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PubMed2005

Osteoporotic fractures of the proximal humerus, pelvis, and ankle: epidemiology and diagnosis.

Although fractures involving the wrist, spine, and proximal femur are known to be strongly associated with osteoporosis, the underlying bone insufficiency often receives insufficient diagnostic and therapeutic attention. Osteoporosis also increases the risk of fractures at other sites. Low-energy fractures in patients older than 50 years should lead to investigations for osteoporosis, the only exceptions being fractures of the skull, cervical spine, fingers, and toes. The incidence rates of fractures of the proximal humerus, pelvis, and ankle are climbing relentlessly. Whereas fractures of the proximal humerus and pelvis are undoubtedly related to osteoporosis, the link is less well established for fractures of the ankle. Mortality and morbidity rates associated with pelvic fractures are similar to those seen with fractures of the proximal femur, in keeping with the fact that both fractures occur in elderly individuals.

Aged↗

PubMed2006

Solitary plasmocytoma of the distal humerus.

A patient presented with chronic shoulder pain from a rare plasmocytoma in the distal humerus that resolved following a pathologic fracture. Staged reconstruction of the elbow after resection of the tumor in the distal humerus resulted in resolution of the patient's elbow and shoulder symptoms.

Arthroplasty, Replacement↗

PubMedDate not supplied

Lateral closing wedge supracondylar osteotomy of humerus for post-traumatic cubitus varus in children.

Cubitus varus deformity following mal-union of a supracondylar fracture of the humerus in children causes no functional disability, but surgical correction is often requested to improve the appearance of the arm. Maintaining the correction after supracondylar osteotomy is a difficult aspect of the operative treatment and remains controversial. Nine children aged between 6 and 12 years (average 8 years and 11 months) underwent lateral closing wedge supracondylar osteotomy of the humerus, for deformity ranging between 10 and 20 degrees (average 13 degrees). The correction required ranged between 16 and 30 degrees (average 21 degrees). The osteotomy was internally fixed with a two hole marrow plate. At follow-up, which ranged between 3 months and 6 years (average 34 months), six patients were graded as good, two as satisfactory and one as a poor result. One patient had transient radial nerve palsy which recovered completely in 2 months. The patient who was graded poor had undercorrection of the deformity at the original operation. There was no incidence of loss of correction due to implant failure. Complete section of the bone to allow medial displacement of the distal fragment is recommended, thereby avoiding lateral bony prominence at the elbow.

Bone Plates↗

PubMed2004

[Severe angular deformity of the humerus: unilateral external fixation for correction and bone lengthening].

We report the case of a 10-year-old child who presented a severely deformed upper limb due to post-traumatic partial proximal epiphysiodesis of the humerus. The goal of treatment was to correct the severe angular deformity, prevent recurrence, and lengthen the humerus 6 cm. We used the De Bastiani callotasis method with osteotomy of the humeral shaft and unilateral external fixation (Orthofix LRS). The bony deformations were corrected progressively. Angular correction induced a geometric lengthening sufficient to match the length of the healthy limb. Lengthening index was 22.7 days/cm. The functional and esthetic results were remarkable. Complementary epiphysiodesis of the proximal physis successfully prevented recurrent deformation.

Anthropometry↗

PubMed1986

Bier's spots reconsidered: a tale of two spots, with speculation on a humerus vein.

It is a widely accepted opinion that some of the spots produced on the forearm and hand by external compression of the brachial artery are the visible evidence of an intraosseous shunt in the humerus. These spots were first evaluated systematically by Bier in 1898. Additional studies were conducted by Rehberg and Carrier in 1922 and by Wolf in 1924, the latter's conclusions providing the currently accepted view. We examined these spots with laser Doppler velocimetry and found no differences in cutaneous perfusion among spots of different coloration. Further, there was no difference between any of the spots produced by occluding the brachial artery and values obtained from the forearm of postmortem subjects. It appears that the differences in coloration are not due to an intraosseous vascular shunt at the level of the mid humerus but, instead, are due to a capacitance phenomenon with venodilation in the dark areas and venoconstriction in the pale areas.

