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PubMedDate not supplied

Radial nerve paralysis associated with fractures of the humerus. A review of 62 cases.

Sixty-two patients with radial nerve paralysis associated with fractures of the humerus were reviewed. Seventy-three per cent of the patients had primary radial nerve paralysis and 27% had secondary paralysis. Conservative management has led to excellent nerve recovery in all groups of patients. Overall, 95% of the patients with radial nerve paralysis recovered normal or near normal function. All patients with secondary paralysis had full functional recovery of the radial nerve. Conservative management is recommended in patients with radial nerve paralysis associated with fractures of the humerus, regardless of age of the patient, cause of injury, level of fracture, type of fracture, and whether paralysis is primary or secondary. Use of dynamic splints and exercises, to keep all joints of the hand and wrist supple, should be an integral part of the treatment. Indications for early surgery are unacceptable fracture reduction, open fractures requiring debridement, and associated vascular injuries. In all open procedures, the radial nerve should be explored at the same time and treated appropriately. EMG studies are recommended at four and six months. If there Is no evidence of recovery, the nerve should be explored. Except in unequivocal irreparable radial nerve damage, tendon transfers should be deferred for at least six months, preferably for one year. The possible effect of entrapment of nerve by scar and callus remains to be established.

Adult↗
PubMed1982

Surgical treatment of nonunions of the surgical neck of the humerus.

End-to-end alignment of the fragments usually does not provide good bone contact or stability for fractures of the surgical neck of the humerus because cavitation of the head fragment and comminution constitute bone stock deficiency. Painful and disabling nonunion of the surgical neck of the humerus in five patients was repaired by impaling one fragment into the other, usually the shaft into the head. A corticocancellous iliac graft bridged the nonunion by extending from the interior of the head to the shaft, where it was fixed by screws. Rush rods were used for internal fixation. All five patients obtained union without evidence of avascular necrosis during the period of observation (12 to 39 months), had good pain relief, and regained satisfactory function.

Adult↗
PubMed1978

[Ascending bipolar nailing using elastic nails in the treatment of fractures of the upper end of the humerus (author's transl)].

In the treatment of non-impacted fractures of the upper end of the humerus, the tendency of many surgeons is to use nailing with the fracture site closed, from the supra-olecranon fossa. This would seem to merit certain criticisms. Following reduction of the fracture, we use Ender elastic nails and two modified nails of a smaller calibre, one inserted via the epicondyle and the other via the epitrochlea. The technique of this ascending bipolar nailing using elastic nails is carried out in a horizontal supine position, which facilitates manoeuvres of reduction and facilitates anaesthesia. Apart from non-impacted fractures of the upper end of the humerus, other indications exist.

Fracture Fixation, Internal↗
PubMed1980

Supracondylar fractures of the humerus in adults.

Supracondylar fractures of the adult humerus are uncommon and present a difficult management problem. In this series of 50 patients better results were obtained by conservative rather than surgical management. In this series poor results were all related to inability to obtain rigid fixation at operation and resultant prolonged immobilization. Initial radiographic assessment is difficult and the shape of the distal humerus makes internal fixation a technical challenge. Except for simple fractures, conservative management is the recommended treatment.

Female↗
PubMed1980

Fractures of the humerus in arm wrestlers.

In 7 cases of fracture of the humerus occurring in arm wrestlers, each patient sustained a simple spiral fracture of the distal third of the humerus. No patient had any neural or vascular compromise. Three patients underwent open reduction and internal fixation with 2 screws, at which time, muscle was found to be interposed between the fracture fragments. The other 4 patients were treated in hanging arm casts. All of the fractures united. Of the 41 cases of this injury reported in English medical literature there were 5 patients with radial nerve palsy and 16 patients who had had operative treatment of the injury. Because of the possibility of participants sustaining such an injury, arm wrestling should not be considered a totally benign sport.

Adult↗
PubMedDate not supplied

Median nerve injuries associated with supracondylar fractures of the humerus in children.

If not specifically examined for median nerve function, partial injury associated with supracondylar fracture of the humerus in children will go unrecognized. These injuries occur in as high as 5% of supracondylar fractures of the humerus in children. The 6 patients reported here as well as many cases described in the orthopedic literature present evidence that special exercises and supportive care are important as soon as the fracture is healed. Functional return may be seen as long as 4 to 5 months following supracondylar fracture, and exploration should be delayed at least that long in this type of peripheral nerve injury.

Child↗
PubMed1995

Articular fractures of the distal portion of the humerus in Vietnamese pot-bellied pigs: six cases (1988-1992)

Medical records of 6 Vietnamese pot-bellied pigs with articular fractures of the distal portion of the humerus were reviewed. Evaluation of the medical records did not reveal a sex predilection. All fractures were associated with minor traumatic episodes in young pigs. Of 6 fractures involving the humeral condyle, 4 involved the medial portion, 1 involved the lateral portion, and 1 was a Y-shaped fracture. Five of the pigs underwent surgical repair of the fracture, and all 5 did not have signs of lameness at follow-up evaluations (mean, 11 months). Of 4 pigs that had follow-up radiography, all had evidence of mild to moderate degenerative joint disease. Articular fractures of the distal portion of the humerus should be considered as a differential diagnosis in all Vietnamese pot-bellied pigs with forelimb lameness, even if the trauma sustained appeared mild. Surgical repair in Vietnamese pot-bellied pigs is straightforward, and excellent clinical results can be expected.

