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At least 811 records · Page 45Linked to original sources
PubMed2002

[Supracondylar humerus fracture in childhood--an efficacy study. Results of a multicenter study by the Pediatric Traumatology Section of the German Society of Trauma Surgery--II: Costs and effectiveness of the treatment].

The following are the results and conclusions of a retrospective research study done on 886 patients with supracondylar fractures of the humerus. The study evaluates how effective the treatment procedures of the fractures are. The patients' fractures were categorized into four groups. It made it easier to differentiate between dislocated and undislocated fractures (see part I Weinberg A et al.). The following parameters were established to evaluate the treatment procedures and to create relevancy to the final outcome depending on the degree of difficulty of the fractures: Length of hospitalization, amount of repositioning procedures (including if an open or closed procedure was needed), amount of post repositioning procedures and the recommended change of therapy, method of retention and fixation, necessary metal removal, amount of check ups needed. The amount of x-ray exams could not be established due to insufficient documentation. The study showed a rather random pattern regarding length of hospitalization and the amount of check ups especially among type I and II patients. Open versus closed repositioning procedures did not seem to be advantageous. The implanted wires did not prevent infections. It just increased the treatment procedure by another hospitalization and anesthesia to remove the implanted wires. Physical therapy was not necessary and was only prescribed in cases of prolonged immobilization. The results of this study generated consequences regarding treatment procedures and developed a more efficient treatment protocol: Type I and II (dislocated and undislocated fractures in one plane) will be treated conservatively on an out-patient basis. Type I in a cast. Type II in a blount or plaster cast with flexed angle between 100 degrees and 130 degrees. Type III an IV (dislocated and undislocated fractures in two or three planes) will be treated if possible with a closed repositioning procedure. Otherwise a close repositioning procedure will be necessary and followed with some kind of KD-osteosynthese to capture the fracture. The patient will be hospitalized for a short period. The blount procedure will not be sufficient for this type of fracture. Therapy and procedure will be translated put in a perspective research study.

Adolescent↗
PubMed2004

Fractures of the proximal humerus in osteoporotic bone.

The purpose of this article was to review critically the current treatment options for fractures of the proximal humerus in patients with severe osteoporosis. The main difficulties lie in correctly diagnosing the fracture and hence selecting the most appropriate method of treatment. The reliability of the diagnosis can be increased by systematically appending additional information to a basic fracture classification. Classification is best carried out on a morphological basis, whereby a descriptor of bone quality can be added in order to introduce the degree of osteoporosis into the decision-making algorithm. Any classification system that claims to provide both treatment and prognosis is inappropriate, because prognosis will depend hopefully on the treatment. Approaches to treatment differ widely amongst centers and surgeons. It is still unclear as to what would be the optimal treatment. Factors such as the individual's functional requirements and ability to cooperate should be given careful consideration. At our institution, hemiarthroplasty is the method of choice for ischemic humeral heads and/or when anatomic reconstruction cannot be obtained. In all other displaced fractures, the main objective is preservation of the head since the best functional results can generally be obtained with internal fixation. Selection of a balanced osteosynthesis, adapted to the weak bone, is mandatory. Bulky, stiff implants are inadequate and may cause additional damage. Load sharing, not load bearing, compound constructions are the aim. Obtaining metaphyseal elastic buttressing is the key element in achieving the necessary load-sharing fixation. The system should allow controlled impaction and be forgiving towards occasional load peaks that will occur and are beyond patient control. Thin and flexible implants are required to realize this type of fixation. Given the polypragmatic approach that is current in clinical practice there is room for further improvement of techniques and implants.

Arthroplasty↗
PubMed2004

Ball-thrower's fracture of the humerus.

A relatively rare case of ball-thrower's fracture of the humerus is presented. Severe muscular action is an uncommon cause of humeral fractures but has been well documented in the orthopedic literature. To our knowledge, this fracture has not been described in the radiology literature, and awareness of this entity could preclude further unnecessary workup. The mechanism of injury and its typical radiographic appearance is described.

Adult↗
PubMed2006

Calculation of rotational deformity in pediatric supracondylar humerus fractures.

