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At least 235 records · Page 13Linked to original sources
PubMed2005

The results of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus: a critical analysis of the results.

BACKGROUND: We would like to define the results of treatment of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus. METHODS: Between 1988 and 1998, 19 consecutive aged patients (older than 65 years old) with displaced comminuted articular fractures of the distal humerus were treated by open reduction and internal fixation with AO reconstruction plate. The age at the time of injury was 71.9 (65-79) years old. According to the AO classification, 15 patients had type C2 and four had type C3 injury. No patient had inflammatory arthritis of the elbow. The period of follow up is 97.2 (60-174) months. RESULTS: All fractures united with union time of 14.6 (11-20) weeks. No implant failure was found. In final follow up, the average flexion contracture was 16.8 degrees with a range of 0-40 degrees , the average active flexion was 128.4 degrees with a range of 115-140 degrees , the average pronation was 80 degrees with a range of 60-90 degrees , and the average supination was 78 degrees with a range of 60-90 degrees . According to the elbow motion classification of Cassebaum, eight (42.1%) patients were graded as very good elbow motion, eight (42.1%) as good, three (15.8%) as fair, and none as poor. The functional results showed that 15 (79%) patients had excellent results, four (21%) had good results, and none had fair or poor results, according to Mayo elbow performance score. The radiographic evaluation in final follow up showed that four patients (21%) had no osteoarthritic (OA) change, 11 (58%) had grade 1 OA, four (21%) had grade 2 OA, and none had grade 3 OA (the scale of Knirk and Jupiter). Fifteen (79%) patients reported no pain and four (21%) had mild pain. All patients were satisfied with their results. However, There were two early post-operative complications, including one (5.3%) superficial wound infection and one (5.3%) iatrogenic ulnar nerve injury. CONCLUSIONS: Open reduction and internal fixation with appropriate surgical technique is effective in the treatment of displaced fractures of the distal humerus in elderly patients.

Aged↗
PubMed1997

Salter-Harris type III fracture-dislocation of the proximal humerus.

Salter-Harris type III fractures of the proximal humerus are rare injuries. We report a Salter-Harris type III anterior fracture-dislocation of the proximal humerus in a 10-year-old boy that was open reduced and internally stabilized. A bone scan performed during the initial hospitalization and at 2-year follow-up revealed devascularization and subsequent revascularization of the humeral head. At 2-year follow-up, the patient had full motion of the shoulder, no pain, and arm strength equal to that of the contralateral side. Four cases of Salter-Harris type III fractures of the proximal humerus have been previously reported; good early clinical outcomes were obtained in all. Despite devascularization of the epiphyseal fragment, excellent clinical outcomes may result.

Child↗
PubMedDate not supplied

Alteration of Baumann's angle by humeral position: implications for treatment of supracondylar humerus fractures.

To determine the effects of limb positioning on Baumann's angle, we made a controlled radiographic study of a 6-year-old cadaver upper extremity specimen. Radiographic measurement of Baumann's angle was obtained at 10 degrees increments of humeral rotation from 40 degrees of internal rotation to 40 degrees of external rotation. These measurements were obtained with the humerus parallel to the x-ray cassette and with the humerus flexed 30 degrees from the cassette. Measurement of Baumann's angle with radiographs obtained with the humerus parallel to the x-ray cassette was associated with less variation in the measured angle (6 degrees of change for every 10 degrees of rotation). The relevance of these findings in management of supracondylar fractures is discussed.

Biomechanical Phenomena↗
PubMedDate not supplied

Lateral condylar fracture of the humerus following posttraumatic cubitus varus.

Posttraumatic cubitus varus is widely regarded as just a cosmetic deformity. Six cases of lateral condylar fracture of the humerus in children with preexisting cubitus varus due to prior elbow fracture are presented. Five occurred following malunited extension-type supracondylar fractures of the humerus; the other occurred following a lateral condylar fracture complicated by lateral overgrowth. All cases were treated by anatomic reduction (two closed, four open) and percutaneous pinning of the lateral condylar fracture. Three of the six cases subsequently underwent supracondylar osteotomy of the distal humerus to correct the underlying varus malalignment. Biomechanical analysis suggests that both the torsional moment and the shear force generated across the capitellar physis by a routine fall are increased by varus malalignment. Posttraumatic cubitus varus may predispose a child to subsequent lateral condylar fracture and should be viewed as more than just a cosmetic deformity.

