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PubMed2005

Effects of three intramedullary pinning techniques on pin location and articular damage in the canine humerus.

The purpose of this study was to compare the pin location and articular damage for intramedullary (IM) pins inserted into the humerus in a directed retrograde, non-directed retrograde, and normograde fashion. Proximal pin positioning in the humerus was significantly more cranial (p < 0.05) using both retrograde techniques when compared to the normograde technique, although this did not cause significant interference with anatomical structures. The distance to the biceps tendon, transverse humeral ligament, and the distal pin location was similar with all insertion techniques, however two of ten pins passed in a non-directed retrograde fashion penetrated the shoulder joint. The results of this study suggest that although non-directed retrograde pinning cannot be recommended, either normograde or retrograde pins directed craniolaterally provide acceptable techniques for insertion of IM pins during distal humeral fracture repair.

Animals↗
PubMed2006

[Percutaneous reduction and fixation of osteoporotic fractures for the proximal humerus in a geriatric population].

OBJECTIVE: To appraise the value of clinical treatment of percutaneous reduction and fixation of osteoporotic fractures for the proximal humerus in a geriatric population. METHODS: Postoperation complication, mortality in hospital and within the first three months postoperation, operation time, blood transfusion requirement, the functional outcome of the shoulder had been analysed and observed in 37 cases for open and closed fixation. RESULTS: Closed reduction provided the benefit of obtaining and holding adequate reduction without the soft-tissue dissection of open reduction and internal fixation. The general complication and mortality in the first three months postoperation in the open reduction and internal fixation cases were more severe than the percutaneous cases. CONCLUSIONS: Open operation increases the risk of the geriatric population with osteoporotic proximal humerus fracture; percutaneous reduction and fixation may be preferable.

Aged↗
PubMed2006

Intraarticular distal humerus fracture complicated by osteogenesis imperfecta treated with primary total elbow arthroplasty: a case report.

Intraarticular fractures of the distal humerus are challenging problems for the treating surgeon. When these fractures are complicated by severe comminution and poor bone quality, open reduction and internal fixation may lead to poor clinical outcomes when compared with those treated with primary total elbow arthroplasty. The population in which this clinical scenario most often arises is the elderly. An unusual case is presented in which a 38-year-old individual was successfully treated with primary total elbow arthroplasty for a highly comminuted, intraarticular distal humerus fracture with severe osteopenia due to osteogenesis imperfecta in which standard plate osteosynthesis was unlikely to provide sufficient stable fixation.

Adult↗
PubMed2006

Clinical evaluation of a new custom offset shoulder prosthesis for treatment of complex fractures of the proximal humerus.

Primary hemiarthroplasty of the shoulder is an accepted procedure to treat complex proximal humeral fractures. The goal of this study was to assess the functional outcome in patients treated with hemiarthroplasty using a custom offset shoulder prosthesis, either for an acute four-part fracture of the proximal humerus or following failed primary treatment of a complex humeral fracture. Thirty seven patients were followed up for a mean of 17 months after shoulder replacement (Group A: four-part-fractures; n = 26, Group B: posttraumatic necrosis/non-union after failed primary treatment; n = 11). The Constant-Murley-Score and radiological score according to Neer's classification were used for postoperative functional and radiological assessment. Following hemiarthroplasty, Group A achieved an average Constant Score of 52 and Group B of 46. The pain relief after hemiarthroplasty was about 53% in Group A and only 33% in Group B. The least satisfying partial function was shoulder mobility in both groups. Radiographic evaluation did not correlate with the Constant Score. Patients secondarily treated with arthroplasty seem to have less chance to achieve a satisfying functional outcome compared to those with immediate hemiarthroplasty. These results emphasise the importance of a careful initial decision to select the most appropriate treatment modality in complex fractures of the proximal humerus.

Aged↗
PubMed1990

Intramedullary osteosynthesis 3. Küntscher nailing in the humerus.

With regard for the principles that govern the correct application of intramedullary osteosynthesis in the long bones of the lower limb, the authors also support its use in the humerus. After an exhaustive survey of the specific problems at this site, a critical review of 130 cases observed over the last 15 years is reported. Extremely favourable results emerged in the treatment of the humerus with this means of synthesis, thanks to its surgical, mechanical and biological advantages.

