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PubMedDate not supplied

[Intramedullary bundle nailing for stabilization of pathologic humerus fractures in malignant tumors].

Pathological fractures of the humerus are mostly due to skeletal metastases or to malignant bone tumours. In most of the cases fracture stabilization as a palliative measurement is the only possible therapy. Our own collective during 1980 through 1987 includes 77 pathological fractures of the long bones, 23 of them located in the humerus. In eight of 15 fractures of the humeral shaft intramedullary nailing was performed, in two cases bone cement was used in addition.

Bone Neoplasms↗
PubMed1989

[Surgical treatment of distal humerus fractures in children].

From 1955 to 1987 414 children with supracondylar fractures of the humerus were treated at the surgical department of the University of Erlangen. Most important for the choice of treatment in supracondylar fractures was the classification of Baumann. 33 children concerning stage I were treated with cuff and collar or cast. Out of 381 patients with stage II and III Baumann's extension was used in 352 children; 29 had to be operated. The operation was indicated in a further 56 children. 20 of these had a lesion of the condylus radialis, 18 of the epicondylus ulnaris, 8 children showed diacondylar, 3 transcondylar lesions, 3 children had injuries of the condylus ulnaris and 4 more children showed splintered fractures. In 234 patients a follow-up was carried out according to the scheme of Morger. In 91% there was an ideal or good late result, in only 2% of the patients the result was unsatisfactory. The majority of distal fractures of the humerus can be treated conservatively with good results; operative treatment does not improve the functional and cosmetic results. It is indicated in complicated forms of fracture, in which satisfying results are not to be expected by conservative treatment.

Child↗
PubMedDate not supplied

Biomechanical effects of malposition of tuberosity fragments on the humeral prosthetic reconstruction for four-part proximal humerus fractures.

Variable outcomes in the prosthetic reconstruction of 4-part humerus fractures often can be attributed to inconsistent and nonanatomic tuberosity placement. To compare the effects of anatomic (anterior fin) versus nonanatomic (lateral fin) tuberosity placement, we developed a dynamic cadaver model for shoulder motion. With the use of a robotically driven, computer-controlled articulator, we tested external rotation torque in 5 fresh human shoulders. After evaluation of the intact shoulders, we experimentally induced 4-part humerus fractures in the specimens. These were then repaired by hemiarthroplasty, with the use of standard techniques to secure the greater and lesser tuberosities in either anatomic or nonanatomic positions; order was randomized. Nonanatomic tuberosity reconstruction led to significant impairment in external rotation kinematics and an 8-fold increase in torque requirements (P =.001). In contrast, anatomic reconstruction produced results indistinguishable from normal shoulder controls. This study underscores the importance of rotational alignment of tuberosities during reconstruction. Failure to properly position tuberosity fragments in the horizontal plane may result in insurmountable postoperative motion restriction.

Adult↗
PubMed2000

Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970-1998 and alarming projections for the new millennium.

We determined the current trends in the number and incidence of osteoporotic fractures of the proximal humerus in Finland by collecting from the National Hospital Discharge Register all patients 60 years of age or more who were admitted to Finnish hospitals in 1970-1998 for primary treatment of such fractures. The fracture was defined osteoporotic if it was caused by a low-energy trauma only, i.e., a fall from standing height or less. The number and incidence (per 10(5) persons) of fractures increased sharply from 208 (number) and 32 (incidence) in 1970 to 1,105 and 110 in 1998. Even after the age-adjustment, the incidence of fractures showed a clear increase: in women from 50 in 1970 to 133 in 1998, and in men from 14 in 1970 to 49 in 1998. If this trend continues, there will be three times more osteoporotic fractures of the proximal humerus in Finland in the year 2030 than there were in 1998.

Aged↗
PubMed2003

Increased mortality after fracture of the surgical neck of the humerus: a case-control study of 253 patients with a 12-year follow-up.

