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PubMed1997

[Epidemiology of supracondylar fractures of the humerus in children in Bangui, Central African Republic].

The purpose of this retrospective study was to evaluate the epidemiological, clinical, and anatomical aspects of supracondylar fractures of the humerus in children treated at the National University Hospital Center (NUHC) of Bangui, Central African Republic. Between January 1992 and March 1995 a total of 119 documented cases involving children between the ages of 0 and 15 years were treated. Most patients were boys (62%) between 3 and 8 years of age. Fracture occurred during play in 74% of cases on the left side (92 cases) more often than the right. The mechanism of fracture was extension in 115 of the 119 cases with only four open fractures. Most fractures (68.1%) were severe (Lagrange Grade 3 and 4). These findings which are comparable to those reported in other countries confirm the high incidence of supracondylar fracture of the humerus and need for appropriate treatment in African orthopedic facilities.

Accidental Falls↗
PubMed1997

Fixation of complex elbow fractures, Part I. General overview and distal humerus fractures.

Complex elbow fractures are those intra-articular injuries which result in displacement or incongruity of one or more of the articulations between the distal humerus, proximal radius, or proximal ulna. The article discusses a system for clinical and radiographic evaluation, operative management, and rehabilitation of distal humerus fractures. This review presents detailed descriptions of skeletal reconstructive techniques for these injuries based on a review of the literature, biomechanic principles, and clinical experience. The importance of rigid internal fixation and early postoperative mobilization is emphasized.

Adult↗
PubMed1997

Comparison of distal humerus fracture fixation: a biomechanical study.

Few biomechanical studies have been done evaluating the rigidity of internal fixation constructs for distal humerus fractures. We assessed the bending and torsional stiffness of five commonly used multiple plate constructs. Plates were applied in three positions: medially, along the medial supracondylar column; laterally, along the lateral supracondylar column; or posterolaterally, extending distally to the capitellum. Each specimen was randomly assigned to one of five construct groups. All plated specimens were stiffer in the frontal plane as compared with the sagittal plane and, when compared with intact specimens, showed a disproportionate decrease in sagittal plane stiffness. Constructs 1 and 5 had significantly greater relative bending stiffness in the sagittal plane than constructs 3 and 4. Construct 4 had the lowest relative bending stiffness in the frontal plane. This reached statistical significance when compared with constructs 2 and 5. There was no significant difference in the torsional stiffness of the five constructs. We conclude that the multiple plate constructs offered significantly less bending stiffness than the intact specimens, with a particular deficiency in the sagittal plane. The triple-plated construct (construct 5) did not confer greater stiffness and was technically difficult to implant. The medial pelvic reconstruction plate combined with the posterolateral DCP (construct 1) provided the greatest sagittal plane stiffness, in addition to comparable frontal plane and torsional stiffness. We recommend its use in the treatment of fractures of the distal humerus.

Adolescent↗
PubMedDate not supplied

Etiology of supracondylar humerus fractures.

The specific etiology of supracondylar humerus fractures in children is not well known. All supracondylar humerus fractures treated at Children's Hospital and Health Center, San Diego (CHSD) over an 8-year period (n = 391) were reviewed to determine specific information about the manner in which the injury occurred. Girls tended to sustain these fractures more often, and the nondominant arm was more often injured. Falls from a height accounted for 70% of the fractures. Children < or = 3 years old tended to fall off of household objects (beds, couches, other objects 3-6 feet high), and children 4 years and older tended to fall from playground equipment such as monkey bars, slides, and swings. Safety precautions should be implemented in homes of young children and at playgrounds to avoid these fractures.

Accidental Falls↗
PubMed1998

[Osteosynthesis of proximal humerus fractures].

Only 5% of adult fractures are fractures of the proximal humerus. In 80% of these fractures one can expect a good result, because they are generally nondisplaced, stable and allow early mobilization. However, the other 20% of these fractures present not only problems with reduction and adequate fixation but also the risk of humeral head necrosis and painful shoulder ankylosis. The operative treatment of displaced fractures of the proximal humerus has changed during the last few years. Minimal osteosynthesis takes into consideration the great extend and the biological aspects of these fractures and provides sufficient stability for early functional therapy. The Neer-classification has proved very useful for both, the indication for and the choice of an operative procedure.