Bone Nails↗
PubMedDate not supplied

Humerus varus: a complication of neonatal, infantile, and childhood injury and infection.

Sixteen cases of humerus varus consequent to proximal humeral fracture and osteomyelitis are described. A similar, but variably severe pattern of progressive deformity occurred in all cases. The medial region of the proximal humeral physis usually either developed slowly or failed to develop, whereas the lateral region developed more normally. This caused progressive angular rotation of the proximal humeral epiphysis and physis, so that the lateral region of the growth plate, in its most severe expression, was almost aligned with the longitudinal axis of the shaft. In the majority of the cases, there was a medial-metaphyseal lucency and adjacent medial-osseous bridge. In some cases, a flattened epiphysis and central bridge were present, with less varus deformation with progressive growth. Shortening of the humerus occurred in all cases. Functional impairment, usually a mild to moderate limitation of glenohumeral abduction, was infrequent, even when the dominant arm was involved. Axial lengthening may yet be undertaken. Surgical realignment with a corrective (valgus) osteotomy of the proximal humerus does not, however, appear functionally necessary for all patients.

Birth Injuries↗
PubMedDate not supplied

Cranial approach to the humerus for repair of fractures in horses and cattle.

A cranial approach to the humerus was developed for application of a compression plate for repair of comminuted humeral fractures in a weanling foal, a calf, a heifer, and a mature cow. An incision was made from the cranial portion of the greater tubercle of the humerus to the radius. The cranial aspect of the humerus was exposed by retraction of the brachiocephalicus muscle and blunt dissection between the biceps brachii and brachialis muscles. A second plate was applied laterally in the heifer and cow by retraction of the brachialis muscle and elevation of the extensor carpi radialis muscle. Successful fracture reduction, alignment, and stabilization were achieved in all four animals.

Animals↗
PubMedDate not supplied

Two techniques for supplementing interlocking nail repair of fractures of the humerus, femur, and tibia: results in 12 dogs and cats.

OBJECTIVE: To describe 2 devices for improving stabilization of inadequately stabilized interlocking nail (ILN) repairs of the humerus, tibia, and femur in dogs and cats. STUDY DESIGN: Prospective study. ANIMALS: Twelve client-owned dogs and cats. METHODS: Two devices to further stabilize ILN repair of inadequately stabilized diaphyseal fractures were developed. Device 1 was an axial extension for the ILN that was connected to a conventional type I external skeletal fixator (ESF) with a short connecting bar. Device 2 had hybrid ILN bolt/ESF pins that were used to lock the ILN and serve as the pins for a type I ESF. Devices were used at the initial surgery when the stability of ILN repair was considered inadequate based on palpable fracture segment movement, insufficient medullary canal filling of the ILN at the fracture site, or when the ILN was used in a buttress mode. Outcome was obtained by recheck examinations, radiography, and telephone interview. RESULTS: Device 1 was applicable to fractures of the humerus and femur, but was not used for fractures of the tibia because the ILN extension would have interfered with the stifle. No gross loosening of the ILN/ESF extension connection to the ILN occurred. Device 2 was easily placed and used in the humerus, femur, and tibia. Device 2 allowed removal of the ILN interlock to one or both main fracture segments non-invasively. Clinically, both devices added stability compared with ILN repair alone. Both devices facilitated controlled destabilization of the fracture repair as healing progressed. Complications of pin tract infection, and premature hybrid bolt/ESF pin loosening resulting in premature ESF removal each occurred in 1 patient. Four of 28 hybrid ILN/ESF pins were grossly loose at 4- or 6-week postoperative recheck examinations. Outcomes were excellent (9), good (1), fair (1), and poor (1). CONCLUSIONS: Inadequately stabilized ILN repair of fractures can be stabilized by use of either device, both of which also permit controlled destabilization of the repair during healing. Device 2 can be used when non-invasive removal of the ILN interlock is desired during healing. CLINICAL RELEVANCE: These 2 devices should be considered as alternative methods for stabilization of inadequately stabilized ILN repairs in dogs and cats, or when controlled destabilization of an ILN fracture repair is desired.

