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This is a case report of a 74-year-old man with an ununited fracture of the lateral condyle of the humerus of 50 years duration. There was minimal loss of motion, a moderate cubitis valgus deformity, and a definite ulnar nerve palsy. Despite the deformity and ulnar palsy, he was able to provide for himself and to perform satisfactorily as a laborer.
The technique of Tikhor-Linberg is described by the authors. It is a limited resection of the upper end of the humerus and the glenoid cavity, the rotator cuff and the deltoid. It is particularly useful in tumours such as chondrosarcoma. Operation is completed by reconstruction using a fibular graft which allows some limited function of the shoulder.
The author has described in 1973 a new approach to the upper end of the humerus. This has been used in 44 cases up to the present time. It is concluded that it is worthwhile in the treatment of tumours, infections, complex fractures or dislocations. However, it should only be used in young adults. In elderly patients, several instances of stiff shoulder have been seen after this approach.
Three cases of osteosarcoma of the proximal femur and humerus in children are reported. They were all highly malignant. They were treated by radical resection and prosthetic replacement with complementary chemotherapy. At 6 months, 2 years and 7 months, and 3 years and 2 months respectively they show no signs of local recurrence or metastases.
A ten-year-old girl underwent excision of a chondrosarcoma of the right proximal humerus with subsequent insertion of a prosthesis. Failure of the device occurred six years after operation, requiring revision to an identical but shorter prosthesis. This device failed 1 1/2 years later and was replaced by a fibular graft inserted in the humeral medullary canal. The fibular graft was removed 18 months later, resulting in a flail right shoulder. The mode of failure in each instance was anterior and superior dislocation of the hemiarthroplasties. Currently, ten years after the initial procedure, the patient is tumor free with a shortened functional right upper extremity.
Bone involvement has been previously reported in various viral diseases, not including varicella. What may have been a varicella lesion of bone appeared in the humerus of an 11-year-boy.
On the basis of 12 cases, the authors suggest use of the axillary approach in everyday surgery on the shoulder and the upper end of the humerus, because of the quality of healing it offers. They describe its safety and limitations. Problems are restricted to slight transverse adhesions across the axilla which are easily cured and even more easily avoidable.
A reduced retroversion angle of the humeral head may predispose to recurrent anterior shoulder dislocation and may also be a factor in persistent instability after soft-tissue repair. We performed rotational osteotomy of the proximal humerus in 20 patients with recurrent anterior shoulder dislocations (10 traumatic, 10 non-traumatic) and a decreased retroversion angle of the humeral head. The mean preoperative retroversion angle was 12 degrees, which was increased after surgery to a mean value of 32 degrees. All patients regained a normal range of shoulder motion and normal function within three months after surgery. At the five-year review all shoulders were stable, pain-free and had no radiological signs of osteoarthritis.
The authors present a variant of Desault's bandage for fixation of conservatively treated injuries of the proximal end of the humerus and for fixation of the upper extremity after surgery in this area. The bandage is made with elastic net bandage (called pruban), it is sufficiently strong and its application is easier and less time consuming.
In a poorly equipped tropical setting, limb amputation is often considered as the only therapeutic solution for malignant tumors or large benign tumors. However it can be avoided by bone replacement using an avascular autologous fibular graft. This method was used in a young girl from Tchad presenting a giant cavernous hemangioma of the humerus. This technique allowed salvage of the extremity but resulted inevitably in radial paralysis. The time needed for bone healing was normal. This technique required minimum facilities and was perfectly biocompatible. It can be used in tropical settings where allograft techniques and prosthetic replacement are not available.
A method of osteosynthesis is being tested for its effectiveness by means of physican and experimental study and animal research. This could make it possible to stabilize fractures of the humerus diaphysis safely with pressure produced intramedullary on the interfragmentary, that is to say through "Kompressions-Bündelnagelung" (compression bundle nailing). Rating tests on skelleted animal bones have shown stability on quasi natural fractures surpassing the exercise load called for the upper arm. This procedure, however, does not prove rating stability by sole means of staying osteosynthesis with only one pair of nails on diagonal (sawed through) fractures of tibia diaphysis. Rating stability is gained however--even with unrelenting use--through "Kompressions-Bündelnagelung", that is an additional filling in the medulla ossium with a bundle of nails, the fracture having been braced already with the first pair of nails. To use this technique routinely a further simplification of process is necessary much like the one solving the distal guying. Also a reposition instrument is needed which would anable simple nailing. Such a repositor is now being tested at our clinics.
