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PubMed1996

Absorbable implants in the treatment of distal humeral fractures in adolescents and adults.

Between 1986 and 1994, 57 consecutive patients with a distal humeral fracture were treated operatively using absorbable implants, 15 of them were treated by combining absorbable pins or screws with metallic implants. According to the AO/ASIF system, there were 13 Type A, 21 Type B and 10 Type C fractures. Thirteen patients were lost to follow-up. The clinical outcome was reviewed in 44 patients with an average follow-up time of 4.6 years. The functional results by Broberg and Morrey were excellent or good in 36 (81%), fair in three (6,8%) and poor in five (11,2%) patients. Twenty-nine (66%) patients indicated their satisfaction with the outcome of the treatment. The elderly had more severely unstable fractures and more unfavourable results than younger patients. A postoperative redisplacement was seen in 11 (25%) patients and infection in seven (16%) patients. An abacterial foreign-body reaction occurred in four (9,1%) patients. The results were favourable in the noncomminuted epicondylar and condylar fractures of the distal humerus as well as in the humeral capitellum fractures. The results were unsatisfactory in the comminuted intraaticular distal humeral fractures.

Absorption↗
PubMed2006

Locking plate fixation for proximal humeral fractures: initial results with a new implant.

Treatment of proximal humeral fractures remains controversial, with multiple reported techniques and variable results. Recently, locking plates have become available for fixation of osteopenic and comminuted fractures. This study reports our initial experience with a new locking plate designed specifically for proximal humeral fractures. We observed 16 patients until union or revision with a mean of 12 months' follow-up. Of the 16 patients, 9 had high-energy injuries. There were nine 3-part, five 2-part, and two 4-part fractures. Twelve of sixteen patients healed without complications. There were 4 nonunions; all occurred in patients with 3-part fractures with metadiaphyseal comminution, 3 of whom were heavy smokers. In patients with united fractures, mean elevation was 132 degrees and mean external rotation was 43 degrees, with mean internal rotation to T11. Locking plate fixation achieved union in 75% of patients in this series. Risk factors for delayed union or nonunion included comminution, smoking, and 3-part fractures. These fractures remain challenging despite the availability of locked plating systems.

Adolescent↗
PubMedDate not supplied

Open intramedullary nailing with tension band and locking sutures for proximal humeral fracture: hot air balloon technique.

To reduce complications and increase fixation after the internal fixation of proximal humeral fractures, interlocking intramedullary nailing and tension-band and locking sutures were used simultaneously, and their results are reviewed. Twenty-six consecutive patients who underwent open intramedullary nailing with tension-band and locking sutures for proximal humeral fractures were selected. The mean follow-up period was 39 months. With regard to the functional evaluation, the mean Neer score was 90 points and the mean American Shoulder and Elbow Surgeons score was 85. When patients were divided into those aged less than 65 years and those aged 65 years or greater and into those with 2-part fractures and those with 3-part fractures, postoperative pain, the American Shoulder and Elbow Surgeons score, and the Neer score showed no difference between the 2 groups. Open intramedullary nailing accompanied by tension-band and locking sutures for proximal humeral fractures shows sufficient fixation in older patients, and therefore, good postoperative shoulder function can be expected.

Accidental Falls↗
PubMed1994

The reduction of humeral fracture in pigeons with intramedullary poly (methyl methacrylate) and neutralization plate fixation.

The reduction of experimental humeral fracture in pigeons was performed with intramedullary bone cement (poly (methyl methacrylate): PMMA) and neutralization plate fixation to investigate the effect on bone fracture healing and the recovery of flying ability. As a result, neither plate nor bone cement fixation held for more than 2 weeks, but not refracture was observed in any cases with both plate and bone cement. In the latter group, it was confirmed by flight tests that almost normal flying ability was recovered in 6 weeks. In pathological findings, blood supply to the fractured ends recovered within 2 weeks and no cortical bone necrosis was observed at the time except for a disturbance of endosteal callus formation. The process of fracture healing on the plate side took place slightly later than that on the non-plate side, and when much PMMA remained between the fractured ends of the cortical bone the bone formation became spongioid. In view of the quick recovery of flying ability, however, plate and bone cement fixation is considered appropriate to prevent the displacement of a humeral fracture in the pigeon.

