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PubMed1995

Humeral fractures after shoulder arthroplasty.

Nine humeral fractures occurred subsequent to 499 shoulder arthroplasties that had been performed between December 1978 and November 1987 at the Mayo Clinic. The time from the arthroplasty to the fracture averaged thirty-nine months (range, eight to 101 months). Seven patients were women and two were men, and the average age was seventy years (range, forty-five to eighty-five years). The arthroplasties were performed for rheumatoid arthritis in five patients and for the sequelae of trauma in four. Six patients had advanced osteopenia, and two had had an ipsilateral total elbow arthroplasty. Six of the fractures were centered at the tip of the prosthesis; one fracture (type A) extended proximally, and five (type B) did not. The three remaining fractures (type C) involved the humeral shaft distal to the implant and extended into the distal humeral metaphysis. Four fractures healed with non-operative treatment. Two fractures that had unacceptable alignment were treated successfully with operative intervention. Three fractures that were treated with immobilization in a splint failed to heal; two of those fractures eventually united after a revision of the prosthesis and bone-grafting was performed, and one fracture remained ununited. Radial nerve palsy developed postoperatively in two patients, and it resolved within three months. Five patients had poor active motion before the fracture, and two of them had even less motion after the fracture was treated. Our experience suggests that long oblique and spiral fractures can be successfully treated non-operatively, provided that the skeletal alignment is acceptable.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1982

Epidemiologic features of humeral fractures.

Five hundred sixty-four Rochester, Minnesota, residents had a total of 586 humeral fractures during the period from 1965 to 1974. Of these, 47% involved the proximal humerus, and 20% the humeral shaft, and 33% the distal humerus. The incidence of humeral fractures associated with severe trauma was relatively higher among children and young adults, and distal humeral fractures predominated. Among the elderly, however, proximal humeral fractures associated with moderate trauma were most common and were responsible for the excess humeral fracture incidence rates among women and the dramatic increase in rates with age for both sexes. Rochester incidence rates for all three humeral fracture sites were substantially greater than those previously reported from the United Kingdom, although the proximal humeral fracture incidence was very similar to that in Malmo, Sweden. The Rochester rates appear to be the best available for use in determining the costs and benefits of efforts to prevent these and other aging or osteoporosis-related fractures in the United States.

Adolescent↗
PubMed1987

Proximal humeral fractures revisited.

Although 80% of proximal humeral fractures can be managed fairly easily, 20% are significantly displaced and difficult to analyze and treat. The four-segment classification of proximal humeral fractures allows the fracture to be understood and described intelligently, provides a guide to treatment, and helps the physician to make early prognostic judgments. Plain radiographs, tomography, and/or CT scanning allows an individual case to be fitted into the classification scheme. Treatment (non-operative or operative) depends on the degree of displacement of the four major segments, whether the humeral articular surface is involved, and whether the glenohumeral joint is dislocated. Follow-up care and rehabilitation are extremely important for an optimum final outcome.

Humans↗
PubMed1984

Axillary artery injury as a complication of proximal humeral fractures. Two case reports and a review of the literature.

Proximal humeral fractures are commonly seen in orthopedic practice. The vast majority of these fractures are nondisplaced. Infrequently, displaced proximal humeral fractures have associated neurovascular injuries. Injury to the brachial plexus is uncommon; axillary artery injury is rare. This is a report of two displaced proximal humeral fractures in elderly, intoxicated patients following low-energy trauma. Both fractures resulted in axillary artery injury requiring vascular reconstruction. Only nine similar cases were found in a review of the literature. Displaced proximal humeral fractures should be carefully evaluated for vascular injury, and arteriography should be used when necessary. If vascular reconstruction is indicated, the fracture must be internally fixed to prevent redisplacement and potential compromise of the vascular repair. Serial postoperative Doppler examinations are necessary to detect thrombus formation. With prompt diagnosis and treatment, prolonged limb ischemia and its sequelae can be prevented.

Aged↗
PubMedDate not supplied

The effectiveness of physiotherapy after operative treatment of supracondylar humeral fractures in children.

