Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Humerus”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 505 records · Page 28Linked to original sources
PubMed2007

Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children.

BACKGROUND: Several radiographic criteria based on only standard anteroposterior and lateral radiographs have been suggested for predicting the stability of lateral condylar fractures of the humerus in children. Despite adherence to these guidelines, further displacement often occurs after the initial diagnosis and stability assessment. The purpose of this study was to define the usefulness of an internal oblique radiograph in the assessment of these fractures. METHODS: We prospectively studied fifty-four lateral humeral condylar fractures in fifty-four children seen between March 2002 and December 2004 to determine the efficacy of internal oblique radiographs in gauging the amount of displacement and the fracture pattern. Plain anteroposterior, lateral, internal oblique, and external oblique radiographs were initially made for all fifty-four patients, and three-dimensional computed tomography scans were performed for seven patients. RESULTS: A large percentage (70%) of the fractures were seen to have different amounts of displacement on the anteroposterior and internal oblique radiographs, and a large percentage (75%) were seen to have different fracture patterns, according to the criteria suggested by Finnbogason et al., on the two views. The internal oblique radiograph was more accurate for demonstrating the fracture gap (thirty cases were seen to have more displacement on that view) and for demonstrating the fracture pattern (twenty cases were seen to have more instability on the internal oblique view). We also confirmed the direction of the fracture line and the location of the fragment more accurately with three-dimensional computed tomography. CONCLUSIONS: It is not optimal to evaluate the amount of displacement and the stability of a lateral condylar fracture of the humerus in children on the basis of just anteroposterior and lateral elbow radiographs. Classifications should be based on the greatest displacement seen on at least three radiographic views, especially the internal oblique view.

Child↗
PubMed1987

External fixation of proximal humerus fracture. Clinical and cadaver study of pinning technique.

The risk of injuring important anatomic structures or interfering with motion of the glenohumeral joint by transcutaneous pinning of the proximal end of the humerus was investigated in 12 cadaver shoulders and in 23 patients with displaced fractures of the proximal humerus. In the cadavers, pinning of the proximal humeral shaft from laterally more than 20 mm below the surgical neck did not injure the neurovascular structures in any case. Pin insertions into the humeral head medial to the intertubercular groove endangered the cephalic vein and interfered with shoulder function by transfixing the subacromial bursa and by restricting internal rotation. Lateral pinning did not carry such risk. In the patients closed reduction and external fixation confirmed the low risk of neurovascular injuries. Lateral pinning of the humeral head resulted in an unrestricted passive mobility of the glenohumeral joint of the anesthetized patient, whereas anterior pinning carried the risk of mechanical restriction of the internal rotation.

Adult↗
PubMed1997

Acute hemiarthroplasty after proximal humerus fracture in old patients. A retrospective evaluation of 18 patients followed for 2-7 years.

We evaluated the outcome of acute shoulder hemiarthroplasty in 18 patients following displaced three- and four-part fractures of the proximal humerus. The mean age of the patients was 82 (70-92) years and the average follow-up time was 3.5 (2-7) years. No revision due to loosening was performed. All patients were evaluated concerning activities of daily living, degree of pain (VAS-scale, 0-100 mm) and range of motion. The patients had a low functional level, but were able to sleep on the operated side and keep up their hobby. 11 patients were painfree and the worst pain recorded was 28 mm. Range of motion for all movements, except extension, was statistically significant lower than for the non-operated side. We conclude that in elderly patients acute hemiarthroplasty following three- or four-part fractures of the proximal humerus results in good pain relief, but a more limited range of motion than that reported for younger patients.

Activities of Daily Living↗
PubMed2007

Innovations in the management of displaced proximal humerus fractures.

The management of displaced proximal humerus fractures has evolved toward humeral head preservation, with treatment decisions based on careful assessment of vascular status, bone quality, fracture pattern, degree of displacement, and patient age and activity level. The AO/ASIF fracture classification is helpful in guiding treatment and in stratifying the risk for associated disruption of the humeral head blood supply. Nonsurgical treatment consists of sling immobilization. For patients requiring surgery, options include closed reduction and percutaneous fixation; transosseous suture fixation; open reduction and internal fixation, with either conventional or locking plate fixation; bone graft; and hemiarthroplasty. Proximal humerus fractures must be evaluated on an individual basis, with treatment tailored according to patient and fracture characteristics.

