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A method of fixing the humerus is presented. A supramid pin is introduced into the medullary cavity and a plate with screws is attached to the bone surface. The screws are driven through the fracture fragments into the supramid pin. The resulting fixation is firm and suitable for certain complicated cases in which the usual fixation methods have their limitations.
Ganulocytic sarcoma (Chloroma) is a tumour of rare variety usually in assocoiation with granulocytic leukemia. It is related to soft tissue with extramedullay infiltration. We present a case of granulocytic sarcoma of humerus which preceded the initial clinical manifestation of acute myeloid leukemia in a young patient which ultimately proved to be FABM2 variety. Though many tissues are affected by this tumour but the most favoured site is the bone.
A personal experience is recounted of operations in cases of tumour involving the humerus or femur with restoration by endoprostheses. Twenty-four patients were treated in this way from 1950 to 1969 inclusive and have been followed up for between four and twenty-four years. The patients selected for treatment have presented chondrosarcoma (ten), so-called benign giant-cell tumour of bone, usually recurrent (nine), angiomatous osteolysis (two), seemingly single thyroid or renal metastasis (two), and ununited pathological fracture after irradiation of a tumour (one). Development of the prostheses from early beginnings is outlined. Some points in surgical management are referred to. The complications and results are recorded.
An elderly woman presented with a pathological fracture of the right humerus. Progressive dissolution of the shaft of this bone took place over six months. No cause could be established and the patient refused biopsy. With only simple splintage for treatment the humeral shaft gradually reformed and re-ossified over a period of two years. The patient has been under review for four and a half years and no further pathology has come to light. The cause of the osteolysis remains obscure.
On the basis of five cases of supraepitrochlear process of the humerus the authors recall the most significant anatomical and clinical aspects of the disease. The presence of clinical symptoms, going under the name of Struthers syndrome, indicates surgical removal.
Hydatid cysts caused by E. multilocularis are less common than those caused by E. granulosus (Pintilie et al., 1996). Infection in the bones is rare, accounts to 0.9-2% of all hydatid cysts (Wirbel et al., 1997). A thirty-five-year old female was presented with a four month history of pain and swelling in her humerus. Plain radiography (Fig. 1) and ultrasonography revealed partial destruction of bone. Laboratory investigations revealed Hb, 15.2 gm, ESR, 11 1st hr and WBC, 10,000. Indirect haemagglutination test using hydatid antigen was positive (1/16,000) and ELISA (IgG) was positive (1/4096). Lung, liver and brain scans were normal. Endosteal-sarcoma was considered and a biopsy was performed. Histopathological examination of bone tissue, showed many cysts (Fig. 11). On surgical operation, a huge number of cysts were found, and removed. The patient was given Albendazole in the recommended dose (Mazyad et al., 1998), and followed up. Six months later, all symptoms and signs regressed. Again three months more, the serological levels markedly decreased and X ray was normal.
Four cases of supracondylar process of the humerus in three patients are presented. The main features of a supracondylar process as compared with an osteochondroma are reviewed. The three patients had pain and one had signs indicating median nerve compression. One had a supracondylar process together with an osteochondroma in the contralateral supracondylar region. One patient with a bilateral supracondylar process refused an operation. The other two patients underwent surgical treatment. The symptoms disappeared in the two patients who were operated.
The cross-sectional geometric parameters were determined serially along the diaphysis of 3 paired humeri and femora of chimpanzees by using the computed X-ray tomographic scans, and compared with those of humans. In magnitude, the femoral parameters were greater and humeral parameters were less, respectively, in humans than in chimpanzees. While the changing pattern among the parameters along the diaphysis was very similar both in the femur and humerus of chimpanzees, the pattern in the humans was reversed between the cross-sectional area and area moments of inertia. In chimpanzees, the femoral parameters increased toward the most proximal diaphysis, whereas humeral parameters yielded a moderate peak in a portion slightly proximal to mid-shaft. Potential mechanisms responsible for these findings were discussed.
Hemangioma is an uncommon bone neoplasm that usually affects the craniofacial bones and spine, accounting for less than 1% of all primary bone tumors. The authors report a case of isolated hemangioma involving the proximal humerus in a 22-year-old man. Radiographically, the lesion was a well-defined osteolytic process with marginal sclerosis. The CT images demonstrated an osteolytic lesion with coarse trabecular pattern and partial cortical breakthrough. Magnetic resonance imaging showed a multilocular and hemorrhagic lesion with fluid-fluid level, that was suggestive of aneurysmal bone cyst.
This paper describes the design of a retractable intramedullary nail for the humerus that does not require inter-locking screws. The developed nail has a series of fins which open out from the casing to grip the medullary canal of the bone, thus securing it in position. Prototypes of the nail have been mechanically tested using static compression, dynamic compression and static torsion tests. During the compression tests no nails were found to fail. Statically a mean force of 809 N was withstood. During dynamic testing all the nails survived 1 million cycles, with a maximum applied load of 400 N. In torsion the two nails failed at 1.0 and 2.2 N m. Based on the mechanical testing, the retractable intramedullary nail would appear strong enough to withstand the expected loading conditions in the human body.