Adolescent↗
PubMed1990

Neural injuries associated with supracondylar fractures of the humerus in children.

A retrospective review of displaced extension-type supracondylar fractures of the humerus in 101 children who were seen consecutively revealed eighteen associated neural injuries in thirteen children. Nine of the neural injuries in eight patients spontaneously resolved at a mean of 2.5 months (range, 1.5 to five months) after injury. The remaining nine lesions in five patients were explored at a mean of 7.5 months (range, five to fourteen months) after injury, because clinical and electromyographic studies showed no return of function. Neurolysis was performed on eight of the nerves that were explored (in five patients), and the remaining radial nerve was found to be completely lacerated and needed nerve-grafting. The length of follow-up after neurolysis averaged twenty-five months (range, thirteen to forty-four months). All five patients had functional recovery, as documented by range-of-motion, grip-strength and lateral pinch-strength, and von Frey and two-point-discrimination sensory testing. The patient who had had nerve-grafting never recovered neural function, and tendon transfers were needed. We concluded that observation and supportive therapy is the preferred initial approach for children who have a neural injury associated with a closed, displaced supracondylar fracture of the humerus. However, if there is no clinical or electromyographic evidence of return of neural function at five months after injury, exploration and neurolysis should be performed. If the nerve is in continuity, the prognosis after neurolysis is excellent.

Adolescent↗
PubMed1989

[Surgical treatment of fractures of the distal end of the humerus in children].

The author presents his epyerience in the treatment of 473 children with fractures of the distal end of the humerus. An effort is made to systemize the fractures according to the degree of their dislocation for working out the optimal method of surgical treatment. Preference is given to actively surgical methods. The problems of stable fixation of the fragments are considered and it is suggested to use a lateral dosed compression apparatus as a fixator. The period of immobilization is considered from the point of siev of the restoration of the circulation in the distal fragment and it is proposed to extend the period of immobilization in the fractures of the distal epiphysis to 5 or 6 weeks. The immediate and the long-term results of the treatment of the fractures of the distal end of the humerus in children are analysed.

Casts, Surgical↗
PubMed1989

[Fractures of the inner epicondyle of the humerus associated with dislocation of the forearm bones in children and adolescents].

The authors attract attention to frequent association of fracture of the inner epicondyle of the humerus with dislocation of the bones of the forearm, which is of great practical importance. On this basis classification of fractures of the inner epicondyle of the humerus is presented. The authors believe that in treating this injury the method of choice should consist in open reposition, which allows to achieve accurate reposition, sanation of the ulnar joint cavity and stable fixation of the fragment. Osteosynthesis by screw-awl provides for reliable fixation of the fragment and allows for early development of the movements in the ulnar joint. Surgical treatment mostly gave excellent and good results and complications were few. The complications observed were mainly connected with late admission of the patients.

Adolescent↗
PubMed1989

Metastatic diaphyseal fractures of the shaft of the humerus. The structural strength evaluation of a new method of treatment with a segmental defect prosthesis.

The surgical treatment of extensive metastatic diaphyseal lesions of the humerus with pathologic fractures is difficult. Patients with failed internal fixation often have large segments of bone loss. Rigid fixation often is not possible in these cases. Four patients were treated with a titanium segmental defect (SD) prosthesis with good clinical results. A comparative in vitro analysis of fixation with the SD prosthesis, a Rush rod, and a dynamic compression plate (DCP) augmented with methylmethacrylate was performed. The SD prosthesis performed better than the Rush rod and DCP in both the nondestructive four-point bending test and the destructive torsional test. The reconstructed humeri using the SD prosthesis had a torsional strength approaching that of an intact specimen. Hence, the SD prosthesis is a useful adjunct device in treating patients with extensive destructive lesions of the humerus secondary to metastatic disease and hematologic malignancies and in patients with malignant diseases who have had failed attempts at internal fixation.

Adult↗
PubMed1988

Nonunion of the humerus.

