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PubMed2003

[Treatment of displaced supracondylar fractures of the humerus in children at the orthopaedic ward of the Children's Hospital in Kielce].

Ninety five children in age from 4 to 12 years (61 boys and 34 girls) with displaced supracondylar distal humerus fractures were treated at the orthopaedic ward of The Children's Hospital in Kielce between I 2000-XII 2001. The method of choice was closed reduction and percutaneous fixation with Kirschner wires (74 children). We also used closed reduction and application of an above elbow cast (12 children), skeletal traction with fixation after swelling resignation (5 children), and open reduction and internal fixation (4 children). In 90 cases we did not observe any neurovascular disorders, and early functional results were good or satisfactory. 2 cases were associated with transient, postreduction radial nerve palsy. In 2 children surgical intervention was necessary due to external compression of the brachial artery in one case, and contusion with brachial artery spasm in another. In one girl we observed development of Volkmann's contracture (treated surgically with good functional result). The authors conclude that the closed reduction and percutaneous K-wire fixation can be used as a treatment of choice for displaced supracondylar fractures of the humerus in children.

Adolescent↗
PubMed1992

[Osteosynthesis of fractures of thr proximal end of the humerus by the screw-pin technique].

Both fascicular pinning as described by Appril and palmate pinning are inconvenient in that the pins can perforate the articular cartilage of the humeral head and provoke premature unpinning because of insufficient fixing in an osteoporotic bone. A new osteosynthesis material has been developed to reduce these inconveniences: the screw-pin. This ensures initial stability in the humeral head and allows immediate postoperative re-education of displaced fractures of the upper end of humerus. Results are presented of the use of this new material since 1988 in 26 fractures of upper end of humerus.

Bone Nails↗
PubMed2003

Treatment results for open comminuted distal humerus intra-articuler fractures with Ilizarov circular external fixator.

In open, intra-articular distal humerus fracture caused by gunshot injury, full functional recovery is difficult to obtain. Three basic treatment methods are available: minimal internal fixation, open reduction-internal fixation, and external fixation. In Gülhane Military Medical Academy Department of Orthopedics and Traumatology, 19 of 20 cases of gunshot injuries were treated with circular external fixator between the January 1995 and December 2000. Nine (45%) cases were type III-A, eight (40%) were type III-B, and three (15%] were type III-C. Eight (40%) cases were brought to the hospital 6 to 8 hours after the injury and 12 (60%) were in late stage. An amputation was done in one case. Mean follow-up period was 34.3 (14-55) months. Union was achieved in all 19 of the cases, and circular external fixator was taken out in a mean period of 4.6 (3-7) months. In the early treatment group, three (42.9%) were good, three (42.9%) were moderate, and one (14.2%) was unsatisfactory. In the late treatment group, five (41.7%) were good, four (33.3) were moderate, and three (25%) were unsatisfactory. Circular external fixator can be preferred as a treatment alternative in selected cases of distal humerus intra-articular open communited fractures because it protects the soft tissue connections and blood circulation of bone fractured, permits early elbow movements, and allows the patient to return to daily life very early.

Adult↗
PubMedDate not supplied

The Fixion expansion nail in the surgical treatment of diaphyseal fractures of the humerus and tibia. Our experience.

The authors present their experience in the application of a Fixion expansion intramedullary nail for the treatment of diaphyseal fractures of the humerus and tibia, in a total of 40 surgeries. The features of the nail are: stability and flexibility of the instrumentation, speed of surgery, minimal exposure to radiation. The results obtained up to now are encouraging; there are no significant problems either during or after surgery, and mean consolidation time is 3 months for fractures of the humerus, and 4 months for those of the tibia. The Fixion nail is a versatile type of instrumentation that is easy to use.

Adult↗
PubMed2003

[Proximal 4-part humerus fractures treated by antegrade nailing with self-stabilizing screws: 31 cases].

