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PubMed1992

Fractures of the distal humerus.

We present a rational approach to the classification and surgical management of intraarticular fractures of the distal humerus. The fractures are classified on the basis of the surgical anatomy of the distal humerus, which is divided into two skeletal columns held together by the trochlea. The basic surgical aim is to restore all three elements with sufficient stability to permit functional movement. The surgical tactics are presented in detail.

Fracture Fixation, Internal↗
PubMed2000

[Temporary stabilization of the elbow using the Zespol fixator for treatment of distal humerus non-union ].

The paper presents the possibility of using the Zespol fixator in treatment of infected non-unions of the distal humerus. A 34 year old patient with a pseudoarthroses of the distal humerus was treated surgically. The procedure consisted of resection of the pseudoarthroses, application of a spongy bone autograft and a Zespol fixator. The temporary stabilisation of the elbow achieved this way lead to a good result.

Adult↗
PubMedDate not supplied

Proximal chondroepiphyseal injuries of the humerus: a description of three cases classified ad Salter-Harris type II.

Proximal chondroepiphyseal injuries of the humerus constitute a very low percentage of traumatic growth pathologies, at around 5% of all fractures during childhood. The treatment most commonly used is conservative, with simple immobilization; nonetheless, in rare cases where surgery is planned, numerous methods of reduction and internal fixation have been proposed. The authors propose their experience in the treatment of a small (3 cases) homogeneous group (Salter-Harris type II) of proximal chondroepiphyseal injuries of the humerus by closed reduction in 2 cases, open reduction in 1, and percutaneous fixation with simple Kirschner wires. The results obtained are excellent, without any complications or sequelae, and with complete recovery of joint range of movement. The authors emphasize the use of this method capable of allowing for early mobilization, thus allowing for the child's rapid and non-traumatic return to a social life.

Adolescent↗
PubMed2001

Parosteal osteosarcoma of the humerus.

The authors report the case of a 50-year-old man who presented with nontraumatic swelling of the left upper arm. The diagnosis of parosteal osteosarcoma of the humerus was made after diagnostic workup. A long diaphyseal segment of the humerus containing the tumor was resected with a healthy margin of soft tissues and was irradiated extracorporeally with a single dose of 30 Gray. The bony segment was then reimplanted after removal of the tumor using plate and screw fixation. Loosening of the proximal screws after one year required additional fixation and autologous cancellous bone grafting. The patient has a nearly three-year-follow-up and there are no signs of tumor recurrence or metastasis. The proximal osteotomy has healed nicely; the distal fixation osteotomy exhibits delayed healing. The pathogenesis of parosteal osteosarcoma is discussed.

Bone Neoplasms↗
PubMed2002

[Results of an inverted shoulder prosthesis after resection for tumor of the proximal humerus].

PURPOSE OF THE STUDY: Treatment of primary bone tumors of the proximal humerus is a major challenge, both in terms of oncological cure and limitation of functional handicap. Extracorporal radiation and reimplantation have provided satisfactory results for the treatment of bone tumors and the inverted shoulder prosthesis has be found to be effective in treating rotator cuff deficiency. We therefore assessed patients treated with a combination of these two treatments in order to search for a better functional outcome. MATERIAL AND METHODS: Conservative resection of the tumor with reconstruction using an inverted shoulder prosthesis was performed in six patients with a tumor of the proximal humerus of type Ia or Ib in the Malawer classification or type S3-S4-S5 in the Musculoskeletal Tumor Society classification. Patients whose tumor involved the deltoid or the glenohumeral joint were not considered for this procedure. The series included four men and two women (4 left and 2 right shoulders) aged 51 years on the average at the time of surgery. RESULTS: Mean follow-up was 12 months. The mean age- and sex-adjusted Constant score was 74% (70-85%). The patients were generally satisfied and were able to continue their daily activities. There were two displacements, one of which was diagnosed immediately and reduced without anesthesia. An abduction pad was worn for six months after reduction. The post-operative period was uneventful. No local recurrence has been observed. DISCUSSION: Our results compared favorably with other therapeutic options for resection-reconstruction reported in the literature: functional outcome was better and more predictable, at least in the short term; oncological results were satisfactory although the follow-up is short, particularly for the three primary malignant tumors. It is known however that the long-term oncology result depends on the quality of the resection and the efficacy of the extracorporeal radiation. Shoulder motion outcome was the least satisfactory in patients who experienced peri-operative complications. We were unable to find any relation between less satisfactory functional outcome and the number of surgical procedures for local recurrence before extracorporeal radiation and arthroplasty (deltoid dystrophy). Normal deltoid function appeared to be crucial for optimal functional outcome with this prosthesis which allows sacrifice of the rotators. The rate of complications was low and recovery of active shoulder movement was more rapid. Despite the short-term nature of these results, and despite the risk of loosening, the inverted shoulder prosthesis appears to be an interesting therapeutic option for these patients.

