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A giant solitary osteochondroma of the proximal humerus in a 9-year-old boy was widely resected. Reconstruction of the bone defect was achieved with two nonvascularized fibula segments which gave sufficient stability to the proximal humerus and yielded rapid bone remodeling into an almost normal cortical bone after six months.
Twelve patients, ranging in age from thirty-four to seventy-two years (average, fifty-three years), were evaluated an average of five years (range, two to eight years) after open reduction and internal fixation of a two-part displaced fracture of the greater tuberosity of the proximal part of the humerus. The indication for operative reduction was one centimeter or more of displacement of the fracture as seen on the diagnostic radiographs. The anterosuperior deltoid-splitting approach, combined with rotation of the humerus, allowed adequate exposure of the retracted tuberosity. Internal fixation of the greater tuberosity with heavy, non-absorbable sutures and careful repair of the rotator cuff permitted early passive motion. All fractures healed without postoperative displacement. Six patients had an excellent result and six had a good result; active elevation averaged 170 degrees. There was one partial, transient palsy of the axillary nerve.
Five cases of fracture of the humerus, including two types were treated over a period of twelve months. Three of these were simple spiral fractures of the lower third of the shaft. The other two were fractures of the medial epicondyle of the humerus. Two of the spiral fractures were complicated by radial nerve paresis and delayed union, and were operatively treated. The remaining three fractures were treated conservatively. These fractures are the result of a number of factors giving rise to violent torsional forces or avulsion forces. All five patients recovered well with respective treatment.
On a total of seventy left humeri of persons in their third to ninth decades of life thirty different bone dimensions were determined macroscoically and checked for age dependence. Strong dependence on age was shown only by the weight and volume of the humerus as well as by the areal and thickness dimensins of the center of the shaft. These were used to set up multidimensional linear regression functions by which it is possible for the age of persons past thirty to be estimated with defined accuracy. Also calculated were discriminant functions which allow the sex of a person to be identified to be determined from three dimensions of the left humeral head, and these are the size of the caput at the cartilage-to-bone interface, the transverse and vertical diameters of the caput humeri or head of the humerus. Of the 49 cases studied only three were found to be in the region of overlap of the dimensions used for calculation. Consequently, the formula would not allow unknown humeri or skeletons, respectively, to be identified as belonging to either male or female persons in 6 percent of the cases only. The results of additional examinations made of 198 right humeri were less accurate and showed a decrease of the sexual dimorphism of bone with age.
Between 1973 and 1985 eighteen patients with bone tumours and two patients with comminuted fractures had their proximal humerus replaced with a custom made isoelastic hemiendoprosthesis. In 1987 a clinical and radiographical review was performed of eleven patients with a mean follow up time of seven years, range 3-10 years. Four patients had pain at rest and six patients experienced severe pain on exertion. Active range of motion was poor and constituted only half of the corresponding range of passive motion. Shoulder girdle muscles were generally weak, only one patient could keep the arm straight in a flexed or abducted position. All patients had returned to their previous occupations, but their ability to perform ADL functions was poor. Rotator cuff insufficiency was considered to be the major cause of poor shoulder function. In comparison to most other surgical alternatives in tumour cases endoprosthetic replacement of the proximal humerus appears to be a safe and reliable method. The endoprosthesis gives stability to the arm and normal elbow and hand function is preserved.
The role of the tendon of the long head of the biceps in the stabilization of the head of the humerus was studied in 15 freely hanging anatomic specimen shoulders. Upward migration of the humeral head was measured by noting any reduction in the acromiohumeral distance in roentgenograms of the shoulder. There was a statistically significant decrease in the acromiohumeral interval on tensing the short head of biceps, but there was no significant change in the interval on tensing either the long head or both heads of the biceps brachii. Severing the tendon of the long head while both the heads were tensed caused a significant upward migration of the head of the humerus. One of the important functions of the long head of the biceps is to stabilize the humeral head in the glenoid during powerful elbow flexion and forearm supination by the main muscle. Sacrifice of the intraarticular segment of this tendon in surgical procedures of the shoulder may produce instability and dysfunction.