Adult↗
PubMed1998

[Indications and results of shoulder prosthetics in complex proximal humerus fractures].

Complex fractures of the proximal humerus are uncommon injuries and a therapeutic challenge to the orthopaedic surgeon. Successful treatment requires proper evaluation of the patient and analysis of standardized high-quality radiographs. The trauma series of radiographs (including true anteroposterior and lateral views in the scapular plane, and axillary view) is essential for accurate fracture assessment. Generally, joint-preserving reconstructive techniques are emphasized, aiming at restoration of the anatomy of the proximal humerus. In young individuals with excellent quality of the bone fragments, careful techniques of reduction and fixation, avoiding additional surgical devascularization, should be performed, even in case of possible impairment of the vascular supply to the humeral head. In elderly individuals with osteoporotic bone and limited compliance throughout aftercare, humeral head replacement may be indicated less restrictively. In the latter group hemiarthoplasty generally can be expected to result in painfree shoulders. However, recovery of function and range of motion are much less predictable.

Adult↗
PubMed1998

An analysis of open reduction of irreducible supracondylar fractures of the humerus in children.

OBJECTIVES: To review experience with irreducible supracondylar fractures requiring open reduction in children, and to propose guidelines for an open approach to supracondylar fractures. DESIGN: A chart review. SETTING: The Children's Hospital of Eastern Ontario (CHEO), a pediatric centre with a large referral base. PATIENTS: Forty-one children (18 boys 23 girls, average age 7 years), who had open reduction of irreducible supracondylar fractures at the CHEO over a 10-year period (1985 to 1995). Of these 41 children, 7 were lost to direct follow-up. INTERVENTIONS: After closed reduction of displaced supracondylar fractures of the humerus failed, all patients underwent open reduction and percutaneous fixation in the operating room. Before operation, 6 had no radial pulse, 5 lost their pulse with flexion after reduction and 4 had unstable fracture patterns. MAIN OUTCOME MEASURES: Assessment of elbow range of motion and carrying angle, distal neurovascular status and radiographic measurement of the Baumann angle and the humerocapitellar angle. RESULTS: In 25 children, the humerus was found to have "buttonholed" through the brachialis muscle; 1 had entrapment of the common flexor muscle at its origin and 1 had entrapment of the triceps. In 15 children there was entrapment or tethering of the median nerve and radial nerve or brachial artery, or both, but this was not predictive of preoperative neurovascular deficit, which was recorded in 21 patients (fully recovered). At follow-up, the Baumann angle and the humerocapitellar angle differed by an average of 2 degrees and 5.3 degrees respectively compared with the unaffected arm. Range of motion was satisfactory in 94% of patients, and there was no significant cubitus varus. CONCLUSION: Open reduction of supracondylar fractures is a safe and effective procedure, for which orthopedists should should lower their threshold, given certain appropriate indicators.

Adolescent↗
PubMed1998

[Surgical treatment of proximal humerus fractures--international multicenter study].

To receive an overview of the presently used methods for the operative treatment of fractures of the proximal humerus a prospective controlled multicenter study was arranged. 146 fractures from 145 patients (76 females, 69 men) were assessed, documented with the AO standard sheets and radiographs and with a one year follow-up examination. Each of the nine clinics used his own treatment scheme. They applied: K-wires (27%) for adaptation and for intramedullary fixation; tension band wires (16%) or sutures (11%) alone or in combination with K-wires; osteosynthesis with screws alone (7%) or with plates (22%). In 17% the humeral-head was acutely replaced with a prosthesis. 11 fractures (8%) had to be reoperated because of instability or loss of fixation. 109 patients were available for clinical review, one patient could be questioned by letter and six patients had died after one year (follow-up 80%). In 38% of patients full limb function was restored, slight impairment persisted in 45% and 17% remained severely handicapped. 96 fractures (89%) were consolidated, 30% with a deformity. 35% of patients still were unable to work full time. The treatment of fractures of the proximal humerus is generally difficult. More over the various operative methods and problematic fracture classification make a differentiate statistical analysis impossible. Still many questions remain. For answers a new trial is mandatory. For this future series fixed guidelines for indications and operative treatment modalities are required to allow a meaningful comparison of results and a scoring system for evaluation of functional outcome is necessary.

