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At least 271 records · Page 15Linked to original sources
PubMed2005

Long-term outcome of a proximal humerus fracture predicted after 1 year: a 13-year prospective population-based follow-up study of 47 patients.

BACKGROUND: Earlier reports of results after proximal humerus fractures have often been short- or medium-term studies. The aim of this investigation was to follow an unselected group of patients prospectively and assess the long-term results in relation to fracture type and health, and to evaluate the possibility of predicting the long-term results after 1 year. METHOD: 258 consecutive urban patients who sustained a proximal humerus fracture in 1987 were followed prospectively and examined after 1 and 13 years. 158 patients had died by the year 2000 and 47 of the surviving patients were available for clinical and radiographic evaluation. The Constant-Murley score (CM-score) was used in the clinical assessment. In the final follow-up group, all patients except 1 were treated nonoperatively. RESULTS: 21 patients had asymptomatic, pain-free shoulders. In 26 patients with shoulder symptoms, 11 had severe pain and 10 had moderate pain, and only 2 of these 21 patients had normal shoulder function. The remaining 5 patients in the symptomatic group had no shoulder pain but had reduced shoulder function. Shoulders with a displaced fracture and also injured shoulders of patients with a chronic disease were significantly worse at the long-term follow-up. The 1-year examination had been able to predict the long-term results with 71% sensitivity for protracted pain and 88% sensitivity for persistent shoulder dysfunction. INTERPRETATION: Our results suggest that there is a substantial mortality in patients with a proximal humerus fracture, as we have previously reported, and that surviving patients frequently have persistent symptoms that can be predicted as early as after 1 year.

Adult↗
PubMed2006

Proximal humerus fracture rehabilitation.

UNLABELLED: The occurrence of proximal humerus fractures will continue to rise with the increasing elderly population. Many patients with proximal humerus fractures have osteoporosis and have poor neuromuscular control mechanisms. This predisposes them to future falls and additional fractures. Patients continue to have shoulder problems as a result of the fracture for many years after the injury. Rehabilitation is central to addressing the problems caused by the fracture. The review of the literature on proximal humerus rehabilitation suggests that treatment must begin immediately if the harmful effects of immobilization are to be avoided. Electrotherapy or hydrotherapy does not enhance recovery and joint mobilization has limited evidence of its efficacy. In the United Kingdom most patients are immobilized routinely for 3 weeks or longer and are referred for physical therapy. The best available evidence for shoulder rehabilitation emphasizes using advice, exercise, and mobilization of limited joints to restore upper limb function. Placing controlled stresses throughout the fracture site at an early stage will optimize bone repair without increasing complication rates. This approach requires cooperation between the referring surgeon and therapist and will optimize the patient's shoulder function and maintain their functional independence. LEVEL OF EVIDENCE: Diagnostic study, level II (systematic review of level II studies). See the Guidelines for Authors for a complete description of levels of evidence.

Fracture Healing↗
PubMed2005

[Closed reduction and percutaneous lateral pin fixation in the treatment of displaced supracondylar fractures of the humerus in children].

OBJECTIVES: We evaluated the results of closed reduction and percutaneous lateral-pin fixation in the treatment of displaced supracondylar fractures of the humerus in children. METHODS: Thirty-four children (25 boys, 9 girls; mean age 7.2 years; range 3 to 13 years) were treated for displaced supracondylar fractures of the humerus. Five patients had Gartland type 2, and 29 patients had type 3 fractures. After closed reduction, lateral-pin fixation was performed with two parallel (n=11) or crossed (n=23) K-wires. Three K-wires were used in five patients. The mean duration of fixation was 3.8 weeks (range 3 to 6 weeks). For comparison with the normal side, the Baumann and carrying angles were measured on anteroposterior, and the humerocapitellar angle on lateral radiographs. The range of motion of the elbow was assessed clinically. The results were evaluated according to the criteria of Flynn et al. after a mean follow-up of 22.6 months (range 10 to 48 months). RESULTS: Union was achieved in all the patients. Complications such as pin-tract infections, myositis ossificans, compartment syndrome, or nerve injuries did not occur. According to the criteria of Flynn et al., functional and radiographic results were satisfactory in all the patients (100%) and in 33 patients (97.1%), respectively. One patient developed cubitus varus of 14 degrees. No significant differences were found between the mean Baumann, humerocapitellar, and carrying angles of the normal and affected sides (p>0.05). CONCLUSION: Closed reduction and percutaneous lateral pinning proved an efficient, reliable, and safe method in the treatment of displaced supracondylar fractures of the humerus in children.