The indications for physiotherapy after supracondylar humeral fractures in children are not clear in the literature, even in the presence of an active or passive limitation of elbow joint motion. The authors therefore performed a prospective randomized study to assess the effectiveness of physiotherapy in improving the elbow range of motion after such fractures. The authors studied two groups of 21 and 22 children with supracondylar humeral fractures Felsenreich types II and III, all without associated neurovascular deficits. All children were treated by open reduction and internal fixation with Kirschner wires inserted from the radial side of the humerus. Postoperative follow-up at 12 and 18 weeks showed a significantly better elbow range of motion in the group with weekly physiotherapy, but there was no difference in elbow motion after 1 year. In each group, one child had an extension deficit of 15 or 20 degrees. The authors conclude that postoperative physiotherapy is unnecessary in children with supracondylar humeral fractures without associated neurovascular injuries.

Child↗
PubMed2003

Swan-shaped bone fixation device made of Ni-Ti shape memory alloy for treating humeral fracture in rabbits.

OBJECTIVE: To establish the animal model for treating humeral fracture with swan-shaped bone fixation device made of Ni-Ti shape memory alloy. METHODS: Models of humeral fractures was established in 30 rabbits and on one side the fracture was fixed with the Ni-Ti shape memory alloy device (SMC side) and on the other with 4-hole dynamic compression plate (DCP side). Anteroposterior radiograph of both humeri were taken at the time points of 2, 4, 8, and 12 weeks respectively after operation. RESULTS: All the rabbits survived the experiment and their forelimbs bore obviously less weight than hindlimb. In SMC side, the humeral fracture healed without either osteoporosis or external callus. The fracture healing in DCP side gave rise to obvious external callus formation, and the healing process took significantly longer time than in SMC group. CONCLUSION: The humerus of rabbit is similar to human humerus in view of their anatomic morphology and biomechanical properties, therefore rabbit humeral fracture models can be ideal for exploring the mechanism of fracture healing induced by the alloy device.

Animals↗
PubMed2003

Radial nerve transposition with humeral fracture fixation: preliminary results.

Humeral shaft fractures traditionally have been managed with closed treatment. In patients with polytrauma, open fractures, and patients at risk for nonunion, open reduction and internal fixation and intramedullary nailing have been advocated. The current study describes a technique used in humeral shaft fractures that reduces the risk of iatrogenic radial nerve injury during plate osteosynthesis in fracture patterns at high risk of nonunion (highly comminuted, transverse fractures). Ten patients who had radial nerve transposition were reviewed retrospectively using the electronic records database at the authors' institution. The average age of the patients was 27 years and average followup was 25 months. All had humeral shaft fractures, AO class A3.2 in four patients, B3.2 in five patients, and C2.2 in one patient. All fractures were deemed to be at high risk for nonunion. There were no iatrogenic nerve palsies as a result of the transposition, and no infections. Two patients had delayed or nonunion, who achieved healing after a second intervention. Transposition of the radial nerve is a useful adjunct to plating of humeral shaft fractures in patients at high risk for nonunion. The technique is safe, does not cause iatrogenic injury, and protects the radial nerve during all subsequent approaches to the fracture site.

Adolescent↗
PubMed1980

Repair of femoral and humeral fractures in adult cattle.

Humeral or femoral fractures in 4 adult bullocks were successfully repaired with Kuntschner clover leaf nails. Animals responded favorably to surgery and physiotherapy, including massage and planned exercise. Follow-up for 1 year revealed near-normal gait and restored utility. The significance of postoperative management, especially of physiotherapy, is stressed.

Animals↗
PubMed1996

Distal Humeral Fractures in Adults.

