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PubMed2002

Biomechanical evaluation of the value of osteosynthesis in supracondylar fracture of the humerus using Kirschner pins in children.

The subject under discussion here is one of the most frequent and most typical fractures in children. The use of Kirschner pins is not in question, but their number and position is. We present here a biomechanical analysis of how the train force affects the fissure in supracondylar fractures of the humerus with different forms of osteosynthesis using Kirschner pins, and how stable the osteosynthesis is. The experiments were carried out at the Laboratory of Biomechanics in the Institute of Anatomy of the Medical Faculty of Zagreb.

Biomechanical Phenomena↗
PubMed2003

Salter-Harris II fracture of the proximal humerus in a preterm infant.

A premature twin infant presented with clinical signs of shoulder injury shortly after birth. He had been delivered by cesarean section due to malpresentation. Bony abnormality was not initially recognized on plain radiographs, but ultrasound revealed a Salter-Harris II fracture of the proximal humerus. Plain radiographs are limited in the premature newborn because of lack of calcification of the epiphysis. Ultrasound examination in these infants can be helpful in determining the true extent of skeletal injury. Immobilization and pain control are then indicated to optimize the outcome.

Diagnosis, Differential↗
PubMed2004

[The angle stable locking-proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-splitting-approach - technique and first results].

The Locking-Proximal-Humerus-Plate (LPHP) was slided from proximally to distally through a small anterior-lateral-deltoid-splitting-approach following a closed reduction. Additional tension band wiring for the rotator cuff was fixed at the plate after screw insertion. The prospective study included 35 patients (age median: 63 years, range: 33-92; male: 13, female: 22) from 08/01-05/02. The follow-up period was set to 3 months postoperatively, whereas 29 patients were able to attend. The patient-group with 2-part fractures (n = 8) showed an average Constant score of 77.6 points (+/- 10.7, "good"), the patients with 3-part fractures (n = 16) an average score of 75.1 points (+/- 14.4, "good") and the patients with 4-part fractures (n = 5) an average score of 64.8 points (+/- 10. 4, "moderate"). Specific, approach-related problems were not observed. Almost all fractures revealed bony union during the first 3 months and only one loss of reduction was found. A screw loosening in 2 cases and a break of the plate in 3 cases were seen as implant related problems, and furthermore in 5 cases the screws placed in the humeral head were too long. Only one early re-osteosynthesis with the same plate was necessary due to an initial non-correct reposition. As demonstrated by these good short-term results, this technique seems to be a suitable procedure for displaced humeral head fractures.

Adult↗
PubMed1991

[Sonographic findings in radiologically non-displaced proximal humerus fractures].

UNLABELLED: In 5 patients with radiological nondisplaced fracture of the proximal humerus and persistent pain of the involved shoulder joint, ultrasonic evaluation was performed statically and dynamically. All patients suffered from a nondisplaced two-part fracture of the greater tuberosity. In four cases we found a significant cranialisation of the greater tuberosity between 1 and 8 mm. Furthermore, we identified a ventral cleft on the fracture side as well as a dorsal dislocation of the fragment. During dynamic examination we observed an impingement of the supraspinatus tendon between the acromion and the greater tuberosity. CLINICAL RELEVANCE: In primary diagnosis of cases with a questionable dislocated fragment and in patients with persistent pain after proximal humeral head fractures, diagnostic ultrasound investigation may yield additional information. This may influence further treatment.

Adult↗
PubMed1991

Supracondylar fractures of the humerus in children.

Supracondylar fractures of the humerus in children were studied in Kuopio University Central Hospital during 1974-1984. The total number of the fractures was 86. Fifty-two patients were examined 13 months to 11 years after the accident. Only severe cases (grade 3 and 4 after Holmberg's classification) were included. Twenty patients were treated operatively, 17 with traction and 15 conventionally with reposition and plaster cast. The age of the patients at the time of the accident was from 21 months to 12 years and at follow-up from five to 23 years. The purpose of this study was to evaluate late results of these three methods. There was no statistical difference between the late results of the treatment groups. Regardless of treatment method careful reposition and controlling retention for both varus, flexion and extension and rotation deformities are essential for good end results.