Adolescent↗
PubMedDate not supplied

Conservative treatment vs prosthetic replacement surgery to treat 3- and 4-fragment fractures of the proximal epiphysis of humerus in the elderly patient.

Several previous studies have revealed a significant difference in the functional results obtained between conservative treatment and prosthetic replacement surgery to treat complex fractures of the proximal end of the humerus. Thus, prosthesis is the gold standard in treatment of such fractures. It is the purpose of this study to analyze the functional results obtained with the conservative treatment of 18 consecutive patients, mean age 78 years, affected with 3- and 4-fragment fractures of the proximal epiphysis of humerus. A comparison of functional results that may be obtained when prosthetic replacement is performed does not show significant differences in this category of patients. Thus, in order to limit complications, when the patient is elderly, complex fracture of the proximal epiphysis of humerus should be treated conservatively.

Aged↗
PubMed2006

[Neer classification of the proximal humerus fractures based on our own material].

INTRODUCTION: About 4-5% of all fractures are localised to the proximal end of the humerus. During the last 30 years a two-time increase has been observed. The cause was ageing of population and a higher incidence of fractures. Treatment improved owing to proper classification based on radiological diagnostics. OBJECTIVE: The principles of diagnostic and classification were presented on the basis of the literature and analysis of the clinical material. MATERIAL: We analysed the ways of the diagnosis and classification of the proximal humerus fractures in 166 patients treated in Traumatologic and Orthopaedics Department of the Bielański Hospital in Warsaw and in Orthopaedics Department of the Medical Postgraduate Medical Education Centre in Otwock during years 1988-2004. RESULTS: The classification suggested in 1970 by Neer has firmly established the way of treatment, is easy to remember, and regarded as the most popular and acceptable practice. It is based on dislocation one or more of the four bone fragments: shaft, head with articular surface, greater and lesser tuberosity of the humerus. Proper assessment of the type of fracture requires precise identification of these elements on radiograms. Correct assessment of dislocations of bone fragments and the way of dislocations is essential matter because specificity of the blood supply that improves heeling of the fracture and efficiency of the affected limb in the future. SUMMARY: It was found that conventional plain radiograms made in AP and Y exposures were sufficient for recognition the type of fracture. When diagnosis was questionable examination had to be broadened by axillar exposure and CT performed in the stated sequence.

Fracture Fixation, Internal↗
PubMed1990

Osteosynthesis for old, established non-union of the lateral condyle of the humerus.

In thirty elbows that had an established non-union of a fracture of the lateral humeral condyle that had occurred more than five years before, treatment consisted of one of three operations: anterior transposition of the ulnar nerve (nine patients), corrective osteotomy of the humerus and anterior transposition of the ulnar nerve (four patients), or osteosynthesis of the non-union combined with neurolysis and anterior transposition of the ulnar nerve, with or without corrective osteotomy of the humerus (seventeen patients). Of the thirty patients, fifteen had been apprehensive when using the elbow, due to lateral instability, or had had pain in the elbow. In thirteen of these fifteen patients, the non-union was treated by osteosynthesis. Afterward, the pain and apprehension disappeared, but the range of motion of the elbow decreased in all but three patients. Three patients had clicking between the humerus and radius, and the bone failed to unite in three others. Osteosynthesis is indicated for the treatment of non-union of the lateral humeral condyle only if the patient has serious pain in the elbow or apprehension when using the elbow, due to lateral instability.

Adolescent↗
PubMed1990

Immediate reconstruction of bone and skin defects of the humerus with free fibular graft and muscle flap.

The following Case Report describes the immediate reconstruction of bone and skin defects of the humerus with a free fibular graft and muscle flap. A 33-year-old white female sustained a gunshot wound to the left upper extremity with a 3.08 caliber high-powered rifle. The entry wound was on the lateral aspect of her mid-arm. The exit wound on the anteromedial aspect of the upper extremity measured approximately 10 x 15 cm. A segmental loss of the middle of the humerus and a defect of the radial nerve were noted. Within 48 hours after injury, reconstructive surgery was begun. A free vascularized fibula graft, peroneal artery, and concomitant vein were harvested from the left lower extremity, prepared, and inserted "peg in hole" fashion between the humerus fragments. The proximal segment was inserted between two fracture fragments, and the two fragments, including the proximal fibula, were transfixed with a single screw. The graft was revascularized with end-to-side anastomosis of the peroneal vessels to the brachial artery and its concomitant vein. The entire reconstruction was then covered with rotation of the latissimus dorsi muscle flap and a split-thickness skin graft. All wounds and the donor site healed primarily. Post-operative orthopaedic management consisted of maintenance of the external fixator for three months. Postoperative x-rays at 5 months showed healing at both ends of the fibular graft. A history of free fibula transfers and a discussion of the importance of aggressive, early, bony reconstruction using the free vascularized fibula graft are presented.