PURPOSE OF THE STUDY: We present results of an internal fixation procedure for 4-part fractures of the upper part of the humerus with or without impaction. MATERIAL AND METHODS: Antegrade nailing with self-stabilizing screws, by Telegraph nail, was used in 31 patients treated between June 1998 and June 1999. The standard insertion technique or the cup-and-ball method were used for nail insertion depending on the type of fracture (Neer and Duparc classification), the cup-and-ball method allowing fixation of more complex fractures. Clinical and radiological data were available for 23 patients at a mean follow-up of two years. Functional outcome was assessed with the Constant score. RESULTS: At last follow-up, the rough Constant score was 63 and the age- and sex-balanced Constant score was 85. Mean antepulsion was 130 degrees. Outcome was significantly better for Duparc type 2 cephalotuberosity fractures (scapula valga) where the weighted Constant score was 93. There were two cases of necrosis. DISCUSSION: Complex fractures of the upper part of the humerus are a major therapeutic challenge. To date, there is no agreement on the most appropriate osteosynthesis method and the results of shoulder prosthesis after trauma remain controversial. The Telegraph nail appears to be a simple and reproducible method of achieving reduction, stability, and early mobilization. Functional outcome has been favorable for type 2 cephalotuberosity fractures and only two cases of necrosis were observed in this series in patients with type 3 and 4 cephalotuberosity fractures. These good results are related to the self-stabilizing effect of the locking screws which allow a stable fixation and revascularization of the bony fragments by creeping substitution. This new system is an attractive alternative to shoulder prostheses in trauma victims with complex displaced fractures without impaction. The surgical technique remains difficult. It would appear reasonable to expect remarkable and reproducible results for impacted fractures.

Adult↗
PubMed2003

[Anterior radial nerve transposition in humerus midshaft fractures: anatomic and clinical study].

PURPOSE OF THE STUDY: Plate fixation of midshaft humerus fractures raises the risk of radial nerve injury. Anterior transposition of the radial nerve has been proposed as a possible solution but few reports have been published. The purpose of the present study was to validate the effect of transposition on the transposed radial nerve and its branches. MATERIAL AND METHODS: We conducted an anatomic study on 10 cadavers. The length of the radial nerve between 2 anatomic landmarks was determined before and after transposition and plate fixation. A clinical evaluation was performed four years after surgery in 6 patients with midshaft humerus fractures treated with plate fixation after radial nerve transposition. RESULTS: The anatomic study demonstrated a mean gain of 11 mm in the length of the radial nerve with no problem for the transposed nerve or its branches. Clinically, osteosynthesis was facilitated and tension on the nerve was reduced. DISCUSSION: These 2 complementary studies demonstrated the releasing effect of transposition on the radial nerve and the facilitated osteosynthesis reported by others. The benefit of transposition is particularly important when bone fixation is particularly difficult to achieve without risk of injuring the radial nerve. Transposition does however require an extensive dissection, and the patient must be informed. CONCLUSION: The ideal indication for anterior transposition of the radial nerve is an oblique fracture of the mid-third to lower-third of the humeral shaft with radial palsy at onset. A certain degree of comminution facilitates the technique. Indications for this technique could however be widened to include cases of difficult osteosynthesis where the option to transpose the radial nerve is always a peroperative decision.

Adult↗
PubMed2003

[Humeral head replacement for the complex treatment of proximal humerus fractures].

OBJECTIVE: To investigate indication, technical key during surgery and early results of humeral head replacement for the treatment of complicated proximal humerus fractures. METHODS: Sixteen patients who received humeral head replacement were reviewed with a mean follow-up period of 6.8 months. Of the 16 patients, 15 suffered acute fractures with the mean interval between injury and surgery being 8 days. 1 case was a malunion after ORIF 1 year ago. The mean age for these patients were 58.9 years. Trauma series X-rays were taken at post-operation 2-week, 6-week, 10-week, 16-week 6-month and the latest follow-up. SST (Simple Shoulder Test) questionnaire, ASES (American Shoulder & Elbow Surgeon) score, Constant-Murley score and UCLA score had been adopted for evaluation at the latest follow-up. RESULTS: The mean ASES score was 89.1 (64 - 94); the mean VAS score was 2.7 (0 - 5); the mean forward flexion was 128.1 degrees (90 degrees - 150 degrees ), external rotation 35 degrees (30 degrees - 40 degrees ), internal rotation at T8-T9 level (L1-T6); the mean Constant-Murley score was 85.7 (53 - 95); the mean UCLA score was 30.4 (21 - 33); the mean number of questions for "yes" in SST questionnaire was 9.3 (7 - 11). The total satisfaction rate for pain relief was 93.8% (15/16), and functional recovery was 87.5% (14/16). CONCLUSIONS: Through strict indication control, appropriate timing, meticulous surgical techniques and long intense rehabilitation, satisfactory results can be obtained in humeral head replacement for the treatment of complicated proximal humerus fractures. Our report is only a preliminary one on early results, and a long-term follow-up data is needed for further evaluation.

