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PubMed1987

Positional signalling and the development of the humerus in the chick limb bud.

The positional signal model for specification of the cartilaginous elements in limb development has been tested by examining the effect on the humerus of grafting a polarizing region to different positions along the anteroposterior axis of the limb bud at stage 16. The humerus between the host and grafted polarizing region was largely normal though there were variations in width, particularly the distal epiphysis. The humerus often showed mirror-image symmetry along the anteroposterior axis. When the grafted polarizing region was in a very anterior position, there were a few cases where a second humerus developed. Anterior to the graft an additional humerus often developed. This was associated with the splitting of the bud into two domains. It is suggested that these results are not consistent with a positional signal model and that an additional mechanism involving an isomorphic prepattern may be involved in the specification of the cartilaginous elements.

Animals↗
PubMed1992

Avascular necrosis after fracture-separation of the distal end of the humerus in children.

Fracture-separation of the distal end of the humerus in children has been reported infrequently, and may be misdiagnosed as a fracture of the condyle or a traumatic dislocation of the elbow. We discuss eight cases of a seldom reported complication following fracture-separation of the distal end of the humerus. This complication consists of dissolution of the trochlea within three to six weeks postinjury and a defect of the medial or central part of the condyle that develops later. The fractures were severely displaced fracture-separation of the distal end of the humerus with large medial or lateral metaphyseal fragment, but initially misdiagnosed as a fracture of the medial, lateral condyle or a traumatic dislocation of the elbow in six of eight cases. We performed open reduction in six cases because of initial misdiagnosis or because of difficulty in satisfactory closed reduction. We speculated that this complication is due to avascular necrosis of the distal end of the humerus, and that fracture-separation of the distal end of the humerus is more common than reported.

Child↗
PubMed1980

[Humerus varus (author's transl)].

Humerus varus is a rare disease and has led to many controversies concerning its classification, its physiopathology, its treatment and even the measurement of the varus angle of the huméral head. This study is based on four personal cases and a review of the literature since 1900 about fifty cases. The relation between humerus varus, congenital aplasia of the glenoïdal articular surface of the scapula, and congenital dislocation of the shoulder, sometimes referred as shoulder dysplasia, is discussed. Two entities must be distinguished: The "true" humerus varus where the epiphyseal plate is in a varus position with a shortened arm. The deformities of the humeral head in varus without main alteration of the epiphyseal plate orientation. When there is a restricted function, especially in abduction, a valgization osteotomy of the proximal part of the humerus can be proposed (one case). The authors have no experience in lengthening of the humerus.

Child↗
PubMed1995

The surgical anatomy of the radial nerve around the humerus.

Twenty-four cadaveric arms were dissected to determine the position of the radial nerve on the posterior aspect of the humerus relative to the posterior tip of the acromion, the medial and lateral epicondyles, the division between the lateral and long heads of the triceps, and the triceps aponeurosis. The radial nerve passed anterior to the long head of triceps and cross onto the posterior shaft of the humerus an average of 124 mm below the posterior tip of the acromion. It was never closer than 97 mm. The nerve usually lies on the medial head of the triceps as it courses posteriorly around the humerus and then leaves the posterior shaft of the humerus an average of 126 mm above the lateral epicondyle and 131 mm above the medial epicondyle. It was never within 100 mm of either epicondyle. The surgeon can use these landmarks as guidelines to avoid the radial nerve during operative intervention on the humerus.

Aged↗
PubMed1997

[Biomechanical comparative study of three types of osteosynthesis in the treatment of supra and intercondylar fractures of the humerus in adults].