Animals↗
PubMed1995

Operative treatment of nonunion of surgical neck fractures of the humerus.

Seventeen patients who had undergone operative treatment for painful nonunion of a surgical neck fracture of the proximal humerus were evaluated an average of 6.3 years (range, 2-11 years) from the time of surgery to determine clinical and radiographic outcome. Ten patients underwent open reduction and internal fixation with tension band wiring and Rush rods, and 7 underwent proximal humeral hemiarthroplasty. The average age of the patients was 60 years old. After surgery, pain, function, and range of motion improved for both groups. University of California Los Angeles scores improved from an average of 4.4 to 22 points in the internal fixation group and from 4.8 to 21.4 in the hemiarthroplasty group. All 17 patients were eventually able to perform activities of daily living independently. No patient in either group was able to return to his or her preinjury level of work. Nonunion persisted in 2 patients who had undergone internal fixation, and avascular necrosis developed in 2 others. Eight of 10 patients in the internal fixation group required removal of the Rush rods for treatment of symptomatic mechanical impingement. Painful nonunion of a surgical neck fracture of the proximal humerus is a difficult problem to manage operatively. Pain relief and functional improvement was similar in patients who underwent either procedure. However, 11 of 17 patients had fair or poor ultimate outcomes.

Activities of Daily Living↗
PubMed1994

Nerve injuries associated with supracondylar fracture of the humerus in children.

Vascular complications associated with supracondylar fracture of humerus are well recognised. Less well recognised are neurological injuries associated with this fracture. A prospective study was conducted to explore the role of open reduction and internal fixation of this fracture. The article presents the incidence of nerve lesions in 46 cases of supracondylar fracture of humerus; review of pertinent literature is also included.

Child↗
PubMed1993

[Results of treatment after conservative and surgical management of proximal humerus fractures].

The proximal fracture of the humerus is still the domain of conservative treatment. In 80% of our patients the humerus fracture was not operated. The remaining 20% were treated surgically. Neer's classification was used for a differentiated approach. In case of surgical therapy the guiding principle should be to choose the least invasive surgical treatment offering the greatest benefit. Minimal treatment should be preferred to prevent necrosis. Further, one should strive to gain an axial adjustment of the fracture rather than placing too much emphasis on compression. The aim should be an early and graded treatment and an early functional therapy. In fractures III, IV and V according to Neer, minimal osteosynthesis should be preferred. This will, if the fracture is not accompanied by other injuries and if there is adequate physiotherapy after surgery, result in a recovery of the function. In relatively young patients with solid spongiosa, good stability and anatomical restoration can be achieved by osteosynthesis. Unfortunately in fractures II and IV according to Neer, as well as in four-segment-fractures unsatisfactory results can not be avoided. In such cases minimal surgery should be performed. Implantation of a shoulder prosthesis is indicated only in case of a secondary painful arthrosis. The only cases in which primary alloarthroplasty is indicated are fractures of group II. In these cases implantation is promising because of the totally preserved muscular insertion. In four-segment and luxation fractures, atraumatic surgical reconstruction should be aimed at.

Adolescent↗
PubMed1993

[Distal humerus fractures in patients over 75 years of age. Long-term results of osteosynthesis].

The aim of this retrospective analysis was to evaluate the adequacy of internal fixation of distal humerus fractures in patients over 75 years of age. 49 patients were evaluated. The mean age was 80 (75-93) years. The fractures were classified as 28 C-, 13 B- and 8 A-types according to the AO-system. Primary stable fixation was followed by early assisted mobilisation. The mean average follow-up time was 18 months. Excellent and good functional results were observed in 85%. 66% of all patients have no pain. There were 6 sensible ulnar nerve lesions, one deep wound infection, one pseudarthrosis of the distal humerus and one non union of the olecranon osteotomy. We conclude from our results that open reduction and internal fixation is indicated also for patients over 75 years with distal intraarticular humeral fractures.

Aged↗
PubMed1993

[Osteotomy of the humerus in the operative treatment of children with complications of obstetrical Duchenne-Erb paralysis].

From 1987 to 1991, 33 children with sequelae to Duchenne--Erb type obstetrical paralysis of an upper extremity were operated on in the clinic. In 20 patients, the operations were performed on the tendinomuscular apparatus of the humeral articulation, in 13--on the humerus. The technique for performance of detorsive osteotomy of the humerus is described. Indications for the given method of operative rehabilitation are substantiated.

Adolescent↗
PubMed1993

Coronal-plane transcondylar fracture of the humerus in a child.