Activities of Daily Living↗
PubMed2002

Reconstructing humerus defects after tumor resection using an intramedullary cortical allograft strut.

BACKGROUND: The humerus is a frequent involvement site of benign bone lesions. Various reconstruction methods have been adopted to restore the defect after excavating the lesion and/or to treat associated pathological fractures. In this study, we reviewed the clinical outcomes of using allogenous cortical struts to the treatment of patients with large humeral defects resulting from benign bone lesions, and investigated the mid-term fate of implanted allografts. METHODS: From 1988 through 1997, 29 patients with space-occupying humeral lesions were treated by eradication of the tumor and reconstruction with an intramedullary allogenous cortical strut. No additional internal fixation was needed for support. Clinical data were recorded, and functional and radiographic results were evaluated. RESULTS: The sizes of defects after eradication of the lesions ranged from 61 to 122 ml (mean, 92 ml). The patients were followed for a mean of 8.8 years. One local recurrence was noted and was successfully treated by repeating the procedure. All patients achieved good to excellent functional results. Follow-up radiographs showed complete healing of the defects, with partial to complete incorporation of the allografts into the host bones. Children had a better chance of complete allograft incorporation than adults. CONCLUSION: Intramedullary allogenous cortical struts act as internal splint mechanically and bone graft material biologically. The combined use of intramedullary allogenous cortical struts and chipped cancellous bone grafts provided good stability and healing probability for large osseous defects in the humerus without the need for implant fixation. Allograft incorporation occurred slowly in adults and might not achieve complete incorporation in adults.

Adolescent↗
PubMed1976

The sub-deltoid approach to the metaphyseal region of the humerus.

In a new surgical approach to the proximal part of the humerus, used in eighteen patients, the distal part of the tendon of the deltoid muscle was divided and the whole muscle was lifted up to give an excellent view of the proximal one-third of the diaphysis, the metaphysis, the surgical neck, and both tuberosities of the humerus. The exposure allowed visualization and protection of the axillary nerve. Postoperatively the deltoid remained functional and only the preoperative condition of the joint seemed to prevent full recovery of function of the muscles in a few patients.

Bone Neoplasms↗
PubMed2002

Chondro-epiphyseal separation of the distal humerus in the newborn. A case report and review of the literature.

Chondro-epiphyseal separation of the distal humerus is a rare injury, and when it occurs in the newborn, it may be difficult to diagnose and is easily mistaken for a dislocation of the elbow. The unimpressive clinical appearance of such an injury of the elbow in an infant, as well as the absence of ossific nuclei of the distal humerus in the newborn, are responsible for the dilemma in making the diagnosis. Ultrasonography, a readily available, non-invasive technique, can be used to evaluate the non-ossified epiphysis about the elbow of infants to demonstrate dislocations, fractures, and physeal separations. Closed reduction with or without percutaneous Kirschner wire fixation is the treatment of choice for these injuries. In this article, we report on a case of complete epiphyseal separation in a neonate and discuss the problems arising in its diagnosis.

Birth Injuries↗
PubMed2003

Endoprosthetic replacement of the proximal humerus. Long-term results.