Animals↗
PubMed2003

Arterial reconstruction using the basilic vein from the zone of injury in pediatric supracondylar humeral fractures: a clinical and radiological series.

The authors describe the advantages of using the basilic vein as an arterial conduit in the management of children with supracondylar humeral fractures requiring vascular repair. Eight children, aged 3 to 10 years, presented with supracondylar humeral fractures and vascular injury. In all eight children, the arteries were successfully reconstructed with a reversed, interposition basilic vein graft harvested from the ipsilateral arm. The basilic vein was anatomically consistent with few side branches and was an excellent size match for the brachial artery. There were no postoperative thromboses. At a minimum follow-up of 1 year, all children had palpable radial pulses and the vein grafts were patent with no anastomotic or other focal stenoses. This series confirms the safety of using a donor vein from within the zone of injury for arterial reconstruction, after a supracondylar humeral fracture. Benefits include a single surgical wound on the less conspicuous medial side of the arm, reduced operating time, and preservation of donor veins that may be subsequently required for the management of atherosclerotic disease.

Angiography↗
PubMed1992

Comparison of surgical and nonsurgical treatment of humeral fractures in horses: 22 cases (1980-1989).

Medical records of 22 horses with humeral fractures were reviewed. The horses were from 2 to 144 months old (mean, 25.8 +/- 37.3 months). Ten horses were treated with stall confinement, 3 were treated surgically, and 9 were euthanatized at the time of diagnosis. Seven of 10 horses treated nonsurgically (stall confinement) were able to be ridden 5 to 12 months after the diagnosis was made (mean, 7.5 +/- 2.6 months). One horse treated nonsurgically was euthanatized 6 months after diagnosis because of laminitis in the contralateral limb. Two horses treated nonsurgically were lost to follow-up evaluation. Two of the 3 horses treated surgically had fractures repaired with Rush pins. The fractured humerus of the third horse was repaired with lag screws. Of the 3 surgically treated horses, 1 was pasture sound 10 months after surgery, but developed varus deviation in the contralateral carpus 6 weeks after repair; 1 horse was euthanatized 2 weeks after surgery because of failure of the implant; and the other horse was sound for riding 10 months after surgery. On the basis of these findings, young horses with humeral fractures that are treated nonsurgically can become sound for riding.

Animals↗
PubMed2002

Results of surgical treatment of intra-articular (ao-c3) distal humeral fractures in adults.

BACKGROUND: The results of intra-articular comminuted distal humeral fractures, which have been treated by open reduction and dual plate fixation, are compared in this study with previously published results. METHODS: At Uludag University Faculty of Medicine Department of Orthopaedics and Traumatology, between 1995 and 2002, the results of 20 cases were evaluated in patients with intra-articular comminuted distal humer- alfractures, who had been treated by open reduction and internal jixation. RESULTS: Eleven (55%) cases were male, nine (45%) were female and mean age was 40.6 (range; 18 to 76). All fractures were C3 type according to AO/ASIF classification. Eight (40%) cases were open fractures and of these, six ( 30% ) were type 3A and 2 ( 1 0% ) were type 3B on the Gustilo-Anderson classification. All the fractures were jixed with dual plate after open reduction. In 25% ~f the cases, superficial wound infection was observed and in 5% heterotopic ossification. CONCLUSION: In adult distal humeral. fractures of type C3, stabilization by dual plate, following open reduction and early commencement of joint movements, has fewer complications and should he the preferred method of treatment. Key Words: Distal humeral, fracture, intra-articular, dual plate. fixation.

Adolescent↗
PubMed2006

Update in the epidemiology of proximal humeral fractures.