BACKGROUND: Several studies have shown a higher mortality rate in patients with osteoporosis-related fractures of the hip and vertebrae. METHOD: In 1999, we did a long-term follow-up case-control mortality study of 253 patients, mean age 72 years, who had sustained a fracture of the surgical neck of the humerus in 1987. RESULTS: We found a higher mortality in fracture patients giving at end point a cumulative survival difference of 16%. The median survival time was 8.9 years in patients and 12 years in controls (p = 0.005). The mortality rate was higher in men during the first 3 years after fracture and fewer than half of the male patients survived this period. The median survival time was 6.5 years in male patients and 12 years in their male controls (p = 0.02). The mortality was only slightly higher in women (p = 0.06). INTERPRETATION: Cardiovascular disease and malignancy were the commonest causes of death in both groups. We could not explain the higher mortality rate in patients with a fracture of the surgical neck of the humerus.

Adult↗
PubMed2000

Radial nerve palsy after simple fracture of the humerus.

Radial nerve palsy is a common complication of simple fracture of the humerus. The aim of this retrospective study was to assess the degree of spontaneous recovery and the need for exploration and repair of the nerve. The study included 26 patients with radial nerve palsy after simple fracture of the humerus. The male:female ratio was 3:1 and the median age was 21 years (range 9-79). Three patients had early exploration of the radial nerve in connection with osteosynthesis, and no appreciable damage to the nerve was found. Two other patients were explored later because they failed to recover. This exploration showed damage to the nerve which required further operation. Twenty-one patients were treated conservatively and all recovered well. None needed later operation. Because of the low incidence of nerve lesions we recommend an expectant policy initially.

Adolescent↗
PubMed2006

Elbow hemiarthroplasty for acute reconstruction of intraarticular distal humerus fractures: a preliminary report involving 4 patients.

We treated 4 female patients (mean age 80) with complex intraarticular acute fracture of the distal humerus with a Kudo humeral component, i.e. a hemiarthroplasty. All fractures were considered impossible to treat with open reduction and internal fixation. At mean 10 (3-14) months, 3 patients had an excellent result and 1 a good result according to the Mayo elbow performance score. We conclude that a hemiarthroplasty may be a valuable alternative in elderly patients with complex fractures of the distal humerus.

Acute Disease↗
PubMed2004

Risk factors for proximal humerus fracture.

This case-control study of proximal humerus fracture included 448 incident female and male cases and 2,023 controls aged 45 years or older identified in five Northern California Kaiser Permanente Medical Centers in 1996-2001. Data were collected by using an interviewer-administered questionnaire. Some factors related to low bone mass, including number of fractures since age 45 years and low dietary calcium intake, were associated with increased risks of fracture, and factors thought to protect against bone loss, such as menopausal hormone therapy and calcium carbonate tablet use, were associated with reduced risks. Fall-related risk factors included previous falls, diabetes mellitus, and difficulty walking in dim light. Possible fall-related risk factors suggested for the first time in this study were seizure medication use (adjusted odds ratio (OR) = 2.80, 95% confidence interval (CI): 1.45, 5.42), depression (OR = 1.34, 95% CI: 0.98, 1.84), almost always using a hearing aid (OR = 1.92, 95% CI: 1.12, 3.31 vs. never prescribed), and left-handedness (OR = 2.36, 95% CI: 1.51, 3.68 vs. right-handedness). Difficulty with activities of daily living and lack of physical activity tended to be associated with increased risk. Prevention of falls among frail, osteoporotic persons would likely reduce the frequency of proximal humerus fracture.

Age Distribution↗
PubMed1996

Surgical treatment of complex fracture of the proximal humerus.