PURPOSE OF THE STUDY: Supra and intercondylar fractures are the most common fractures of the distal end of the humerus in adult. An osteosynthesis consisting of a plate is the treatment of choice. But location and type of plate always remain open for debate. The authors present the results of an in vitro biomechanical study, which compared the stiffness of three types of osteosynthesis commonly used in these fractures. MATERIAL AND METHODS: The devices were on one hand the premolded lateral plate of Lecestre and Dupont (Howmedica) used alone or in conjunction with a medial 1/3 tubular plate of the AO group, and on the other hand a posterior plate, of which we are developing a new model, the Lambda plate (Protek) "Y"-shaped, monoblock, flat and molded on the humerus during operation. The study compared these different methods of fixation on fresh human humeri. In a first part, the posterior plate was compared to the single lateral one; in a second part, the posterior plate was compared to the coupled lateral and medial plates. The three plates were made of identical material. Both studies used eight pairs of bones with supra and intercondylar fractures realized by sawing. Each bone of a pair was fixed with one of the two types of device. Each humerus underwent different loading forces; sagittal bending (anterior and posterior) and torsion. The displacements were recorded using a calibrated measuring device coupled to two displacement sensors. The stiffness was calculated on force/displacement curves. RESULTS: In anterior bending, the Lambda posterior fixation was significantly stiffer than the single lateral one (p < 0.05) (239 +/- 109 versus 129 +/- 65 N/mm), and was not significantly different of the bilateral fixation (229 +/- 93 versus 224 +/- 108 N/mm). In posterior bending, the mean stiffness of the Lambda fixation was not significantly different to that of the lateral fixation (91 +/- 27 versus 91 +/- 52 N/mm), and less than that of the bilateral one (130 +/- 39 versus 170 +/- 70 N/mm), but not significantly. In torsion the mean stiffness of the Lambda fixation was superior to that of the lateral one (146.75 +/- 50.66 versus 119.75 +/- 58.8 Nm/rad), and bilateral one (233.31 +/- 107.47 versus 212.31 +/- 113.55 Nm/rad), but again not significantly. DISCUSSION: The ideal osteosynthesis for the fractures of the humeral distal doesn't exist, because the bone undergoes antero-posterior and posteroanterior cyclical forces during elbow flexion. Therefore the best device should be placed on both sides of the bone, but anatomical reasons make this location impossible. According to our study, we think the "less worst" device is the posterior one using the Lambda plate. Its symmetrical design allows a best loading distribution on the two columns. Its thickness compensates for its posterior location and the short interval between two holes allows to put many screws (4 to 6) into the epiphysis. All supra and intercondylar fractures, comminuted or not, can be treated with this material. The single lateral device isn't still enough. Its stiffness mainly depends on the orientation of the oblique screw in the medial column. But the design of this column doesn't always allow for an optimal location of the screw, which is the reason of several failures. The bilateral device gives a stiffness, comparable to the posterior one, but doesn't allow as many screws as the Lambda plate in the epiphysis. Therefore, it can't be used in very distal fractures. CONCLUSION: In spite of the progress of the material and the accuracy of the indications, the treatment of supra and intercondylar fractures of the distal end of the humerus is always a difficult problem. The devices have to be as stable as possible to allow an early motion. The best one should be placed on both sides of the distal humerus, because of the sagittal cyclic forces it undergoes, but this location is anatomically impossible. Our study concludes that the device using the Lambda plate i

Biomechanical Phenomena↗
PubMed2006

[Complex proximal humerus fractures--management with a humeral head prosthesis? Clinical and radiological results of a prospective study].

BACKGROUND: Proximal humerus fractures are one of the most common fractures in elderly patients. In the treatment of complex proximal humerus fractures, primary hemiarthroplasty is still discussed controversially. The present study was undertaken to evaluate the results of primary hemiarthroplasty in the treatment of proximal humerus fractures with a modular prosthesis (EPOCA, Fa. Argomedical, Gifhorn, Germany). MATERIAL AND METHODS: A prospective study of 24 patients with complex humerus fracture (NEER: IV/4, V/4, VI/4, and head split fracture) was performed from August 2000 to December 2002. Mean age was 75.6 years (range: 52-92); 18 patients were seen for follow-up after 0.5 and 1 year, respectively. The Constant-Murley score (max. 100 points) and the UCLA Rating System (max. 35 points) were calculated for functional assessment of the operated shoulder. RESULTS: Fifteen patients (83%) were pain free 1 year after the operation. The Constant-Murley score improved from 52 (+/-17) to 56 (+/-18) at the second follow-up after 1 year. On the contralateral side a score of 86 (+/-10) was assessed (p<0.05 vs operated side). Correspondingly, shoulder function according to the UCLA Rating System improved [25 (+/-4); 27 (+/-5)]. CONCLUSIONS: Osteoporotic bone of older patients often may not permit stable internal fixation of complex proximal humerus fractures. In these situations primary hemiarthroplasty is the treatment of choice.