We studied 100 patients who had undergone endoprosthetic replacement of the proximal humerus between 1976 and 1998. The outcome was assessed with regard to the survivorship of the patients, the salvaged limbs and the prostheses. Function was determined in the 47 surviving patients, of whom 30 were assessed using the Musculo-Skeletal Tumour Society (MSTS) rating scale and 38 completed the Toronto Extremity Salvage Score (TESS) questionnaire. The median age of the patients was 34 years (10 to 80). The mean follow-up period for surviving patients was nine years (2 to 20). The mean MSTS score at follow-up was 79% and the mean TESS score was 72%. The length of bone which was resected influenced the functional outcome. Abduction of the shoulder was to 45 degrees in most patients. The overall survival was 42% at ten years and that of the limb without amputation 93%. The survival of the prostheses using mechanical failure as the endpoint was 86.5% at 20 years. Endoprosthetic replacement of the proximal humerus is a predictable procedure providing reasonable function of the arm with a low rate of complications at long-term follow-up.

Activities of Daily Living↗
PubMedDate not supplied

Resection of the proximal humerus for metastases and replacement with RPS prosthesis.

In the surgical treatment of metastatic lesions of the proximal humerus it is important to find solutions that eliminate pain and solve the mechanical problem in a short time and with reduced costs. In 90% of cases, intralesional curettage, freezing with liquid nitrogen and cement enhanced intramedullary instrumentation is capable of brilliantly solving the problems of these patients. When, instead, osteolysis involves the greater tuberosity and/or the joint region, resection of the proximal humerus followed by reconstruction with a modular prosthesis is indicated. Of those available on the market, the RPS system (LIMA) has features that make it equivalent to others, but at costs considerably lower. However, in reconstructions with prostheses, active abduction is significantly limited. A personal series of 20 patients is presented.

Adult↗
PubMed2003

The reversed Delta shoulder prosthesis in reconstruction of the proximal humerus after tumour resection.

The authors present two series of six and seven patients respectively, with a tumour of the proximal humerus, who were treated at two different institutions with a Delta type inverted shoulder prosthesis (DePuy International Ltd) after a Malawer type Ia or Ib resection. The rationale of using an inverted shoulder prosthesis is the aim to improve the functional outcome in rotator cuff deficient shoulders. This type of prosthesis medializes and lowers the centre of rotation, lengthens the lever arm of the deltoid muscle and improves its function. At one institution the resected part of the humerus was re-implanted after extracorporeal irradiation. It was fixed intramedullarly by cementation of the humeral prosthetic component to facilitate restoration of humeral height. This graft allowed reinsertion of muscles (deltoid, pectoralis, biceps) thus improving power generation postoperatively. The largest glenosphere, size 42, was routinely used to reconstruct the glenoid; this theoretically improves the functional outcome (increased external rotation) and stability. At the other institution no graft augmentation was used except in one patient. The height of the humeral prosthetic component was assessed after resection of the tumour by measurement of the resected part. The prosthetic stem was fitted in the remaining part of the humeral diaphysis, in three cases by cementation and in three cases by press-fit (hydroxyapatite coating). Muscle balance was appreciated intra-operatively. Stability of the prosthesis was directly related to the level of resection. Both techniques resulted in a minimum active abduction of 60 degrees, reaching 90 degrees or more in most patients. When compared to other results in the literature, this is a major functional improvement. The mean adjusted postoperative Constant score was 72.5% (range: 30-90%), and the mean MSTS score was 75.8% (range 36.7-96.7%).

Adult↗
PubMed2004

[Double recurrent humerus osteochondroma].

This paper presents rare case of the double recurrent humerus osteochondroma in 18 years old man. Tumour was removed twice, in the age 5 and 10 years. In 18 years after tiny injury odoema and pain associated double, recurrent exostosis. Precise analysis of radiograms allowed diagnosis of infracture of one of exostosis and excluded malignant transformation. Whole tumour resection could patient's heal and make final diagnosis--double recurrent humerus osteochondroma.

Adolescent↗
PubMedDate not supplied

[Humerus varus congenitus (author's transl)].

Two cases of humerus varus congenitus have been treated by lengthening of the humerus using an external distraction device. The first was lengthened by about 6 centimetres and the second by about four centimetres. In one case, primary bone union was obtained and in the second, secondary grafting had to be done. The clinical results were satisfactory.

Adult↗
PubMed2005

The distal humerus--a blind test of Rogers' sexing technique using a documented skeletal collection.