Sixteen patients aged 19 to 63 years (average, 52 years) were observed from 1.8 to 5.6 years (average, 3.8 years) after open reduction and internal fixation with or without external fixation of 3- and 4-part displaced fractures of the proximal humerus. There were 12, 3-part displaced greater tuberosity and surgical neck fractures with 6 concomitant dislocations. Four cases were 4-part fractures with 3 concomitant dislocations. Fixation was achieved with heavy sutures or wire that incorporated the rotator cuff tendon, tuberosities, and shaft combined with threaded pins or Hoffmann external fixation to enhanced stability for early rehabilitation. According to Neer's criteria, 14 (87%) of the 16 patients had satisfactory or excellent results. Two (13%) of the 16 had unsatisfactory results. The use of a technique of limited soft tissue dissection and internal fixation with or without external fixation achieved good fracture stability and a high percentage of satisfactory results. The limitations of the procedure include (1) patients who could not tolerate anesthesia, (2) complex displaced fractures in older patients with osteoporotic bone that cannot hold pins or external fixation, (3) older patients with 4-part fracture dislocations in which avascular necrosis of the humeral head occurs frequently and in which a subsequent endoprosthesis insertion is inappropriate if osteosynthesis fails, and (4) head splitting fractures. The described approach provides an alternative method for the treatment of complex displaced fractures of the proximal humerus.

Adult↗
PubMedDate not supplied

Effect of surgical delay on perioperative complications and need for open reduction in supracondylar humerus fractures in children.

This retrospective study examined whether a delay of greater than 12 hours is associated with an increased risk of perioperative complications in the operative treatment of supracondylar humerus fractures in children. Of 150 consecutive children with supracondylar fractures, 50 underwent surgery in less than 12 hours and 100 underwent surgery greater than 12 hours after injury. There was no significant difference between groups in rate of open reduction (P = 0.55), pin tract infection (P = 1.0), iatrogenic nerve injury (P = 1.0), vascular complication (P = 0.33), or compartment syndrome (P = 1.0), including when Gartland type III fractures were analyzed independently. There was no iatrogenic nerve injury, no compartment syndrome, and one pin tract infection in 150 patients. The study confirms previous retrospective studies finding no significant difference in perioperative complications or rate of open reduction in children undergoing early versus delayed surgical treatment of supracondylar humerus fractures.

Child↗
PubMed1991

Supraintercondylar fractures of the distal humerus: results of internal fixation.

Operative treatment is considered to be the primary method of treatment for supraintercondylar fractures of the distal end of the humerus. Anatomical reduction and stable fixation of the fracture allows for early postoperative functional treatment and, subsequently, better results than other methods. Two series of patients with supraintercondylar fractures of the humerus, one from 1969 to 1980, and the second from 1981 to 1988, are presented. Although these series do not differ widely in their final outcomes, certain philosophies and operative techniques did change for the better.

Adult↗
PubMed1993

Surgical treatment of the radial nerve lesions associated with fractures of the humerus.

Twelve patients who were surgically treated for radical nerve injuries associated with fractures of the humerus are reviewed. The average follow-up was 6 years (range 1-10). The mean time to full recovery was 19 months (range 12-40). Three fractures were open, and nine were closed. Seven of the fractures were located in the distal third of the humerus; two were in the middle third; two were segmental, involving both the middle and the distal thirds of the shaft; and one was supracondylar. All patients received initial treatment of the fracture in other medical units. The mean interval between the lesion and surgical treatment of the nerve injury was 6 months (range 25 days to 15 months). Perineural fibrosis at the lesion site was observed in four patients. Three nerves were found entrapped in the callus. In two cases the nerve was found to be partially divided, and in three cases a total section was observed. The techniques employed were microsurgical reconstruction with interfascicular grafting using sural nerve in six patients, neurolysis in five cases, and tendon transfers in one case. Excellent and good results were obtained in 91% of cases. In the case with a poor result, tendon transfers were made, with an acceptable functional result.

Adolescent↗
PubMed1997

External fixation for severe open fractures of the humerus caused by missiles.