Animals↗
PubMed2006

Percutaneous fixation of comminuted fractures of the humerus: initial experience at Al Razi hospital, Kuwait.

OBJECTIVE: To present initial experience of 12 cases of percutaneous plating of the comminuted fractures of the humerus using minimal access surgery and standard low-contact dynamic compression plate. PATIENTS AND METHODS: Twelve patients (11 males and 1 female) with an average age of 29.8 years (range 17-46 years) with comminuted diaphyseal fractures of the humerus were treated by minimal access surgery using standard AO/ASIF implants. Fracture was reduced indirectly either by manipulation or by a femoral distractor. Image intensifier was used to monitor the reduction and fixation. The plate was fixed on the anterior surface of the humerus using proximal and distal minimal incision on the anterior aspect of the upper arm. RESULTS: All fractures were united, and all patients had a good range of motion in the adjacent joints. In 1 patient, there was a transient neurological deficit. CONCLUSION: Percutaneous fixation of comminuted fractures of the humeral shaft is an alternative to standard open surgery, reducing the surgical impact and giving an excellent functional result.

Adolescent↗
PubMed2003

Treatment of pathological fractures of the humerus with a locked intramedullary nail.

OBJECTIVE: The humerus is a common site for metastasis. Intramedullary nail fixation has been reported to be the best form of fixation for this disease but complications occur. This study aimed to assess the use of a new humeral nail to treat pathological fractures and impending pathological fractures of the humerus. METHODS: 29 patients received 31 Austofix locked intramedullary humeral nails: 25 for pathological fractures and 6 for impending fractures; 24 nails were inserted anterograde and 7 retrograde. Cement augmentation was applied in 4 patients, and adjuvant therapy was used in 28 patients. Complications occurred in 12 patients. RESULTS: Fixation failed in 6 patients: 2 due to intraoperative fractures during retrograde nailing, one due to a fracture through screw holes postoperatively, and 3 due to local progression of disease. Difficulty in distal locking of the nail was encountered in 4 patients. Locked intramedullary nailing resulted in a stable humerus in 80% of patients. CONCLUSION: Retrograde insertion of the nail is associated with an increased risk of intra-operative fracture, and disease progression can occur, despite the administration of adjuvant therapy.

Adult↗
PubMed1998

Second fracture of the distal humerus after varus malunion of a supracondylar fracture in children.

Nine children sustained a second fracture of the distal humerus after union of an ipsilateral supracondylar fracture which had healed with cubitus varus. There were eight boys and one girl with a mean age of five years (1 to 8) at the time of the second fracture which occurred at a mean of 1.5 years after the first. In all patients, the second fracture was an epiphyseal injury of the distal humerus, either associated with a fracture of the lateral metaphysis below the site of the previous supracondylar fracture, or a fracture-separation of the entire distal humeral epiphysis. This suggests that the physis and epiphysis tend to be more subject to injury than the metaphysis of the distal humerus in children who have had a previous supracondylar fracture with varus malunion.

Child↗
PubMed2000

Rigid internal fixation of fractures of the proximal humerus in older patients.

In 42 elderly patients, 33 women and nine men with a mean age of 72 years, we treated displaced fractures of the proximal humerus (34 three-part, 8 four-part) using a blade plate and a standard deltopectoral approach. Functional treatment was started immediately after surgery. We reviewed 41 patients at one year and 38 at final follow-up at 3.4 years (2.4 to 4.5). At the final review, all the fractures had healed. The clinical results were graded as excellent in 13 patients, good in 17, fair in seven, and poor in one. The median Constant score was 73 +/- 18. Avascular necrosis of the humeral head occurred in two patients (5%). We conclude that rigid fixation of displaced fractures of the proximal humerus with a blade plate in the elderly patient provides sufficient primary stability to allow early functional treatment. The incidence of avascular necrosis and nonunion was low. Restoration of the anatomy and biomechanics may contribute to a good functional outcome when compared with alternative methods of fixation or conservative treatment. Regardless of the age of the patients, we advocate primary open reduction and rigid internal fixation of three- and four-part fractures of the proximal humerus.

