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At least 253 records · Page 14Linked to original sources
PubMed1991

Ipsilateral proximal metaphyseal and flexion supracondylar humerus fractures with an associated olecranon avulsion fracture.

An ipsilateral proximal humerus fracture, "flexion" supracondylar humerus fracture, and olecranon fracture found together is a rare event. The supracondylar fracture should be reduced and percutaneously pinned before the ipsilateral upper extremity fractures are reduced. Displaced supracondylar fractures should be pinned with crossed smooth pins. Most pediatric proximal humerus and olecranon fractures can be treated closed.

Child↗
PubMed2004

Accuracy of the axillary projection to determine fracture angulation of the proximal humerus.

The accuracy of measuring angulation of stable proximal humerus fractures using the axillary lateral projection was investigated. A closing wedge osteotomy with apex anterior angulation was performed on two cadaveric humeri to simulate a stable surgical neck fracture. One specimen was fixed at 30 degrees angulation and the other at 55 degrees. Axillary radiographs were taken with each specimen articulating with the glenoid of a cadaveric scapula. The humerus was held in neutral rotation. Abduction was set at 30 degrees, 60 degrees, and 90 degrees. In each position of abduction, an axillary lateral radiograph was taken in 30 degrees forward flexion, neutral, and 30 degrees extension to simulate various arm positions. A total of nine radiographs were taken for each specimen. The axillary view is not accurate for measurement of proximal humerus angulation at the arm positions commonly encountered in the trauma setting.

Axilla↗
PubMed2001

Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement.

BACKGROUND: The commonly accepted treatment of displaced supracondylar fractures of the humerus in children is fracture reduction and percutaneous pin fixation; however, there is controversy about the optimal placement of the pins. A crossed-pin configuration is believed to be mechanically more stable than lateral pins alone; however, the ulnar nerve can be injured with the use of a medial pin. It has not been proved that the added stability of a medial pin is clinically necessary since, in young children, pin fixation is always augmented with immobilization in a splint or cast. METHODS: We retrospectively reviewed the results of reduction and Kirschner wire fixation of 345 extension-type supracondylar fractures in children. Maintenance of fracture reduction and evidence of ulnar nerve injury were evaluated in relation to pin configuration and fracture pattern. Of 141 children who had a Gartland type-2 fracture (a partially intact posterior cortex), seventy-four were treated with lateral pins only and sixty-seven were treated with crossed pins. Of 204 children who had a Gartland type-3 (unstable) fracture, fifty-one were treated with lateral pins only and 153 were treated with crossed pins. RESULTS: There was no difference with regard to maintenance of fracture reduction, as seen on anteroposterior and lateral radiographs, between the crossed pins and the lateral pins. The configuration of the pins did not affect the maintenance of reduction of either the Gartland type-2 fractures or the Gartland type-3 fractures. Ulnar nerve injury was not seen in the 125 patients in whom only lateral pins were used. The use of a medial pin was associated with ulnar nerve injury in 4% (six) of 149 patients in whom the pin was applied without hyperflexion of the elbow and in 15% (eleven) of seventy-one in whom the medial pin was applied with the elbow hyperflexed. Two years after the pinning, one of the seventeen children with ulnar nerve injury had persistent motor weakness and a sensory deficit. CONCLUSIONS: Fixation with only lateral pins is safe and effective for both Gartland type-2 and Gartland type-3 (unstable) supracondylar fractures of the humerus in children. The use of only lateral pins prevents iatrogenic injury to the ulnar nerve. On the basis of our findings, we do not recommend the routine use of crossed pins in the treatment of supracondylar fractures of the humerus in children. If a medial pin is used, the elbow should not be hyperflexed during its insertion.

Bone Nails↗
PubMed2001

Recurrent supracondylar humerus fracture following prior malunion.

