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A case of adamantinoma of the humerus with Ewing-like pathological features has been reported. In addition to the unusual pathological features, the apparently juxtacortical location of the lesion is of great interest--also a highly unusual feature for an adamantinoma.
The 'classical' surgical treatment of unicameral bone cysts of the humerus with curettage and bone grafting is unreliable with approximately 40% failure rate. The author describes a technique of subperiosteal diaphyseal and metaphyseal resection and replacement with a section of fibula maintained in position with an intramedullary nail and further supported by massive tibial cortical and cancellous grafting. Consistent incorporation of the graft and excellent remodelling were observed in 36 patients so treated. No complications or recurrence were reported.
Seven patients with eccentrically placed tumours of the distal end of the humerus treated with partial resection and autogenous iliac bone grafting are reported. The functional results are discussed.
Forty-six patients with chronic haematogenous osteomyelitis of the humerus were treated surgically between 1968 and 1987. Operation involved decompression, sequestrectomy and saucerisation, and was always covered by between 10 and 60 days of antibiotic treatment. Forty-three patients were followed up for between 3 months and 20 years, 36 for more than 1 year. Thirty-nine patients achieved healing after one operation and 7 relapsed, of whom 6 healed after a second procedure.
Data from a series of 45 internal fixations for malignant secondary tumors of the humerus are analyzed. The tumors occurred late in the evolution of the cancer, and represented 24% of appendicular bone metastases for which operations were performed. Statistics of the patients, fractures, treatment, and results are presented and conclusions drawn. Prognosis should be related to the types of primary tumor. Blind nailing or pinning is recommended, and indications for preventive osteosynthesis are discussed.
This report describes the results of 17 arthroplasties of the hip joint for tumors or metastases in the proximal part of the femur and 3 arthroplasties of the shoulder joint because of tumors in the proximal humerus. Based on case reports the paper discusses the indication in the case of malignant, potentially malignant and benign primary bone tumors and in the case of metastases. In addition principles for the construction of suitable hip and shoulder prostheses are cited, whereby the partial joint replacement continues to retain its justification beside total replacement. While the results of the hip arthroplasty proved satisfactory, the results of the corresponding operation on the shoulder are less satisfactory and urge to exercise more restraint in the operative indication.
Insufficient criteria to distinguish enchondroma from low-grade chondrosarcoma occasionally lead to uncertainty concerning the optimal extent of surgery. For either tumor the clinical outcome is mainly compromised by local recurrence. Reviewing our medical records, we retrospectively identified a female patient who was diagnosed as suffering from a large enchondroma of the left humerus in childhood and could be followed up for almost two decades. Following local excision of the tumor at the age of 14 years, clinical follow-up was uneventful for 20 years. A potential primary extensive excision or amputation would have substantially compromised this young woman's quality of life. The complete preservation of function here following a local excision has stimulated a critical discussion of radical surgical treatment.
Treatment of experimental distal subluxation in the shoulder joint was achieved by transposition of the coracoacromial ligament and its bony attachment from the acromion to the lesser tuberosity of the humerus. This transposition also reduced external rotation in the first 40 degrees of abduction. The method, which was applied in two clinical cases of distal subluxation, proves reasonable from a biomechanical point of view and yields satisfactory primary clinical results.
A case of enormous enlargement and destruction of the right humerus is reported in a middle aged, right-handed, skilled manual worker. The tumour is cosmetically very ugly but right upper limb function is good. Advice from readers on the management of this case is honestly and thankfully requested, particularly information on what might be done should functional deterioration force us to undertake surgery.
We present a case of intra-articular osteoid osteoma of the humerus simulating chronic monoarthritis of the elbow in an 18-year-old male right-handed recreational tennis player. CT revealed a well-defined nidus in the coronoid fossa. Microscopic examination of the synovium showed a lymphofollicular synovitis that resembled the synovitis in rheumatoid arthritis.
The dimensions and morphology of a critical zone of the intertubercular sulcus (ITS) of the humerus were specified for 100 dry bones. The upper part of the ITS was narrow and at an angle with the lower part. The tendon of the long head of the biceps brachii muscle (TLBB) was particularly worn down during its course through this critical zone. The critical zone extended from the first perceptible proximal depression to the distal extremity of the lesser tubercle. It showed a proximal part of 12.4 mm (standard deviation = 2.23) and a distal part of 15.1 mm (s.d. = 3.37). The two parts made an angle of 142 degrees (s.d. = 7.87). Its total length was 28.5 mm (s.d. = 4.74), depth 2.44 mm (s.d. = 0.49), width 6.33 mm (s.d. = 0.84). The supratubercular ridge was the only bony variation, found in 45% of the bones of this series. Bony abnormalities were of three types: (1) calcifications in 39% of the bones, (2) lateral spurs in 32% and medial spurs in 23%, (3) degenerative changes in 9% of the bones. Biometric considerations showed that the TLBB inside the ITS was unstable. The supratubercular ridge could increase this instability and thus favor disease of the tendon. Bony abnormalities which may be associated with TLBB lesions, can be seen in radiographs.