OBJECTIVE: To evaluate the use of external fixation of the humerus after missile injuries. DESIGN: Retrospective. SETTING: University medical center. PATIENTS: Twenty-six soldiers with twenty-six open Gustilo type III fractures. INTERVENTIONS: Immediate external fixation. MAIN OUTCOME MEASURES: Clinical, functional, social, and rehabilitation criteria were evaluated. RESULTS: Excellent in fourteen patients (61%), good in four (17%), fair in three (13%), and poor in two (9%). All fractures eventually healed. CONCLUSION: External fixation is the preferred initial treatment for stabilizing severe open missile fractures of the humerus. Its use, together with radical debridement of dead bone, has reduced the incidence of chronic infection and improved the prognosis of vascular repairs. As a result, the rate of morbidity and upper limb amputation has been reduced significantly, compared with our previous experience.

Adult↗
PubMed1999

Early versus delayed reduction and pinning of type III displaced supracondylar fractures of the humerus in children: a comparative study.

OBJECTIVES: To determine whether children with Type III displaced supracondylar fractures of the humerus that were pinned in a delayed fashion, defined as more than eight hours after fracture, had a greater need for open reduction than patients with similar fractures pinned more urgently, within eight hours after the trauma. Also, to determine whether those patients treated later fared any worse than patients treated earlier. DESIGN: Retrospective review of consecutive patients. SETTING: Level I pediatric trauma center at a tertiary children's hospital. PATIENTS: Fifty-eight consecutive patients, twenty-three with early pinning and thirty-five with delayed pinning. A subgroup of sixteen patients was followed for detailed clinical outcome. INTERVENTION: Closed or open reduction and percutaneous pinning MAIN OUTCOME MEASUREMENTS: Need for open reduction in either group. A separate subgroup was examined for carrying angle and evidence of low-grade compartment syndrome (such as grip strength and range of motion). RESULTS: There was no difference in the need for open reduction in the group that was delayed and pinned more than eight hours following fracture. Follow-up examination showed no clinical difference between the two groups in any parameter measured. CONCLUSIONS: These results indicate that many supracondylar fractures of the humerus can be treated safely in a delayed manner with an excellent clinical result and without unduly prolonging the hospital stay (such as with traction). This allows the patient to be NPO and the surgeon to operate in daylight hours, saving time, hospital resources, and fatigue.

Bone Nails↗
PubMed2000

Retrograde nailing of humeral shaft fractures: a biomechanical study of its effects on the strength of the distal humerus.

OBJECTIVES: The purpose of this study was to evaluate the loss of strength in the distal humerus that resulted from the creation of two different entry portals used for retrograde humeral nailing. DESIGN: Nine pairs, treated as blocks of size two, of fresh frozen humeri from individuals free of musculoskeletal disease were randomly divided into three groups in a balanced incomplete block experimental design. INTERVENTION: The specimens were tested intact (control) or with an entry portal drilled in either the distal metaphyseal triangle or the proximal slope of the olecranon fossa. Two of these three conditions were applied to each pair of the bones. Therefore, three pairs of bones accommodated testing of all possible combinations of the two treatments. All specimens were tested in torsion at a rate of 30 degrees per second until failure or fracture. RESULTS: The creation of an entry portal reduced the ultimate torque to 63 percent of that of the intact specimens (p = 0.044) and the energy absorbed to failure to 27 percent of that of the intact specimens (p = 0.039). The metaphyseal entry portal reduced the torque to failure to 71 percent of that of the intact specimens (p = 0.143) and the energy absorbed to failure to 37 percent of that of the intact specimens (p = 0.073), The olecranon fossa entry portal reduced the torque to failure to 55 percent of that of the intact specimens (p = 0.035) and the energy absorbed to failure to 18 percent (p = 0.058) of that of the intact specimens. CONCLUSIONS: Surgeons should be aware of the loss of strength in the distal humerus after retrograde humeral nailing. This is especially important when prescribing postoperative mobilization in which the upper extremities will be used for weight-bearing in either transfers or ambulation.

Aged↗
PubMed2003

The treatment and functional outcome of type IV coronal shear fractures of the distal humerus: a retrospective review of five cases.