Casts, Surgical↗
PubMedDate not supplied

[Skeletal muscle involvement in enthesopathy of the lateral epicondyle of the humerus (so-called tennis elbow)].

Muscle specimens from the origin of the m. extensor carpi radialis brevis, were obtained from 53 patients suffering from chronic enthesopathy of the lateral epicondyle of humerus (EELH). Frank neurogenic atrophy as well as disuse atrophy were caused by radicular irritation due to the cervicobrachial syndrome. The borderline and/or reinnervation patterns of the muscle lesion may be due to the compression neuropathy of the peripheral branches of the radial nerve or may reflect adaptation of the muscle to the chronic nociceptive stimulation in sense of chronic reflex atrophy of the muscle. The elbow joint, and especially the humeroradial joint in cases of EELH represents a functional unit. Any damage to any part leads to secondary reparative and adaptive changes in other structures including the muscle.

Adenosine Triphosphatases↗
PubMed1981

[Adequate treatment of supracondylar fracture of the humerus with associated brachial artery and nerve injury in childhood (author's transl)].

Injury to the brachial artery and the nerve trunks, accompanying supra- and peri-condylar humerus fractures, occurs in children particularly in seriously dislocated fractures of Baumann Type II and III. Prompt treatment aims at avoiding late sequelae, especially ischaemic muscle contracture. Based on 6 of our own cases, the significance of brachial artery angiogram when the pulse does not become palpable, and of operative investigation, is expounded.

Adolescent↗
PubMed1993

A long-term follow-up study of children with supracondylar fractures of the humerus.

A retrospective study to assess the long-term results of the treatment of supracondylar fractures of the humerus was undertaken to provide guidance on the management of these troublesome injuries. In our experience as long as there was less than 25% displacement on an anteroposterior (A/P) or lateral x-ray, and less than 10 degrees angulation on an A/P or lateral x-ray, it is not essential to achieve an anatomical reduction, and good elbow function could be expected. Although children do not appear to correct for valgus or varus deformity there was no functional deficit from this deformity in this series. It was found that major displacements were more likely to have a worse result than undisplaced or minimally displaced fractures. These results would support a conservative approach to the management of these fractures--closed reduction followed by three weeks in a collar and cuff. If the position proved unstable, closed reduction was re-attempted or internal fixation performed. Conservative treatment was safe and effective, and the results comparable with other series that advocate internal fixation.

Child↗
PubMedDate not supplied

Internal fixation for coronal shear fracture of the distal end of the humerus by the anterolateral approach.

Six patients with a displaced coronal shear fracture of the distal end of the humerus were treated surgically with the anterolateral approach to the elbow, in which the capitulum and trochlea could be exposed widely. All underwent open reduction and internal fixation to reduce anatomically and mobilize the joint at an early stage. The mean duration of follow-up was 40 months (range, 24-54 months). All fractures healed with an acceptable functional result. In no case did we observe collapse of the capitulum or trochlea. We recommend open reduction by the anterolateral approach, which provides good exposure of the fracture sites and allows internal fixation to be accomplished with the use of Herbert screws, resulting in good fixation and compression of the bone fragments.

Accidental Falls↗
PubMedDate not supplied

Operative treatment of type C intercondylar fractures of the distal humerus: results after a mean follow-up of 2 years in a series of 18 patients.

We reviewed the results of internal fixation in a series of 18 patients (mean age, 44.4 years; SD, 19.1 years; range, 16-81 years) with type C intraarticular fractures of the distal humerus after a mean follow-up of 24.7 months (range, 10-41 months; SD, 9.3 months). An excellent or good result was observed in 10 patients (56%), according to the rating system of the Orthopaedic Trauma Association. All patients younger than 40 years (n = 8) had an excellent or good result, whereas those rates were found in only 2 of 10 patients older than 50 years. Low range of elbow motion (extension-flexion) and, consequently, inferior postoperative score were also correlated to male sex, the triceps-splitting approach, and immobilization exceeding 3 weeks. When stability of the humeral columns is achieved and the articular platform is reconstructed, satisfactory results can be obtained, even in comminuted supracondylar fractures. However, age over 50 years, poor bone quality, and open fracture are correlated with increased risk for an inferior postoperative result. Early mobilization, when possible, and the use of an olecranon osteotomy are recommended.