Adult↗
PubMed1992

[Treatment of subcapital humerus fracture with the Prévot nail].

Displaced subcapital fractures of the humerus are difficult to manage due to the specific anatomical and biological conditions in the proximal humerus. With respect to the fracture type and extent of displacement of the humeral head and the tuberosities the concepts for treatment remain controversial. A large spectrum of recommendations for the treatment of unstable subcapital fractures are known ranging from conservative treatment, open reduction and internal fixation using different implants to the primary prosthetic replacement of the humeral head. Recent results from basic research emphasize the importance of sound tissue viability for undisturbed fracture healing and influence today's strategies in fracture management. Minimal exposure of the fracture area, indirect reduction techniques and a minimal but optimal biomechanical use of implants can help to avoid some of the possible (and partially iatrogenic) complications. Fixation of subcapital humeral fractures by intramedullary pinning seems to provide sufficient stability without damaging the vascularity of the fracture fragments leaving intact in addition the soft tissues around the shoulder. The treatment of proximal humeral fractures by the use of Prévotnails is presented in this paper and some possible problems of the method are discussed.

Aged↗
PubMed2004

Functional evaluation of comminuted intra-articular fractures of the distal humerus (AO type C). Long term results in twenty-six patients.

The authors present the results achieved in 26 patients who presented with intra-articular fractures of the distal humerus (8 AO type C1, 8 C2 and 10 C3) and who were operatively treated between 1999 and 2001; they were retrospectively evaluated after a mean follow-up period of 70.2 months. There were 12 males and 14 females with a mean age of 46.1 years. After a standard posterior approach with olecranon osteotomy, internal fixation was achieved with unilateral or bilateral plates and screws, or isolated screws and/or Kirschner wires. Anterior intramuscular transposition of the ulnar nerve was performed in 14 of the patients. The results were evaluated using the criteria of Morrey. The results were graded as excellent in 6 patients (23.1%), very good in 15 (57.6%) and fair in 5 (19.3%). Complications included postoperative ulnar nerve palsy (1), wire migration (4), heterotopic ossification (3), infection (2) and material failure (2). The overall re-operation rate was 38.4%. The authors conclude that careful preoperative planning, transolecranon approach for good visualisation, routine ulnar nerve exploration and stable internal fixation facilitating early active rehabilitation, remain the gold standard for the treatment of intra-articular fractures of the distal humerus.

Adolescent↗
PubMed2004

[Percutaneous pinning for the treatment of proximal humerus fractures].

OBJECTIVE: The indication, surgical techniques and results had been discussed through clinical analysis of percutaneous pinning for the treatment of proximal humerus fractures. METHODS: Forty-nine patients with 49 shoulders treated with percutaneous pinning had been reviewed with a mean follow-up period of 16.9 months. All were acute fractures, with a mean age of 40.4 years. There were 39 2-part surgical neck fractures, 6 impacted 2-part greater tuberosity fractures and 4 valgus-impaction 4-part fractures. SST (Simple Shoulder Test) questionnaire, ASES (American Shoulder & Elbow Surgeon) score, Constant-Murley score and UCLA score had been adopted for final evaluation at the latest follow-up. RESULTS: The mean ASES score was 91.4, the mean VAS score was 1.7, the mean forward flexion was 146.7 degrees, external rotation 39.6 degrees, internal rotation at T(8)-T(9) level; the mean Constant-Murley score was 88.2; the mean UCLA score was 31.2; the mean number of questions for "yes" in SST questionnaire was 10.1. All fractures healed with a mean period of 8.8 weeks. No patient had been found for any evidence of humeral head necrosis at the latest follow-up The total satisfaction rate for pain relieve was 95.9% (47/49), and for functional recovery was 91.8% (45/49). CONCLUSIONS: Most 2-part surgical neck fractures, impacted 2-part greater tuberosity fractures and 4-part valgus-impaction fractures are good indications for percutaneous pinning. With appropriate and intense rehabilitation, satisfactory results can be expected in percutaneous pinning for the treatment of certain types of proximal humerus fractures.

Adolescent↗
PubMed2004

A minimally invasive approach for plate fixation of the proximal humerus.

