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At least 649 records · Page 36Linked to original sources
PubMed1985

En-bloc resection for proximal humerus osteogenic sarcoma.

From 1975 to 1982, 101 children were treated for osteogenic sarcoma at the Children's Hospital of the Medical Center and Dana Farber Cancer Institute, Boston. 12 of these patients presented proximal humerus localisation and 8 underwent a local en-bloc resection. In the past these lesions were surgically treated by disarticulation of the shoulder or by interscapulothoracic amputation (forequarter amputation); the death rate was very high. Nowadays, high-dosage chemotherapy and resection of lung metastases carry new hopes for better and prolonged survival, and also for a higher rate of complete remissions. The quality of this prolonged life can be improved if en-bloc resection of the shoulder with upper limb preservation is performed.

Adolescent↗
PubMed2001

The enthesis of the elbow-joint capsule of the dog humerus.

The enthesis of the elbow-joint capsule in the dog is described histologically in relation to the specific mechanical forces that operate in different regions along its line of attachment. Special attention is given to the collagen fibre-bone interface in those parts of the capsule that are highly affected by mechanical stress. The histological features of the enthesis are heterogeneous along the entire circumference of the attachment site. Three types of collagen fibre-bone interconnections can be distinguished: (1) periosteal insertion: attachment to the periosteum of the humerus; (2) bony insertion: attachment directly to peripheral osteons; (3) fibrocartilaginous insertion: attachment to the bone via fibrocartilage. The periosteal insertion covers the greatest part of the joint capsule attachment line, along the peripheral borders of the radial and olecranon fossae. In contrast, bony insertions and fibrocartilaginous insertions are focally arranged: bony insertions in the caudoproximal aspect of the olecranon fossa, related to nutrient foramina; fibrocartilaginous insertions in combination with the attachment of distinct ligaments. This distribution reflects a strict relation between the type of enthesis and the biomechanical stress at the attachment site. The periosteal insertion type is predominant in entheses adjacent to pouches of a loose joint capsule -- i.e., regions less dependent on the high tensile strength of collagen fibres. Fibrocartilaginous insertions characterise areas of the joint capsule which are subjected to high biomechanical traction during joint movement. Both structurally and functionally, the entheses of the fibrous layer of the joint capsule are similar to those of tendons and ligaments.

Animals↗
PubMed2002

Osteotomy of the humerus to improve external rotation in nine patients with brachial plexus palsy.

Malfunction of the infraspinatus muscle and teres minor muscle illustrate the typical clinical picture in patients with brachial plexus palsy. The arm hangs down in an inwardly rotated position and elbow flexion is hindered by striking of the lower arm against the thorax. Between 1995 and 2000, we have done external rotational osteotomy of the humerus for nine patients with brachial plexus palsy. The mean age of the patients at the time of operation was 29 years (range 15 to 42). The mean follow-up time was 24 (6 to 69) months. Preoperatively, the patients all had appreciable deficits of external rotation (mean deficit 37 degrees, range 10 degrees to 70 degrees). As a result of osteotomy, external rotation was improved in all patients, the mean increase being 42 degrees (range 25 degrees to 60 degrees). All patients were subjectively content with the improved position of the arm and its function. They were able to move their hands to their faces without striking the lower arm against the chest on elbow flexion, or without compensatory evasive movement of the shoulder.

Adolescent↗
PubMed1977

Atypical fibrous histiocytoma of the humerus: a light and electron microscopic study.

A unique osseous tumor, which arose in the humerus of a 44-year-old white man, is reported. The lesion was designated atypical fibrous histiocytoma because of the absence of atypical mitoses despite prominent nuclear pleomorphism of tumor cells. The tumor was composed mainly of spindle cells, tightly packed in a storiform pattern. Clear histiocytes and tumor giant cells were occasionally seen. Toward the proximal and distal ends, the tumor showed increasing fibrogenesis, and the ends were composed of areas of packed clear histiocytes and acellular myxoid matrix with focal calcification. Ultrastructurally, five cell types comprised the tumor, but fibroblast-like cells predominated. Histiocyte-like, xanthomatous, giant and undifferentiated cells were observed only occasionally. The patient has been followed for five years after disarticulation without developing evidence of distant metastasis.

Adult↗
PubMed1990

Effects of spaceflight on rat humerus geometry, biomechanics, and biochemistry.

The effects of a 12.5-day spaceflight (Cosmos 1887 biosatellite) on the geometric, biomechanical, and biochemical characteristics of humeri of male specific pathogen-free rats were examined. Humeri of age-matched basal control, synchronous control, and vivarium control rats were contrasted with the flight bones to examine the influence of growth and space environment on bone development. Lack of humerus longitudinal growth occurred during the 12.5 days in spaceflight. In addition, the normal mid-diaphysial periosteal appositional growth was affected; compared with their controls, the spaceflight humeri had less cortical cross-sectional area, smaller periosteal circumferences, smaller anterior-posterior periosteal diameters, and smaller second moments of area with respect to the bending and nonbending axes. The flexural rigidity of the flight humeri was comparable to that of the younger basal control rats and significantly less than that of the synchronous and vivarium controls; the elastic moduli of all four groups, nonetheless, were not significantly different. Generally, the matrix biochemistry of the mid-diaphysial cross sections showed no differences among groups. Thus, the spaceflight differences in humeral mechanical strength and flexural rigidity were probably a result of the differences in humeral geometry rather than material properties.

