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PubMed2005

Significance of the latissimus dorsi for shoulder instability. I. Variations in its anatomy around the humerus and scapula.

In a cadaveric instability model that leaves all muscles intact initially, we studied anteroinferior glenohumeral dislocation behavior after section of the ligaments on the humeral side of the joint. In this study, the latissimus dorsi seemed to play a role when complete section did not result in a locked anteroinferior dislocation. We therefore initiated a study to test the hypothesis that the latissimus dorsi may, in certain circumstances, depending on variations in its anatomy, influence dislocation behavior. Here, in Part I, we present the results of the anatomic study of latissimus dorsi and its tendons. The anatomy of the latissimus dorsi pertaining to the scapula and humerus was studied in 100 cadaver specimens. The distance between the uppermost part of the tendon of both the latissimus dorsi and the teres major and the edge of the articular cartilage of the humeral head (tendon-cartilage distance, TCD) as well as the width and length of the tendons were measured. Furthermore, the relationship between latissimus dorsi and the inferior angle of the scapula was studied. The tendon of the latissimus dorsi inserted at a variable distance from the cartilage of the humeral head: the TCD ranged from 12.6 to 31.6 mm (mean 21.06 mm+/-5.11 mm). The latissimus dorsi can have muscular fibers arising from the inferior angle of the scapula (type 1 scapular connection, 43%). Alternatively, there may be only a few fibrous strands between the muscle and the scapula or there may be an intervening bursa (type 2 scapular connection, 57%). This variability in the morphology of the latissimus dorsi may be a factor explaining the differences observed in a study of humerus-based sequential cutting of the glenohumeral capsule. This possibility is explored in Part II of the study. The latissimus dorsi may also complete the tendinous protection of the humeral side of the capsule generally provided by the rotator cuff.

Cadaver↗
PubMed1994

Humerus and femur length in fetuses with Down syndrome.

The aim of the study was to assess the value of sonographic measurement of fetal humerus and femur lengths in the second trimester as a screening tool for Down syndrome (DS). We reviewed retrospectively fetal sonographic biometry made at the time of amniocentesis between 15 and 19 weeks. The study group consisted of 27 DS fetuses. The control group comprised 500 normal fetuses chosen randomly. The expected humeral and femoral lengths for a given biparietal diameter were estimated by linear regression equations from the 500 normal fetuses. Receiver operating characteristic curve analysis was performed to evaluate both the detection rate and the false-positive rate of different cut-off values of measured to expected lengths ratios. The median femur and humeral lengths in DS fetuses were 0.91 times the expected values. No significant differences in the detection rate and false-positive rate were found between the humerus and femur lengths. When the humeral and femoral lengths were combined, we observed a remarkable reduction in the false-positive rate. A measured to expected length ratio of 0.91 detected 44.4 per cent of DS fetuses with 7.6 per cent false positives. These results suggest that the combination of femoral and humeral lengths may permit a more efficient use of ultrasound in screening for Down syndrome than the use of either alone.

Down Syndrome↗
PubMed1999

Patterns of sexual dimorphism in the hominoid distal humerus.

Basic biomechanical principles predict that body size differences and differences in the positional behavior of primates should impact on the design of the locomotor skeleton. Allometric distortions in joint shape might be expected between sexes if the degree of body size dimorphism is substantial and/or if sex-specific differences exist in behavior. Nevertheless, there are few documented cases of sexual dimorphism in the limb joints of hominoids, despite substantial body size dimorphism and some reports of intersexual differences in positional behavior. This study re-examines sexual dimorphism in the hominoid distal humerus using coordinate data, and distinguishes explicitly between degree of dimorphism (i.e., the magnitude of intersexual differences) and pattern of dimorphism (i.e. , the nature of these differences). Using a variety of multivariate morphometric methods (e.g., canonical variates analysis of Mosimann shape variables; Euclidean Distance Matrix Analysis of both form and pattern difference matrices), we address the following issues: (1) do males and females of different species and subspecies (or ethnic groups for humans) maintain similar joint shapes? (2) are multiple patterns of dimorphism evident in this region of hominoids? (3) are differences and similarities in degree and pattern predicted by phylogenetic propinquity and positional behavior? For the most part, our results support earlier findings that sexual dimorphism in the shape of the anthropoid elbow is slight. Of the eight taxa considered here, only the western lowland gorillas exhibited significant differences in the shape of the distal humerus. Gorilla gorilla gorilla also displays a significantly different pattern of dimorphism from the orang-utan. Pattern differences between Andaman Islanders and both mountain gorillas and the orang-utan also approach statistical significance (P<0.06 and P<0.08, respectively). Overall, and despite marked differences in the degree of dimorphism, the knuckle-walking African apes are more similar in patterns of dimorphism to each other than to other taxa (e.g., gorillas are more similar to orang-utans in degree, but more similar to chimpanzees and bonobos in pattern). We could find no definitive "human pattern" in our results and suspect that this is because human upper limbs face less stringent mechanical constraints since they are relieved of locomotor stresses (but we cannot rule out the possibility of undocumented differences among our human groups in sex-specific, work-related activities). We anticipate finding additional pattern differences among anthropoids in articular dimorphism as we add other taxa to our sample (including fossil hominids), and examine other joint systems.