Activities of Daily Living↗
PubMed2004

Treatment of supracondylar fracture of the humerus in children by skeletal traction in a brace.

In 1980, we developed a specially designed brace for treating supracondylar fractures of the humerus in children, along with an easy and safe technique of reduction by skeletal traction. This method, which takes into consideration only the medial tilting and anterior angulation of the distal fragment, achieves complete reduction, ignoring any lateral, posterior and minor rotational displacements of the fragment. Skeletal traction is applied through a screw inserted into the olecranon and the angulation at the fracture site is reduced regardless of the anatomical position without manipulation. We treated 193 children with displaced supracondylar fractures of the humerus using this method between 1980 and 2001. Only four children (2%) developed cubitus varus. The majority obtained an excellent range of movement at the elbow; one had a 25 degree limitation of flexion. This technique is an effective and easy method of treating supracondylar fractures of the humerus in children.

Braces↗
PubMed2005

Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review.

The management of radial nerve palsy associated with fractures of the shaft of the humerus has been disputed for several decades. This study has systematically reviewed the published evidence and developed an algorithm to guide management. We searched web-based databases for studies published in the past 40 years and identified further pages through manual searches of the bibliography in papers identified electronically. Of 391 papers identified initially, encompassing a total of 1045 patients with radial nerve palsy, 35 papers met all our criteria for eligibility. Meticulous extraction of the data was carried out according to a preset protocol. The overall prevalence of radial nerve palsy after fracture of the shaft of the humerus in 21 papers was 11.8% (532 palsies in 4517 fractures). Fractures of the middle and middle-distal parts of the shaft had a significantly higher association with radial nerve palsy than those in other parts. Transverse and spiral fractures were more likely to be associated with radial nerve palsy than oblique and comminuted patterns of fracture (p < 0.001). The overall rate of recovery was 88.1% (921 of 1045), with spontaneous recovery reaching 70.7% (411 of 581) in patients treated conservatively. There was no significant difference in the final results when comparing groups which were initially managed expectantly with those explored early, suggesting that the initial expectant treatment did not affect the extent of nerve recovery adversely and would avoid many unnecessary operations. A treatment algorithm for the management of radial nerve palsy associated with fracture of the shaft of the humerus is recommended by the authors.

Algorithms↗
PubMed2001

Percutaneous pinning of the proximal part of the humerus. An anatomic study.

BACKGROUND: Closed reduction and percutaneous pinning of unstable proximal humeral fractures is a well-described technique with some theoretical advantages over open techniques. To our knowledge, the risk of injury to neurovascular structures from percutaneous pinning of the proximal part of the humerus has not been studied. We sought to quantify this risk using a cadaveric model. METHODS: In ten fresh-frozen cadaveric shoulders, the intact proximal part of the humerus was pinned under fluoroscopic guidance with use of an identical published technique. A total of five 2.5-mm terminally threaded AO pins, including two lateral, one anterior, and two greater tuberosity pins, were used in each shoulder. The specimens were then dissected to determine the distance of each pin from adjacent neurovascular structures as well as key anatomic relationships. RESULTS: The proximal lateral pins were located at a mean distance of 3 mm from the anterior branch of the axillary nerve. Four of the twenty lateral pins were noted to penetrate the articular cartilage of the humeral head. The anterior pins were located at a mean distance of 2 mm from the tendon of the long head of the biceps (perforating the tendon in three specimens) and of 11 mm from the cephalic vein (perforating the vein in one specimen). The proximal tuberosity pins were located at a mean distance of 6 and 7 mm from the axillary nerve and the posterior humeral circumflex artery (tenting the structures in two specimens with internal rotation), respectively. These pins moved away from the nerve with external rotation of the humerus. CONCLUSIONS: The technique used in this study may be associated with a risk of injury to important anatomic structures about the shoulder. Lateral pins should be distal enough to avoid injury to the anterior branch of the axillary nerve, and multiple fluoroscopic views should be obtained to avoid penetration of the humeral head cartilage. There may be a risk of injury to the cephalic vein, the biceps tendon, and the musculocutaneous nerve with use of anterior pins, and these pins should be employed with caution. Greater tuberosity pins should be placed with the arm in external rotation, should be aimed for a point 20 mm from the inferior aspect of the humeral head, and should not overpenetrate the cortex.