Algorithms↗
PubMed1976

Classification and treatment of intercondyloid fractures of the humerus.

The authors describe the satisfactory results obtained in sixteen intercondyloid fractures of the humerus, thirteen of which were treated surgically. The preference for surgical treatment in such fractures is based in the assumption that, as in all articular fractures, a good functional result can only be achieved if there is the most perfect possible reconstruction of the fragments and the joint surface. A classification is therefore suggested which is based not purely on anatomical criteria, but is also related to treatment and prognosis. The slendor nature of the distal end of the humerus and the danger of metal reaction call for the use of fixation devices that are efficient but slender, such as fine screws and crossed wires. The precise method of fixation is conditioned above all by the direction of the fracture lines. More solid fixation with early mobilisation can be achieved by compression screws, and less solid fixation with longer immobilisation is achieved by fixation with crossed Kirschner wires. Consequently, the more oblique types of fracture with fragments with long beaks that allow more stable fixation with compression screws have the more favourable prognosis. In the evaluation of results, the authors emphasize the importance of using parameters which take into account the functionally useful range of joint movement.

Adult↗
PubMed1999

Recurrent fracture of the humerus in a softball player.

Fracture of a normal humerus can occur during the act of throwing an object. We present the case of a young woman who sustained a spiral fracture of the distal humeral shaft with concomitant radial nerve palsy while throwing a softball and who, after clinical and radiographic evidence of bony healing, suffered a repeat humerus fracture, also while throwing a softball.

Adult↗
PubMed2001

Epidemiological features of supracondylar fractures of the humerus in Chinese children.

We studied 450 children with a supracondylar fracture of the humerus in the period 1991 to 1995, and were able to collect full management details in 403 of them (253 boys and 150 girls). The median age at presentation was 6 years (6.6 years in boys, and 5 years in girls), with the nondominant humerus 1.5 times more commonly injured. Fifteen percent of children presented more than 1 day after the injury. Garland type III fractures constituted 45% of cases, type I 30%, and type II 24%, with flexion type fractures present only in 1% of the children. A nerve injury was associated with the fracture in 19 cases. Although the radial pulse was not palpable at presentation in nine patients, only one child had diminished distal circulation requiring exploration. Concomitant fractures were present in 14 patients. Elbow hyperextension was greater than in a comparable group of noninjured children. Open reduction was necessary in 20% of these children, most being managed by manipulation under anaesthesia, at times associated with percutaneous Kirschner wiring. The hospital stay was 2 days or less in two-thirds of the patients, with more than 90% discharged home within 1 week of admission. In conclusion, many Chinese patients attend hospital later than their Western counterparts, and the rate of flexion-type injuries is low.

Adolescent↗
PubMedDate not supplied

External dynamic fixation in fractures of the humerus: can it still be considered treatment of second choice?

The authors report 40 patients affected with diaphyseal fracture of the humerus treated by dynamic axial fixator (FAD Orthofix). Minimum follow-up was 2 years. A clinical and radiographic retrospective study was conducted with the purpose of verifying the validity of external fixation as treatment of choice in diaphyseal fractures of the humerus. The results were evaluated considering healing time, extent and type of complications, long-term clinical, radiographic and functional findings. Results were: excellent: 35; good: 2; fair: 2; poor: 1. Complications were: nonunione: 1; reimplantation of FAD screws: 1; 4 infections of the screw holes, 3 realignments due to secondary displacement, 1 re-fracture after removal of the implant. There were no iatrogenic lesions of the radial nerve, or infections of the fracture site. The authors conclude that this semi-invasive, versatile and well-tolerated method, may be considered a valid alternative to conservative treatment, or to internal fixation even in cases of single trauma, despite limits related to the degree of collaboration of the patient, particularly with regard to debridement of the screw holes and periodical clinical and radiographic monitoring.

Adolescent↗
PubMedDate not supplied

Treatment of completely displaced supracondylar fracture of the humerus in children by cross-fixation with three Kirschner wires.