Aged↗
PubMed1999

Age related biomechanical properties of the glenoid-anterior band of the inferior glenohumeral ligament-humerus complex.

OBJECTIVE: To quantify the biomechanical properties of the glenoid-anterior band of the inferior glenohumeral ligament-humerus complex for the two age groups. DESIGN: In vitro human cadaver study evaluating the biomechanical properties of the glenoid-anterior band of the inferior glenohumeral ligament-humerus complex for a younger group (n=5, mean age 38.5, SD 0.5 years) and an older group (n=7, mean age 74.8, SD 5.3 years). BACKGROUND: Glenohumeral instability is more of a problem in younger than in older individuals, primarily because recurrence is much more common at a young age. METHODS: Tensile testing was performed on the glenoid-anterior band of the inferior glenohumeral ligament-humerus complex in the shoulder apprehension position using a custom jig, Instron machine and a video digitizing system. RESULTS: In the younger individuals disruption of the complex most often occurred at the glenoid-labrum region of the glenoid insertion site. In the older individual, disruption most often occurred at the midsubstance region. The load and the stress at failure of the glenoid-anterior band of the inferior glenohumeral ligament-humerus complex showed that the older group was only 61% and 46% of the younger group, respectively. CONCLUSIONS: The structural properties of the glenoid-anterior band of the inferior glenohumeral ligament-humerus complex and the material characteristics of the anterior band of the inferior glenohumeral ligament for the younger group were significantly superior than the older group. RELEVANCE: A stronger and more extensive repair, such as the traditional open technique, may be necessary for younger individuals with glenohumeral instability whereas in older individuals, a different repair technique, such as an arthroscopic technique, may be sufficient.

Adult↗
PubMed1998

Secular trends in the osteoporotic fractures of the distal humerus in elderly women.

Osteoporosis, with its sequelae of fracture, is a major, continuously increasing threat to the health of the elderly, and therefore reliable epidemiological information is needed for assessment of the fracture development in the future and for effective fracture prevention. However, very little population-based information is available concerning the nationwide numbers, incidences and especially secular trends of osteoporotic fractures other than those occurring at the hip. We determined the current trends in the number and incidence of osteoporotic fractures of the distal humerus in Finnish women in 1970-1995 by collecting from the National Hospital Discharge Register all female patients aged 60 years or more who were admitted to our hospitals in 1970-1972, 1974-1975, 1978-1980, 1983-1985 and 1988-1995 for primary treatment of first osteoporotic fracture of the distal humerus. The fracture was defined as osteoporotic if it occurred on individuals aged 60 years or more as a consequence of a moderate or minimal trauma only (a fall from standing height or less). We also predicted the fracture development till the year 2030 by a regression model, a model that took into account the predicted changes in the fracture incidences and population at risk. The number and incidence (per 100,000 women) of osteoporotic fractures of the distal humerus in Finnish women aged 60 years or more increased from 42 (number) and 11 (incidence) in 1970 to 175 and 30 in 1995. The age-adjusted incidence of osteoporotic fractures of the distal humerus also increased, from 12/100,000 women in 1970 to 28/100,000 women in 1995. If this trend continues, the number of these fractures in Finnish women will be almost three-fold in the year 2030 compared with that in 1995. We conclude that the number of osteoporotic fractures of the distal humerus in elderly Finnish women is increasing more rapidly than can be accounted for by the demographic changes alone and therefore effective preventive measures are imperative to keep this problem in control.

Age Factors↗
PubMed2000

Compartment syndrome in ipsilateral humerus and forearm fractures in children.

Ipsilateral fractures of the humerus and forearm are uncommon injuries in children. The incidence of compartment syndrome in association with these fractures is controversial. The authors reviewed 978 consecutive children admitted to the hospital with upper extremity long bone fractures during a 13-year period. Forty-three children with ipsilateral fractures of the humerus and forearm were identified. Of 33 children with a supracondylar humerus fracture and ipsilateral forearm fracture, three children (7%) had compartment syndrome develop and required forearm fasciotomies. All three cases of compartment syndrome occurred among nine children with ipsilateral displaced extension supracondylar humerus and displaced forearm fractures; the incidence of compartment syndrome was 33% in this group. These findings suggest that children who sustain a displaced extension supracondylar humerus fracture and displaced forearm fracture are at significant risk for compartment syndrome. These children should be monitored closely during the perioperative period for signs and symptoms of increasing intracompartmental pressures in the forearm.