Bone Nails↗
PubMed2003

Open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus.

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. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See p. 2 for complete description of levels of evidence.

Adolescent↗
PubMed2006

Two-part surgical neck fractures of the proximal part of the humerus. A biomechanical evaluation of two fixation techniques.

BACKGROUND: Successful internal fixation of fractures of the surgical neck of the humerus can be difficult to achieve because of osteopenia of the proximal aspect of the humerus. The purpose of this study was to compare the biomechanical stability of a proximal humeral intramedullary nail and a locking plate for the treatment of a comminuted two-part fracture of the surgical neck in a human cadaver model. METHODS: Twenty-four cadaveric humeri were instrumented with use of either a titanium proximal humeral nail (PHN) or a 3.5-mm locking compression plate for the proximal part of the humerus (LCP-PH). The specimens were matched by bone mineral density and were separated into four experimental groups with six humeri in each: PHN bending, LCP-PH bending, PHN torsion, or LCP-PH torsion. Comminuted fractures of the surgical neck were simulated by excising a 10-mm wedge of bone. Bending specimens were cyclically loaded from 0 to 7.5 Nm of varus bending moment at the fracture site. Torsion specimens were cyclically loaded to +/-2 Nm of axial torque. The mean and maximum displacement in bending, mean and maximum angular rotation in torsion, and stiffness of the bone-implant constructs were compared. RESULTS: In bending, the LCP-PH group demonstrated significantly less mean displacement of the distal fragment than did the PHN group over 5000 cycles (p = 0.002). In torsion, the LCP-PH group demonstrated significantly less mean angular rotation than did the PHN group over 5000 cycles (p = 0.04). A significant number of specimens in the PHN group failed prior to reaching 5000 cycles (p = 0.04). The LCP-PH implant created a significantly stiffer bone-implant construct than did the PHN implant (p = 0.007). CONCLUSIONS: The LCP proximal humeral plate demonstrated superior biomechanical characteristics compared with the proximal humeral nail when tested cyclically in both cantilevered varus bending and torsion. The rate of early failure of the proximal humeral nail could reflect the high moment transmitted to the locking proximal screw-bone interface in this implant. CLINICAL RELEVANCE: The high failure rate in torsion of the proximal humeral nail-bone construct is concerning, and, with relatively osteoporotic bone and early motion, the results could be poor.

Adult↗
PubMed1978

Percutaneous pinning of supracondylar fractures of the humerus.

Six cases of supracondylar fracture of the humerus in children were treated by closed reduction and percutaneous pinning with two Kirschner wires inserted laterally through the capitellum of the humerus. This treatment has the same advantages as the commonly used percutaneous pinning with crossed Kirschner wires inserted through the epicondyles of the humerus, and it further eliminates the risk of damaging the ulnar nerve by the insertion of the medial Kirschner wire.

Adolescent↗
PubMed1990

Fractures of the proximal humerus in children. Nine-year follow-up of 64 unoperated on cases.

Fracture of the proximal humerus in children is rare. The records from 1976 to 1977 of 77 patients aged 0-15 years with a fracture or epiphyseal separation of the proximal humerus were reviewed. Totally, 64 of 72 patients had a follow-up examination (median observation time 9 years). Twenty-one children had an epiphyseal separation and 51 a metaphyseal fracture. All but 1 were treated conservatively. Seven had slight sequelae at follow-up, i.e., transient pain or minor restriction of motion. The rest were asymptomatic. Full remodeling of fractures left displaced occurred in all the cases. No avascular necrosis or shortening of the humerus were found. Nonoperative treatment is appropriate for proximal humeral fractures in children, even for those with extensive displacement.

Adolescent↗