UNLABELLED: We sought to determine current trends in the number of fall-related and osteoporosis-related proximal humeral fractures in elderly Finns during last three decades. We collected data from the National Hospital Discharge Register on all patients 60 years or older who were admitted to Finnish hospitals from 1970 to 2002 for primary treatment of proximal humeral fractures. Fractures induced by traffic accidents or other high-energy traumas were excluded. The number and incidence (per 100,000 patients) of fractures increased from 208 (number) and 32 (incidence) in 1970 to 1120 (number) and 105 (incidence) in 2002. The age adjusted incidence of proximal humeral fractures also showed an increase, from 51 (1970) to 129 (2002) in women, and from 14 (1970) to 48 (2002) in men. In women 80 years or older, the age specific incidence of fracture increased from 90 (1970) to 294 (2002), while in the other age groups trend changes were less extensive. The mean patient age also increased, from 73 years (1970) to 78 years (2002) in women and from 70 years (1970) to 73 years (2002) in men. If these trends continue, the number of fractures in elderly Finns will triple during the next three decades. LEVEL OF EVIDENCE: Prognostic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed2005

Concept of treatment in supracondylar humeral fractures.

This opinion of treatment for children's supracondylar humeral fractures discusses techniques of fracture reduction and stabilization. A useful method of external visualization of the fracture is reviewed. The article discusses the treatment of 95 fractures in children using crossed and two lateral pin techniques.

Bone Nails↗
PubMed1997

Complications of humeral head replacement for proximal humeral fractures.

The indications for humeral head replacement in acute fractures and in chronic fracture problems have been studied over many decades and are reasonably well defined. Complications have probably been understudied. Many different complications occur, and their frequency and the need for reoperation is quite high. Because of the variety of complications that occur, familiarity with preventive measures and treatment options is important, not only to deal with complications arising from endoprostheses, but also to treat musculoskeletal infections, nerve injuries, fractures, instability, nonunion of tuberosities, malunion, and rotator cuff or capsule contracture or tearing. Physicians also must be able to integrate reparative/reconstructive surgery with a program of postoperative rehabilitation. The challenges are many. Treatment often provides considerable improvement for the patient, but often the extent of the improvement is somewhat less than optimal.

Adult↗
PubMed2003

[Epidemiology, treatment and results of proximal humeral fractures: experience of a district hospital in a sports- and tourism area].

AIM OF THE STUDY: The epidemiology, therapy and results of proximal humeral fractures in a touristic area were investigated and our concept for treatment presented. METHODS: Between 1.1.1999 and 30.04.2000 adult patients with proximal humeral fractures were included, the fractures classified (Codman/Neer and AO) and results determined after an average of 9 months. RESULTS: 62 adults were treated. 59 (95 %) had an accident during leisure time, mainly skiing accidents (52 %). 7 patients (11 %) had an associated luxation of the shoulder. 51 (82 %) were treated conservatively, 11 (18 %) operatively with a T-plate. The conservatively treated had to wear a Gilchrist-cast for an average of 29 (operatively 13) days, started passive movement after 20 (operatively 9) days, and active movement after 44 (operatively 45) days. The 32 employed (52 %) were not able to work for 46 days on average. Overall, 52 patients (84 %) were totally or mostly satisfied with the result. 5 among the 13 patients (38.5 %) with 3- or 4-part-fractures, and 4 among the 11 operated patients (36.4 %) were not satisfied with the result. CONCLUSIONS: Proximal humeral fractures are common skiing injuries, they need a long and intensive treatment and are economically expensive. The Codman/Neer and AO-classifications are equal. The results for simple, mainly conservatively treated fractures (Codman/Neer 1, 2A, 2-part) are good. Complex, mainly operatively treated fractures (Codman/Neer 3- and 4-part) have a much poorer prognosis. Diagnostically the computed tomography with 3-D-reconstruction is recommended for a better representation of the fracture and a safer choice of the therapeutical strategy.