Under certain circumstances, fractures of the humerus may not heal. Some fractures experience delayed union and some develop nonunion despite improved methods of treatment. This chapter discussed nonunion and fracture fixation methods in the proximal, middle, and distal thirds of the humerus. Special circumstances were discussed, such as infection, nerve palsy, comminution, and electrical stimulation.

Electric Stimulation Therapy↗
PubMed1988

Non-union of fractures of the distal end of the humerus.

The records of twenty patients who had been treated for a non-union of the distal end of the humerus at the Massachusetts General Hospital from 1968 to 1984 were reviewed. Thirteen of the fractures were extra-articular and seven were intra-articular. Seven fractures had been open and nine had been associated with multiple trauma. Eight had been initially treated by open reduction and internal fixation; five, by closed reduction and immobilization; four, by skeletal traction; two, by external fixation; and one, by débridement and immobilization. The average time from the original fracture to the treatment of the non-union was twenty months (range, three to 120 months). All but one patient had pain and instability, and fifteen (75 per cent) had limited motion of the elbow. Radiographically, eleven were considered to have a reactive non-union and nine, a non-reactive non-union. Seventeen (94 per cent) of the eighteen non-unions ultimately united. Two patients underwent excision of the distal end of the humerus and replacement with an allograft. At follow-up (average, 3.6 years), function in one patient was rated as excellent; in six, as good; in seven, as fair; and in six, as poor. The patients who had an extra-articular supracondylar non-union had the best over-all results, while those who had a non-union that was associated with an intra-articular component or severe soft-tissue trauma did less well. It should be emphasized, however, that most of the patients in this study continued to have a major long-term disability, despite the fact that union was successful.

Adult↗
PubMed1988

[Intra-articular unicondylar humerus fractures. Late results following stable osteosynthesis].

The authors report the late results in a series of 45 unicondylar intra-articular fractures of the distal humerus treated by internal fixation. The fractures were classified according the AO system. The average follow-up time was 4.25 years. A rating scale was used that was based on patient interviews. Based on the late results, internal fixation is concluded to be the treatment of choice for all unicondylar intra-articular fractures of the humerus.

Adolescent↗
PubMed1987

Supracondylar fractures of the humerus in children. A modified technique for closed pinning.

Complications in the treatment of displaced supracondylar fractures of the humerus (DSFH), particularly cubitus varus, are a persistent problem. A prospective study was conducted on 20 children with DSFH, using a modified technique to reduce and pin the fracture. All fractures were treated with closed reduction and percutaneous pinning. After the fracture was internally fixed, intraoperative anteroposterior roentgenograms of each distal humerus were compared, using Baumann's angle. The reduction was accepted if Baumann's angle on the fractured extremity was within 4 degrees of that on the normal side. If the angles were not within 4 degrees, the closed reduction and percutaneous pinning was repeated. In this prospective series, all patients had a reduction to within 4 degrees of the normal side before they left the operating room. Three weeks after percutaneous pinning, the pins were removed and range of motion was begun. All patients returned for clinical and roentgenographic examination. With an average follow-up period of 17.2 months, all patients had excellent or good results. No patient developed cubitus varus deformity. Strict adherence to the guidelines of the protocol prevented cubitus varus deformity in this series of children with DSFH.

Bone Nails↗
PubMed1987

Supraintercondylar fractures of the humerus--treatment by the Vigliani osteosynthesis.

Nineteen cases of supraintercondylar fractures of the humerus treated by the Vigliani osteosynthesis technique are described. This consists of wide transolecranon exposure of the fracture, stabilisation of the epiphyseal fragments with a transcondylar screw, and of the metaphyseo-epiphyseal junction with two condylo-diaphyseal "Eiffel Tower" Kirschner wires. The ulnar nerve is transposed anteriorly and the operation is carried out early in order to prevent neural disturbances and intra and/or periarticular ossification. The results confirm the validity of this method, which respects the delicate structure of this part of the humerus. Postoperative plaster is necessary as an indispensable complement to "minimum" osteosynthesis but this is quite free from risk. The importance of careful and gradual mobilisation of the elbow is also confirmed. Finally, this method combines the advantages of stable osteosynthesis in compression (screw and nut) at the epiphyseal site, with those of elastic osteosynthesis (Kirschner wires) at the metaphyseo-epiphyseal junction.