The authors investigated 63 consecutive patients (average age 6 years 6 months) who underwent cross-fixation with three Kirschner wires after reduction of a completely displaced supracondylar fracture (type 3) of the humerus. All fractures were reduced and fixed by inserting two parallel Kirschner wires in the lateral side, followed by one crossed medial Kirschner wire under fluoroscopic guidance. Lateral pins were inserted in parallel or divergent fashion to ensure stability. With a medial crossed pin insertion, the elbow was carefully extended for easy palpation and protection of the ulnar nerve without displacing the reduced fracture. Skin incision for detection of the ulnar nerve before medial Kirschner wire fixation was not required. There was no iatrogenic ulnar nerve injury caused by the Kirschner wires. The clinical outcome of the surgery after an average of 17 months was investigated: 62 (98.4%) of the 63 patients studied showed a "satisfactory" result. Cross-fixation with three Kirschner wires is considered an effective and safe method for avoiding ulnar nerve injury in the treatment of a completely displaced supracondylar fracture of the humerus in children.

Bone Wires↗
PubMed2001

[Supracondylar fractures of the humerus and disorders of circulation].

Supracondylar fractures (SF) of the humerus are the third most common type of fractures in childhood. The highest rate of pulselessness fracture of the distal humerus is the extension-type. The aim of our treatment is to minimize potential complications. Our management of pulselessness supracondylar fracture is more aggressive compared with other dpts. 223 (100%) patients with SF were treated at the dpt. of Paediatric Surgery, University Children's Hospital in Bratislava, in the 5-year period of (1995-1999). 11 (4.93%) patients remained pulseless after reposition of bone fragments. These patients underwent surgical revision of the brachial artery. Spasms of the brachial artery (BA) occurred in six patients, a lesion of BA in three patients and thrombosis of BA in two patients. We performed revision of the brachial artery by a Fogarthy catheter in six patients--in four cases with thrombectomy. In two cases we released the vessel from bone fragments. In two patients was replaced the injured segment of the brachial artery by a venous allotransplant. Peroperative angiography was performed in six patients. We reoperated three patients with early postoperative complications. We did not record any case of Volkmann's contracture.

Brachial Artery↗
PubMed2002

[Medial approaches to the distal humerus for fracture fixation].

PURPOSE OF THE STUDY: We report our experience with the medial and medioposterior approaches to the humeral diaphysis for plate fixation of the proximal humerus. MATERIAL AND METHODS: Fifteen patients were treated for shaft fracture (n=13) or nonunion (n=2) of the distal third of the humerus without radial nerve involvement. The medial approach was performed in the supine position and the medioposterior approach in the prone position. Bone healing was achieved in all cases. Three patients experienced sensorial irritation in the territory of the median nerve after the medial approach; one case did not regress. There were no complications with the medioposterior approach. DISCUSSION: Dissection of the radial nerve can be avoided with these two approaches which also have a cosmetic advantage. The medioposterior approach appears to be preferable because of the comfortable operative position and the absence of risk for the median nerve. Both approaches are however contraindicated if there is preoperative involvement of the radial nerve.

Adolescent↗
PubMed2002

[Internal fixation of proximal humerus fracture by "palm tree" pinning].

PURPOSE OF THE STUDY: Fractures of the proximal humerus are increasingly frequent. Conservative treatment is most often proposed, but surgery must be performed when the displacement is significant and/or when the fracture is unstable. Osteoporosois and comminution are two essential elements for deciding on the surgical technique. MATERIAL AND METHODS: This retrospective study included 31 patients who underwent pinning from the deltoid V according to the Kapandji procedure. There were 19 females and 12 males. Mean age was 61 years. There was a fracture of one of the tuberosities in 12 cases and significant metaphyseal comminution in 8. RESULTS: Mean follow-up was 26 months. Outcome was excellent or good in 22 cases (70.9%), fair in 4 (12.9%), and poor in 5 (16.2%). Fifteen complications were noted (48.4%): material displacement 8 cases, reflex sympathic dystrophy 3 cases, radial nerve palsy 2 cases, head osteonecrosis 1 case, and humeral fracture at the site of insertion of the K wires 1 case. DISCUSSION: At the present time, there is no consensus for the surgical management of fractures of the proximal humerus, including proximal metaphyseal fracture with or without fracture of one of the tuberosities. Closed reduction and pinning is not really an invasive procedure, and does not injure the rotator cuff. Surgical approach at the level of the deltoid V according to the Kapandji technique avoids elbow pain and stiffness. The procedure requires a fluoroscan and experience to obtain satisfactory divergence of the K wires in the humeral head, an essential technical point. This procedure cannot be recommended for elderly patients whose bone quality is too poor to obtain good fixation of the K wires.