In this report, two patients sustained a recurrent supracondylar humerus fracture following malunion of a previous supracondylar humerus fracture. The patients were treated for their first fracture at 5 and 6 years of age, respectively. One underwent open reduction with percutaneous pinning, and the other was treated with closed reduction with casting. Both patients healed in a moderate degree of extension after the first fracture. Two years later, both sustained a second fracture of the supracondylar humerus. Both had closed reduction with percutaneous pinning and went on to heal uneventfully. We speculate that ensuing post-traumatic extension deformity may accentuate a child's tendency for elbow hyperextension. Extension malunion may place the child at increased risk for a second fracture via similar mechanisms of injury.

Child↗
PubMed1975

Epidemiology of fracture of the upper end of the humerus.

The age and sex specific indicence was calculated in 729 cases of fracture of the upper end of the humerus. The prevalence of other fractures and conditions in these patients was investigated. The age and sex specific incidence is as that of femoral neck fracture with a rapid increase with age, twice as fast in women as in men. Only fractures which include evulsion of the greater tuberosity deviate somewhat from that pattern. The more displaced fractures have a tendency to occur later in life. The prevalence of other fractures is about doubled in patients with fracture of the proximal end of the humerus as compared to age and sex matched controls. This is true for fracture of the distal end of the forearm and fracture of the upper end of the femur but also for other fractures. The prevalence of severe alcoholism was significantly greater than in controls. A history of gastric resection was in these patients about three times as frequent as in a control sample. We conclude that fracture of the upper end of the humerus must be assigned a prominent place in the category of bone fragility fractures.

Adolescent↗
PubMed2002

[Simultaneous ipsilateral humerus and forearm fractures in children].

OBJECTIVES: To evaluate the results of treatment with early reduction and internal fixation for simultaneous ipsilateral distal humerus and forearm fractures in children. METHODS: The study included six patients (1 girl, 5 boys; mean age 11.5 years; range 9 to 13 years) who underwent treatment for ipsilateral humerus distal and forearm fractures. Reduction and fixation of fractures were performed percutaneously or by mini-open incisions. At the end of the follow-up period, patients were evaluated according to the Flynn's criteria. Radiologic and functional results on the involved side were compared with that of the normal. The mean follow-up period was 35 months (range 24 to 52 months). RESULTS: According to the Flynn's criteria, radiologic outcome was perfect in four patients (67%), and good in two (33%); functional results were perfect in three (50%), and good in three patients (50%). There were no significant differences between the two extremities with respect to elbow and wrist range of motion and radiologic parameters of the elbows. CONCLUSION: Early anatomic realignment of soft tissues and early active rehabilitation in simultaneous ipsilateral fractures of the distal humerus and forearm are significant factors for a satisfactory outcome. Treatment with early reduction and internal fixation with minimal soft tissue damage seems to be the method of choice in these fractures.

Adolescent↗
PubMed2002

Blood transfusion in proximal humerus fractures.

This article is the first to specifically address blood transfusions associated with surgical treatment of proximal humerus fractures. In our study, we retrospectively reviewed charts of all patients admitted to our institution with a diagnosis of proximal humerus fracture from January 1, 1994, to December 31, 1997. The transfusion rate for patients who sustained a proximal humerus fracture was 15%. Compared with patients treated nonoperatively, patients who underwent a surgical procedure were not at increased risk for requiring transfusion. Age, hematocrit level on admission, treatment method, and estimated amount of blood loss in patients who underwent a surgical procedure varied significantly between those who received a transfusion and those who did not. Certain characteristics placed patients at increased risk for requiring transfusion--age older than 60, admission hematocrit level less than 33%, and hemiarthroplasty as definitive surgical treatment. This information is important both in educating patients and their families and in making management decisions.

Aged↗
PubMed2003

[Comparison between the results of intramedullary nailing and compression plate fixation in the treatment of humerus fractures].