A large variation in the shape of the medial epicondyle is encountered. This study was performed to investigate any role of the shape of medial humeral epicondyle in the etiology of osteoarthritis in the elbow, which can lead to cubital tunnel syndrome. A total of 71 humerus from 36 cadaveric specimens (mean age 75, ranging from 52 to 93) were used to study the morphological characterization of the medial humeral epicondyle. The specimens were divided into four types according to the index of medial epicondylar breadth and medial epicondylar length. A correlation was found between the angle of inclination of the sulcus nervi ulnaris and osteophyte formation in the medial epicondyle. This finding suggested that Type 2 (wider type) and 3 (longer type) might each contribute to the onset of osteoarthritis, resulting in cubital tunnel syndrome. However, we found some cases of Type 1 (wider and longer type) with a large angle and only minor osteophyte formation, suggesting that a large inclination angle of the sulcus nervi ulnaris alone was not an independent factor in osteophyte formation. Moreover from our results of measuring the distance between the tip of the medial epicondyle and the medial edge of the anterior medial collateral ligament origin, we concluded that medial epicondylectomy (King's method) without damaging this ligament should be performed at a point approximately 20% of the overall width of the medial epicondyle from the tip of the medial epicondyle.
Fetuses from 105-250 mm C.-R. length were investigated. Using special software dimensions were taken from X-ray pictures. Quantitative changes occurring in humerus during fetal period were determined and expressed graphically.
Of 1,118 supracondylar fractures of the humerus in children treated over a six-year period, 189 are described with a follow-up of more than two years. These patients were treated with closed reduction and percutaneous fixation of the fragments with two wires. Eighty-five per cent of the final results were satisfactory.
Between 1980 and 1995, 11 children with osteosarcoma were treated at the Clinic of Pediatric Surgery of the Martin-Luther-University, Halle-Wittenberg. In the first years of this period we treated six of the children according to the protocols of the study group "Tumors" of the Society for Pediatric Surgery. At that time the preferred concept was radical surgical resection followed by adjuvant chemotherapy. For several years we favored the therapeutic regime of the Society for Pediatric Oncology and Hematology and treated five children according to the principles of the cooperative studies of osteosarcoma. With the introduction of aggressive neo-adjuvant chemotherapy it was possible to perform reconstructive limb surgery. We report on our own first experiences with the "Clavicula pro humero", an operation according to Winkelmann for malignant bone tumors of the proximal humerus. This new operative method is described and possible complications are discussed.
Pathological fracture in histologically proven post-Paget osteosarcoma of the humerus is a rare complication. Due to individual requests as well as age and comorbidity, a course of primary palliative treatment was chosen in the present case. Survival time after diagnosis was 9 months and the patient died of a tumor-independent disease. Even in combined treatment, consisting of surgery and (neo-)adjuvant radio-/chemotherapy, prognosis of osteosarcomas secondary to Paget's disease remains very disappointing. Therefore, in treatment of this highly lethal tumor the patient's individual requests and personal situation often require more consideration than in many other malignancies.
A case of an osteosarcoma following a pathological fracture through a small benign-looking cortical lesion of the proximal humerus is described. The unusual evolution from a small cortical lesion to a malignant lesion raises the question whether this is a case of an intracortical osteosarcoma that has some distinct features from those of previously reported cases.
In order to restore the function of shoulder joint in patient with tumor of upper end of humerus, artificial humeral head replacement was performed. The materials included resinene, nylon-6 and large molecular polyethylene from 1978 to 1993, 14 patients were treated. The tumors involved in this group were giant cell tumor, synviosarcoma, bone cyst, osteochondroma, osteoblastoma, osteofibrosarcoma, osteosarcoma, chondrosarcoma, parosteosarcoma and malignant giant cell tumor. After resection of the tumor, the artificial prosthesis was implanted with bone cement. After 1 to 16 years follow-up, functions of the shoulder joint were reserved in 86% of the patients.