Adolescent↗
PubMed1992

[Classification of fractures and problems in proximal humeral fractures].

Complex fractures of the proximal humerus may be difficult to assess and treat. Open or closed reduction and fixation may lead to malunion, nonunion, and/or avascular necrosis. Conversely, hemiarthroplasty also does not always result in satisfactory functional results. Various classifications have been established to compare the results of treatment and assist in decision making. The most commonly used classifications are those of Neer and the AO/ASIF group both of which appear to overestimate the relevance of avascular necrosis and underestimate the relevance of malunion. Because of the inter- and intraobserver variability in classifying these fractures, there is the potential for a wide variety of treatment recommendations, and predicting the prognosis becomes less accurate. Further work should be done in standardizing the classifications of proximal humerus fractures and defining the necessary X-ray projections.

Fracture Fixation, Internal↗
PubMed2002

[Kapandji intramedullary wire osteosynthesis in proximal humeral fractures].

For operative treatment of proximal humeral fractures minimal invasive techniques reduce the risk of iatrogenic damage of blood supply and periarticular scarring. Reported preliminary results are encouraging. We present our experience achieved with an intramedullary wire fixation adapted from a report of Kapandji in 1989. Between 3/95 and 6/00 29 patients were treated with this technique at our institution. All received early functional treatment. 14 patients (average mean age 56 years at time of trauma) who had a minimum follow up of 24 months (mean 36.4 months) and therefore allowed a preliminary conclusion regarding avascular head necrosis (AVN) were reexamined by use of the Constant Score and x-ray. We examined three unstable 2-part, four 3-part and seven 4-part fractures (5 of them valgus-impacted). The mean Constant Score at follow up was 70 points (31-86 points). We saw one total collapse of the humeral head because of AVN. In one patient the distal end of the wires led to a skin irritation and had to be shortened. We observed no secondary fragment displacement or non-unions. In our hands, this technique offers good results, even in valgus-impacted 4-part fractures of the elderly and allows internal fixation in little displaced but unstable fractures with the benefit of early functional treatment instead of longer immobilization. Based on the experience with intramedullary wiring the previously performed technique using threading wires was abandoned and the indication for primary arthroplasty considerably influenced.

Adult↗
PubMed1995

[Treatment and outcome of supracondylar humeral fractures in childhood].

In an 8-year period, from 1985 to 1992, 89 children presenting with a supracondylar humeral fracture were treated at the Department for Traumatology, Philipps-University, Marburg. All dislocated fractures (n = 48) were treated surgically. The majority (n = 34) of dislocated fractures were reduced open by a radial and an ulnar approach and subsequently stabilized using crosswise introduced K-wires. All fractures were differentiated retrospectively according to the degree of dislocation, the presence of associated injuries, the type of treatment chosen, and the function outcome. Fifty-two patients were reexamined. Clinically relevant varus deformities (4% of cases) and impaired elbow function were observed only in cases where anatomic fracture reduction or fracture fixation was not obtained. Critical analysis of our results and the literature led us to the development of a new, treatment-oriented classification of supracondylar humeral fractures in children. We consider fractures that are dislocated less than 20 degrees, and where dislocation exists only in a saggital plane to be type A fractures. These fractures can be treated conservatively. Type B fractures are fractures that are dislocated more than 20 degrees only in the saggital plane, but with remaining ventral or dorsal cortical bony contact between the fragments. In these fractures, we perform closed fracture reduction and K-wire stabilization. Type C fractures are fractures with rotational deformity, fractures dislocated in a frontal plane and fractures dislocated in a saggital plane with loss of cortical bony contact between proximal and distal fragments. Type C fractures should be reduced open by both a radial and an ulnar approach and subsequently stabilized using K-wires, introduced crosswise.

Adolescent↗
PubMed2001

The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children.