OBJECTIVES: The results of open reduction and internal fixation of humeral shaft fractures by either an intramedullary nail or a dynamic compression plate were compared. METHODS: The study included 60 patients (43 males, 17 females; mean age 38 years; range 19 to 61 years) with humerus fractures. Thirty-three patients were treated with intramedullary nails and 27 patients with dynamic compression plates. Functional results were evaluated according to the Stewart and Hundley's criteria. The two methods were compared. The mean follow-up period was 42 months (range 28 to 72 months). RESULTS: Healing times did not differ between the two treatment groups (p>0.05). Radial nerve palsy occurred only in the dynamic compression plate group, with four patients being affected. On the other hand, the rate of non-union was significantly higher in patients treated with intramedullary nailing (p<0.05). CONCLUSION: No ideal fixation technique exists in the treatment of humerus fractures. Despite higher non-union rates, intramedullary nailing may be the method of choice in the treatment of humerus fractures because of such advantages as low morbidity, small dissection of soft tissues, and greater ease of application.

Adult↗
PubMed2003

[Treatment of supracondylar humerus fractures in children, according to Gartland classification].

Supracondylar fractures are the most common fractures in the area of elbow in children. The purpose of this study was to review and analyze the treatment patterns of supracondylar humerus fractures in childhood. There were 93 children with supracondylar humerus fractures treated in the Department of Pediatric Orthopedics within the period from March 2000 till November 2002. Ninety fractures were extension-type injuries, 3 were flexion injuries, these were not included in our study. Supracondylar humerus fractures were classified according to Gartland classification. Type III fractures were found in 63 patients, type II fractures were seen in 23 patients and 4 patients had type I fractures. Indications for treatment were determined according to fracture type. Four children were treated with external immobilization alone. Twenty-three patients underwent closed reduction and percutaneous pinning by K-wires. Sixty-two patients were treated with closed reduction and external immobilization such as a plaster cast or according to Blount. Eleven of these 62 children (type III) underwent close or open reduction and internal fixation in follow-up. In 1 case of comminutive fracture a patient underwent immediate operation. There were no early or late complications. All operated patients healed without sequela and had excellent or good results. We had noticed that all manipulations should be performed immediately in order to avoid severe swelling and neurological or vascular complications. In type I fractures we performed the external immobilization only. Type II displaced fractures can be treated satisfactorily with closed reduction and external immobilization. Type III displaced fractures should be treated with closed reduction and percutaneous pinning with K-wires under the fluoroscope guidance. It is believed to be a safe, reliable and efficient method for treatment of this difficult fracture. Indications for open reduction and internal fixation includes open fractures, fractures complicated by vascular injury, unsatisfactory closed reduction due to unstable fracture.

Adolescent↗
PubMed2003

Treatment of open supracondylar fracture of humerus.

OBJECTIVE: To explore the injury mechanism and treatment principle of open supracondylar fracture of humerus. METHODS: The data of 32 patients with open supracondylar fracture of humerus hospitalized in our department in the recent 20 years were analyzed retrospectively. On an average, they were followed up for 30 months. The relationship between the fracture type, situation of wounds, operating time, operating method and time for postoperative functional exercise and final function of elbow joint were evaluated with Flynn scoring standard. RESULTS: Excellent therapeutic effect was found in 14 cases, good in 12 and bad in 6, with the percentage of fine therapeutic effect of 81.25%. CONCLUSIONS: For the patients with open supracondylar fracture of humerus, debridement and internal fixation should be made as early as possible, for thorough debridement and correct internal fixation are the key points to improve the prognosis.

Adolescent↗
PubMed2000

Closed reduction and percutaneous K-wires fixation of displaced supracondylar humerus fractures in children.

OBJECTIVE: To observe the effects of closed reduction and percutaneous K-wires fixation of displaced supracondylar humerus fracture in children. METHODS: Retrospective review of fourteen patients who sustained displaced supracondylar fracture of distal humerus treated by closed reduction and percutaneous K-wires fixation. RESULTS: All patients' K-wires were removed at 4 weeks post-operation. Their elbow function regained at weeks. The average period of followed up was 10 month (varies from 6 to 18 month), all fractures healed without any permanent complications. Two transient nerves palsy, ulnar and radial nerve each, recovered 12 weeks and 16 weeks post-operation respectively. CONCLUSION: Closed reduction and percutaneous K-wires fixation is a safe and efficient treatment for humerus surpracondylar fracture in children.