Animals↗
PubMed1990

The Tikhoff-Linberg procedure for bone tumors of the proximal humerus: the classical "extensive" technique versus a modified "transglenoid" resection.

The authors report on two groups of patients (each with 12) with primary bone tumors of the humerus who underwent either a classical Tikhoff-Linberg (T-L) procedure or a modified technique by which the body of the scapula was saved. The latter procedure was an "en bloc" resection of the glenohumeral joint after an extra-capsular osteotomy of the neck of the scapula, followed by reconstruction with a modular prosthesis. Indications, perioperative differences, and complications of both procedures are discussed. Besides producing better aesthetic and functional results, the modified technique offered the advantages of shorter anesthesia time, less blood loss, and a better anchorage of the prosthesis. The results of this study show that the proposed modification of the T-L procedure is indicated in patients with bone tumors of the proximal humerus in which invasion of the joint capsule is present without macroscopic involvement of the glenoid.

Adolescent↗
PubMed1986

Concentration of cefuroxime in the bones of albino white rats: a comparative study of femur, humerus, and mandible.

The levels of cefuroxime in rat bones with a different morphology, function, blood supply, and proportion between lamellar and cancellous bone were studied, after a 24-h administration of 750mg/kg X 3. The concentrations in the right and left femora, humeri, and mandibles of the same animal were measured 2 h after the last administration. The result indicate statistically significant differences between femur and humerus (P less than 0.001), femur and mandible (P less than 0.05), and humerus and mandible (P less than 0.05).

Animals↗
PubMed1979

A bioceramic endoprosthesis for the replacement of the proximal humerus.

In patients with malignant tumors in the region of the shoulder, radical resection can avoid amputation in most instances. To improve the function of the arm, endoprosthetic replacement of the defect is desirable. A three-component endoprosthesis made of a bioceramic material (aluminium oxide) was designed, implanted without bone cement. Fast anchorage to bone is achieved by using a conical sleeve, fixed upon the previously conically reamed humerus shaft. A stable primary fit is always feasible. Subsequent bone in growth into grooves inside the conical sleeve provides a permanent anchorage of the endoprosthesis. The authors experiences are based on implantations of 38 endoprostheses. The original diseases were primary malignant bone tumors in 19 patients, one case of "solitary" plasmocytoma and metastases into the proximal humerus in 16 patients. In two women, resection was made because of posttraumatic subcapital humeral pseudarthrosis. The follow-up study includes only those 27 cases operated on at least one year ago. 12 of the 14 patients with primary tumors have been surviving for 12-55 months (range 27.4) without signs of metastases or recurrent disease. Seven patients with metastases died of their original diseases after 7.7 months on the average. Owing to extensive resection of the shoulder musculature the mobility in the shoulder joint is considerably reduced. All the patients have good movement of the elbow joint and free function of the hand.

Activities of Daily Living↗
PubMed1979

Total subperiosteal resection treatment of solitary bone cysts of the humerus.

The solitary bone cyst is most frequently located in the upper arm and the average age of the affected patients is between 7 and 9 years, thus perceptibly lower than in cases where solitary bone cyst occurs elsewhere, where the average age is 15. The tendency towards recurrence before 10 years of age is twice as great as the tendency after that age. Investigation of the results obtained from the treatment of 26 patients suffering from solitary bone cyst of the humerus showed a recurrence rate of 55% after curettage and filling-in of the defect with cancellous bone grafts, whereas after total subperiosteal resection and bridging the defect with an autologous tibia graft the corresponding recurrence frequency was 7%. The average duration of the plaster cast fixing period after resection treatment was 18 days longer than after curettage, but the low rate of recurrence in the first-mentioned case makes up for this disadvantage. It is absolutely essential to retain the periosteum in cases of cyst resections. The defect is bridged over by an autologous tibia graft, but fibula grafts are also suitable for bridging the defect. Osteosyntheses are not necessary with latent cysts. In the case of active cysts screws, wire loops, Kirschner wires, and thin Küntscher nails can be used as temporary stabilisation means. Plate osteosyntheses constitute an exception. Complete removal of the cyst by resection is the most certain prophylactic method against recurrence, and hence the most reliable form of treatment of the solitary bone cyst of the humerus.