OBJECTIVE: To present the treatment method and outcome of 5 cases of type IV coronal shear fractures of the distal end of the humerus. DESIGN: Retrospective study. PATIENTS: Five patients with an isolated type IV coronal shear fracture of the distal end of the humerus. INTERVENTION: Open reduction and internal fixation of the fractures utilizing Herbert screws, through a modified extensile lateral Kocher approach. MAIN OUTCOME MEASUREMENTS: Functional elbow index rating scale of Broberg-Morrey, Mayo Elbow Performance Score, subjective satisfaction rate and subjective functional limitations, and radiographic evaluation of the operated elbows for the presence or absence of osteonecrosis and degenerative joint disease changes. RESULTS: The follow-up time ranged from 39 to 50 months. All fractures healed within 6 to 9 weeks. The latest radiographic evaluation revealed mild degenerative joint disease changes in 1 patient and osteonecrosis of the coronal shear fragment in another. None of the patients reported pain even during strenuous activities, and none had clinical findings or subjective complaints suggesting instability of the elbow joint. Four patients regained full range of elbow motion compared with the contralateral elbow, and only 1 had a 10 degrees extension lag. The muscle strength of the major muscle groups of the operated elbow was equal to that of the uninjured elbow when tested clinically. No patient reported limitations in activities, and all indicated complete satisfaction with their outcome. According to the Broberg-Morrey scale and the Mayo Elbow Performance Score, all results were excellent, with scores ranging from 98 to 100 points. CONCLUSIONS: Recognition of this particular type of injury, prompt treatment with anatomic reduction and internal fixation, and early rehabilitation can lead to excellent functional outcomes.

Adult↗
PubMed2003

Two-part and three-part fractures of the proximal humerus treated with suture fixation.

OBJECTIVE: To evaluate the radiographic and clinical outcomes of patients with displaced proximal humerus fractures (two-part and three-part) treated with nonabsorbable rotator cuff-incorporating sutures. DESIGN: Retrospective. SETTING: University hospital. PATIENTS: There were 27 patients (28 shoulders) with displaced proximal humerus fractures. There were 13 greater tuberosity (GT) and 9 surgical neck (SN) two-part fractures and 6 GT/SN three-part fractures. The average age was 64 years (range 38 to 84 years). The average follow-up was 4.4 years (range 1.0 to 11.5 years). INTERVENTION: All patients were surgically treated solely with heavy polyester nonabsorbable sutures. MAIN OUTCOME MEASUREMENTS: Functional assessment was obtained using the American Shoulder and Elbow Surgeons (ASES) score and Neer's criteria, which grade outcomes as excellent, satisfactory, or unsatisfactory. RESULTS: Overall, there were 22 (78%) excellent, 3 (11%) satisfactory, and 3 (11%) unsatisfactory results, and the average ASES score was 87.1 (range 35.0 to 100.0). All shoulders healed radiographically without evidence of avascular necrosis of the humeral head. Twenty-four shoulders (86%) had anatomic alignment on postoperative radiographs. Of four shoulders with nonanatomic alignment, three had ASES scores of >/=90, with excellent Neer scores. When comparing patients with isolated two-part GT fractures (n = 13) with patients having two-part SN or three-part SN/GT fractures (n = 15), there were no statistically significant differences with respect to range of motion (P > 0.05) and outcome measures (P > 0.05). All patients who had unsatisfactory outcomes were noncompliant with physical therapy, with ASES scores averaging 39.4 (range 35.0 to 43.3). CONCLUSION: Two-part and three-part GT and SN fractures can be treated satisfactorily with heavy nonabsorbable rotator cuff-incorporating sutures, particularly in elderly patients. Hardware-associated complications are obviated. Patients with SN fractures treated with sutures can have outcomes similar to patients with two-part GT fractures. Although the goal is to reconstruct a "one-part" fracture pattern, some residual deformity does not preclude an excellent outcome. A compliant patient is crucial for a successful result.

Adult↗