Continuous monitoring of existing methods of skeletal diagnosis allows improving the reliability of personal identification in forensic and archaeological contexts. This study reports on a blind test re-evaluating the sexing technique proposed by Rogers (8) involving the distal humerus. A total of 351 humeri (184 male, 167 female specimens) from the documented skeletal assemblage of St. Bride's, London, was analyzed for the following traits: trochlear constriction, trochlear symmetry, olecranon fossa shape, and angle of the medial epicondyle. Individual traits showed substantial sex-discriminatory capacity, with "olecranon fossa shape" being most consistently accurate (84.6%) in predicting sex. The combination of all four traits provided an overall accuracy of 79.1%, including those individuals assessed as "probable" male and female. This renders the technique useful for forensic applications. The distal humerus can be recommended for sex assessment in addition to more established markers, especially since this part of the skeleton is frequently well preserved.

Female↗
PubMed2005

The feline humerus. An anatomical study with relevance to external skeletal fixator and intramedullary pin placement.

The humeri of eleven feline cadavers were dissected and safe anatomical areas for placing external skeletal fixator pins were determined. Relevant measurements taken of the humeral condyle enabled a determination of a safe pin diameter range of 1.5 to 2.2 mm for transcondylar pins. Further anatomical measurements allowed recommendations to be made to angle pins in the distal humerus in a distolateral proximomedial direction so that the ESF pin penetrates the for cortex at least 20 mm proximal to the medial epicondyle in order to avoid pin penetration of the supracondylar foramen. Cross sections taken of the distal humerus revealed that passage of an IM pin into the medial aspect of the humeral condyle was possible in less than half the cases.

Animals↗
PubMed2006

The length of the humerus in human embryos at developmental stages 18-23.

The length of the humerus was measured in 69 staged human embryos at developmental stages 18-23 (7 and 8 weeks). It was found that the length of the humerus increases from 2.0 mm at stage 18 to 5.4 mm at stage 23. There were slight variations at certain of the stages investigated. Asymmetry between limb lengths was not found during the embryonic period under examination.

Anthropometry↗
PubMed2006

[Prosthesis replacement of proximal humerus after resection of malignant tumor].

OBJECTIVE: To study the operative effect and complication of the prosthesis replacement of the proximal humerus with malignant tumor. METHODS: From October 1998 to August 2003, the prosthesis replacement was performed to treat the proximal femur with malignant tumor in 4 patients, including 2 patients with osteosarcoma (Enneking staging, I A) and 2 patients with giant cell tumor of the bone (II A, II B). By the International Society of Limb Salvage (ISOLS) criterion, the 2 cases of osteosarcoma were preoperatively scored as 4 and 5 points, and 2 cases of giant cell tumor of the bone were scored as 9 and 11 points. The patients' psychological conditions as well as their limb pain, shape, locality, activity, and function were also observed. RESULTS: The follow-up for 24-58 months (mean, 44 months) showed that there was no local recurrence or infection in all the patients except one patient who had the loosening of the screws for the fixation 17 months after operation and had no treatment. After operation, all the patients had a better postoperative extention angle from 22 degrees to 41 degrees (mean, 25 degrees), bending angle from 29 degrees to 80 degrees (mean, 35 degrees), abduction angle from 5 degrees to 28 degrees, and circumgyrate angle from 15 degrees to 22 degrees in their shoulder joints. However, the shoulder joint function was still unstable to some extent and the joints had a decreased strength. By the criterion formulated by the ISOLS, the postoperative score for assessing the 2 patients with osteosarcoma was increased by 16 points when compared with the preoperative score; the score for the 2 patients with giant cell tumor of the bone was increased by 9.5 points. CONCLUSION: The prosthesis replacement to treat the malignant tumor of the proximal humerus is the good method of choice and has a good therapeutic result; however, there are more complications and so the method should be cautiously employed in the clinical practice.

Adult↗
PubMed2006

Periosteal chondroma of the proximal humerus: a case report and review of the literature.

Periosteal chondroma is a slow growing benign cartilaginous tumor of bone. It is rarely reported among Thai people. The authors present a case ofperiosteal chondroma of the proximal humerus. A 14-year-old girl was admitted with a painless mass around her left shoulder On magnetic resonance images, a subcutaneous lesion with hypointensity on TI-weighted images and marked hyperintensity on T2-weighted images, eroded the underlying cortical bone of the proximal humerus. The patient underwent marginal excision. There was no recurrence of the lesion during 3 years of follow-up.

Adolescent↗