Distal humeral fractures in adults often pose a challenge to the orthopaedic surgeon. Preoperative planning, minimal devitalization of bone and soft tissue, and adherence to the prerequisites of biomechanical fixation are all important elements in effecting the desired end result. The chevron modification of the olecranon osteotomy affords excellent surgical exposure of the joint surface for fractures with an intra-articular component. When two plates are used to fix the lateral and medial distal humeral columns, it is best to orient them so that, when looked at in cross section, they are at right angles to each other. The achievement and maintenance of an anatomic reduction secure enough to permit early functional, pain-free motion of the elbow can be best ensured by open reduction and internal fixation with careful attention to detail.

Journal Article↗
PubMed1995

Humeral fractures without obvious etiologies in children less than 3 years of age: when is it abuse?

OBJECTIVE: To determine the occurrence and frequency of abuse in children with humeral fractures without immediately obvious etiologies who are less than 3 years old and present with arm injuries. METHODS: A retrospective chart review was conducted of all children less than 3 years old treated for a humeral fracture at Children's Hospital Medical Center between July 1, 1990, and September 10, 1993. One hundred twenty-four charts of children with humeral fractures were reviewed for possible abuse using previously developed criteria. Charts were evaluated independently by the investigators. Consensus was reached on classification of each chart into the following categories: abuse, indeterminate, or not abuse. RESULTS: Abuse was diagnosed in 9 of 25 (36%) children less than 15 months of age, but in only 1 of 99 (1%) children older than 15 months (P < .05). Abuse was excluded in 91 of 124 (73%) children. No determination of abuse (indeterminate) could be made in 23 of 124 (18.5%) children. In children less than 15 months of age, abuse was diagnosed in 2 of 10 (20%) with supracondylar fractures and in 7 of 12 (58%) with spiral/oblique fractures. CONCLUSION: The prevalence of abuse in our children presenting with humeral fractures was much lower than in other published reports, especially in the children over the age of 15 months. However, we found a higher prevalence of supracondylar fractures associated with abuse than those same reports. Given these findings, abuse should be considered in all children less than 15 months of age with humeral fractures, including those with supracondylar fractures. The majority of humeral fractures in children are accidental, especially beyond the age of 15 months.

Child Abuse↗
PubMed2001

[Repair of humeral fracture and non-union with transfer of vascularized periosteal flap].

OBJECTIVE: To study the results of humeral fracture and non-union repaired by vascularized periosteal flap transfer. METHODS: The clinical data of humeral fracture and non-union in 23 cases were analysized retrospectively since 1995. Among them, minuted or several segmental fracture in 12 cases, non-union in 11 cases, and following injury of radial nerve in 7 cases. The operative method was open reduction, inner or external fixation with vascularized periosteal flap transfer. RESULTS: The period of follow-up was 6 months to 2 years. The repair result of all patients was excellent and good, but elbow joint motion in 2 cases of non-union was not satisfactory. The periosteal flap had good osteogenic ability. The period of bone union was 2 to 5 months in humeral fracture and non-union. And function of radial nerve was recovery. CONCLUSION: Transfer of distal humeral periosteal flap pedicled with radial collateral vessels is a better method for humeral fracture and non-union.

Adolescent↗
PubMed1994

Double tension band osteosynthesis in supra- and transcondylar humeral fractures.

Distal intra-articular bicondylar humeral fractures are usually treated by means of cancellous screw(s) for the condylar block and one or two plates for fixation of the block to the shaft. The method and results of double tension band osteosynthesis instead of double plating for fixation of the condylar block to the shaft are described here. The advantages of double tension band wiring are an easier and faster procedure, less periosteal and muscle damage, and symmetrical compression. The functional results and complications of patients treated by this method are compared with the results of patients treated with plate fixation.

Adult↗
PubMed1988

External fixation of complex open humeral fractures.

Seven cases of complex open humeral fractures treated by external fixation are reported. The external fixation allowed the associated injuries to nerves, arteries and soft tissues to be adequately treated. Four cases developed non-union and of these, three cases treated by bone-grafting and plating united, but the one case treated by intramedullary nail without bone-graft did not unite. Frame construction and pin placement are discussed. The recommended plan for treatment of these fractures is initial external fixation until adequate soft tissue healing is achieved and sepsis controlled. Then early bone-grafting and plating is advocated if there is no progressive fracture healing. The problems and advantages encountered in the use of external fixation are also described.

