxation fractures. The overall functional outcome of all cases was good. More than 18 months after surgery the mean general "Constant Score" was 57; the mean side-related "Constant Score" was 89%. The Simple Shoulder Test revealed a pain-free range of motion in 41 (89.1%) of the individuals. The majority of the patients were satisfied with the results regarding remaining range of activity of the injured limb. In five cases significant complications occurred. In two cases the head of the humerus collapsed, and in one case a necrosis of the head occurred. In one individual the implant broke after an additional trauma. In this case a re-osteosynthesis utilizing a tibia plate was performed and the patient was excluded from further follow-up investigations. One soft tissue infection occurred after initial surgery. CONCLUSION: It has been shown that results after fixation of proximal humerus fractures with fixed-angle implants are good. The functional outcome is good and complications are rare. Our results correlate with other investigations regarding fracture reduction using fixed-angle plates and nails.
Successful treatment of three- and four-part proximal humerus fractures is a therapeutic challenge to the surgeon, particularly in the case of elderly patients. Open reduction and internal fixation have been advocated, but have not consistently produced acceptable results. The results of humeral head replacement as a salvage procedure after non-union or failed open reduction and internal fixation are less predictable. The outcome of hemiarthroplasty (Neer II) performed for three- and four-part proximal humerus fractures in elderly patients was studied. The average patient follow-up was 42.9 months (range 5-98). Eighteen women and eight men with an average age of 64.5 years were evaluated according to the UCLA. Constant-Murley and HSS Score. A Visual Score (0-100 points) was also used. Hemiarthroplasty was performed in 11 patients within 4 weeks of trauma and in 15 patients after 4 weeks. Fair, good, or excellent results were achieved in 80% (UCLA and Visual), 73% (HSS) and 46% (Constant-Murley) of the patients, respectively. Ninety-six percent of the patients reported only slight or no pain. The range of motion was limited in almost all cases. The outcome was not significantly influenced by age, sex and follow-up time. However, there was a significant correlation between the outcome and the length of time between injury and humeral head replacement (r = -0.5). The outcome after early hemiarthroplasty was better than after late humeral head replacement (UCLA: 27.1 +/- 4.6 vs 22.5 +/- 5.6 P = 0.04; Constant-Murley: 65.6 +/- 18.5 vs 47.5 +/- 18.6, P = 0.02; HSS: 74.0 +/- 14.4 vs 63.5 +/- 17.6, P = 0.17). Self-assessment did not differ between these two groups. After early hemiarthroplasty, active forward flexion was significantly better. This study indicates that early humeral head replacement for three- and four-part proximal humerus fractures in elderly patients achieved better functional outcome than delayed humeral head replacement. The decision to perform prosthetic humeral head replacement in these cases should be made as early as possible after trauma.
Supracondylar fracture of the humerus is the most frequently investigated fracture in children. However, systematic studies about postoperative growth patterns cannot be found in the literature. In this retrospective study, the authors attempt to delineate the configuration of supracondylar fractures which allow spontaneous correction of a malalignment or cause post-traumatic growth disturbances. The study included 256 children with supracondylar fracture of the humerus: 184 of them (71.9%) were available for longterm follow-up. The plain films of these children were reviewed and the Baumann and shaft-capitulum angles recorded. Spontaneous correction of a primarily displaced fracture was found in 13.0% ( n=21) of all fractures in the sagittal plane. Spontaneous correction in the frontal plane could not be shown. Growth disturbance was discovered in 10.5% ( n=16) in the frontal plane. No growth disturbance was demonstrated in the sagittal plane. The relatively small number of growth disturbances can be attributed to the low growth potential of the distal physeal plate of the humerus. Growth disturbances with secondary rotational errors were not observed in this study. Spontaneous corrections of alignment in the sagittal plane are only possible under a certain age. Spontaneous correction in the frontal plane, however, is inadequately assessed with this study. The design of a prospective study was formulated to assess how to improve the therapeutic management of supracondylar fractures and to answer additional open questions. Follow-up radiographs and standardized clinical evaluations have to be performed at the time of first free range of movement and 2 years after the trauma. This study will investigate whether therapeutic progress at follow-up is better evaluated with radiological or clinical means.
