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PubMedDate not supplied

Forearm and humeral fractures.

Fractures of the forearm in an adult may involve the ulna, the radius, or both, or one may be fractured and the other dislocated. Because the ulna and the radius are joined by the interosseous membrane, injury to one often also affects the other. In the same way, the humerus can be effected from injuries of pressure at the site of the elbow. It is always wise to x-ray the entire upper extremity in most upper-limb injuries. Whatever the injury is, the patient will be incapacitated for several months by loosing the use of his or her upper extremity.

Biomechanical Phenomena↗
PubMed2006

Open medial placement of Kirschner wires for supracondylar humeral fractures in children.

PURPOSE: To assess the efficacy of our protocol for treatment of displaced Gartland type-3 supracondylar fractures of the humerus in children. METHODS: Records of 43 children with displaced Gartland type-3 supracondylar fractures of the humerus admitted from October 1997 to October 2003 were reviewed. Patients were treated within 12 hours of admission by closed reduction (n=33) or open reduction (n=10). Crossed medial and lateral Kirschner wires through a medial approach were used in all patients. A 3-cm incision was made medially to identify the correct entry point of the medial wire, and thus prevent ulnar nerve injury. The incision was extendable for open reduction if closed reduction was unsuccessful. RESULTS: The mean age of the 43 patients was 7.2 years (range, 2-14 years). The mean follow-up period was 48 months (range, 12-84 months). 83% of the fractures occurred in boys. All fractures were closed, extension type, with 28 (65.1%) involved the right elbow. No patient had iatrogenic ulnar nerve injury. All patients showed satisfactory results according to Flynn criteria. CONCLUSION: If closed reduction is unsuccessful, open reduction and open medial placement of crossed Kirschner wires can provide reliable results. The small medial incision provides a viewing point for entry of the wire and prevents iatrogenic injury of the ulnar nerve. It is cosmetically more acceptable and can be extended to facilitate open reduction.

Adolescent↗
PubMed2006

Supracondylar humeral fractures in children: ten years' experience in a teaching hospital.

Although supracondylar fracture is a very common elbow injury in childhood, there is no consensus on the timing of surgery, approach for open reduction and positioning of fixation wires. We report our ten-year experience between 1993 and 2003 in 291 children. Most fractures (285; 98%) were extension injuries, mainly Gartland types II (73; 25%) and III (163; 56%). Six (2%) were open fractures and a neurovascular deficit was seen in 12 (4%) patients. Of the 236 children (81%) who required an operation, 181 (77%) were taken to theatre on the day of admission. Most (177; 75%) of the operations were performed by specialist registrars. Fixation was by crossed Kirschner wires in 158 of 186 (85%) patients and open reduction was necessary in 52 (22%). A post-operative neurological deficit was seen in nine patients (4%) and three (1%) required exploration of the ulnar nerve. Only 22 (4%) patients had a long-term deformity, nine (3%) from malreduction and three (1%) because of growth arrest, but corrective surgery for functional limitation was required in only three (1%) patients.

Accidental Falls↗
PubMed2004

ORIF of delayed unions and nonunions of distal humeral fractures. Surgical technique.

BACKGROUND: The purpose of the present retrospective study was to evaluate the results of open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus. METHODS: Between 1976 and 2001, fifty-two patients with a delayed union (thirteen patients) or nonunion (thirty-nine patients) of the distal part of the humerus were treated with open reduction and internal fixation along with selective elbow joint arthrolysis and bone-grafting. The average time to presentation was eighteen months (range, two to 192 months) after the injury. Thirty-nine of the fifty-two patients had undergone an average of 1.6 previous operations. There were twenty-seven supracondylar, six transcondylar, thirteen intercondylar, two lateral condylar, and four medial condylar delayed unions or nonunions. The average duration of follow-up was thirty-three months (range, three to 198 months). RESULTS: Fifty-one of the fifty-two patients had healing of the delayed union or nonunion after the index operation; the average time to union was six months (range, two to twenty-four months). The average range of elbow motion increased from 71 degrees preoperatively to 94 degrees postoperatively. Complications included two superficial infections, two deep infections, and five cases of ulnar neuropathy. Fifteen patients (29%) needed additional surgery after the index procedure. Specifically, seven patients underwent removal of prominent hardware; six underwent hardware removal along with excision of heterotopic bone, ulnar neurolysis, and/or manipulation under anesthesia; one underwent irrigation and débridement; and one underwent compartment release. CONCLUSIONS: Open reduction through an extensile exposure and rigid internal fixation consistently results in healing of a delayed union or nonunion of the distal part of the humerus. An improved range of motion of the elbow can be achieved by securing the site of the nonunion and performing aggressive elbow joint arthrolysis and soft-tissue releases in patients with severe contractures.