OBJECTIVE: Supracondylar humerus fractures (SCHF) are common in the pediatric population. Cubitus varus deformity (CVD) is the most common long-term complication of SCHFs and may lead to elbow instability and deficits in throwing or extension. Distal fragment malrotation in the axial plane disposes to fragment tilt and CVD; however, no simple method of assessing fracture malrotation exists. This study tested a mathematical method of measuring axial plane malrotation in SCHFs based on plain radiographs. DESIGN: A pediatric SCHF model was made, and x-rays were taken at known intervals of rotation. Five independent, blinded observers measured these films. Calculated rotation for each data set was compared to the known rotation. The identical protocol was performed for an aluminum phantom. RESULTS: The reliability and agreement of the rotation values were good for both models. CONCLUSIONS: This method is a reliable, accurate, and cost-effective means of calculating SCHF distal fragment malrotation and warrants clinical application.

Child↗
PubMed1998

The treatment of displaced supracondylar fractures of the humerus in children. A comparison of three methods.

This retrospective study compares the long-term results of the treatment of 135 children with displaced extension-type supracondylar fractures of the humerus using 3 different methods. Closed reduction and percutaneous fixation was superior with excellent and good results in 87% and had the lowest incidence of poor results (8%). Open reduction and wire fixation, and closed reduction with a plaster cast gave excellent and good results in 74% and 60% respectively. Closed reduction and wire fixation is recommended as the treatment for grades II and III supracondylar fractures.

Bone Wires↗
PubMed2005

Fractures in the proximal humerus: functional outcome and evaluation of 70 patients treated in hospital.

INTRODUCTION: Patients with proximal humeral fractures are mostly elderly. In addition to the proximal humeral fracture, they often have other injuries related to poor bone quality. The surgical treatment of proximal humeral fractures in elderly patients with comminuted fractures is associated with several problems and a high frequency of complications. The aims of this study were to evaluate patients with a proximal humeral fracture treated in a hospital, assess the outcome of the fracture treatment, and decide whether surgical treatment of displaced proximal humeral fractures is superior to conservative treatment or not. MATERIALS AND METHODS: Patients with fractures of the proximal part of the humerus treated in our hospital were followed during two different periods (14 and 10 months). The study in the first time period was retrospective in design, while in the second period the patients were followed prospectively. Seventy patients, (71% women) with a mean age of 71 years, were included in the study. A functional test was performed within 12-14 months after the injury using a modified Rowe shoulder score. Surgical treatment was performed in 15 patients (21%). Neither the surgical approach nor the implants used for osteosynthesis were standardized. Fifty-five patients (79%) were treated conservatively with a modified Velpeau bandage or a sling. RESULTS: The fractures were classified according to AO into type A (27%), type B (58%) and type C (14%). Osteoporotic risk factors were present in many of the patients, mainly characterized by other skeletal injuries than the proximal humeral fracture (43%). In the group of complex, displaced, non-impacted fractures B2, B3, C2, C3 included (20 fractures), the group treated conservatively had a mean Rowe score of 48/75 (64% of maximum score) and SD 16.8, while in the surgically treated group the mean score was 28/75 (38% of maximum score) and SD 8.1. The difference between the two treatments was significant, with a p-value of 0.01 in favour of the conservatively treated group. CONCLUSION: The number of patients in each of the fracture groups was low, but surgery did not benefit the patients with complex, displaced fractures in this study.

Adult↗
PubMed2006

Hinged external fixation and closed reduction for distal humerus fracture.

Elbow fractures are relatively rare in extremity injuries. Functional deficits often comprise the outcome. We report of a 77-year-old diabetic lady with a distal humerus fracture. She was treated with external fixation and closed reduction. Special emphasis was directed to early motion exercises. Follow-up after 1 year demonstrated a range of motion of 0-30-130 degrees for extension and flexion of the elbow joint. No neurovascular deficits were seen. The use of a hinged device was successful in re-establishing a good function. Although there are no earlier reports using this technique in acute treatment, we consider this strategy as an alternative option in carefully selected cases.

Accidental Falls↗
PubMed1998

Level of physical activity in elderly patients after hemiarthroplasty for three- and four-part fractures of the proximal humerus.