BACKGROUND: People with metastatic fracture of the humerus are of poor general health. Often they are not able to compensate the handicap of an impaired extremity. Standard osteosynthetic techniques are not always applicable. To reduce the trauma of the operation, we used the Fixion expandable nail system. METHODS: At two centers, 23 metastatic fractures of the humerus (in 22 patients) were stabilized with a new nailing system. The nail expands under hydraulic pressure up to 150% of its uninflated diameter, gaining long frictional contact to the bone. All patients were followed up until osseous healing occurred or until they died. RESULTS AND CONCLUSIONS: The operative time was approximately 32 min, including 1.4 min fluoroscopy time. Nail insertion is brief and therefore not very stressful to the group of debilitated patients who require this intervention. Immediately postoperatively, the upper extremity is stable to permit physiotherapy. In these few patients, we saw no complications. The advantages of the surgical approach appear to outweigh those of conservative management options if a simple and safe surgical technique makes the humerus stable enough to resist normal daily loads.
INTRODUCTION: Treatment choice for displaced, intercondylar fractures of the distal humerus is open reduction and internal fixation (ORIF) through a posterior approach. The triceps-reflecting anconeus pedicle (TRAP) approach, combination of modified Kocher and Bryan-Morrey has been described as a conservative surgical exposure for fixation of the complex intercondylar fractures. MATERIALS AND METHODS: Eleven patients with intercondylar fractures of the humerus operated with this approach were reviewed. The mean follow-up was 26 (14-40) months. The aetiology of injuries was mostly fall on the elbow. There were five females and six males and the average age of the patients was 58.3 years (range 16-70 years). RESULTS: According to Müller et al.'s classification; five were Type C1, four were Type C2 and, two were Type C3. At the final follow-up; Type C1 and C2 fractures had a ROM of 116 degrees (range 95 degrees-140 degrees) and, Type C3 fractures had a ROM of 85 degrees which showed limitation of elbow motion. Average humerotrochlear angle is 93.4 degrees (range 90 degrees-98 degrees). Two patients had transient n. ulnaris paraesthesia and one had heterotopic ossification. CONCLUSION: Our results demonstrate that TRAP approach is extensile enough in treating these complex fractures however both articular reconstruction and fixation can be easily managed without creating an olecranon fracture. No significant triceps weakness and dysfunction was observed after TRAP approach in the treatment of the intercondylar fractures of the humerus.
Three cases with injury of the axillary artery and brachial plexus complicating a displaced proximal fracture of the humerus are presented. In two patients the arterial injury was not recognized on admission. Vascular repair had to be carried out in all three cases. Two patients showed a persistent neurological deficit. In two of the cases, the arterial injury may have been caused by an attempt at closed reduction of the fracture. The possibility of axillary arterial injury should be considered in proximal fractures of the humerus with severe medial displacement of the shaft of the humerus.
Four children, who developed ulnar nerve palsy following percutaneous fixation of supracondylar fracture of the humerus by Kirschner wires (K-wires) are reported. In one the K-wire was removed within 48 h and the neuropraxia recovered immediately. In the other three patients recovery took an average of 6 weeks after removal of the wires and only after exploration of the ulnar nerve. The nerve was found to be trapped behind the medial epicondyle of the humerus. Release and subsequent transposition of the nerve resulted in recovery. Certain measures are suggested to prevent this avoidable complication in the treatment of supracondylar fractures of the humerus in children.
When an operative treatment is indicated for comminuted fractures of the proximal and middle one-third of the humerus, plate fixation is one of the better options. However, a long plate must be applied from the lateral aspect of the greater tuberosity to the shaft of the humerus, which requires dissection of the deltoid muscle insertion. We twisted the long plate and fixed it from the lateral aspect of the greater tuberosity to the anterior or antero-medial aspect of the mid or the distal shaft of the humerus preserving the deltoid muscle insertion in nine patients (10 limbs). Eight out of 10 cases involved comminuted segmental fractures of the proximal humeral shaft, the surgical neck, and the greater tuberosity. Tricortical autoiliac bone graft was necessary in two patients to restore the neck-shaft angle. All fractures healed uneventfully at 19 weeks on average without additional procedure (range: 14-28 weeks). Shoulder function was evaluated according to Neer's criteria. Three patients were classified as excellent, five satisfactory, and as two unsatisfactory, there was no failure.