Animals↗
PubMed1996

The rationales of interlocking nailing of the femur, tibia, and humerus.

Interlocking nailing has been increasingly used to treat acute and chronic afflictions of long bones. Although the interlocking construct is similar, regardless of the anatomic area of application, the results and complications of this type of fixation in the femur, tibia, and humerus differ. This review compares the anatomy, biologic response to injury, and functional expectations of these 3 distinct long bones with respect to interlocking nailing. Final results seem related more closely to the bony anatomy and soft tissue injury than to any inherent success of interlocking techniques.

Bone Nails↗
PubMed1997

Arc osteotomy of the humerus to correct cubitus varus.

The appearance of the elbow after corrective osteotomy for cubitus varus often is different from that of the unaffected side, even if the carrying angle of the affected side is corrected to match that of the unaffected side. Not only must the carrying angle formed by the humerus and the ulna be corrected, but the lateral shift between the humeral axis and the ulnar axis also should be corrected to achieve a matching appearance after corrective osteotomy. Based on this concept, a technique of arc osteotomy was developed to correct simultaneously both the angle and the lateral shift of the affected elbow joint to match those of the unaffected side. This new method has been used to treat 12 patients. The length of followup averaged 28 months, with a range of 8 to 70 months. The carrying angle was corrected from 22 degrees varus on average to 6 degrees valgus on average, with a difference between the right and left side of 2 degrees on average. No complication was observed during the treatment. The average range of motion of the elbow joint was from 0 degrees extension to 125 degrees flexion preoperatively and from 6 degrees hyperextension to 134 degrees flexion postoperatively.

Adolescent↗
PubMed1999

Involvement of the humerus in two generations with spondyloepiphyseal dysplasia.

Children with spondyloepiphyseal dysplasia present with a disproportionate short stature, platyspondyly, scoliosis, coxa vara, and clubfeet. Extraskeletal manifestations such as retinal detachment and deafness have been reported. The authors report two patients, a mother and her daughter, aged 35 and 6 years, with findings of pseudarthrosislike lesions in the middiaphysis of both humeri. The mother had minimal symptoms that resolved spontaneously, and the child had no symptoms related to these lesions. The radiographs of the mother show complete remodeling of the lesion. The pseudarthrosislike lesion of the humerus may be one of the manifestations of spondyloepiphyseal dysplasia congentia. In time, the bone remodels completely. Because this is a relatively new radiographic finding, the authors suggest performing a radiograph of the humeri in patients with spondyloepiphyseal dysplasia congenita at least once during childhood.

Adult↗
PubMed2000

Aggressive aneurysmal bone cyst of the proximal humerus. A case report.

The case of an 11-year-old girl with a rapidly expanding, massive lesion in the right proximal humerus is reported. After biopsy, surgical treatment of the aneurysmal bone cyst consisted of aggressive intralesional resection with autogenous tibial strut grafting for reconstruction. After followup of 17 years with no recurrence of disease, there is excellent graft incorporation and remodeling and excellent function of the shoulder.

Biopsy↗
PubMed2006

The anconeus flap transolecranon approach to the distal humerus.

The transolecranon approach for the treatment of distal humerus fractures and nonunions is commonly used. A complication of the standard osteotomy is denervation of the anconeus muscle, which provides dynamic stability to the lateral side of the elbow by preventing varus and posterolateral rotatory instability. This article describes the anconeus flap transolecranon (AFT) approach, which utilizes an internervous plane to preserve the anconeus muscle and a chevron-shaped osteotomy for maximal joint exposure. The approach is straightforward to perform with limited complications.

Dermatologic Surgical Procedures↗
PubMed1999

The static rotator cuff does not affect inferior translation of the humerus at the glenohumeral joint.

BACKGROUND: The static contribution of the rotator cuff to the inferior stability of the shoulder is poorly understood. The purpose of this study was to determine the effect of static rotator cuff muscles on the inferior stability of the glenohumeral joint. METHODS: The humeral head positions relative to the glenoid were obtained in 12 shoulder specimens under the following conditions: with and without a 1.5-kg load; with the humerus adducted and abducted 90 degrees; and in three stages of dissection: (1) before release of any of the rotator cuff muscles, (2) after release of the supraspinatus or the cuff muscles other than the supraspinatus, and (3) after release of all of the cuff muscles. The order of release was changed in two ways: release of the supraspinatus followed by the release of other muscles in one group, and the opposite order in the other group. RESULTS: In both adduction and abduction, there were no significant differences in the positions of the humeral head either among the three stages of release or between the two different orders of release. CONCLUSION: The static contribution of the cuff muscles to the inferior stability of the shoulder is insignificant.