Adolescent↗
PubMed1986

[Intrathoracic dislocation of the head of the humerus].

Intrathoracic displacement of the proximal humerus following axillary luxation is a rare injury; but with ipsilateral serial costal fracture and/or single costal fracture with contused lung it has to be included in the considerations concerning differential diagnosis and the tactics of surgical approach. The primary measures are determined by the extent of pulmonary damage; the further course is marked by aseptic necrosis of the head of the humerus. On the basis of our study case we are describing a typical course, and discussing its problems taking into consideration the individual publications available so far.

Adult↗
PubMed1993

Micromelic dwarfism--humerus, femur, tibia type. Report of a case.

A 12.5-year-old girl with severe micromelic dwarfism and characteristic radiographic findings is reported. The most important phenotypic abnormality was dwarfism (stature < 100 cm); the patient had a normal face and intelligence. The diagnostic radiographic findings were those of spondylo-epimetaphyseal dysplasia characterized by severe shortening of humerus, femur and tibia, hypoplastic but normal-shaped fibula, ulna and radius, uniform shortening of the short tubular bones and moderately severe platyspondyly. These radiographic changes were already present at birth, which should make it possible to recognize the disease in the newborn. We propose naming this disorder micromelic dwarfism-humerus, femur, tibia type.

Child↗
PubMed1982

[Non unions of the humerus shaft (author's transl)].

The clinical evaluation of 121 cases of non union of the humerus shaft shows that 46 of these occurred after conservative and 75 after operative treatment. The main failures could be found after conservative treatment by traction methods. Operative treatment by intramedullary splinting did not achieve sufficient stability. The high rate of non unions after plate osteosynthesis is caused by basic technical faults in nearly all cases. The number of postoperative nerve palsy is remarkable. All cases could be healed by means of proper plate osteosynthesis after decortication combined with cancellous bone grafting in 12 atrophic non unions. The high rate of non unions of the humerus shaft gives occasion to reflect upon the correct indications for fracture treatment. From our point of view a more conservative attitude should be required.

Adolescent↗
PubMed2004

Feasibility of quantitative ultrasound measurements on the humerus of newborn infants for the assessment of the skeletal status.

Quantitative ultrasound (QUS), although widely used in adults has, so far, been scarcely employed in newborn infants and children. This study aimed to evaluate the feasibility of the use of QUS in newborn children and the factors influencing QUS parameters. In 140 consecutive healthy full-term newborn babies (76 male and 64 female; gestational age: 39.5 +/- 1.5 weeks) QUS parameters were assessed within 3 days of the child's birth at the distal diaphysis of the humerus by use of Bone Profiler, after an appropriate modification of caliper and software. In all subjects we evaluated the amplitude-dependent speed of sound (AD-SoS) (meters per second), the characterizing graphic trace parameters [signal dynamic (SDy), fast wave amplitude (FWA) and bone transmission time (BTT)], SoS (meters per second), that is, the speed of sound calculated on the first peak, and hBTT, that is, the interval time between the first peak of the ultrasound and when this reaches the speed of 1,570 m/s, which is the velocity of ultrasound in the soft tissue. This latter parameter allows one to measure bone tissue independently of soft tissue. QUS measurements were also performed at the phalanges on all mothers (age range 24-38 years), who also completed a self-report questionnaire on their obstetric history, smoking and dietary habits and family history of osteoporosis. In 73 mothers and their children QUS was repeated after 12 months. All QUS parameters were slightly higher in male than in female newborn infants but the difference was not significant. BTT and hBTT of neonates showed a significant relationship with birth weight (r = 0.20; P < 0.05 and r = 0.37; P < 0.01, respectively) and with cranial circumference (r = 0.22; P < 0.05 and r = 0.36; P < 0.01, respectively). In newborn infants none of the QUS parameters was significantly influenced by maternal QUS or by maternal smoking and calcium intake. In a model of multiple regression analysis the cranial circumference was the only parameter entered into the model, explaining approximately 15% of hBTT value. At month 12 AD-SoS and SoS were slightly lower than at birth (-11% and -0.1%, respectively), whereas both BTT and hBTT showed a significant (P < 0001) increase. The present study demonstrated the feasibility of the use of QUS, as assessed by a new measurement approach at the humerus, in the evaluation of skeletal status in neonates. BTT and, above all, hBTT, appears to be the best parameter for both evaluation of skeletal status at birth and monitoring of bone growth in the first year of life.