Fracture Fixation, Internal↗
PubMed1992

Postoperative complications of distal humeral fractures. 27/96 adults followed up for 6 (2-10) years.

Of 96 adult patients with a distal intercondylar, intraarticular fracture of the humerus treated operatively during a 10-year period, 27 patients suffered a local complication, while the total number of individual complications were 34. There were six postoperative infections, 12 neural injuries, and 16 fixation failures. Because of the complication, a reoperation was performed in 12 of the 27 patients. The final outcome was assessed at a reexamination after a mean follow-up period of 6 (2-10) years. Three patients had a permanent dysfunction of the ulnar nerve. In another 3 patients, failure of the fixation had resulted in an established nonunion of the distal humerus. It appeared that the possibilities of internal fixation in several cases had been overestimated.

Adolescent↗
PubMed1998

[Treatment of humeral fractures by Marchetti nailing. Apropos of 45 cases].

Between 1995 and 1997 we implanted 45 Marchetti nails. These nails were implanted for traumatic fractures in 39 patients, but also for pathologic fractures in 5 patients. Among these 39 patients, 7 were lost of view, the average age was 60 years. Among these 39 patients, 4 have got an other treatment before which failed. 10 fractures were placed D1, 8 fractures placed D2, 5 fractures placed D3, 16 fractures placed D4 according to the classification of Hackethal modified by De la Caffinière. The fracture type was classified according to A. O. classification: 7 A1, 11 A2, 7 A3, 2 B1, 6 B2, 1 B3, 4 C1, 1 C2. Among the 32 patients reviewed with an average of follow-up of 11 months, we have observed 5 very good results, 14 good results, 6 passable results and 3 bad results (classification of Stewart and Hundley). The average length of consolidation was 3 months. At follow-up the average elbow mobility was 129 degrees. Among the 3 bad results, there were 2 pseudarthrosis, in D4 zone. We have got 3 supracondylar fractures during the removal of the nail and 2 impactions of the metaphysis fracture. 5 patients had a nailing for pathologic fractures, one of them bilateral (4 women and one man, average age 65 years). Only two patients were reviewed, the fracture healed without any difference with the traumatic group. Contrary to other nailing, this materiel respects the rotator cuff. The global functional result was good.

Adolescent↗
PubMed1975

[The surgical treatment of distal humeral fractures].

The treatment of this kind of fractures, especially involving the elbow-joint still is difficult and needs a thoroughly preoperative planning as well as an exact operative technique. Even in spite of optimal therapy failures are not avoidable in some cases, as our statistic shows.

Aged↗
PubMed1975

[Treatment of humeral fractures by intramedullary osteosynthesis].

Observations over 175 patients, treated for closed and open fractures of the brachial bone by intramedullary osteosynthesis with a metallic nail, are analysed. Among 175 patients 128 subjects were operated upon for closed brachial fractures, 26--for open fractures, and 21--for gunshot ones.

Adolescent↗
PubMedDate not supplied

[Treatment of the displaced distal humeral fractures- the original AO procedure by means of two reconstructive plates].

The aim of this paper is to assess the actual method of surgical treatment of the displaced fractures of the distal humerus, that is the AO technique, by means of 2 reconstructive plates. Until recently, we were very keen on using the Lecestre-type plate placed on the lateral pillar of the distal humerus. Since September 2001 we have managed to treat these types of fractures in the manner they are treated all over the world. Thus, the arch of motion of the elbow is improved both in terms of flexion and extension. Moreover, the 2 reconstructive plates can be properly molded on the surface of the bone entailing a firmly stabilized distal humerus.

Bone Plates↗