Biomechanical Phenomena↗
PubMed2001

Bipedicled vascularized fibula flap for proximal humerus defect in a child.

Vascularized bone transfer is becoming the most important option in the many cases in which durable, long-standing bone reconstruction is needed. The transfer of the vascularized epiphyseal plate, although controversial, is advantageous in cases where future growth is needed (i.e., congenital anomalies and tumor resections in children). The use of the free fibular head flap, based on epiphyseal blood supply augmentation, was reported using the anterior tibial artery, or part of it, as the nutritional vessel. By using both the peroneal artery and the specific branch to the fibular head as a bipedicled free flap, we ensured both long-bone fibula reconstruction and augmented blood supply to the head. We report a case of subtotal resection of the humerus due to osteosarcoma in a child that was reconstructed by this method. A preoperative study was conducted on fresh cadavers to identify the specific pedicle of the fibular head. The biceps femoris tendon was used to better stabilize the shoulder joint. The child recovered well and showed good progress in rehabilitation. On follow-up 1 year postoperatively, the shoulder joint remained limited, but showed no signs of substantial remodeling on x-ray. Good elbow and wrist-hand functions were noted. The child developed a single lung metastasis that was also removed. The question remains if the theoretical advantages in bone remodeling, shoulder stability, and bone growth are worth the extra time of surgery or the possible added donor and recipient site complications.

Bone Neoplasms↗
PubMed1987

Acute fracture of the proximal humerus superimposed on a chronic posterior dislocation of the humeral head.

We have reported the case of a 73-year-old woman with a posterior shoulder dislocation and comminuted fracture of the proximal humerus occurring during a seizure. Surgery disclosed an acute humeral fracture superimposed on a chronically dislocated humeral head. Endoprosthetic replacement yielded a satisfactory clinical result. We found no similar report in the literature.

Acute Disease↗
PubMed2003

Evaluation and treatment of metastases to the humerus.

The humerus is the second most common long bone site of metastatic disease, and the proximal third and diaphysis are frequent sites. Purely lytic disease and cortical bone destruction increase the risk of fracture more than 50%. For most patients, external beam irradiation is effective as a means of pain control and halting bone destruction. Fractures of the head or surgical neck can be treated with standard endoprostheses, whereas extensive proximal bone destruction is treated with custom proximal humeral replacements. Impending and complete diaphyseal fractures can be treated effectively with either intramedullary nail fixation or plate fixation. Rigid fixation, which can be achieved with dual plate fixation, is optimal because patients can begin immediate unrestricted activities using the upper extremity. Methylmethacrylate is an effective adjuvant for filling defects and for augmenting the fixation of intramedullary nails and screws. Postoperative external beam irradiation is necessary to prevent progressive bone destruction and subsequent loss of fixation.

Bone Neoplasms↗
PubMed2006

Clavicula pro humero reconstruction after wide resection of the proximal humerus.

The optimal reconstruction procedure after resection of proximal humeral bone tumors is controversial. We performed clavicula pro humero reconstruction in seven consecutive patients after wide resection of malignant proximal humerus tumors to determine the functional outcomes and to clarify whether this procedure could reduce the occurrence of complications. The histologic diagnoses were conventional osteosarcoma in four patients, chondrosarcoma in two, and parosteal osteosarcoma in one. Postoperative function was assessed with the Musculoskeletal Tumor Society upper extremities scale and an evaluation chart for activities of daily living. The mean Musculoskeletal Tumor Society score was 69%. Stable results were obtained regardless of the extent of the resection, and the results as a flail shoulder were satisfactory. The mean daily activity rating was approximately 80%. The activities of daily living functional rating was better (92%) when the nondominant hand was affected compared with the dominant hand (69%). Bony union was achieved in all seven patients. We observed no instances of infection, fracture, or nonunion. The clavicula pro humero reconstruction is a useful procedure that could reduce the occurrence of complications, especially in young patients and in patients with involvement of the nondominant arm.

Adult↗
PubMedDate not supplied

Management of supracondylar fractures of humerus with condylar involvement in children.

The intent of this study was to heighten awareness and to present the authors' experience of an uncommon supracondylar humerus fracture in children. Twenty-two children were studied over a period of 18 years. The average age was 7 years, and oldest child was 11 years at time of injury. The fracture subtypes with medial condyle, lateral condyle, and intercondylar extensions were classified based on radiographs. The patients were followed for an average of 6.5 years. Eighteen injuries (82%) were graded excellent or good, and there were two each with fair or poor outcomes. The most common complication was loss of carrying angle of more than 10 degrees, which occurred in three children. The best results were seen in cases where three or four cross-fixing wires were used across the fractures. The authors recommend closed reduction techniques and percutaneous multiple cross-pin fixation for the displaced fracture. The fracture is unique and distinctive enough to warrant a designation as supracondylar fracture type IV with subtypes in the younger child.

Bone Wires↗