Adult↗
PubMed1998

Treatment of pathologic fractures of the humerus with Seidel nailing.

A retrospective study is presented of 14 patients with pathologic fractures of the humerus (12 established, two impending) treated with Seidel nailing from 1988 through 1995 in the authors' institution. There were nine women and five men whose average age was 59.5 years. Breast, prostate, and kidney hypernephroma accounted for the majority of the primary lesions. All but one lesion were located in the middle shaft of the humerus. Ten lesions were considered large (> 5 cm long). In five cases an open curettage and allografting were done. Early pain relief was successful in 85% of the patients. The worst complication found was definite nerve palsy in two (14.28%) patients. Ten fractures healed and two failed to heal. Two thirds of the patients had good functional results. The average survival was 12 months. Intramedullary fixation of pathologic fractures improves the quality of life by controlling pain for most patients.

Adult↗
PubMed1998

[Isolated avulsion fracture of the lesser tuberosity of the humerus. Apropos of a case].

PURPOSE OF THE STUDY: The authors report a rare case of an isolated avulsion fracture of the lesser tuberosity of the humerus in an adult. The aim of the study was to highlight diagnostic features as well as surgical treatment. MATERIAL: A 31 year old woman presented an isolated avulsion fracture of the lesser tuberosity of the humerus. Physical exam, standard radiographs of the shoulder as well as a computed tomographies (CT) were obtained. METHODS: An assessment was made of the patient's complaints, signs and symptoms, diagnosis, surgical treatment, physical therapy and follow-up. Final clinical results were evaluated according to external rotation and muscular strength of the shoulder. RESULTS: The diagnosis was evoked on standard radiographs of the shoulder and confirmed by CT. The patient was operated on the 8th day following trauma and pendular physical therapy was initiated on the third day postoperatively. The patient recovered her daily activities from the 6th week and was back at work by the end of the 2nd month. Follow up at 12 months showed a painless shoulder with external rotation at 50 degrees in adduction and 70 degrees in abduction. Muscular strength was identical to the contralateral side. No antero-medial impingement was detected due to the hardware. DISCUSSION: This observation illustrates the rare aspect of this fracture, already recognized in literature. The fracture mechanism remains unknown. We agree with Haas, Ross and Love that it might be due to a forced external rotation of the shoulder at 60 degrees of abduction. We highlight the role of the "axillary view" and of the magnetic resonance imaging (MRI) in the diagnostic approach. Treatment is surgical by open reduction and internal fixation of the detached fragment. CONCLUSION: Treatment must be surgical whenever there is a slight displacement of the detached fragment, to prevent non union, mal union or an antero-medial impingement that might limit mobility and muscular strength.

Adult↗
PubMed1998

[Dislocated proximal humerus fracture--results after stabilization with a double plate].

Between October 1995 und December 1997, 57 patients with displaced 2-, 3- and 4-part fractures of the proximal humerus were treated by open reduction and internal fixation with two one-third tubular plates which were applied to the anterior and lateral aspect of the proximal humerus. For the follow-up evaluation shoulder function was assessed in 38 patients after an average of 16.8 +/- 4.2 months using the Constant-score: 32% of the patients showed excellent, 37% good, 21% satisfactory, and 10% unsatisfactory results. The high stability of this technique allows intensive physiotherapy in the early post-operative period and early reintegration in activities of daily living.

Aged↗
PubMed2000

Humerus varus deformity in Roman period burials from Kellis 2, Dakhleh, Egypt.

Humerus varus deformity (HVD) occurs unilaterally in a female (#85) skeleton and bilaterally in a male (#124) from Kellis 2, a Roman period cemetery (circa 300-450 AD) from Dakhleh, Egypt. The affected humeri were shortened, their glenohumeral joints deformed, and their upper diaphyses were angulated. The skeletons were otherwise normal. The severity of the changes suggests that the underlying growth disturbances occurred early in postnatal development. The differential diagnosis considers the mucopolysaccharidoses, thalassemia, infection, and birth trauma, with the latter being favored. Clinical data show limited morbidity or functional impairment in individuals with HVD, although radiographic analysis suggests that #85 may have favored her dominant arm. Ortner and Putschar (1981), and Hershkovitz et al (1991) describe the only other archaeological cases of HVD. These authors provide useful, though limited, information on the differential diagnosis of HVD in archaeological specimens. Future research should focus on documenting the prevalence and expressivity of HVD in Mediterranean population samples where thalassemia evolved. HVD is relatively common in thalassemics and this approach would be valuable for documenting the range of osseous responses characteristic of HVD.