The authors report a case of brucella osteomyelitis of the upper end of the humerus in a 77-year-old patient, presenting as a large swelling of the soft tissues of the shoulder, present for a year. The diagnosis was made by isolation of the organism and specific serology. The authors stress the value of magnetic resonance imaging, which provided confirmation of the diagnosis of osteomyelitis as well as an accurate topographic assessment.
Aseptic bone necrosis in adults is usually caused by circulation defects or metabolic diseases but may also occur without any obvious reason. In these "idiopathic" cases, alcoholism seems to play a prominent role. In addition to the frequently affected femoral heads other bones may be involved. Here a remarkable pattern of localizations is reported: the bilateral idiopathic necroses of the heads of both humerus and femur. Untreated aseptic bone necroses close to a joint commonly leads to severe secondary arthrosis and destruction of the joint within a short time. Therefore, only a diagnosis in an early stage of the disease offers the chance of a successful joint-preserving therapy. In cases of clinically suspected aseptic bone necrosis but still negative or doubtful X-ray findings, bone scans or MRI are reliable methods of verifying the diagnosis.
Measurements of the maximum width and depth of the intertubercular sulcus (ITS) and the angles formed by the medial and lateral walls of the ITS with the plane of its floor were recorded in 200 adult human humeri, 100 each from the right and left sides. The ITS was more often wider and its medial wall formed a more acute angle with the plane of its floor in right-sided humeri. A supratubercular ridge on the humerus was present more frequently on the right than on the left. The presence of this ridge is probably more necessary on the right to prevent medial displacement of the long head of the biceps tendon from the ITS. The greater thrust exerted by the taut tendon of the long head of the biceps in the upper limb that is used preferentially probably induces structural differences in the ITS.
We present a case of a 22-month-old child with swollen upper part of the right arm and osteolytic lesion of the right humerus, which resembled a neoplastic process. Epidemiological history revealed no scratch marks on the skin or cutaneous papule or pustule. Presumptive diagnosis of hematogenous osteomyelitis was established, but treatment with fusidic acid was unsuccessful. Histological examination of the bioptic specimen of the soft tissue swelling showed a lymph node morphology, with numerous granulomas with central stellate necrosis. Indirect immunofluorescence assay for Bartonella henselae yielded positive results. New treatment included 15 days of trimetoprime and sulfamethoxazole, followed by azithromycin for 5 days. Four months later, swelling resolved and osteolytic lesion almost completely healed with formation of surrounding sclerosis. In conclusion, cat-scratch disease without positive epidemiological history and primary cutaneous papule or pustule may be a serious diagnostic problem, but can be solved by serological and histological examination.
The case of a ten-year old girl, presenting with pain and restricted movement of the left arm is reviewed. X-rays and bone scan suggested an Ewing's sarcoma of the left humerus, so that the child was referred to surgery. Surprisingly, the histological examination of the surgical specimen revealed a solitary eosinophilic granuloma of the bone.
A new biomodular prosthesis was used for the treatment of a displaced fracture of the proximal part of the humerus in twenty-two shoulders in twenty-two patients. The fractures were classified according to the Neer system; there were thirteen four-part, five three-part, and four head-splitting fractures. There were fifteen women and seven men, and the mean age was seventy years (range, forty-nine to eighty-seven years). The hemiarthroplasty was performed an average of eleven days (range, one to forty-five days) after the injury. The deltopectoral interval was used in all patients, and the prosthesis was implanted with cement in twenty of the shoulders. All of the patients participated in a supervised program of rehabilitation. The patients were followed for an average of thirty-six months (range, twenty-six to forty-nine months). Twenty of the twenty-two patients had a good or excellent result. The active forward elevation averaged 119 degrees; external rotation, 40 degrees; and internal rotation, to the twelfth thoracic vertebra. All of the patients except for the two who had a poor result had satisfactory relief of pain. The two patients who had a poor result had a successful revision with a modular prosthesis of the same design. The modular head could be removed, enabling the surgeon to gain access to the glenoid and to adjust the soft tissues. The over-all scores correlated inversely with the age of the patients and the interval from the injury to the operation.(ABSTRACT TRUNCATED AT 250 WORDS)
Thirty-six patients of type C intercondylar fractures of lower end of humerus who visited JN Medical College, Aligarh between January, 2001 and January, 2003 were included in the study. All patients were treated surgically by open reduction and internal fixation with 4mm cancellous screws, reconstruction plates, one-third tubular plates. Early physiotherapy was started and the results graded using Krishnamoorthy criteria.
The authors make evaluation of functional outcomes proximal humerus fractures depending on applied method using Constant-Murley score in own modification. The clinical material of 1980-2004 years were 93 cases, 41 male (44.1%) and 52 female (55.9%) aged between 28-81 years. The operative treatment was employed in 52 cases (45.1%), nonoperativ in 18 cases (19.4%) and functional treatment using direct traction by olecranion in 33 cases (35.5%). Obtained outcomes based on Constant-Murley score in own modification notice limitation range of motion injured joint, reduction of muscle streught in shoulder rim and decrease of physical activity independently used method of treatment.