Adult↗
PubMed2003

Three-dimensional distribution of bone density in the proximal humerus.

Bone quality of the proximal humerus is important for the surgical treatment of proximal humeral fractures and rotator cuff tears. However, very few studies have evaluated the areal bone mineral density (BMD) of the proximal humerus. The aim of this study was to analyze the volumetric BMD (vBMD) using peripheral-quantitative-computed-tomography. Total, trabecular and cortical vBMD were determined separately for the proximal and distal half of the humeral head, the surgical neck and seven specific regions of interest. The greater tuberosity (GT) was divided into three regions, and the lesser tuberosity (LT) and articular surface (AS) were each divided into two regions. The proximal head showed a significantly higher trabecular (+ 46%) and cortical vBMD (+ 15%) than the distal one. The mean trabecular vBMD of AS was significantly higher (+ 80%), and the cortical vBMD was significantly lower (- 11%) than that of the tuberosities. In the proximal half of GT, trabecular vBMD was higher in the posterior than in the middle and anterior regions. Cortical vBMD was higher in middle region than in the anterior and posterior ones. In the distal half of GT, trabecular vBMD was significantly higher in the posterior than in the middle region, and cortical vBMD was significantly higher in the anterior than in the middle region. In one. These results point to bone sites that may provide stronger fixation for implants, reduce the risk of implant loosening, and therefore improve patient outcome.

Absorptiometry, Photon↗
PubMed2000

Solid aneurysmal bone cyst in the humerus.

We report on a 69-year-old woman with a solid variant of aneurysmal bone cyst (solid ABC) in the left humerus with a pathological fracture. Radiographically, the lesion exhibited a relatively well-defined osteolytic lesion in the diaphysis of the left humerus. On magnetic resonance (MR) imaging, the medullary lesion exhibited a homogeneous signal intensity isointense with surrounding normal muscles on the T1-weighted images and a mixture of low and high signal intensity on the T2-weighted images. Contrast-enhanced T1-weighted images revealed diffuse enhancement of the entire lesion. The pathological study showed a proliferation of fibroblasts, histiocytes, chronic inflammatory cells and numerous multinucleated giant cells in a collagenous matrix. Abundant osteoid formation in the matrix was observed, but the cells were devoid of nuclear atypia. Aneurysmal cystic cavities were absent. A review of the English literature found 22 cases of solid ABC of the long bones.

Aged↗
PubMed2004

Endoprosthetic replacement of the humerus combined with trapezius and latissimus dorsi transfer: a report of three patients.

INTRODUCTION: To improve the functional outcome after proximal and/or total humerus replacement, we combined the surgical procedures described by Bateman and Gerber. MATERIALS AND METHODS: In three patients after wide tumor resection, endoprosthetic replacement with a modular tumor endoprosthesis (MUTARS System) was performed. In addition to a capsular and muscular reconstruction using the Trevira tube, a trapezius transfer onto the Trevira tube in combination with a latissimus dorsi transfer onto the Trevira tube was performed. The patients were immobilized for 6 weeks after surgery with an abductor cast. RESULTS: After a follow-up of 1 year, there was no significant improvement of the shoulder function in comparison with patients who did not undergo the combined muscle transfer (control group n=16: mean abduction 37.5 degrees ; mean anteversion 35.0 degrees ; mean internal rotation 15.2 degrees ; mean external rotation 25.2 degrees ). CONCLUSION: In our patients, the combination of the Gerber and the Bateman procedures did not improve the shoulder function in patients with proximal and/or total humerus replacements. Therefore, the functional results do not justify two separate approaches and a prolonged operation time.

Adolescent↗
PubMed2006

Course of the innervation supply of medial head of triceps muscle and anconeus muscle at the posterior aspect of humerus (anatomical study).