Accidental Falls↗
PubMedDate not supplied

Surgical anatomy of multipart fractures of the proximal humerus.

The gross fracture anatomy was recorded in a cohort of 22 consecutive patients who underwent open surgery for 3-part and 4-part fractures of the proximal humerus and was compared with preoperative radiographs in a blind manner. It was noted that 8 of the 22 fractures did not correspond to any category of the Neer or AO/Orthopaedic Trauma Association/Jakob classification. These fractures had 3 displaced segments in terms of surgical anatomy, but the humeral head was free of soft tissue. In addition, the soft-tissue attachments to the head were closely related to the articular surface orientation on radiographs (medially oriented or not), rather than to the number of displaced segments or to the grouping of the AO/Orthopaedic Trauma Association/Jakob classification. Thus, in our study population, the current classification systems were inaccurate for realizing the fracture anatomy, particularly humeral head status. They would be accurate if the articular surface orientation was taken into account.

Aged↗
PubMed2002

Strength and motion after hemiarthroplasty in displaced four-fragment fracture of the proximal humerus: 27 patients followed for 1-6 years.

We evaluated 27 patients with shoulder hemiarthroplasty after displaced four-fragment fracture of the proximal humerus after mean 4 (1-6) years. Isometric strength measurements (Kintrex) and three-dimensional motion analysis (Elite-System) were performed on the operated and unoperated shoulders. Clinical assessment was based on Constant's score and Neer's scoring system. The isometric strength of the operated and unoperated sides were 22 (SD 8.6) Nm and 24 (SD 5.9) Nm in abduction and 48 (SD 14) Nm and 65 (SD 21) Nm, respectively in adduction (the latter was statistically significant). Motion analyses at follow-up showed a mean reduction in glenohumeral movement. Increases in acceleration and deceleration of the acromion at the operated side were noted, indicating a change in glenohumeral rhythm during maximal abduction. The Constant score was 45 (SD 15) points with a significant reduction in the range of motion. 15 patients had some degree of heterotopic ossification. On the basis of our findings, the impaired function seems to be caused by reduced glenohumeral mobility rather than muscle strength. We also found a better outcome after early than late hemiarthroplasty.

Adult↗
PubMed2003

Recalcitrant posttraumatic nonunion of the humerus: 23 patients reconstructed with vascularized bone graft.

We treated 23 patients with recalcitrant posttraumatic humeral shaft nonunion with vascularized bone grafts (fibula 10, femur 10 and scapula 3). 21/23 patients healed primarily. Venous thrombosis in the graft necessitated postoperative thrombectomy in 2 patients. Complications at the donor site were trivial. We used a vascularized fibular graft in patients with a large bone defect and with poor intrinsic stability of the nonunion site and a corticoperiosteal femoral graft in atrophic nonunion without a substantial bone defect. The scapula graft is easy to transfer to the surgical neck of the humerus on its pedicle.

Adult↗
PubMed2006

Treatment of 2- and 3-part fractures of the proximal humerus using external fixation: a retrospective evaluation of 62 patients.