Plate fixation for unstable fractures of the proximal humerus has seen mixed results as evidenced by the trials of new methods of fixation. The deltopectoral surgical approach is most frequently used and requires significant muscle retraction and soft tissue stripping to expose the lateral humeral neck. This may contribute to avascular necrosis and fixation failure. Lateral approaches have been limited to 5 cm distal to the acromion because of the course of the anterior branch of the axillary nerve. A recent anatomic study has demonstrated the predictability of the position of the axillary nerve as it crosses the anterior deltoid raphe, which allows it to be isolated and protected, and dissection can be extended distally. In addition, no accessory motor branches to the anterior head of the deltoid cross the raphe, so extending an incision through the raphe after protecting the main motor branch of the axillary does not place the innervation to the anterior deltoid at risk. This surgical approach allows exposure of the proximal humerus and indirect reduction of the fracture, with subsequent locking plate fixation, adhering to the principles of biological fixation.

Bone Nails↗
PubMed2004

[A new method of preoperative modeling of perosseous osteosynthesis for fractures of the humerus bone and forearm bones].

The aim of the investigation was to improve results of treatment of patients with fractures of the humerus and forearm bones by complex treatment using numerical processing of video-information and computed modeling of the operation of perosseous osteosynthesis. A personal computer equipped with means for lead-in and visualization of the image was used for an analysis of rentgenograms. Among 144 patients treated for fractures of the humerus and forearm bones there were 83 treated using the method of perosseous osteosynthesis. The numerical computed modeling of the operation was fulfilled in 41 patients. The method allowed to improve the anatomical and functional results, to shorten the duration of the treatment, to reduce the number of complications and unsatisfactory outcomes, to optimize the method of perosseous osteosynthesis as a whole.

Adolescent↗
PubMed2005

[Repair of refractory bone nonunion in the distal humerus].

OBJECTIVE: To investigate the effect of microsurgical repair of refractory bone defects and nonunion in distal humerus. METHODS: Twelve cases of bone defects and nonunion in distal humerus were repaired with free vascularised fibular graft and fixed with the anatomical bone plate. Of the 12 cases, 8 had pseudarthrosis, and 4 had bone defects 3-5 cm. Fibular graft ranged from 5-15 cm, 8.5 cm in average. RESULTS: After a follow-up of 3-18 months, 8.5 months in average, all cases of free vascularised fibular graft healed within 3-8 months. The fibular graft thickened as time passed. Normal recessive osseous elbow joint, improvement in the inflection and extension of elbow joint, and normal revolving of forearm were attained. The short of limbs were corrected. Satisfactory functions of supporting and fine operation were attained. CONCLUSION: With the support of anatomical bone plate, the fibular graft can help the recovery of joint function and repair bone defects and nonunion as to avoid joint replacement with prosthesis.

Adolescent↗
PubMed1992

Percutaneous stabilization of unstable fractures of the humerus.

Forty-eight of fifty-four patients who had had closed reduction and percutaneous pinning of an unstable fracture of the proximal end of the humerus were available for clinical and roentgenographic follow-up at an average of three years (range, two to seven years) after the operation. According to the point-scale of Saillant et al., the result was good or excellent in thirty-four patients, fair in ten, and poor in four. Four patients had loss of fixation and had repeat fixation with percutaneous pinning after a second closed reduction. Only one of them had a poor result because of malunion. Four patients had a superficial pin-track infection and loosening of pins, one patient had a deep infection, and two had a non-union. Complete avascular necrosis with collapse of the humeral head developed in only two patients. However, eight patients had localized avascular necrosis with transient cyst formation and sclerosis in the humeral head that resolved over one to two years; these were thought to represent subtotal avascular necrosis. Although closed reduction and percutaneous pinning is a technically demanding procedure, it offered results in our patients that were comparable with or superior to those after previously described operative methods for the treatment of unstable fractures of the proximal end of the humerus.

Adolescent↗
PubMed1992

[Osteosynthesis in dislocated fractures of the humerus head].