Adult↗
PubMedDate not supplied

Fractures of the proximal humerus involving the intertubercular groove.

The purpose of this study was to analyse the involvement of the gliding surface of the biceps tendon in fractures of the proximal humerus. Fifteen patients had a fracture of the proximal humerus verified with antero-posterior and axillary radiographs. Tangential radiographs of the intertubercular groove, obtained from the shoulder joint, showed involvement of the intertubercular groove in 13 patients (87%), which could not be shown with other projections. Groove radiographs revealed in 3 patients a dislocation of the fragments of the greater tuberosity large enough to require surgical treatment, but which had not been found using conventional techniques. Therefore, a groove radiograph should be used to precise fractures of the proximal humerus.

Adult↗
PubMed1988

Supracondylar fractures of the humerus--results of surgical treatment.

Forty-eight patients with supracondylar fractures of the humerus have been treated at St. Michael's Hospital in the past 10 years. Forty-six of the 48 were treated surgically. A comparison was made between the use of standard AO (ASIF) plates with a pre-contoured plate especially designed for the distal humerus. The results of this comparison suggested that the specifically designed plate provided superior fixation and better anatomic restoration of the distal humerus. Anatomic reduction, rigid fixation, and early surgery provide the best results.

Adult↗
PubMed1987

Closed nailing of the humerus--from down under.

Closed intramedullary nailing of the humerus using a curved clover-leaf nail (Pohl nail) is a relatively minor operative procedure and is associated with few complications. The technique of the operation when performed from below (29 cases) and also from above (7 cases) is that as described initially by Kuntscher and his colleagues. This paper presents the technique and the experience from 1978 to 1985 with 36 cases (20 for metastatic bone deposits, four in multiple injury patients, three in patients with a severe head injury, four in patients with multiple fractures in the same limb and five in other patients particularly elderly women with osteoporotic bones). This review demonstrates the efficacy of closed intramedullary nailing of the humerus particularly when the nail is inserted into the humerus from below just proximal to the olecranon fossa.

Aged↗
PubMed1986

Pathologic fracture of the humerus.

Review of patients with pathologic fracture of the humerus disclosed that closed treatment resulted in a high incidence of pain, disability, and failure to heal. The most common cause of pathologic fracture of the humerus is breast cancer. A review of records of 103 patients with persistent disease after initial treatment for breast cancer revealed that 19 had humeral metastases (18.5%); of those with humeral metastases, two patients (10%) had pathologic fractures. Prophylactic internal fixation of humeral metastases is not routinely recommended, but operative treatment for pathologic fracture of the humerus is generally superior to nonoperative methods of fracture management.

Aged↗
PubMed1984

Management of concomitant ipsilateral fractures of the humerus and forearm.

We treated nineteen patients with concomitant ipsilateral fractures of the humerus and forearm resulting in a so-called floating elbow. The injuries that were treated without open reduction and internal fixation had a high incidence of non-union of the humerus. This has led us to prefer open reduction and internal fixation of both the humerus and the forearm fracture.

Adolescent↗
PubMed1993

Treatment of difficult fractures and nonunions of the humerus and elbow with a modified Küntscher nail.

A series of fourteen difficult fractures and nonunions of the humerus and elbow have been treated over a period of twenty-eight years with a modified Kuntscher Nail. A total of twenty-six operative attempts had been previously made in this group of fourteen patients. One patient had eight failed surgeries prior to treatment. Slots were placed along the spine of the nail for transfixion with screws. In two instances additional modification of the Kuntscher nail was made by attaching a plate to the end of the nail for fixation to the ulna after retrograde insertion into the humerus. One such device was used to fuse the elbow. The other was used to stabilize a low nonunion in which the elbow was already fused. Union was obtained in nine cases with failure in five. Four of the failures united with one additional surgery. The one failed case had a surgical neck fracture which was eventually treated with a Neer prosthesis. The method described may not be superior to other methods; however, it can be successful in obtaining union in difficult elbow and humerus fractures or nonunions resulting from multiple failed prior procedures.

Adult↗
PubMed1994

Biomechanical evaluation of methods of internal fixation of the distal humerus.