Study of the humeral cortex of 89 acute cadavers showed that an important factor contributing to the physiologic bone loss of aging is increasing bone porosity. Mean cortical porosity increases in both sexes with age, from 4.6% in men and 4% in women at 40 years of age to 10% and more at age 80. In the population studied, no significant difference of porosity was observed between men and women. Apparent mineral density is linked to porosity, and decreases markedly with age in women. Changes in men are lesser in magnitude and show a larger difference of density values. Correction of the apparent mineral density, by a factor reflecting the proportion of vascular and resorption spaces in the cortical bone, produces a true mineral density which does not vary significantly with age in either sex. The density values obtained for the proximal humerus differ from those in the literature which represent the femur. However, they are more readily compared with the results of clinical densitometry and may have greater clinical applications.
Rarely the spectrum of conventional radiographic studies of the proximal humerus resp. shoulder joint is used in its full potential. This frequently results in erroneous interpretation. Five essential X-ray examinations are presented with respect to technique and diagnostic value.
39 patients with pathological fractures of the humerus were treated by isoelastic polyacetal endoprosthesis. Ten patients received a humeral-head-prosthesis and 32 a prosthesis of the humeral-shaft. The average survival time was nine months. Three times within the first group of twelve patients fracture of the cone of the prosthesis occurred. Therefore an additional stabilization of the contact zone between bone and prosthesis by plate-osteosynthesis was performed in the following 20 operations, preventing breakage of the material. In contrast to the conventional posterior approach to the humeral-shaft we chose a ventrolateral approach between the biceps and triceps muscle. This technique is less traumatic and leads to a shorter operation time. In patients with pathological humeral fractures a conception of treatment is demonstrated which provides an immediate stability by using endoprostheses to preserve the quality of life of oncological patients.
We report on a 20-year-old patient with McCune-Albright syndrome suffering from global respiratory insufficiency who required continuous mask ventilation and where intubation had to be avoided. Perivascular axillary anesthesia according to Weber was performed for a double corrective osteotomy of the humerus. During plexus anesthesia the patient was positioned on the non-anesthesized side in a 15 degrees Trendelenburg position. An extension of analgesia was observed up to the complete upper arm region. Using the modified positioning an extension of brachial plexus anesthesia is possible.
The purpose of this study was to (1) quantify the healing process of the human osteoporotic proximal humerus fracture (PHF) expressed in terms of callus formation over the fracture region using BMD scanning, and (2) quantify the impact of medical intervention with vitamin D3 and calcium on the healing process of the human osteoporotic fracture. The conservatively treated PHF was chosen in order to follow the genuine fracture healing without influence of osteosynthetic materials or casts. Thirty women (mean age = 78 years; range = 58-88) with a PHF, osteoporosis or osteopenia (based on a hip scan, WHO criteria), and not taking any drugs related to bone formation, including calcium or vitamin D supplementation, were randomly assigned to either oral 800 IU vitamin D3 plus 1 g calcium or placebo, in a double-blind prospective study. We measured biochemical, radiographic, and bone mineral density effect parameters to evaluate the impact on the healing process. Scanning procedures of the fractured shoulder included use of a fixation device to obtain the highest possible precision. Double scans of the fractured shoulder revealed a coefficient of variation (CV) on BMD measurements that improved from 2.8% immediately after fracture occurrence to 1.7% at 12 weeks (P = 0.003) approaching the 1.2% levels observed over the healthy shoulder. BMD was similar in the two groups at baseline (active 0.534 g/cm2 vs. placebo 0.518 g/cm2), and both increased over the 12-week observation period, with peak levels in week 6. By week 6 BMD levels were higher in the active group (0.623 g/cm2) compared with the placebo group (0.570 g/cm2, P = 0.006). Thirty seven percent of the patients presented with vitamin D levels below 30 nmol/l, indicative of mild vitamin D insufficiency. In conclusion, we have demonstrated that it is possible to quantify callus formation of the PHF with sufficiently high precision to demonstrate the positive influence of vitamin D3 and calcium over the first 6 weeks after fracture. Whether this results in more stable fractures, extends to other fracture types, or applies to other osteogenic bone agents such as bisphosphonates remains to be examined.
Intraosseous schwannomas are rare benign neoplasms of the bone, of which fewer than 200 cases have been described in the world literature. These tumors are well-defined, lytic lesions, rarely associated with pathologic fracture. The mandible is the most frequently involved bone. We present only the third case of an intraosseous schwannoma involving the humerus.
The clinicoradiologic and pathologic aspects of an intracortical, diaphyseal chondromyxoid fibroma of the humerus are reported. Because of the location of the lesion, the possibility of chondromyxoid fibroma was not considered radiologically. The diagnosis was made only after histologic examination of tissue obtained via an open biopsy, which led to the appropriate treatment, surgical curettage.