Adolescent↗
PubMedDate not supplied

The surgical treatment of fractures of the upper end of the humerus by blind pinning (author's transl).

During a period of five years, the authors have treated 250 fractures of the upper end of the humerus. Fifty-one were treated by blind pinning. Six to eight Kirschner wires are passed up to the head of the humerus under X-ray control through a hole made on the posterior aspect of the lower end of the humerus just above the olecranon fossa. The functional results were satisfactory in 70% of cases. The indications for pinning were for severely displaced fractures, comminuted fractures, either impacted or not, or slipping of the upper humeral epiphysis. The results were less satisfactory in cases with an elevated greater tuberosity. The technique cannot be applied to fracture-dislocations.

Adolescent↗
PubMed2004

Functional outcome following internal fixation of intraarticular fractures of the distal humerus (AO type C).

The aim of this study was to evaluate the functional outcome following internal fixation of intraarticular fractures of the distal humerus (AO Type C) with a minimum follow-up of two years. A retrospective evaluation with prospective clinical review was carried out. Twenty-six consecutive patients with fractures of the distal humerus were treated over a 31-month period. Their mean age was 56 years (range, 18-82). Six patients were not available for final clinical review. Analysis of the results were based on the medical records, pre-operative and postoperative radiographs of all 26 patients and clinical review of 20 patients at a mean follow-up of 35 months (range, 24-48 months). Twenty-six fractures were fixed using the AO double column plating techniques. Radiographic evaluation of the quality of reduction was carried out using a grading system. Clinical outcome was assessed using the Broberg and Morrey functional rating index. Fourteen patients (70%) had an excellent or good outcome, five patients (25%) a fair outcome and one patient (5%) had a poor result. Three patients (15%) underwent a second procedure for hardware removal. The mean arc of flexion was 112 degrees (range, 85 to 122). Mean pronation was 75 degrees (range, 60-82) and supination was 76 degrees (range, 60-80). No patients had achieved normal grip strength; the mean grip strength was 82% (range, 46-90%) compared to the uninjured side. Fifteen patients (75%) were able to return to their pre-injury level of occupation and activity. Seventeen patients (85%) were satisfied with the final outcome. We conclude that internal fixation of intraarticular fractures of the distal humerus is an effective procedure with an excellent or good functional outcome in most patient age groups. Patients have a high level of satisfaction and the majority return to their previous level of activity.

Adolescent↗
PubMed2004

Is manual foot lenght measurement of comparable value to ultrasound femur and humerus measurement in anatomical studies for the assessment of foetal age?

Contemporary anatomical studies require reliable methods for determining foetal age. Menstrual age is often found to be inadequate. A combination of several anatomical features showing age-dependency may result both in exact age approximation and pathology detection. The authors compared the manual foot length measurements with the ultrasound femur and humerus length measurements of aborted foetuses in the calculation of foetal age. The correlation between femur length and foot length as well as humerus length and foot length were statistically significant. The expected value formulae for foot length are presented. The authors conclude that foetal age assessment based on foot length metering is reliable before the 7th calendar month of pregnancy and correlates with ultrasound measurements of the humerus and femur.

Anthropometry↗
PubMed2004

Proximal humerus fractures in the elderly are we operating on too many?

Proximal humerus fractures in the elderly are a relatively rare injury, the treatment of which remains controversial, especially regarding Neer displaced two-part, and three-part and four-part fractures. Operative indications for most displaced proximal humerus fractures in the elderly remain poorly defined, but recent literature is actually supporting less aggressive approaches except for the most severe fractures. Recent epidemiological and larger scale retrospective studies fail to show a significant functional difference between operative and non-operative treatment of displaced two-part and three-part fractures in the elderly. Most four-part fractures appear to be best treated with hemiarthroplasty. Recent meta-analyses show a need for well-executed, randomized, prospective studies that can be used to provide evidence-based templates for appropriate management of displaced proximal humerus fractures in the elderly.