Brachial Artery↗

PubMed1993

Comparison of fluid infusion rates among peripheral intravenous and humerus, femur, malleolus, and tibial intraosseous sites in normovolemic and hypovolemic piglets.

STUDY OBJECTIVES: To compare infusion rates from various intraosseous sites (tibial, medial malleolar, distal femoral, and humeral) and at a peripheral IV site under gravity and pressure flow in normovolemic and hypovolemic states. DESIGN AND SETTING: A piglet model was used to assess rates of infusion under varying conditions in a university hospital animal laboratory. Analysis of variance was used to evaluate site differences. PARTICIPANTS: Twenty-three Yorkshire-Landrace mix pigs (weight, 12 to 23 kg) were studied. INTERVENTIONS: Animals were anesthetized and intubated before cannulation with 18-gauge bone marrow needles at intraosseous sites and 22-gauge Teflon catheters in peripheral vessels. Infusion rates under gravity and 300 mm Hg pressure were determined. Infusion rates under similar conditions were repeated in hypovolemic animals with acute bleeding of 25 mL/kg. MEASUREMENTS AND MAIN RESULTS: Mean infusion rates (mL/min) for gravity versus 300 mm Hg pressure in normovolemic pigs were 13.1 versus 40.9 for peripheral IV, 11.1 versus 41.3 for humerus, 9.3 versus 29.5 for femur, 8.2 versus 24.1 for malleolus, and 4.3 versus 17.0 for tibia. Hypovolemia resulted in average decreased rates of 32%. Infusion rates were significantly different between sites and between normovolemia and hypovolemia (P = .0001). CONCLUSION: Intravenous access is the most efficacious method of acute volume replacement. Intraosseous sites differ in the infusion rates obtained--descending order is humerus, femur, malleolus, and tibia, but each is a reasonable alternative for short-term vascular access.

Animals↗

PubMed1998

Sexual dimorphism in the humerus: a comparative analysis of Chinese, Japanese and Thais.

Determination of sex from the skeleton is vital to medicolegal investigations. There is no longer any question that populations differ in size and proportions and these differences affect the metric assessment of sex. The extent of variation in sexual dimorphism among Asian Mongoloids within and between regions has not been quantified by discriminant function analysis, nor have standards for most groups been introduced for the humerus. Therefore, the purpose of this research is to establish metric standards for sex determination from the humerus of Chinese, Japanese and Thais, as well as to compare size and sexual dimorphism in these Asian Mongoloid populations. The database for this study consisted of documented skeletal samples from China (N = 87), Japan (N = 90), and Thailand (N = 104). Six standard dimensions, including maximum length, vertical head diameter, minimum midshaft diameter, maximum midshaft diameter, midshaft circumference, and epicondylar breadth were taken and subjected to stepwise and direct discriminant function analysis. Of dimensions selected by the stepwise function, vertical head diameter and epicondylar breadth were the only elements common to all three groups. Overall, mean accuracies were highest using formulae produced by the stepwise procedure and ranged from 86.8% in the Chinese to 92.4% in the Japanese to 97.1% in the Thais. Group comparisons also revealed that while the Chinese had the largest measurements, they were the least dimorphic. The reverse was true for the Thais and the Japanese were intermediate on both counts. In cross validation tests, classification accuracy decreased in all cases where a formula from one group was applied to another. It was therefore concluded even though all individuals were Asian Mongoloids, these regionally diverse populations exhibited significant metric differences that affect sex determination from the skeleton. These findings confirm those of previous studies that there is a need for group specific metric standards of assessment.

China↗

PubMed2000

Bone marrow edema in the greater tuberosity of the humerus at MR imaging: association with rotator cuff tears and traumatic injury.