Spiral fractures of the humerus in ball throwers are rare clinical entities that can be confused with pathologic fractures. These fractures have been reported in various throwing sports, arm wrestling, and hand grenade throwing. They most commonly occur in the distal third of the humerus in young, active individuals. They are often preceded by throwing arm pain. Neurologic sequelae are rare. Herein, a case is presented of spiral fracture of the humerus in a softball player, and the assessment and management of these fractures, as well as their etiologic contrast to stress and pathologic fractures, are reviewed.
Twenty-three shoulders in 23 patients with failed treatment of three- and four-part proximal humerus fractures subsequently treated with prosthetic arthroplasty were reviewed. The initial treatment was closed in 10 cases and open in 13. The complications of treatment included malunions in 17, nonunions in four, traumatic arthritis in 14, avascular necrosis in nine, humeral shortening in six, and deltoid paresis in four. In 20 cases prosthetic arthroplasty was performed an average of 15.8 months after injury. Three other cases had arthroplasty 19, 20, and 22 years after the original fracture. Seventeen were treated with a total shoulder arthroplasty, and six had a humeral head replacement. Thirteen had a tuberosity osteotomy, and eight had lengthening of the subscapularis tendon. Prosthetic arthroplasty reduced the shoulder pain in 22 (95%). Average active forward elevation increased from 68 degrees to 92 degrees, and active external rotation increased from 6 degrees to 27 degrees. After arthroplasty 53% of the patients were able to do activities at or above shoulder level compared with 15% before arthroplasty. Late surgery for failed early treatment is technically difficult, and the results are inferior to those reported for acute humeral head replacement. These findings should be considered when treatment is selected for acute three- and four-part proximal humerus fractures. Nonetheless late arthroplasty is a satisfactory reconstructive option when primary treatment of proximal humerus fractures fails.
Proximal humerus fractures are common injuries and represent approximately 5% of all fractures. These fractures are infrequently associated with neurovascular injuries. Brachial plexus injuries are uncommon, whereas axillary artery injuries are rare. A review of 19 previously reported cases of axillary artery injury after proximal humerus fracture revealed that 84% occurred in patients older than 50 years, 53% were associated with brachial plexus injury, and 21% resulted in upper extremity amputation. This study describes a case of axillary artery injury after proximal humerus fracture and, on the basis of a literature review, offers suggestions for the early diagnosis and effective treatment of this uncommon injury.
PURPOSE OF THE STUDY: In intra-articular fractures of the distal humerus, full functional recovery is difficult to obtain. An osteosynthesis by plate is the treatment of choice, but location and type of plate always remain open for debate. We present a consecutive series of intra-articular fractures of the distal humerus treated by osteosynthesis. The aim of the study is to determine and to compare the results of various types of osteosynthesis. MATERIALS AND METHODS: We reviewed 55 patients at an average of 108 months after early internal fixation for intraarticular displaced fractures of the distal humerus type C according to the A.O. classification. Intraarticular osteotomy of olecranon was used in 37 subjects (67.27%). The osteosynthesis has been achieved with a precasted lateral plate for 31 patients, with two posterior plates in 18 subjects, with a screwing on triangulation in four patients and with pins in two patients. RESULTS: The osteosynthesis with two posterior plates obtained a good result between 78.57% and 92.86% of cases, whereas the osteosynthesis with a precasted lateral plate gave a good result between 73.68% and 76.32% of cases according to the score used for estimation. In the aggregate, the functional estimate has a good result in the most of the cases whatever the score of estimate. At follow up we observed an average range of motion of 103 degrees. This value is quite good because it corresponds to the sector of the useful functional mobility. DISCUSSION: The review of our cases and the literature prompt us to follow the way of the osteosynthesis in adjusting indications to the type of fracture and in using a well-codifed technology. As it is already the case, a minimal osteosynthesis by screwing or by pins must be left except for peculiar cases in osteopenic elderly patients and if they have a very poor health. Contrary to other studies, the osteosynthesis with two posterior plates has given us better results provided that it has been systematically associated with a triangulation screwing in order to increase the strength of fitting in the sagittal plan. The precasted lateral plate gives a stable fitting too, nevertheless it is well advised to associate it to an osteosynthesis of medium column especially when the fracture is type C3. We have statistically proved that the age is not contraindication for osteosynthesis. CONCLUSION: This surgery is difficult and entails complications. The dismantling of the synthesis always gives poor results particularly if it is succeeded by an immobilization in plaster. The poor reduction, origin of arthrosis, of loss of bony substance and of calcifications worsen the functional prognosis. Last but not least, a good result can be obtained in the most of the cases however the types of fractures.