A coronal plane fracture of the distal humerus in a child is an uncommon fracture, with the most familiar example being a capitellar fracture. An unusual coronal fracture of the entire distal humeral articular surface (capitellum and trochlea) occurred in a three-year-old boy. This fracture pattern has been described in adults but is believed to be previously unreported in children. This Salter-Harris Type IV fracture was initially misdiagnosed as a lateral humeral condyle fracture. Three years after treatment with open reduction and pin fixation, the distal humerus shows no evidence of growth disturbance.

Bone Wires↗
PubMedDate not supplied

[Hydatidosis of the humerus complicated with fracture, bacterial infection, fistula, and extraosseous localization].

The clinical case of an apparently healthy 63-year-old man from a rural area, with previous contact with dogs, who had a pathological fracture of the right humerus is presented. Initially he presented slight local pain, and functional discapacity. Eight months later, after a radiological study and surgery (curettage), diagnosis of hydatid disease was made. Later on, after receiving two courses with albendazole, the parent continued in similar conditions for seven years, when his situation became complicated with bacterial, fistula and extraoseous hydatidosis. The humerus was resected and a segmentary prothesis was successfully set.

Axilla↗
PubMed1991

[Intra-articular fractures of the distal humerus].

The authors analysed 79 patients with intraarticular fracture of the distal end of the humerus, treated during the past 5 years. Seventeen patients were treated by conservative methods, and 62 by surgery. Of the latter, 23 required emergency operations. In the majority of cases, open reduction was accomplished by special plates for the distal end of the humerus and by Y-plates. Screws, Kirschner wires and suture of bone fragments were rarely used. The most frequently employed approach was osteotomy of the olecranon. The results were excellent, except in 13 patients.

Adult↗
PubMed1996

Pain is a major determinant of impaired performance in standardized active motor tests. A study in patients with fracture of the proximal humerus.

We have followed the recovery of motor performance and the subsidence of pain for one year in 12 patients after fracture of the proximal humerus. Performance scores during standardized active motor tests were recorded 3, 8, 16, 24, and 52 weeks after injury, and the pain ratings during each of three manoeuvres were assessed on a modified Borg verbal scale. The manoeuvres were: Hand in Neck, Hand in Back, and Pour out of a Pot. In a cross-sectional analysis of data obtained 3 weeks after injury, significant correlations were found between movement-induced pain and impairment of performance in all three tests. A multivariate analysis indicated a strong association between decreasing pain and increasing performance and this was significant after elimination of the influence of healing as measured by time. In contrast, the association between time and increasing performance, after eliminating of the influence of decreasing pain, was weak and non-significant. It is concluded that pain is a major determinant of impaired performance after fracture of the proximal humerus, and that performance scores in standardized active motor tests are inversely correlated with the amount of movement-induced pain.

Aged↗
PubMedDate not supplied

Brachialis muscle entrapment in displaced supracondylar humerus fractures: a technique of closed reduction and report of initial results.

A retrospective review was conducted of 152 extension-type supracondylar humerus fractures in 151 children. Ninety-two (61%) of 152 of these fractures were displaced (Gartland type III). Initial irreducibility was present in 20 of the 92 displaced fractures. Brachialis muscle interposition was diagnosed by physical examination or intraoperative findings in 18 (90%) of the 20 initially irreducible fractures. Sixteen of the fractures with brachialis muscle interposition underwent an attempt at freeing the impaled proximal fragment by the described "milking maneuver." The maneuver was successful in 15 of the 16 patients and was followed by closed reduction and percutaneous pinning. Three of the remaining four cases required open reduction and pinning. We identify the incidence of initial irreducibility in displaced supracondylar humerus fractures, describe clinical findings suggestive of brachialis entrapment, and demonstrate the milking maneuver to be a valuable technique in the treatment of displaced supracondylar fractures with brachialis interposition.

Bone Nails↗
PubMed1997

Hemiarthroplasty in the treatment of comminuted intraarticular fractures of the proximal humerus.

Thirty-eight patients with four-part proximal humerus fractures and fracture dislocations were treated with humeral head replacement between 1989 and 1995. At followup (mean, 37 months; range, 12-48 months) the patients were evaluated for postoperative pain, active range of motion, muscular strength, overall function in every day activities, and patient satisfaction. Complications developed in five patients and consisted of humeral component malposition (one shoulder), rotator cuff insufficiency (two shoulders), and heterotopic ossification (two shoulders). According to the Neer criteria, the overall results were: 32 (84%) patients had no pain and improved motion (active forward elevation averaged 130 degrees, external rotation 45 degrees, and average internal rotation to the first lumbar vertebra); in this group strength and function 6 months postoperatively was 80% of the normal side and reached 90% of the normal side at 1 year postoperatively under continuous stretching and strengthening exercises; and 34 patients (90%) were satisfied with their treatment. The results of the study indicate that humeral head replacement is a dependable method to restore comfort and function to patients with acute or old four-part fractures of the proximal humerus. However, recovery of function and range of motion are much less predictable in patients with an old injury.

Adult↗