UNLABELLED: The purpose of this study was to determine the prevalence of bone marrow edema in the greater tuberosity of the humerus on MR imaging, the association with other findings at MR imaging and the injury mechanism which can lead to this finding. SUBJECTS AND METHODS: MR reports from 863 patients referred for shoulder MRI over 74 months were reviewed to identify patients with marrow edema in the greater tuberosity. The MR images from patients with greater tuberosity marrow edema were reviewed by consensus of two radiologists for the extent of marrow edema and for associated injuries. Marrow edema in the greater tuberosity was seen in 11 of 863 patients (1.3%). Nine patients (82%) had associated rotator cuff tear by MR imaging (four full thickness and five partial thickness), one patient had avulsion of the greater tuberosity from the humerus, and one had no rotator cuff abnormality. History of trauma was reported by eight patients including fall without direct blow to the shoulder (6), car accident (1) and direct blow to the top of the shoulder (1). Marrow edema in the greater tuberosity is an infrequent finding. Marrow edema most often is associated with a history of trauma and with rotator cuff abnormalities including full thickness tears. The history of trauma without direct blow to the shoulder and the location of the edema indicates that marrow edema often results from avulsion injury by the supraspinatus tendon.

Adult↗

PubMed1997

The relationship of suture anchor failure and bone density to proximal humerus location: a cadaveric study.

The purpose of this study was to evaluate spatial variations in the pullout strength of a suture anchor in the proximal humerus, and to correlate any differences with the local mineral density (BMD). Screw-type suture anchors threaded with wire sutures were inserted at six different anchor insertion sites in 11 human cadaveric humeri (average age, 80 years). Load to failure tests with forces applied in line with the axis of insertion were performed, and bone mineral density measurements were then made at these sites. The greater tuberosity showed anterior and posterior differences in anchor pullout force (P = .03), with the posterior portion showing higher strength (154 N) than the anterior area (96 N). Neither the lesser tuberosity (185 N anterior area and 177 N posterior area) nor the humeral neck (170 N anterior and 174 N posterior area) showed significant differences, and they were statistically equivalent to the greater tuberosity. There was no demonstrable difference in BMD at any of the six sites tested. There is no support for the hypothesis that significant differences in load to failure exist among the lesser tuberosity, humeral neck, and greater tuberosity. Also, there is no support for the hypothesis that the load to failure variations for the proximal humerus are dependent on BMD. Bone mineral density appears to have no correlation with the pullout strength of a screw-type suture anchor.

Aged↗

PubMed1995

A histochemical study on the enzymatic activity in the proximal epiphysis of the humerus during the prenatal and postnatal periods in rats.

In order to investigate the activity of certain enzymes [Alkaline phosphatase (ALP), Acid phosphatase (ACP), Adenosine triphosphatase (ATPase), 5'-Nucleotidase (5'-N)] in the proximal epiphysis of the humerus, tissue specimens were obtained from pregnant rats on the 15th, 17th, 19th and 20th days of gestation and on the 1st, 10th, 20th, 30th, 40th and 60th days of postnatal development. Enzymatic activity in the chondral ossification, in the perichondral areas of the epiphysis, was first seen on the 15th day of gestation. ALP and ATPase could also be observed for the first time in fetuses aged 15 days, whereas ACP and 5'-N could not be detected. These latter enzymes were observed for the first time in the proximal humeral epiphysis of fetuses aged 17 days. ALP, a marker for hypertrophic and calcifying cartilage, was observed extensively in the central hypertrophic part of the cartilaginous perichondral zones, which showed calcification during the development of the epiphysis. ALP, ATP and 5'-N activity was very marked in the cytoplasm of osteoblasts and in the periosteal matrix, but strong ACP activity was found in the cells of the chondrolysis zone. In conclusion; according to our observations, heterogeneity of the proximal epiphysis of the humerus exhibits intrinsic differences between the cells of different zones. The activity of all enzymes showed an increase according to the developmental age. This suggests that all of these enzymes play a role during developmental ossification.

5'-Nucleotidase↗

PubMedDate not supplied

Operative treatment of nonunions of the surgical neck of the humerus.

Twenty patients underwent surgical reconstruction for nonunion of fractures of the surgical neck of the humerus. Average time from injury to surgery was 10 months (range 4 to 14 months). The operation consisted of bone grafting combined with humeral head replacement in 10 cases and open reduction and internal fixation in 10 cases. Results, at an average follow-up of 51 months (range 24 to 124 months), were excellent in five (25%), satisfactory in six (30%), and unsatisfactory in nine (45%). Twelve nonunions resulted from fractures initially treated with close reduction; repair of these nonunions achieved by 67% excellent or satisfactory results. Eight nonunions resulted from fractures initially treated with internal fixation; repair of these nonunions achieved only 38% excellent or satisfactory results. Fifteen complications, 11 of which necessitated reoperation, occurred. Surgical reconstruction for nonunions of the surgical neck of the humerus usually results in significant improvement in pain but much more modest improvement in active motion and function. Surgery should be reserved for patients with significant symptoms and disability.