Most proximal humeral fractures in the elderly population are related to osteoporosis. Several methods have been proposed to treat surgical neck fractures of the proximal humerus in elderly people. This study investigates a new method of intramedullary pinning with tension-band wiring. From June 1998 to March 2001, 10 female patients with a mean age of 73.0 years and displaced two- or three-part surgical neck fractures of the proximal humerus were studied. Two intramedullary pins were used with tension-band wiring via a deltopectoral approach with minimum dissection. The mean follow-up was 20.6 months. Final outcome was evaluated using the constant score, visual analog scale (VAS) score, questionnaire, and an outcome assessment form. The outcome was excellent in four patients, good in five, and fair in one. The mean Constant score was 80.8 and the VAS score was 83.0. There was no nonunion, avascular necrosis, deep infection, or pin migration. No patient needed further revision open reduction with internal fixation or prosthesis replacement. We therefore concluded that intramedullary pinning with tension-band wiring is a safe, reliable method, with few complications, for treating surgical neck fractures of the proximal humerus in elderly patients.
A survey of all fractures in patients > or =35 years of age for hip, distal radius, and proximal humerus was performed in Tottori Prefecture, Japan. Hip fracture survey was done for the years 1986-1988, and also 1992-1994. A distal radius and proximal humerus fracture survey was done for the years 1986-1988, 1992, and 1995. The age- and gender-specific incidence rates of these three types of fracture among Japanese were substantially lower than those of whites living in North America or northern Europe. The age-adjusted incidence rates of hip fracture (per 100,000 person-years) were 40.7 and 114.1 in 1986 and 57.1 and 145.2 in 1994 for men and women, respectively, showing a significant increase with time for women. Upon examination of individual fracture types, there was no significant increase in cervical fractures, whereas a significant increase was observed in trochanteric fractures for women. The age-adjusted incidence rates of distal radius fractures for women were 164.9 in 1986 and 211.4 in 1995, showing a significant increase with time; however, no increase was observed among men. Incidence of proximal humerus fractures was 10.3 and 42.0 in 1986 and 17.1 and 47.9 in 1995 for men and women, respectively, and these increases were significant for both genders.
AIM: The aim of this study is to evaluate whether sonography as a primary diagnostic tool can be used for the diagnosis of supracondylar fractures of the humerus within a screening regimen. METHOD: With standardized sonography, a total of 75 children with suspected fractures of the distal humerus were investigated. The initially retrospective study (learning phase) was followed by a prospective study. All examinations were counter-checked by radiography. Supplementary to the standard sections two new sectional planes had to be added and evaluated. RESULTS: Of 65 children with fractures of the elbow, 43 had supracondylar fractures. All fractures could be visualized sonographically in the retrospective study and were diagnosed in the prospective examination. No supracondylar fracture was overlooked. Five results were falsely positive and would have been classified as undislocated supracondylar fractures type Baumann I. With the introduction of the two new sectional planes (dorsal radial and dorsal ulnar longitudinal section), rotatory deformity could be assessed. CONCLUSION: The longitudinal sections of the first compartment (standard sections) together with the two newly added dorsal radial and ulnar sections improved the diagnosis of supracondylar fractures of the humerus. The primarily unsatisfactory results could be improved by introduction of these additional sections, which are now recommended as standard sections of ultrasound application. Having acquired sufficient experience, the method can be used as a screening method for primary diagnosis and documentation of supracondylar fractures.
Stable internal fixation is essential to obtain healing of an ununited fracture of the proximal humerus. Standard plate and screw fixation may be inadequate to secure a small, osteopenic proximal fragment. We used blade plates and autogenous cancellous bone graft to repair ununited fractures of the proximal humerus in 25 patients (19 women and 6 men) with a mean age of 61 years. Healing was documented in 23 of 25 patients (92%). Objective and subjective instruments documented substantial functional improvement in patients with healed fractures. The results were classified as good or excellent in 20 of 25 patients, and few complications were encountered. Blade plate fixation facilitates successful treatment of ununited fractures of the proximal humerus.