Adolescent↗
PubMedDate not supplied

Predicting ulnar nerve location in pinning of supracondylar humerus fractures.

Thirty-four consecutive patients with displaced supracondylar humerus fractures were treated with reduction and percutaneous pinning. The precise location of the ulnar nerve to the medial pin was determined by intraoperative nerve stimulation. In 22 of the 34 patients, the authors attempted to predict the location of the ulnar nerve by palpation and placing a mark on the skin. They also recorded the ability to feel the anatomic landmarks for pin fixation, including the medial epicondyle and ulnar nerve. The average distance from the medial pin to the predicted location was 9.3 mm, whereas the actual distance measured 7.6 mm, for a significant difference of 1.7 mm. Statistically, the authors could not accurately predict the location of the ulnar nerve prior to blind percutaneous crossed K-wire fixation of supracondylar humerus fractures. However, clinically they were fairly close in their prediction and documented safe insertion and distance from the nerve. Intraoperative nerve stimulation may assist in localizing the nerve prior to placement of the medial pin. Stimulation of the pin itself following insertion is another technique to ensure safe pin placement and decrease the risk of injury.

Adolescent↗
PubMed2002

[Fracture of the supracondylar process of the humerus associated with Monteggia fracture].

Fractures of the supracondylar process of the humerus have been rarely described in the medical literature. This is a bony projection that arises from the anteromedial surface of the distal humerus, and present in only one per cent of the population. We present a patient with this rare injury associated with a Monteggia fracture of the forearm. The proximity of neurovascular structures to the process makes them vulnerable to injury associated with this fracture. We present a review of the literature and treatment guidelines.

Adult↗
PubMed2002

[Early results of the operative treatment of the supracondylar humerus fractures in children].

Hereby paper presents the early results of the operative treatment of the 83 supracondylar humerus fractures in children. Two operative methods are applied: closed or opened reposition of the fractures under the x-ray monitoring with K-wires stabilisation. About 20% of fractures were treated with the use of closed reposition method. All children underwent the operation in the first day of admission. The average time of hospitalisation lasted for 6 days. The results were evaluated after average 14 months long observation. Very good results were achieved in 94% of cases. The limbs axis deviations during the time of observation were not noticed. The authors suggest operative reposition with K-wires fixation in the treatment of the supracondylar fractures of the humerus in children.

Adolescent↗
PubMed1976

Küntscher intramedullary reaming and nail fixation for nonunion of the humerus.

Thirteen cases of nonunion of the humerus were treated by intramedullary reaming and nail fixation. Rigid stabilization which was usual after operating upon other long bones was not always secured in these cases, and supplementary plaster immobilization was necessary. Seven fractures healed and 3 fractures required re-nailing before healing. Three fractures did not heal in spite of reoperation, but in 2 of these cases the nail provided stability and controlled pain and motion at fracture site. Nonunion of the humerus is a difficult problem, irrespective of the method of treatment.

Adult↗
PubMed2003

[Lesions of the peripheral nerves after surgical treatment of fractures of the distal humerus].

In the work we have examined 44 patients (16 women and 28 men), which the break of distal humerus is saned with operation, using adequate OSM. The average years of women patients was 29 (from 3 to 79), and of male patients 24 (from 1 to 75). After thr operative sanitary breaks distal part of humerus, using adequate OSM (fillo Kurschneri, platho metalico, clavo spiralis), it can come on lesion of perifer nerves of the arm, and mostly of n. radialis. Lesions of n. radialis we have notice on 5 patients. The rehabilitation our patients was made with prevention contraction of shoulder, elbow, hand and fingers using kinesitherapy, hydrotherapy and electrotherapy paralysis musculature with intentional exercises to the reinervation of perifer motor neuron and raising the force of musculus.

Adolescent↗