Adult↗
PubMed2002

Locked nailing of spiral humeral fractures with or without radial nerve entrapment.

The experience of locked nailing of spiral humeral fractures and the perioperative conditions of the radial nerve are reported. The nerve is at risk of entrapment after such a fracture, and severe injury may occur during closed nailing. Among 162 humeral fractures treated by locked nailing, there were 21 spiral fractures: 18 acute fractures, and three delayed unions. The distribution of the fractures was two at the middle and 19 at the distal (1/3). Twelve patients had preoperative radial nerve palsy. All fractures excluding one middle fracture were retrograde nailed, and all patients had radial nerve exploration. Thirteen fractures were locked statically, seven were locked distally and had cerclage wiring, and one was locked distally only. Fisher's exact tests showed that the risk of radial nerve entrapment significantly increased in fractures with varus angulation or resulting from high-energy trauma. All the patients achieved fracture union and regained satisfactory joint functions. The author suggests that in external rotational spiral humeral fractures, radial nerve exploration should be done if nerve entrapment is highly suspected, irrespective of the fracture location or nerve palsy. Locked nailing with transfixing screws or cerclage wire could be a reliable treatment method for these fractures.

Adult↗
PubMed2000

Humeral blade plate fixation of intercalary allografts and segmentally comminuted proximal humeral fractures: a preliminary report.

The AO 90 degrees humeral blade plate is a relatively new device, whose primary indication and previously described use is for proximal humeral fracture non-union. This study describes the use of the humeral blade plate for extended indications-fixation of segmentally comminuted proximal humeral fractures in two patients and fixation of humeral intercalary allografts after primary humeral neoplasm resection in three patients. A mean follow-up of 20 months revealed union in both fractures and five of the six allograft-host junctions. One patient required subsequent bone grafting for non-union at a proximal allograft-host junction. Functional results were excellent in three patients, good in one, and fair in one. Problems encountered intraoperatively were directly related to the limited array of implants. The long plates which were needed had blades which were too long and required intra-operative trimming in three cases. In four cases, additional plates were used to supplement the blade plate for distal fixation. In conclusion, the humeral blade plate is a useful device for fixation in these extended indications, but longer plates with 30.0 and 40.0-mm blade lengths should be made available.

Adult↗
PubMed2003

Primary hemiarthroplasty for treatment of proximal humeral fractures.

BACKGROUND: Primary hemiarthroplasty of the shoulder is used to treat complex proximal humeral fractures, although the reported functional results following this method of treatment have varied widely. The aim of this study was to prospectively assess the prosthetic survival and functional outcomes in a large series of patients treated with shoulder hemiarthroplasty for a proximal humeral fracture. By determining the factors that affected the outcome, we also aimed to produce models that could be used clinically to estimate the functional outcome at one year following surgery. METHODS: A thirteen-year observational cohort study of 163 consecutive patients treated with hemiarthroplasty for a proximal humeral fracture was performed. Twenty-five patients died or were lost to follow-up in the first year after treatment, leaving 138 patients who had assessment of shoulder function with use of the modified Constant score at one year postinjury. RESULTS: The overall rate of prosthetic survival was 96.9% at one year, 95.3% at five years, and 93.9% at ten years. The overall median modified Constant score was 64 points at one year, with a typically good score for pain relief (median, 15 points) and poorer scores, with a greater scatter of values, for function (median, 12 points), range of motion (median, 24 points), and muscle power (median, 14 points). Of the factors that were assessed immediately after the injury, only patient age, the presence of a neurological deficit, tobacco usage, and alcohol consumption were significantly predictive of the one-year Constant score (p < 0.05). Of the factors that were assessed at six weeks postinjury, those that predicted the one-year Constant score included the age of the patient, the presence of a persistent neurological deficit, the need for an early reoperation, the degree of displacement of the prosthetic head from the central axis of the glenoid seen radiographically, and the degree of displacement of the tuberosities seen radiographically. CONCLUSIONS: Primary shoulder hemiarthroplasty performed for the treatment of a proximal humeral fracture in medically fit and cooperative adults is associated with satisfactory prosthetic survival at an average of 6.3 years. Although the shoulder is usually free of pain following this procedure, the overall functional result, in terms of range of motion, function, and power, at one year varies. A good functional outcome can be anticipated for a younger individual who has no preoperative neurological deficit, no postoperative complications, and a satisfactory radiographic appearance of the shoulder at six weeks. The results are poorer in the larger group of elderly patients who undergo this procedure, especially if they have a neurological deficit, a postoperative complication requiring a reoperation, or an eccentrically located prosthesis with retracted tuberosities.