Adolescent↗
PubMed2003

Combined olecranon osteotomy and posterior triceps splitting approach for complex fractures of the distal humerus.

Complex fractures involving the intercondylar/supracondylar distal humerus with extension into the mid to proximal humeral shaft are difficult to manage through a single standard surgical approach. We present and review a technique that combines an olecranon osteotomy with a posterior triceps splitting approach to the humerus. This technique was used in two patients who presented with severe intercondylar fractures of the distal humerus and extension proximally to the midshaft of the humerus. The technique allowed extensive distal humerus exposure, including the supracondylar/intercondylar region, and excellent exposure of the humeral shaft proximally to the surgical neck.

Adult↗
PubMed2003

Extensor mechanism-sparing paratricipital posterior approach to the distal humerus.

Adequate exposure of the articular surface of the distal humerus and elbow joint is required for operative stabilization of bicolumnar distal humerus fractures. The transolecranon approach, which provides complete posterior visualization and access to the distal humerus, is commonly used. Nevertheless, an olecranon osteotomy and other extensor mechanism-disrupting approaches have risks and possible complications. Alternative exposures have been described primarily for total elbow arthroplasty, but these involve extensive and potentially devascularizing dissections. In extra-articular (OTA type A) and simple articular distal humeral fractures with simple or multifragmentary metaphyseal involvement (OTA type C1 and C2), extensile approaches may not be necessary. For these fracture patterns, an alternative exposure is the extensor mechanism-sparing paratricipital posterior approach to the distal humerus through a midline posterior incision. This approach avoids an osteotomy and mobilizes the triceps and anconeus muscle off the posterior humerus and the intermuscular septae and provides adequate exposure for open reduction and internal fixation.

Adult↗
PubMed2005

A true triceps-splitting approach for treatment of distal humerus fractures: a preliminary report.

BACKGROUND: The treatment of distal humerus fractures has traditionally been performed via a posterior approach and an olecranon osteotomy. The article reports the authors' clinical experience using a triceps-splitting approach for a consecutive series of patients with distal humerus fractures. METHODS: A consecutive series of 37 patients with 39 distal humerus fractures were treated with a triceps-splitting approach. All the fractures were managed with two-column fixation. RESULTS: A total of 33 patients (34 fractures) were available for follow-up evaluation over an average of 26 months (range, 13-48 months). There were five type A and 29 type C fractures. Five of the fractures were grade 1 open. There were three elbows with clinically asymptomatic valgus instability (<5 degrees at 30 degrees flexion) and one elbow with symptomatic varus instability. There was one case of heterotopic ossification, limiting motion; one transient ulnar nerve palsy; one severe infection requiring resection arthroplasty; and five nonunions. Four of the five nonunions involved patients older than 65 years. CONCLUSIONS: The use of a triceps-splitting approach to gain access to the distal humerus provided adequate exposure and had an acceptable complication rate. In addition to allowing for distal humerus reconstruction, it avoided the reported complications of olecranon osteotomy and is easily extensile if required.

Adolescent↗
PubMedDate not supplied

Supracondylar fractures of the humerus associated with ipsilateral forearm fractures in children: a report of forty-seven cases.

Supracondylar fractures of the humerus associated with ipsilateral forearm fractures are uncommon and treatment recommendations are controversial. The purpose of this study was to determine whether pin fixation of both fracture components, humerus and forearm, would improve the outcome. In a two-center trial, 884 children sustaining supracondylar fractures of the humerus were retrospectively reviewed, and 47 (5.3%) showed associated ipsilateral forearm fractures. Of those, 29 underwent Kirschner-wire fixation of the forearm fracture, and 18 of the forearm fractures were treated with casting alone. Three of the 18 forearm fractures with casting alone reangulated. There were no reangulations in the patients who had pin fixation of their fractures. There were no complications due to pin fixation in the humerus or the forearm. In unstable supracondylar humerus and forearm fractures, stabilization with pin fixation to prevent reangulation should be considered.