We report on 13 physically active patients who performed sports activities at a weekend or recreational level when they suffered a severe proximal humerus fracture or fracture dislocation. All patients were treated using the NEER II hemiarthroplasty, 9 patients within 4 weeks after trauma and 4 patients 2, 5, 10 and 15 months after trauma. At an average follow-up of 50 (range 6-98) months, all patients were evaluated, both by clinical review and radiographs. Patients obtained 69.0 points using the HSS score (Hospital for Special Surgery) for evaluation. Subjectively, 85% of the patients evaluated the result as 'good' or 'excellent' on a visual analogue scale for satisfaction. There was no radiographic evidence of implant loosening. At an average period of 33 (range 16-52) weeks 10 patients started with their physical activities again without a change in their participation level.

Aged↗
PubMed1976

The results of prosthetic replacement in fracture-dislocations of the upper end of the humerus.

Eleven patients with fracture-dislocation of the upper end of the humerus treated by a Neer prosthesis are reviewed. The results of treatment are very disappointing. The complication rate is high. From these results in a small series, it would appear that prosthetic replacement of the humeral head does not offer the patient any significant advantage when compared with other reported methods. The possible cause of these poor results are discussed.

Aged↗
PubMed1977

'Straight lateral traction' in selected supracondylar fractures of the humerus in children.

A method of treating completely displaced supracondylar fractures of the humerus in children by 'straight lateral traction', as originally used by John Dunlop, is recommended. The results in 26 children, selected because manipulation had failed to achieve reduction, is examined, and indicates that this treatment is satisfactory for some problem fractures, leading usually to good results in terms of resolution of complications and return of function. It also avoids the ugly deformities of the elbow which follow reliance on a single form of treatment for all supracondylar fractures. Failure of anatomical reduction by the appliance is shown to be in the plane of elbow movement, where normal physiological mechanisms correct the bone by remodelling. Where there is epiphyseal damage, deformities may occur with any form of treatment.

Child↗
PubMed1979

Varus deformity in supracondylar fractures of the humerus in children.

Eighty cases of supracondylar fracture of the humerus at the elbow in children have been analysed. The post-reduction radiograph of the fracture was classified depending on the residual deformity present and related to the loss of carrying angle and cubitus varus deformity at the time of follow-up. Fifty-four percent of the displaced fractures showed a loss of carrying angle greater than 5 degrees, and of these 23 per cent developed cubitus varus deformity. Eighty-five per cent of those cases with a loss of carrying angle greater than 10 degrees showed either residual tilt or medial rotation on the post-reduction radiograph. All cases in which there was residual medial tilt after manipulation and 40 per cent of those with medial rotation on the post-reduction radiograph developed cubitus varus. In our series, there was no evidence of epiphyseal injury causing the deformity and in none of the cases was the deformity progressive. It is suggested that, in order to reduce the incidence of varus deformity in suprocondylar fractures, open reduction and internal fixation is indicated in those fractures in which tilt or medial rotation cannot be reduced by conservative means.

Adolescent↗
PubMed1980

Fractures of the neck of the humerus: a review of the late results.

Eighty patients with fractures of the proximal part of the humerus were reviewed not less than 18 months later. The severity of the fracture, the duration of initial rest in a sling and the duration of physiotherapy all independently affected the result. A total of 81 per cent had satisfactory results. The patients with undisplaced fractures had better results (94 per cent satisfactory), but spent longer before beginning physiotherapy which necessitated a longer course. Early active movements within the limits of pain and discomfort are suggested in order to improve the ultimate result.

Follow-Up Studies↗
PubMed1980

Dislocation of the median nerve and brachial artery in supracondylar fractures of the humerus.

Two patients are described in whom the median nerve was dislocated and incarcerated between the fragments of a supracondylar fracture of the humerus. In one, the brachial artery was similarly incarcerated and was in spasm. In the second, the brachial artery had been ruptured by the upper fragment. Circulation was restored by operation in both instances. The mechanism of dislocation is discussed.

Brachial Artery↗
PubMed1983

Surgical treatment of T and Y fractures of the distal humerus.

Intercondylar T and Y fractures of the distal humerus in adults present a challenge. Open reduction and internal fixation in 19 cases over a 7-year period gave excellent or good results in 15 cases. Campbell's posterior approach to the elbow joint gave a satisfactory exposure. Anterior transposition of the ulnar nerve is a very useful adjunct to prevent late neuritis. A new method of classification is suggested, taking into account the importance of the supracondylar ridge for adequate stability.

Bone Screws↗