BACKGROUND: The purpose of this study was to evaluate the perioperative complication rates associated with early surgical treatment (eight hours or less following injury) and delayed surgical treatment (more than eight hours following injury) of displaced supracondylar humeral fractures in children. METHODS: Fifty-two patients had early surgical treatment and 146 patients had delayed surgical treatment of a displaced supracondylar humeral fracture. The perioperative complication rates of the two groups were compared with the use of bivariate and multivariate statistical methods. RESULTS: There was no significant difference between the two groups with respect to the need for conversion to formal open reduction and internal fixation (p = 0.56), pin-track infection (p = 0.12), or iatrogenic nerve injury (p = 0.72). No compartment syndromes occurred in either group. Power analysis revealed that our study had an 86% power to detect a 20% difference between the two groups if one existed. CONCLUSIONS: We were unable to identify any significant difference, with regard to perioperative complication rates, between early and delayed treatment of displaced supracondylar humeral fractures. Within the parameters outlined in our study, we think that the timing of surgical intervention can be either early or delayed as deemed appropriate by the surgeon.

Adolescent↗
PubMedDate not supplied

Periprosthetic humeral fractures: mechanisms of fracture and treatment options.

In 20 patients, 21 periprosthetic humeral fractures were reviewed retrospectively. The mean follow-up time was 27.1 months. Mild osteopenia was present in 45% of the patients, whereas 30% had severe osteopenia. Five mechanisms of fracture were identified, including 3 intraoperative causes that are avoidable. Treatment with stable intramedullary fixation utilizing the humeral stem and cerclage wiring provided superior results in terms of time to union, adverse effect on rehabilitation, and occurrence and severity of surgical complications. Diaphyseal fractures that were treated with standard stem arthroplasty with or without supplemental fixation had a longer time to fracture union, a higher complication rate, and prolonged rehabilitation. Fractures of the proximal humeral metaphysis can be treated with standard stem arthroplasty and cerclage wiring if the stem extends distal to the fracture site by at least 3 cortical diameters. Anatomic reduction of fractures treated by surgical means results in shorter healing times. Cast or brace immobilization can be used for management of postoperative fractures that occur distal to a well-fixed and stable prosthetic stem. Cast or brace immobilization results in fracture union but rehabilitation may be greatly impaired, and there is an increased risk of complications associated with immobilization of the extremity. Long-stem intramedullary fixation with cerclage wiring is the preferred surgical option for treatment of unstable humeral shaft fractures.

Adult↗
PubMed2006

Early complications of operatively treated proximal humeral fractures.

Minimal information exists regarding early complications after operatively treated proximal humeral fractures. Of the 82 shoulders that had osteosynthesis, 42 had a (nonmedical) complication, with 21 requiring further surgery. Of 42 shoulders with complications, 12 were related to incomplete reduction, 16 had loss of anatomic fracture fixation, 9 had delayed healing, 3 had an infection, 1 had rotator cuff failure, and 1 had loose bodies. Fixed-angle plates had lower rates of initial malpositioning and resultant malunion. Of the 22 shoulders requiring hemiarthroplasty, 14 had an early complication. Of these, 7 had complications relating to implant insertion or tuberosity malreduction at the index operation and 7 had problems with tuberosity healing. The rate of complications after operative treatment of proximal humeral fractures is high. All efforts at fracture fragment fixation with osteosynthesis and hemiarthroplasty should be directed at obtaining anatomic fracture fixation that resists displacement.

Adult↗
PubMed1993

[Displaced proximal humeral fracture--conservative treatment].

The results of 42 patients with displaced proximal humeral fractures treated by conservative methods were reviewed. Follow-up evaluation included clinical and radiographic examination median two years after the trauma. The results were assessed using Neer's protocol. The patients were asked to assess the results. The patients assessed the results better than the Neer score (p < 0.001). The patients' response to non-operative treatment was satisfactory. It is concluded that the Neer classification of the results underestimates the degree of satisfaction achieved by the patients. It is concluded that displaced proximal humeral fractures can be treated satisfactorily by non-operative methods.

Adult↗