Adolescent↗
PubMed2005

[The treatment of middle and lower thirds fractures of humerus by anterior plate fixation].

OBJECTIVE: To study the effect of anterior plate fixation on the treatment of middle and lower thirds fractures of humerus and the possibility of operating without injuring the radial nerve. METHODS: Forty-nine patients with the middle and lower thirds fractures of the humerus were treated with anterior plate fixation from March 1998 to December 2002. Of the 49 patients, 27 were with new fractures, 12 with old fractures, and 10 with nonunion fractures. According to AO classification, of the 49 patients, there were 19 type A, 14 type B1, 9 type B2, 5 type B3, 2 type C1. Thirty-seven patients had closed fractures and 12 had open fractures. Of the 12 patients, 8 were type Gustilo I , 4 were type Gustilo I . Four out of the 49 patients were associated with radial nerve palsy. All patients were treated with anterior plate fixation through the anterior approach to the humerus. The radial nerves injured were explored. RESULTS: Of the 49 patients, 48 were followed up 6 to 48 months (28.7 months on average). All fractures were healed within 3 to 9 months(4.7 months on average). Fixed plates of 37 patients out of the 49 were removed. No iatrogenic radial nerve injury occurred in the 82 times of the operations among the 49 patients. CONCLUSION: The treatment of middle and lower thirds fractures of humerus by anterior plate fixation through the anterior approach to the humerus does not interfere with the fracture healing and can prevent the iatrogenic radial nerve injury.

Adolescent↗
PubMed1987

[Early functional treatment of humerus shaft fractures by the Sarmiento method].

The functional treatment of humerus shaft fractures with a brace according to Sarmiento is described. Reported are the results of the functional treatment of 47 humerus shaft fractures. Every humerus shaft fracture normally treated conservatively, including the humerus shaft fractures in polytraumatised patients and those patients with a primary radial nerve injury, can be treated in this way. The functional treatment of humerus shaft fractures results in a quick and uneventful healing of the fracture with a good function and cosmetic aspect.

Adolescent↗
PubMed1987

[Surgical therapy of dislocation fractures of the head of the humerus in adults. Personal procedure and results].

Surgical intervention is indicated in the vast majority of humerus head fracture dislocations. In the present paper, we report on the results of 24 such interventions performed between 1975 and 1984. Implantation of a T-plate is considered the standard procedure to obtain osteosynthetic stability during exercise. However, in elderly patients or in cases of multiple fragment fracture, this procedure is inadequate to achieve the required stability. In such cases, development of a humerus head necrosis would rather be promoted. If a sufficiently stable osteosynthesis without the risk of necrosis cannot be achieved, we prefer replacement of the humerus head by a shoulder prosthesis to humerus head resection, resection-interposition-arthroplasty or shoulder arthrodesis. However, not only optimal surgical management of humerus head fracture dislocations has a decisive influence on the later function of the most flexible human joint with the important rotator cuff, but also properly performed active and systematic postoperative physiotherapy.

Adult↗
PubMed1982

Morphometric analysis of the distal humerus of some Cenozoic Catarrhines: the Late Divergence Hypothesis revisited.