Activities of Daily Living↗

PubMedDate not supplied

Retroversion of the proximal humerus in relationship to prosthetic replacement arthroplasty.

Arthroplasty of the proximal humerus positions a prosthetic articular surface in relation to the humeral canal. Most descriptions of surgical technique recommend positioning the humeral component in 30 degrees to 45 degrees of retroversion. This study measured retroversion in relationship to the surgically reamed canal and introduced a method of measurement pertinent to prosthetic reconstruction. The canals of 21 cadaveric humeri were surgically reamed, the articular margins of the humeral heads were outlined with steel wire, and the trochlear axes were transfixed with Steinman pins. Under fluoroscopy the humeri were rotated on a jig that allowed rotation around the reamer and measurement of retroversion relative to the plane of the articular surface. Retroversion of the proximal humerus is highly variable, ranging in this study from 10 degrees to 55 degrees (mean 29.8 degrees). Anatomic reconstruction of the retroversion angle must be individualized. Palpation of the rotator cuff insertion is recommended prior to humeral head resection to avoid inadvertant cuff injury.

Cadaver↗

PubMedDate not supplied

Osteoid osteoma of the proximal humerus: two misleading cases.

Osteoid osteoma (OO) is a common bone disease, making up 2.6% of all bone tumors and 11% of all benign bone tumors. The typical clinical features include variable pain, often worse at night and markedly responsive to salicylates, and a characteristic roentgenographic appearance of bony sclerosis around a lucent nidus. Although this might suggest an easy diagnosis, diagnosis can often be delayed 1 or 2 years, especially when the lesion is located near a joint. Such a lesion at the upper end of the humerus is rare. In a series of 245 cases Dahlin found only 5 cases out of 18 involving the humerus. Rockwood, in a series grouping OO and osteoblastoma together, identified a 10% to 15% frequency out of all shoulder tumors. The misleading aspects of juxtaarticular OO are well known. However, involvement of the superior humeral epiphysis has only been reported briefly in one patient. The two cases presented in this article show the diagnostic difficulty encountered in this location and misleading clinical, radiologic, and sometimes histologic aspects of patient evaluation.

Adult↗

PubMedDate not supplied

A modification of Henry's anterior approach to the humerus.

A retrospective chart review identified patients who had surgery through Henry's standard anterior and anterolateral approaches to the humerus. Of the patients contacted, 62% had problems with the skin incision with reports of pain, numbness, and tingling around the scar. The frequency of cutaneous problems including neuroma prompted an anatomic study; the lower lateral cutaneous nerve branches to the arm were dissected in seven cadaver arms to determine their course. Henry's incision was then compared with a midline anterior incision. The cutaneous nerves were noticeably less numerous and smaller in diameter in the midline incision, probably related to the internervous, or watershed zone of cutaneous nerves in the anterior midline of the arm. Henry's standard intermuscular humeral exposure was no more difficult with the anterior midline incision. This study supports the notion that an anterior midline incision to approach the shaft of the humerus would minimize scar discomfort from cutaneous nerve injury.

Adolescent↗

PubMed2001

Torsional testing and peripheral quantitative computed tomography in rat humerus.