The best results following fractures of the distal humerus are provided by anatomic reduction and rigid internal fixation. Plates of two designs placed in five different fixation configurations were used to determine the construct that would maximize rigidity of fixation of the distal humerus. Using a cadaver distal humerus osteotomy, with and then without cortical contact, motion of the distal fragment was measured with respect to the proximal fragment in axial and torsional loading, anterior to posterior and posterior to anterior bending, and lateral to medial and medial to lateral bending. With cortical contact, two plates when placed medial and lateral or at 90 degrees to each other provided equivalent rigidity. However, with a cortical gap, the combination of a specially designed anatomic lateral buttress "J" plate and a medial reconstruction plate gave the greatest rigidity (ANOVA, p < 0.05). Two-plate constructs do not require placement at 90 degrees to obtain sufficient rigidity, but do require placement on separate bony pillars and different surfaces.

Biomechanical Phenomena↗
PubMed1993

[Results of treatment of humerus shaft fractures].

"It is common practice to treat shaft fractures of the humerus conservatively" says the relevant literature. The results of 126 humerus shaft fractures in the years 1980 to 1989 are reported: 28 fractures were treated conservatively, 98 fractures underwent surgery using plate fixation, mainly the broad AO/ASIF-4,5-mm-DCP. As complications following operative treatment 4 temporary palsies of the radial nerve (4%), three cases of infection (3%) and one non-union (1%) were observed. The striking advantages of internal fixation are the chance of early functional treatment and the high convenience for the patient. The results reveal correctly performed osteosynthesis as an alternative method to conservative treatment of humerus shaft fractures.

Adolescent↗
PubMed1993

[Results of reconstructive surgery in fractures of the proximal humerus].

In treatment of comminuted dislocation fractures of the proximal humerus the most serious therapeutic problem still remains the 6th group of Neer's classification, in particular fractures with four fragments and with a completely dislocated and devitalized head. The authors present in a retrospective study an overall comparison of results assembled in 30 patients (and 19 checked patients resp.) who were operated by the technique of anatomical reconstruction (13 and 8 patients resp.) or by the authors own technique of non-anatomical reconstruction (17 and 11 patients resp.), all operated on account of comminuted dislocation fractures of the proximal humerus at the orthopaedic clinics of the First and Third Medical Faculty, Charles University, Prague in 1976-1988. Analysis of the results of the checked patients made the authors draw the following conclusions: 1. Fractures of the proximal end of the humerus is a relative frequent injury, in particular in the elderly. About 20% of these injuries call for surgical treatment. 2. In all non-anatomical reconstructions the mobility is very restricted in particular exorotation, in anatomical reconstructions the restriction is much smaller. 3. In all patients operated by the technique of non-anatomical reconstruction within three years necrobiotic reconstruction of the fragment of the head occurred which is the greater, the larger the fragment of the head which was preserved. 4. The result of the reconstruction depends on the preservation of nurture of the fragment of the head and on selection of an adequate technique of osteosynthesis. 5. In anatomical reconstructions the most frequent complication was loosening of the osteosynthetic material, a varus position of the head and pseudoarthrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Percutaneous pinning of the proximal humerus.

Percutaneous pinning, which has been recommended for unstable, unimpacted two-part fractures of the proximal humerus, requires satisfactory closed reduction and maintenance of reduction with minimum arm movement. Most surgeons usually keep the image intensifier in the anteroposterior (AP) plane and rotate the arm to obtain a second view. This arm movement may render closed reduction and percutaneous pin fixation difficult. A four-step technique that facilitates closed reduction and percutaneous fixation of unstable fractures of the proximal humerus and permits adequate visualization of the proximal humerus in both the AP and axillary planes is presented.

Fracture Fixation, Intramedullary↗
PubMed1998

[Retrograde intramedullary nailing in proximal fracture of the humerus in the elderly patient. Results of a minimally invasive management concept].

Retrograde intramedullary fixation of proximal humerus fractures with flexible wires was evaluated in a prospectively documented study. Seventy-four fractures in 73 patients with unstable proximal humerus shaft or neck fractures were fixed with 3-11 flexible intramedullary wires. The age of the patients averaged 72 years (42 females, 31 males). In nine fractures additional implants (screws, cerclages) were used to fix dislocated fragments through an anterior approach to the shoulder. Complications associated with the procedure especially in osteoporotic bone were secondary loss of reduction (16%) and wire migration (21%) which lead to revision surgery in 14% of patients within 6 weeks. A minimum follow-up of 12 months (average 16.5 months) could be obtained in 61 patients (84%). According to the Neer- and Constant-scores 60% showed good or excellent results, 30% had a satisfactory and 10% had an unsatisfactory or poor result.--Retrograde intramedullary, flexible wire fixation can provide an overall satisfactory outcome in unstable proximal humerus fractures of the elderly. However, the high incidence of secondary wire dislocations especially in marked osteoporosis appears to be an unsolved problem of this treatment modality.

Aged↗