Age Factors↗
PubMedDate not supplied

Percutaneous pinning in displaced supracondylar fracture of humerus in children.

BACKGROUND: Supracondylar fracture of humerus is the most common fracture in first decade of life. There are various treatment modalities for this fracture i.e closed reduction and casting, open reduction and internal fixation and percutaneous pinning. Study was conducted to know the outcome of Percutaneous Pinning in the management of displaced supracondylar fracture of humerus in children. METHODS: This study was conducted at orthopedic unit of Khyber Teaching Hospital Peshawar from January 1996 to December 2000. Twenty children of 3-12 years age with displaced supracondylar fracture (Gartland type II & III) of humerus were included. Outcome measures were according to Flynn criteria i.e loss of elbow motion & carrying angle. RESULTS: The children presenting were 14 male (70%) and 6 females (30%). The involved side was left in fifteen(75%) and right in five(25%) of patients. Nineteen patients (95%) had extension type & one patient (5%) had flexion type of fracture. Gartland type II were six (30%) & type III were fourteen (70%). Our result showed excellent outcome in thirteen (65%), good outcome in four (20 %) and poor outcome in three (15 %) patients. CONCLUSION: Percutaneous pinning is safe, cost effective, time saving and provides greater skeletal stability with excellent results.

Bone Nails↗
PubMed1992

[Can humerus shaft fractures be treated with osteosynthesis?].

The treatment of fractures of the humerus shaft is still controversial. The results of functional treatment (brace) are good, consolidation occurs in most cases within 8-10 weeks, slight malalignment can be accepted, and there is no risk of postoperative complications like osteitis, neurological iatrogenic disorders and technical errors. On the other hand a correct osteosynthesis allows painless functional postoperative treatment, the patient comfort is excellent and a selected group of patients might return to work faster. We present the results of plate fixation of humerus shaft fractures in 127 patients, operated from 1980 to 1988. 102 patients were clinically and radiologically controlled after 1 year: 85 patients (83.4%) presented an excellent or good result with complete functional recovery. 17 patients (16.6%) showed a limited range of motion in shoulder and/or elbow mostly due to other fractures of the same arm or to persistent neurological disorders (plexus or radial lesions). Postoperative complications included 2 postoperative radial palsies recovering completely within months, 5 failures of internal fixation due to technical errors, 2 pseudarthrosis and 4 postoperative infections, healed by reoperation and early removal of the implant with one exception (osteitis). We therefore conclude, that a correct plate fixation of humerus shaft fractures is an alternative to conservative treatment. The main advantage is better patient comfort and shorter disability for a selected group of patients.

Adolescent↗
PubMed2005

[Functional results of displaced lateral condyle fractures of the humerus with four-week K-wire fixation in children].

OBJECTIVES: We evaluated the radiographic and clinical functional results of four-week K-wire fixation in the treatment of displaced lateral condyle fractures of the humerus. METHODS: The study included 69 children (19 girls, 50 boys; mean age 6.1 years; range 2 to 12 years) with displaced (>2 mm) lateral condyle fractures of the humerus. All the patients were treated by open reduction and internal fixation with two K-wires for four weeks. The fractures were classified according to the criteria by Milch and Badelon and functional results were evaluated according to the criteria by Hardacre et al. The mean follow-up period was 39 months (range 26 to 89 months). RESULTS: No complications were seen in the early follow-up period. On final evaluations, the carrying angles of both elbows were equal in 57 patients (82.6%), with a mean difference of 5 degrees in 11 patients (15.9%). The range of motion of the humeroulnar joint on the affected side differed from that on the contralateral side in only 15 patients (21.7%) with a mean of 5 degrees. Radiographic evaluations showed overgrowth of the lateral condyle and new bone formation over the condyle in 33 patients (47.8%). Functional results were excellent in 54 patients (78.3%) and good in 15 patients (21.7%). Nonunion did not occur. CONCLUSION: Treatment of displaced lateral condyle fractures of the humerus with open reduction and four-week K-wire fixation proved to be efficient to achieve satisfactory functional results.

Bone Wires↗