The authors report a series of 20 patients affected with metastatic lesions of the proximal humerus (19 cases) or scapula (one case) treated by intra-or extra-articular resection of the humerus and successive reconstruction with an I.O.R. type shoulder modular prosthesis. This method is indicated for the treatment of patients with extensive destruction of the epiphysis and cortical bone and limited invasion of the surrounding soft tissues. Prosthetic implant does not contraindicate the use of postoperative radiotherapy, and the cement used to anchor the endomedullary shaft contributes to the sterilization of any metastatic microfoces present by means of an intense esothermic polymerization reaction. The results obtained were satisfactory, with regression of pain and good functional recovery of the limb. There were no postoperative complications.
Surgical treatment of metastasis disease of the humerus was applied for 46 lesions among 42 patients, i-e 22% of overall osteosyntheses for skeletal metastasis. Two patients only are still alive at 3 and 4 years. The mean survival time is 8.1 months and at 3 months 50% died. Metastasis disease of the humerus becomes evident late during the evolution of the primary cancer, but 26% are revealing lesions. For 9.5% the primary tumor remains unknown. After review of the surgical methods generally used, indirect osteosynthesis by intra-medullary pinning according to Hackethal, without bone cement, is alleged. So the arm is immediately mobilized and a complementary irradiation is applied in post-operative. Prophylactic fixation of impending fractures is encouraged in order to suppress pain, and for better function. This paper demonstrates the changing concept of internal fixation of pathologic fractures and recommends intra-medullary nailing or pinning.
In a group of birds (passerines and non-passerines) body weight was found to be highly correlated with the length of the humerus and with the area of the foramen magnum. In addition, body weight was highly correlated with humerus length in 58 specimens of streak-necked fly-catcher, Mionectes striaticollis, suggesting a possible use of this measurement to estimate body weight of individuals in a single species. Body weight was not correlated with foramen magnum area in 25 specimens of savannah sparrow, Ammodramus sandwichensis.
Cubitus varus following supracondylar fracture of the humerus in children consists of varus, hyperextension, and internal rotation deformities of the distal bone fragment of the humerus. There has been no simple clinical method of measuring internal rotation deformity. The authors report here on a method of accurately measuring the internal rotation of the shoulder in a position with the elbow at 90 degrees flexion on the back and the shoulder held at the maximum extension. When a patient with developing cubitus varus attempts to rotate his shoulder internally, there is an apparent increase in the degree of internal rotation at the shoulder of the fractured side. The mean value of the angle formed between the horizontal plane of the back and the mid-line of the forearm was approximately 0 degrees in 217 normal children, whereas an increase of 35 degrees was seen in seven children with cubitus varus. When this angle was corrected successfully, the angle after surgical correction became approximately 0 degrees. In the treatment of cubitus varus deformity, it is necessary to simultaneously correct three-dimensional deformities.
Taking as a starting point the known fact that the vertical proportions of man are dependent upon stature, a study has been made to investigate if the relations between individual segments of long tubular bones are also dependent upon overall bone length. For these investigations, use was made of 356 human femurs of unknown sex, which were obtained from the bone collection of the Institute of Anatomy (Kurp 1979), and 70 human humeri of known sex (Kropf 1979), which were obtained from the Institute of Forensic Medicine and Criminology, Karl Marx University at Leipzig, and which had already been measured in connection with problems of forensic osteology. There were established relations between defined partial lengths, with the most suitable ones being selected and represented graphically. The severity of relationship was additionally determined by means of correlation and regression analyses, respectively. It was possible to show that the relative proportion of segment no. 4 (distance between the proximal point of the intercondylar fossa of the femur and the distal point of the medial condyle of the femur) and segment no. 5 (distance between the proximal point of the greater trochanter and the midpoint of the lesser trochanter) constantly decreases with the overall length of the femur. The quotient of diaphysial size and bone length decreases as the length of the humerus increases. The proportion of compacta in the total cross-sectional area in the mid-diaphysis becomes greater and greater as the length of the humerus increases. The total cross-sectional area and the compacta cross-section area in the middle of the humeral diaphysis tend to change with the overall bone length in that longer female and male humeri have larger total cross-sectional and compacta cross-section areas than shorter humeri of the same sex.
Dislocated fractures of the head of humerus are rare and prognostically unfavourable. In elderly patients only functional therapy should be practiced. Surgery attempts to make operative reduction of the dislocation and careful fixation of the head of humerus. Endoprotheses may relieve the patient from pain, but cannot restore active mobility due to the lack of muscle insertion.