Washburn's Late Divergence Hypothesis (LDH) makes a series of predictions about the phyletic affinities of extant hominoids and also predicts the locomotor behavior of the "formative ape," the common ancestor to the African apes and humans, and of the earliest hominids. The present study explores some of these predictions in the light of distal humerus morphology. Multivariate analysis of distal humerus metrics, corrected for the within-groups distortion of shape by size, was used to compare a broad sample of 22 modern anthropoid taxa with 15 fossils from the Fayum, Rusinga Island, Ft. Ternan, Neudorf an der March, Kanapoi, Kromdraai, Lake Turkana, and Hadar. The results of this analysis support some aspects of the LDH, while other aspects are unresolved. Specifically, the distal humeri of the large hominoids are very distinct from those of other anthropoids; however, Hylobates is not associated clearly with either hominoids or monkeys. This suggests that "brachiation" (sensu Hylobates) is too specialized a behavior and cannot explain the common set of characteristics known to unify the hominoids. Among the large apes, there is no discrimination that can be made between the African apes and Pongo, and Homo appears only slightly closer to Pongo than to the other apes. This offers little insight into the question of whether humans did, or did not, go through a "knuckle-walking" stage in their ancestry. The Oligocene and Miocene distal humeri sustain Washburn's assertion that the "formative apes" resembled the suspensory quadrupedal platyrrhines like Ateles. The Miocene P. africanus specimen highlights the uniqueness of Hylobates in showing that this fossil "bridges" the morphology of the acrobatic cebids and the morphology of the larger apes; it appears to be clearly "intermediate" between the two groups. Hylobates, by contrast, has affinities with no fossil, does not connect with the apes, and is generally isolated except for its connection with colobines. Among the Plio-Pleistocene fossils, the Hadar sample proves to be quite primitive, and may be close to the point where hominids and pongids diverged. The Kanapoi distal humerus (KP 271), far from being more "human-like" than Australopithecus, clearly associates with the hyperrobust Australopithecines from Lake Turkana. The stratigraphically late Kromdraai distal humerus is the only hominid to be projected near Homo. The Plio-Pleistocene hominids generally evince a pattern consistent with the prediction of a late separation of hominids and pongids. But, the results of this study, like many before it, fail to resolve the central question of whether the last common ancestor of the African apes and humans "knuckle-walked." It is suggested here that this may be an unresolvable problem.

Animals↗
PubMed1996

Dimensions and estimated mechanical characteristics of the humerus after long-term tennis loading.

This study evaluated the effects of long-term unilateral physical activity (tennis) on the playing arm humerus. Total lengths of both humeri, site-specific widths, and the bone mineral contents (BMC) at the proximal, middle, and distal parts of the bones were measured using dual-energy X-ray absorptiometry (DXA). Bone mineral apparent density (BMAD), cortical wall thickness (CWT), cross-sectional moment of inertia (CSMI), and section modulus (Z) were approximated from the DXA data for describing the bone's mechanical characteristics more concretely. The study population consisted of 67 healthy, competitive tennis players (17 young men with a mean age [+/- SD] of 25 +/- 5 years, 30 young women with a mean age of 19 +/- 3 years, and 20 older women with a mean age of 43 +/- 5 years) and 57 sedentary controls (16 young men with mean age of 25 +/- 5 years, 25 years, 25 young women with a mean age of 21 +/- 3 years, and 16 older women with mean age of 39 +/- 6 years). All the players had competitive playing histories greater than 4 years. The young male and female players had started their playing careers in childhood (men at the age of 10 +/- 3 years, women 9 +/- 2 years), while the older female players started the training at adulthood (29 +/- 6 years). The playing-to-nonplaying or dominant-to-nondominant arm differences in humeral length ranged from +0.2 to +1.4%, the difference being significant in young male players (+1.4%), young female controls (+1.1%), and older female players (+0.7%). When comparing players' relative side-to-side length differences with those of the controls, no significant differences were found. Significant side-to-side differences in humeral width were observed in all groups except male controls. Compared with the controls, the relative side-to-side width differences were significantly larger at the proximal humerus of the young male players (controls +1.2%, players +3.7%) and the distal humerus of young female players (controls -0.2%, players +1.6%). Compared with the controls, the players' relative side-to-side differences in BMC (range, +7.6 to +25.2%), BMD (+5.8 to +22.5%), BMAD (+5.5 to +20.4%), CWT (+6.9 to +45.2%), CSMI (+7.8 to +26.4%), and Z (+3.0 to +21.7%) were significantly larger in all measured humeral sites except BMAD in the distal humeri of the older female players. These relative side-to-side differences were clearly and significantly larger in the young players (+11.7 to +45.2%) than in the older players (+3.0 to +12.4%). In conclusion, long-term intensive tennis playing, especially if started in childhood or adolescence, clearly increases the humeral BMC, BMD, and CWT but seems to have only a minor effect on the width of this particular bone. In this respect, there seems to be no sex difference. However, along with the increases in mineral mass and density, the changes in bone width are important in increasing the bending stiffness and strength of the humerus. In older players, the relative side-to-side differences are at the same level or only slightly larger than those in their age-matched controls. This suggests that even intense physical loading of a mature bone is only marginally better in increasing the bone mass, bone density, and CWT of the target bone than the normal daily use of the dominant extremity.

Absorptiometry, Photon↗