Accidental Falls↗
PubMedDate not supplied

Nerve lesions in proximal humeral fractures.

In the literature nerve injury is not frequently considered a problem in proximal humeral fractures. Only a few studies exist concerning traction injury of nerves in fractures of the proximal humerus after low-velocity trauma. Almost all of them are retrospective and did not use electromyography. Patients with identical fractures can show quite different outcomes, which vary between complete recovery and severely limited shoulder function. On the assumption that nerve lesions can play a role in the recovery of conservatively and operatively treated proximal humeral fractures, we started a prospective follow-up study with electromyographic investigation. For this study, 143 consecutive proximal humeral fractures due to low-velocity trauma were included. According to the Neer classification, 93 were nondisplaced and 50 were displaced fractures. Denervation on the electromyogram was found in 96 patients (67%). The nerves most frequently involved were the axillary nerve (83 [58%]) and the suprascapular nerve (69 [48%]). Frequently a combination of nerve lesions was seen. Nerve lesions were much more frequent in displaced fractures (82% [41/50]) than in nondisplaced fractures (59% [55/93]). Complicating nerve lesions in patients older than 20 years of age were seen in about the same percentage of patients per decade. Nerve injury and the corresponding loss of muscle strength recovered well in all patients; however, the duration of the recovery was prolonged in cases with nerve lesions. Restoration of the function of the shoulder was less favorable. It is important to realize that, in both conservative and operative treatment of proximal humeral fractures, a paresis due to nerve injury can affect the restoration of shoulder motions. An electromyogram can be useful in the investigation of nerve lesions, because detection only by clinical examination proved to be very difficult. Because of the favorable electrophysiological recovery, no indication for exploration of nerve lesions was present in this series of fractures due to low-velocity trauma.

Adolescent↗
PubMed2006

Treatment of multidirectionally unstable supracondylar humeral fractures in children. A modified Gartland type-IV fracture.

BACKGROUND: There is an uncommon subset of supracondylar humeral fractures in children that are so unstable they can displace into both flexion and extension. The purposes of this study were to describe this subset of supracondylar fractures and to report a new technique of closed reduction and percutaneous pinning for their treatment. METHODS: In a retrospective review of 297 consecutive displaced supracondylar humeral fractures in children treated operatively at our institution, we identified nine that were completely unstable with documented displacement into both flexion and extension as seen on fluoroscopic examination with the patient under anesthesia. We used a new technique for closed reduction and fixation of these fractures, and then we assessed fracture-healing and complications from the injury and treatment. RESULTS: All nine fractures were treated satisfactorily with closed reduction and percutaneous pinning. The complication rate associated with these unstable fractures was no higher than that associated with the 288 more stable fractures. Seven of the nine fractures were stabilized with lateral entry pin placement, and two fractures were stabilized with crossed medial and lateral pins. None of the patients had a nonunion, cubitus varus, malunion, additional surgery, or loss of motion. CONCLUSIONS: In rare supracondylar fractures in children, multidirectional instability results in displacement into flexion and/or extension. This fracture can be classified as type IV according to the Gartland system, as it is less stable than a Gartland type-III extension supracondylar fracture. These fractures can be treated successfully with a new technique of closed reduction and percutaneous pinning, thus avoiding open reduction.

Bone Nails↗