BACKGROUND: Treatment of fractures of the humeral head remains controversial. We reviewed the outcome of our treatment of 2- and 3-part fractures of the proximal humerus using external fixation as a way of preventing damage to the vascularity of the humeral head and of reducing the risk of infection associated with open techniques. METHOD: We retrospectively evaluated 2- and 3-part fractures of the humeral head, both clinically and radiographically, in 62 consecutive patients who were treated using external fixation. The mean follow-up time was 1.5 (1-2) years. RESULTS: The reduction was considered to be good in 50 cases, and 8 cases were consolidated in varus and 4 cases in valgus. The fracture healed in all patients. Except for 1 case of superficial infection around the screws and 1 redisplacement after a new fall, there were no early complications. Necrosis of the humeral head was not observed. 2 of the patients underwent shoulder replacement because of severe pain. The mean Constant score was 84 points, with satisfactory results (>or=80 points) in 49 of the 62 patients. Sex, age, side, or type of fracture had no influence on the outcome. INTERPRETATION: This procedure provides satisfactory early functional results, simplifies rehabilitation by limiting postoperative motion to a lesser degree than other techniques, is less aggressive than open reduction techniques and osteosynthesis, and leads to few complications.

Adult↗
PubMed2004

Characteristics of fallers who fracture at the foot, distal forearm, proximal humerus, pelvis, and shaft of the tibia/fibula compared with fallers who do not fracture.

This case-control study examined the relation of circumstances of falls and characteristics of fallers with risk of fractures at five sites among persons 45 years of age or older from five Kaiser Permanente Medical Centers in Northern California from 1996 to 2001. Included were distal forearm (n = 1,016), foot (n = 574), proximal humerus (n = 467), pelvis (n = 150), and shaft of the tibia/fibula (n = 141) cases who fell at the time of their fracture, and controls (n = 512) who reported falling in the year before the interview but did not fracture. Interviewers collected information by using a standardized questionnaire. Medium-/high-heeled shoes and shoes with a narrow heel increased the risk of all fractures, and slip-on shoes (adjusted odds ratio = 2.3, 95% confidence interval: 1.4, 4.0) and sandals (adjusted odds ratio = 3.1, 95% confidence interval: 1.5, 6.3) increased the risk of foot fractures. Falling from more than a standing height increased the risk of all fractures by two- to fivefold, while breaking the fall was associated with lower risks of all fractures except the distal forearm. Physical activity and hormone therapy were associated with lower risks of most fractures. These results suggest ways in which risks of fractures in older persons can be reduced.

Accidental Falls↗
PubMedDate not supplied

False aneurysm of the brachial artery complicating closed fracture of the humerus. A case report.

A 66-year-old, obese, mentally retarded man sustained a closed spiral fracture of the humerus accompanied by development of a large false aneurysm arising from a small rent in the distal third of the brachial artery. Because of the patient's body habitus, mental deficiency, and paucity of objective physical findings, the arterial injury was not suspected until expensive pressure necrosis necessitated shoulder disarticulation as a lifesaving measure. Although false aneurysms are known to complicate penetrating trauma and various surgical procedures using metallic implants, the lesion has not been previously reported with closed long bone fractures. The authors wish to alert others to occurrence of the occult arterial injury in association with a relatively common extremity fracture. The need to exercise special awareness and suspicion of subtle injuries in patients whose age, mental status, or associated trauma render communication of symptoms impossible, cannot be overemphasized.

Aged↗
PubMed1996

Ender nailing for unstable surgical neck fractures of the humerus in elderly patients.

The purpose of this study was to assess the effects of stabilization of displaced and unstable surgical neck fractures of the humerus by Ender nailing followed by protected passive range of motion exercise of the shoulder. Thirty-four patients (29 women and 5 men) with such fractures were treated. The average age of patients was 69.5 years (range, 48-86 years), and the average followup period was 9.9 months (range, 6-22 months). Protected passive range of motion of the shoulder was started in 2 weeks after surgery for 25 patients and in 3 to 4 weeks for 9 patients. All patients experienced pain relief immediately after surgery. Bone union occurred at 5.9 weeks (range, 4-10 weeks) in all but 1 patient. The average range of motion of the shoulder at followup was 129.7 degrees elevation and 43.2 degrees external rotation. The average limitation of elbow extension was 4.3 degrees. The most important points of this procedure are to obtain immediate relief of pain, to stabilize the unstable fragment, and to begin protected passive range of motion of the shoulder before extensive adhesions develop.

Aged↗