Animals↗
PubMed1988

Aggressive posttraumatic osteoporosis of the humerus simulating a malignant neoplasm.

Eleven patients with an unusual, moth-eaten, destructive lesion in the humerus simulating a malignant neoplasm are presented. The radiographic changes developed over an extended period after trauma. This pattern of posttraumatic osteoporosis can easily be mistaken for a malignancy. An awareness of the entity helps one to make the correct diagnosis. Also, certain helpful hints are pointed out.

Adult↗
PubMed2005

Curvature, length, and cross-sectional geometry of the femur and humerus in anthropoid primates.

The aims of this study were to describe the curvature of anthropoid limb bones quantitatively, to determine how limb bone curvature scales with body mass, and to discuss how bone curvature influences static measures of bone strength. Femora and humeri in six anthropoid genera of Old World monkeys, New World monkeys, and gibbons were used. Bone length, curvature, and cross-sectional properties were incorporated into the analysis. These variables were obtained by a new method using three-dimensional morphological data reconstructed from consecutive CT images. This method revealed the patterns of curvature of anthropoid limb bones. Log-transformed scaling analyses of the characters revealed that bone length and especially bone curvature strongly reflected taxonomic/locomotor differences. As compared with Old World monkeys, New World monkeys and gibbons in particular have a proportionally long and less curved femur and humerus relative to body mass. It is also revealed that the section modulus relative to body mass varies less between taxonomic/locomotor groups in anthropoids. Calculation of theoretical bending strengths implied that Old World monkeys achieve near-constant bending strength in accordance with the tendency observed in general terrestrial mammals. Relatively shorter bone length and larger A-P curvature of Old World monkeys largely contribute to this uniformity. Bending strengths in New World monkeys and gibbons were, however, a little lower under lateral loading and extremely stronger and more variable under axial loading as compared with Old World monkeys, due to their relative elongated and weakly curved femora and humeri. These results suggest that arboreal locomotion, including quadrupedalism and suspension, requires functional demands quite dissimilar to those required in terrestrial quadrupedalism.

Animals↗
PubMed1975

Septal apertures in the humerus of normal and experimental rats.

Septal apertures of the humerus are rare in wild and domesticated rats but their occurrence is more frequent in females than in males and on the left than on the right side. Septal apertures can be produced experimentally by hypophysectomy due to an extreme reduction of the thickness of the septal wall. Other endocrine ablations, starvation and unilateral front leg paralysis do not produce a sufficient reduction of septal wall thickness to cause septal apertures. Their occurrence is also not correlated with total humeral robusticity. Thus, the manifestations of septal apertures in a non-specialized mammal such as the rat do not differ from those in higher primates.

Animals↗
PubMed2003

Fine-needle aspiration biopsy of solid aneurysmal bone cyst in the humerus.

We report the fine-needle aspiration biopsy (FNAB) cytology findings of a solid aneurysmal bone cyst in the left humerus of a 69-yr-old woman. Radiographically, the lesion showed an extensive, relatively well-defined osteolysis in the diaphysis, with a pathologic fracture. FNAB smears of the lesion consisted of benign, mononuclear cells and numerous osteoclast-like multinucleated giant cells. Some clusters of the mononuclear cells were closely associated with dense, homogeneous, extracellular, matrix material. To our knowledge, the FNAB features of solid ABC of the long bones have not been described previously in the English-language literature. The cytologic features are indistinguishable from those of giant cell tumors of bone and brown tumors of hyperparathyroidism.

Aged↗
PubMed1995

High-grade surface osteosarcoma of the humerus.

We presented a case of high-grade surface osteosarcoma of the humerus in a 12-year-old girl and the results of our analysis of 26 cases reported in the literature. Twelve of the 21 patients for whom substantial follow-up information was reported had died of the disease, and the results of the analysis regarding the efficacy of chemotherapy and medullary involvement were ambiguous. It is emphasized that high-grade surface osteosarcoma is a distinct entity, since it is associated with a poorer prognosis than other osteosarcomas arising on the surface of bone.

Bone Neoplasms↗