INTRODUCTION: In elbow surgery; posterior side of joint has been described as the front door for accessing the elbow pathologies. Triceps splitting, triceps reflection, posterolateral Kocher, posteromedial Bryan-Morrey, modified MacAusland transolecranon approaches are the well known posterior surgical approaches. In the English literature, release and transposition of ulnar nerve on the medial side was fully described in posterior approaches. We believe that there was a need to identify the structures at the lateral aspect of the elbow while an iatrogenic injury may inversely effect an excellent radiological result. Therefore, we exposed the detailed innervation supply to the anconeus muscle and medial head of triceps muscle and tried to show possible denervation sites of these two structures during posterior approaches. MATERIALS AND METHODS: This study was performed on 14 elbows in formalin-preserved 7 cadavers. We exposed the course of the innervation supply to the medial head of triceps muscle and anconeus muscle and tried to show possible denervation sites of these two structures during posterior approaches. The branching pattern of radial nerve innervating anconeus muscle and its deriving level from radial nerve was identified. Distance from a vertical line which is passing through lateral epicondyle to branching point was measured. RESULTS: The mean distance of the branching point of the nerve to medial head of triceps muscle and anconeus was 168.3 mm (range 130.36-185.4). The nerve to anconeus muscle ran along the posterior aspect of the humerus from the horizontal line passing through lateral epicondyle at a distance of 142.20 mm (range 153.72-136.41) medial to olecranon and at a distance of 47.45 mm (range 77.13-30.14) lateral to olecranon. CONCLUSION: Although splitting the fibers of triceps proximaly increases the exposure of the posterior humerus, innervation of the lateral portion of the medial head of triceps muscle and anconeus muscle may be jeoparadized. Therefore, surgeons who have interest in elbow surgery; (1) should revise the course of the nerve to medial head of triceps and anconeus muscle, (2) be aware of possible iatrogenic injury of the extensor muscles of the elbow via transtricipital approaches, (3) try to choose a more conservative posterior surgical approach.

Elbow↗
PubMed1993

Treatment of selected extension supracondylar fractures of the humerus by manipulation and strapping in flexion.

The long-term results after the manipulation and strapping in flexion of selected extension supracondylar fractures of the humerus were evaluated in 43 children. Reduced fractures that were stable when immobilized in approximately 110 degrees of flexion, without producing circulatory obstruction, were treated in this manner. After a minimum review of 4 years, 95 per cent of the children had an excellent or good range of elbow motion and 88 per cent had excellent or good elbow alignment. No child had Volkmann's ischaemic contracture. Five children had cubitus varus which was due to malunion in three, but was unrelated to the treatment of the supracondylar fracture in two children. If these two latter children were excluded then excellent or good alignment was observed in all children who had a Baumann (humerocapitellar) angle of 80 degrees or less at the time of reduction and 84 degrees or less 10 days after the fracture. We concluded that manipulation and strapping in flexion was suitable for approximately 60 per cent of children with isolated displaced supracondylar fractures of the humerus.

Bandages↗
PubMed1987

Cellular composition of the bone marrow in the chicken, a comparison of femur, tibia and humerus.

A comparison of cellular composition of marrow from femur, tibia and humerus was made at hatch and at 3, 4, 6, and 12 weeks of age. There were no significant differences between femoral, tibial, and humeral marrow in relative and absolute cell numbers, mitotic indices or thymidine uptake. However, the cellularity per mg of marrow was consistently lower for the humerus than it was for the femur and tibia. There was a significantly greater frequency of immature granulocytes in the femur and tibia at hatch than at 4 weeks of age.

Aging↗
PubMed2005

Helical plating of the proximal humerus.

The ideal treatment for fractures of the proximal humerus has not been definitively agreed upon. Several recent reports have described a technique of helical plating for proximal humeral fractures, in which the proximal plate is placed laterally on the greater tuberosity, and spirals 90 degrees distally to lie on the anterior surface of the humeral shaft. The purpose of this study was to evaluate the feasibility of helical plating using a less invasive surgical approach and placing screws percutaneously in the distal plate. Dissection of 10 cadaveric upper extremity specimens was performed, using an extended anterolateral acromial approach followed by percutaneous helical plating. With the plate secured, the neurovascular structures which crossed the anterior humerus superficial to the plate were exposed and identified. Only the musculocutaneous nerve crossed anterior to the plate and was at risk for percutaneous screw placement. The nerve location was found in a consistent location among the specimens. The danger zone for the nerve location was found to be at an average of 13.5 cm from the greater tuberosity (99% CI: 12.2-14.8 cm). Though clinical experience is necessary to validate this plating technique, it appears that avoiding this danger zone in which the musculocutaneous nerve crosses will allow safe percutaneous screw placement and permit minimally invasive plating of these fractures.

Aged↗