Adolescent↗
PubMed1986

The three-part fracture of the proximal part of the humerus. Operative treatment.

A retrospective review of the cases of fifteen patients with a three-part fracture of the proximal part of the humerus is presented. Fourteen of the fractures were treated with tension-band wiring and one, with an AO buttress plate. The patients were evaluated for pain, range of motion, strength, and function of the involved shoulder and the radiographic result at an average of fifty-four months after the injury. At follow-up, the shoulders had an average of 126 degrees of active elevation, 29 degrees of active external rotation, 81 degrees of active abduction, and internal rotation to the second lumbar vertebra. The only early complication was failure of fixation in the patient who had been treated with a buttress plate. In two patients, radiographic evidence of avascular necrosis of the humeral head later developed, and one of them required revision to a hemiarthroplasty. In conclusion, we recommend operative treatment for the healthy, active individual who has a three-part fracture of the proximal part of the humerus. We found that the best results with these difficult fractures are obtained using tension-band wiring.

Aged↗
PubMed1979

[Fractures of the head and tuberosities of the humerus: treatment of malposition (author's transl)].

Fractures of the head and tuberosities of the humerus combine "horizontalisation" with impaction of the head of the humerus into the cortical funnel of the upper metaphysis which then forms a "buffer" with a sub-acromial "camshaft effect". In addition, there may be a subjacent metaphyseal comminution or even a split in the head. These various factors render surgical treatment difficult, when it is sought to restore normal anatomical conditions by osteosynthesis, with uncertain anatomical and functional results because of the double risk of early separation of the fragments and of secondary necrosis. There exists the possibility of operation vis a transdeltoid approach which combines resection of the cortical cuff and lateral transposition with bringing down of the capsulo-tendinous layer. This simple technique has the advantage of almost invariably offering a satisfactory functional result.

Humans↗
PubMed1983

Prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus.

During the period from 1970 through 1979, proximal humeral arthroplasty with prostheses of the Neer design was performed in 49 shoulders (48 patients) with complex acute or chronic fractures and fracture-dislocations of the proximal humerus. Follow-up evaluation included physical and roentgenographic examination at least two years after surgery for 43 of the 48 patients and averaged 38 months (range, 2-10 years). Of the 43 patients with adequate follow-up evaluation, 16 had acute and 27 (1 bilateral) had chronic fracture problems. Pain relief was satisfactory in all of the 16 shoulders with acute fractures and in 25 of the 28 shoulders with chronic fracture problems. Active abduction averaged 101 degrees in the acute fracture group (range, 35 degrees-160 degrees) and 112 degrees in the chronic fracture group (range, 20 degrees-180 degrees). Complications in shoulders with acute fractures were associated with problems in tuberosity and rotator cuff healing. Complications were more frequent in shoulders with chronic fractures and fracture-dislocations, and were generally related to surgical difficulty, extensive tissue scarring, and distortion of anatomy. The Neer prosthesis affords satisfactory pain relief for both acute and chronic complex fracture-dislocations of the proximal humerus, but the return of function is governed by the security of tuberosity-muscle cuff repair, sufficient protection after operation, and long-term physiotherapy. If possible, surgery should be performed early to avoid the scarring and inelasticity that engender complications and limit functional recovery in shoulders with chronic fractures.

Adult↗
PubMed1978

Supracondylar fracture of the humerus in children.

Seventy-eight supracondylar fractures of the humerus in children were reviewed to compare four kinds of treatment: closed reduction and immobilization in a cast or splint, overhead skeletal traction, side-arm skeletal traction, and Dunlop's skin traction. The skeletal traction device usually used was a winged screw of our own design. The arms treated in overhead traction had significantly less change in carrying angle than those treated in side-arm traction. Significant changes in carrying angle were encountered in three instances of medially impacted so-called non-displaced fractures. There were two instances of significant carrying-angle change due to overgrowth of the lateral aspect of the distal part of the humerus. Overhead traction, utilizing a winged traction screw, was the most effective method of treatment that we found. There were no instances of Volkmann's ischemic contracture.

Casts, Surgical↗