Fractures and Epiphyseal separations of the proximal humerus are usually non-operatively treated with a generally good result. However, sometimes, a surgical treatment may be required. Twenty fractures of the proximal humerus occurring in children were treated operatively. From these 20 cases, the authors precise the indications and the ways of surgical treatment in this type of lesion. They insist upon the value of the angulation on the lateral radiograph of the shoulder which, if important, may often signify an interposition of the tendon of the long head of the biceps between the fracture fragments causing irreductibility; they propose a classification of the fractures referring to this angle. Considering surgical procedure, delto-pectoral approach is the most commonly used, although axillary way is more esthaetic. Kirschner wires and screws are the best means of synthesis. Anyway, this surgical treatment has to remain exceptional.
A new type of endoprosthesis of the humerus is presented. It is indicated in resection of the proximal humerus for primary and secondary neoplasms. After describing its construction and the technique for fitting it, the writers analyse the clinical results in thirteen cases. They emphasize the advantages over prostheses of other kinds: simplicity of fitting, wide possibilities of adaptation to individual cases, and the very satisfactory aesthetic and functional aspect.
It has been proposed that the wing bud is induced by some axial influence at a specific confined location and that the ZPA is the residual influence of such induction. The purpose of the present investigation was to test this hypothesis. Tantalum foil barriers were placed lateral to the mesonephric duct and parallel to the long axis of the embryo in the wing field of stage-12 to -15 chick embryos. These barriers blocked the somatopleure's communication with more medial tissues at specific somitic levels. The results of these experiments demonstrate that (1) the limb is not induced at one specific point, (2) portions of the humerus appear to be induced segmentally along the entire limb field and (3) the ZPA is not induced by axial structures. We propose a model of wing development suggesting that the humerus is induced as several separate components which then fuse to form the definitive bone.
From human humerus diaphyses 5 cross-sections of well defined sites were taken. The shape of these cross-sections was described by x,y-coordinate data. The size of the cross-section area, the positions of the primary and secondary stress minimum as well as the positions of the primary and secondary stress maximum were analysed. The plane with the lowest average stress over the total area of the sites 1, 2 and 3 shifts about 58 degrees from medial = 0 degrees. The increase of stress in direction to the bending planes with a maximum of average stress is lower than 30%. The humerus diaphysis in the proximal part (sites 1, 2, 3) seems to be relatively well adapted to the movements of abduction, adduction, anteversion, and retroversion. However the plane of best adaption seems to be the sagittal one. The cross-sectional site 4 represents a transitional segment with 2 types of torsion of the plane of best adaption to bending stresses. Type A is characterised by a enormous torsion between the cross-sectional sites 4 and 5, type B between the sites 3 and 4. The plane with the lowest average stress of the cross-sectional site 5 is located by 127 degrees. In this plane the diaphysis seems to be well adapted to bending forces in a more sagittal plane.
The medial rotation deformity of the distal humerus usually exists in the cubitus varus deformity but has received little attention. Study of this deformity in 29 cases of cubitus varus was carried out using the osteotomized bony specimens that were removed during closed wedge osteotomy in order to determine the actual bone deformity. The average duration of the varus deformity was 5.6 yrs (range 1 to 11). The medial rotation deformity of the distal humerus averaged 27 degrees (range 15 to 45). There was no correlation between the degree of rotation and that of the varus deformity (correlation coefficient r = 0.15). The affected-side shoulder compensated well in both internal and external rotation, and had a greater arc of rotation than that of the normal side. The affected-side shoulder exhibited an internal rotation deformity with an average of 16 degrees (range 5 to 25), with restriction of external rotation of only 13 degrees (range 0 to 20) in comparison to normal side shoulder.
The body of a 38-year-old man was found buried. The first step of the discovery was an anonymous telephone call. The body had 5 stab wounds (3 in the back, 1 in the left upper arm and 1 in the right leg). The cause of death was considered to be loss of blood due to a stab wound in the lung. The wounds in the kidney and the left humerus had peculiar shapes. The wound on the kidney was 1.1 cm long and had notches in the center of both margins of the wound. A V-shaped nick was noted on the humerus. Based on the above findings it was assumed that the murder weapon was a tapering 4-edged instrument. Later, based on the confession of the assailants, a pickaxe with the above-mentioned characteristics was discovered in a river. The victim was a member of a gang (Bohryoku-dan) and the assailants were members of another one. The present situation of gangs in Japan is briefly outlined.