The operative treatment of displaced fractures of the proximal humerus has changed during the last few years. Minimal osteosynthesis takes into consideration to a great extent the biological aspects of these fractures and provides sufficient stability for early functional therapy. Neer's classification has proved very useful for both the indication for and the choice of an operative procedure. The high necrosis rate of the operatively stabilized humeral head has considerably influenced the operative strategy. This is shown in two separately controlled patient groups. From 1970 to 1980, 65 patients and from 1983 to 1987, 30 patients with displaced fractures of the proximal humerus were treated operatively. Within the first group, in more than half the cases a T-plate osteosynthesis was performed, a minimal osteosynthesis being performed in only 1 out of 5 patients. In the second group, we exclusively performed minimal osteosynthesis. More favourable results were achieved in fractures with two or three fragments, in younger patients and in isolated shoulder injuries than with four-fragment fractures or luxated fractures, in older and in polytraumatized patients. Using minimal osteosynthesis instead of plate osteosynthesis in four-fragment fractures, functional results were achieved which, in 75%, were satisfactory or better. The necrosis rate of the humeral head also declined. We conclude that head-preserving methods seem advisable in these severe forms of humeral fractures.

Adolescent↗
PubMed2005

The effect of greater tuberosity placement on active range of motion after hemiarthroplasty for acute fractures of the proximal humerus.

Union of the greater tuberosity to the humeral shaft after hemiarthroplasty for acute fractures of the proximal humerus is a critical factor in the restoration of glenohumeral function. A retrospective review was undertaken to examine 23 consecutive patients who underwent hemiarthroplasty for the treatment of acute three- and four-part fractures of the proximal humerus. The study was conducted to examine the relationship between the position of the healed greater tuberosity and postoperative range of motion. The average age of the patients was 66.5 years. The average follow up was 3.8 years with a range of 24 to 108 months. Active range of motion was measured in forward elevation, external rotation, and internal rotation. Postoperative radiographs were examined to determine the position of the united greater tuberosity in relation to the top of the replaced humeral head. The tuberosity was fixed at an average of 15.4 mm below the top of the humeral head (range: 3 to 26 mm). A radiographic assessment of a control population of 50 normal proximal humeri demonstrated an average tuberosity position of 6.7 mm (range: 2 to 12 mm) below the superior aspect of the humeral head. Polynomial regression analysis demonstrated a polynomial relationship for active range of motion and tuberosity height. ANOVA testing demonstrated statistically significant differences in all ranges of motion. Active forward elevation for Group I (3 to 9 mm) was 88 degrees, Group 11 (10 to 16 mm) was 126 degrees, and Group III (17 to 26 mm) was 85 degrees (p = 0.04). Active external rotation for Group I was 19 degrees, Group II was 48 degrees, and Group III was 29 degrees (p = 0.01). Active internal rotation for Group I was to L2, Group II was to T10, and Group III was to L2 (p = 0.01). Although many factors affect the final ranges of motion in patients who undergo prosthetic replacement for acute proximal humeral fractures we believe that placement of the greater tuberosity 10 to 16 mm below the humeral head will assist in the maximum recovery of glenohumeral motion.

Adult↗
PubMed2005

Management of distal humerus fractures.

Fractures of the distal humerus are complex injuries that can be effectively treated with open reduction and internal fixation (ORiF). Exposure of a complex intra-articular fracture may best be achieved through a posterior approach with osteotomy of the olecranon process. The ulnar nerve must be identified and protected, the articular surface must be reduced anatomically, and rigid fixation must be applied to both the medial and lateral columns of the distal humerus. Range of motion should be initiated as soon as possible postoperatively. Complications such as ulnar neuropathy, elbow stiffness, heterotopic ossification, and nonunion should be treated aggressively. Total elbow arthroplasty represents an effective option for fractures that cannot be treated with ORIF.

Fracture Fixation, Internal↗
PubMed1992

[Intramedullary nailing osteosynthesis with epiphyseal fixation of fractures of the proximal humerus in adults. 1 to 3-year follow-up].

The authors used a medullary pinning with epiphyseal fixation in the treatment of superior metaphyseal fractures of the humerus for 41 patients aged 22 to 82 years. There were 28 cases with epiphyseal fractures and 12 with metaphyseal fractures. The follow-up was 1 to 3 years. The pins were introduced through the triceps brachii after perforation of the diaphysis, 1 cm above the ulnar fossa. Results were very good. Strength returned within 8.5 weeks. There was only one case of nonunion of a proximal diaphyseal fracture due to a technical fault (diastasis between fragments). Rehabilitation began immediately, resulting in good elbow motion in 35 cases. The shoulder motion was the same as the healthy side in 36 cases, and inferior to 90 degrees of abduction in only two complex epiphyseal fracture. The proximal humerus was never perforated by the pins. The authors find this new instrumentation to be very effective.

Adult↗