Peripheral quantitative computed tomography (pQCT) is a noninvasive method mainly used to evaluate the densitometric and geometric properties of bone. In the present study, we evaluate the different variables provided by pQCT examination and their ability to predict the mechanical strength properties of the rat humerus. Humeri from 68 female rats were utilized. These humeri represented bone with a wide range of mechanical and densitometric properties as well as geometric dimensions. Various characteristics, such as volumetric cortical density, total mineral content, cortical thickness, total cross-sectional area, cortical area, and polar strength strain index (SSI), were measured by pQCT. The reproducibility of these measurements was good, with a coefficient of variation (CV) ranging from 0.8% to 4.9%. Bone composition (e.g., ash weight, water content, and inorganic content) and bone dimensions (e.g., length, waist, and volume) were also determined. The mechanical properties (maximum torque, torsion at failure, and stiffness) were measured by torsional testing. Stepwise multiple linear regression was performed to identify the best explanatory variables for each mechanical parameter. Total cross-sectional area and polar SSI were equally well correlated to stiffness (r = 0.57, p < 0.001), whereas ash weight was superior to the pQCT variables to explain maximum torque (r = 0.42, p < 0.001). No other independent pQCT variable entered the two models in the stepwise regression analysis. It was found to be feasible to measure properties of the rat humerus with pQCT. Cross-sectional area and the polar SSI were shown to be the best explanatory variables for stiffness, whereas ash weight was the best predictor for maximum torque.

Animals↗

PubMed2002

Orthopedic pitfalls in the ED: pediatric supracondylar humerus fractures.

Supracondylar humerus fractures are the most common fracture around the elbow in the pediatric population. They are the result of a fall on an outstretched arm and are seen primarily in the first decade of life. The diagnosis of these fractures can be subtle and, if missed, can result in vascular, structural, or neurologic injuries. Prompt diagnosis and treatment of these injuries is important to improved clinical outcome. The emergency physician needs to remain vigilant for this diagnosis to avoid this orthopedic pitfall. This review article examines the clinical presentation, diagnostic technique, and management options applicable to the emergency physician in the treatment of supracondylar humerus fractures.

Child↗

PubMed2002

Rotation osteotomy of the humerus for Erb's palsy in children with humeral head deformity.

The most common secondary deformity in older children with Erb's birth palsy is internal rotation contracture of the shoulder. The results of external rotation osteotomy of the humerus in a selected series of children with shoulder internal rotation contracture are reported. Fifteen consecutive patients with a mean age of 6.5 years were included. In all children the internal rotation contracture was associated with loss of the normal sphericity of the humeral head as assessed by preoperative magnetic resonance imaging. The humerus osteotomy was carried out just below the insertion of the deltoid muscle, and fixation was done with stainless steel plate and screws. The results were assessed with a modified Mallet score. Before surgery 12 children had a score of 2 and 3 children had a score of 3. At final follow-up evaluation (range, 1-5 years; average, 3 years), all 15 children had improved shoulder function and obtained a modified Mallet score of 4. An extra bonus of the osteotomy procedure was slight improvement of shoulder abduction and elbow extension. All children could dress, wash, perform self-cleaning, and feed themselves better and no longer needed help with these activities. This osteotomy for selected children is simple and safe and has a high satisfaction rate functionally and aesthetically.

Brachial Plexus Neuropathies↗

PubMed2003

Elastic stable intramedullary nailing for the treatment of complicated juvenile bone cysts of the humerus.

Juvenile bone cysts usually are asymptomatic and may manifest as pathological fractures. Since the new method of flexible intramedullary nailing (" Elastic Stable Intramedullary Nailing" - ESIN or " Embrochage Centro- Médullaire Elastique Stable" - ECMES) has demonstrated superb results in the treatment of non-pathologic fractures of the long bones in childhood, this method is rapidly gaining popularity for the treatment of spontaneous or pathological fractures. Given the self-limiting natural history of juvenile bone cysts with eventual spontaneous healing, our goal is to stabilise the pathological fracture and the biomechanically weakened humerus. We treated 15 patients with 16 pathological fractures (one re-fracture) due to juvenile bone cysts of the proximal humerus. All fractures healed completely without pseudarthrosis. Complications were a secondary fracture in otherwise correctly positioned nails. Five of the 15 implants remain in situ, in 6 cases a repeat osteosynthesis was necessary, in one case the nails had to be changed because of the re-fracture. Ten of the 15 juvenile bone cysts healed over a period of 3 years, the nails were removed and so far there have been no further fractures in this group. In the other 5 cases, the juvenile bone cysts have progressively filled with sclerotic bone, and the nails remain in situ.

Adolescent↗