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PubMed2002

Minimally invasive fixation for unstable two-part proximal humeral fractures: surgical techniques and clinical results using j-nails.

OBJECTIVES: To evaluate the outcome of a minimally invasive treatment of unstable two-part proximal humeral fractures using a J-nail. DESIGN: Retrospective case series. PATIENTS: Forty-one unstable two-part proximal humeral fractures (thirty women and eleven men) with a mean age of sixty-five years (range 18 to 95 years) were studied. INTERVENTION: Closed reduction and internal fixation with J-nails. MAIN OUTCOME MEASURES: All fractures were classified using Neer's classification and were displaced and unstable. Forty of the two-part fractures were at the surgical neck and one at the anatomic neck. All patients had a closed reduction and intramedullary fixation using three J-nails. The mean follow-up period was twenty-nine months (range 2 to 4 years). Clinical assessment was performed by doctors who did not participate in the primary surgery and was graded according to Neer's scoring system. RESULTS: All patients experienced immediate pain relief. At the two-year follow-up, the mean angles of active forward elevation, abduction, and extension were 138 degrees (range 80 to 180 degrees), 132 degrees (range 80 to 170 degrees), and 65 degrees (range 40 to 85 degrees), respectively. According to Neer's criteria, the outcome was excellent in twenty-five patients, satisfactory in twelve, unsatisfactory in three, and a failure in one. The final Neer's score showed a significant negative correlation with age (p < 0.01). CONCLUSION: J-nail fixation has the advantage of being an almost closed method without the disadvantage of muscle transfixation associated with other methods. The procedure is simple and involves minimal invasion of the soft tissue. Shoulder and elbow function is not impeded because the nails are inserted just below the distal part of the deltoid muscle insertion. This surgical technique may be one of the more reliable and effective treatments for proximal humeral fractures.

Adolescent↗
PubMedDate not supplied

Complications of operative fixation of proximal humeral fractures in patients with rheumatoid arthritis.

Currently, there is no information in the literature on operative treatment of proximal humeral fractures in patients with rheumatoid arthritis. Eleven patients underwent osteosynthesis of the proximal humerus from December 1987 to December 2002. Nine patients were treated for acute fractures, and two were treated for nonunions. Four had loss of initial anatomic reduction, two were treated nonoperatively with resultant malunion, and two required revision fixation. Two patients with symptomatic pseudarthrosis were treated with internal fixation and bone grafting. Both had complications (1 requiring hemiarthroplasty after painful nonunion and 1 with chondrolysis). All patients with acute fractures achieved fracture union. One patient had an excellent result, four had satisfactory results, and six had an unsatisfactory result. Patients and treating physicians should be aware of the high rate of complications and unsatisfactory results in patients with rheumatoid arthritis who undergo operative treatment of proximal humeral fractures.

Acute Disease↗
PubMed2005

[Comparison between the lateral and medial approaches in terms of functional and cosmetic results in the surgical treatment of type III supracondylar humeral fractures in children].

OBJECTIVES: We compared the functional and cosmetic results of lateral and medial approaches in the surgical treatment of type III supracondylar humeral fractures in children. METHODS: The study included two groups in which type III supracondylar humeral fractures were treated using either lateral (12 boys, 8 girls; mean age 7.2 years; range 4 to 12 years) or medial (16 boys, 4 girls; mean age 7.4 years; range 3 to 11 years) approaches and internal fixation. Functional and cosmetic results were assessed according to the criteria proposed by Flynn et al. The mean follow-up periods were 19.8 months (range 8 to 30 months) and 19.5 months (range 12 to 27 months) in the lateral and medial approach groups, respectively. Patient satisfaction was also inquired regarding the site of the incision scar. RESULTS: In the lateral approach group, functional results were excellent in 18 patients (90%), good in one patient (5%), and fair in one patient, while cosmetic results were excellent in 19 patients (95%) and good in one patient. In the medial approach group, 19 patients (95%) had excellent and one patient (5%) had good functional results, while all the patients had an excellent cosmetic result (p>0.05). Complications were seen only in the lateral approach group, including transient ulnar nerve palsy in one patient, and cubitus varus deformity due to limited range of motion in another. The satisfaction rates concerning the site of the incision scar were 25% and 70% in the lateral and medial approach groups, respectively. CONCLUSION: Although no significant differences were found between the lateral and medial approaches in terms of functional and cosmetic results, the medial approach may be more convenient due to a lower risk for ulnar nerve injury and to a greater acceptability of the medial incision scar on the part of the patients.

Bone Wires↗
PubMed1991

Flexible intramedullary pins in the treatment of unstable proximal humeral fractures.

A series of 35 proximal humeral fractures treated with flexible intramedullary pins between 1986 and 1988 are presented. Special design features of the pins include a proximal 15 degrees angulated 20 mm tip and a 20 mm curve distally. The method is suitable for fractures in the surgical neck with displacement of bone width (AO-type A2/2). In cases of fracture-dislocation or three- or four-part fractures it is only suitable when the fragments can be reduced satisfactorily. Complications are minimal with 95 per cent bone union.

Bone Nails↗
PubMed1979

Independent exercises versus physiotherapy in nondisplaced proximal humeral fractures.

42 patients with undisplaced, proximal humeral fractures were randomly assigned into two groups in order to compare the results of instruction to the patient for independent exercises and conventional physiotherapy. No differences appeared between the groups subjectively or as regards functional parameters at 1 as well as at 3 months after the fracture and at a follow up more than 1 year later. As no disadvantage could be found instructions to the patients should in these cases be regarded as a satisfactory after-treatment.

Adult↗
PubMed1985

Late results in supracondylar humeral fractures in children.

The end results of supracondylar humeral fractures in 151 children after an average follow-up period of 15 years are presented. The relationship between the carrying angle and the functional result was analyzed. A deformity of the carrying angle was not felt by the patients to be a cosmetic handicap, and the functional results were not problematic. However, the least satisfactory subjective results in the series were associated with a decrease of the carrying angle by at least 10 degrees and with a significant proportion of the limitations of movement of the elbow joint.

Biomechanical Phenomena↗
PubMed2006

Displaced proximal humeral fractures: intramedullary nailing versus conservative treatment.

INTRODUCTION: A variety of different treatment options are available for displaced three- or four-part fractures. In a retrospective cohort study we evaluated the results of intramedullary nailing with the ACE nail and conservative treatment of displaced proximal humeral fractures. MATERIALS AND METHODS: Twenty-four patients suffered a neer 4, 5 or 6 proximal humeral fracture who were treated with intramedullary nailing. Sixteen patients received conservative treatment for their Neer 4, 5 or 6 fracture. RESULTS: Taking critical remarks in consideration, the results of intramedullary nailing are not very satisfactory compared to the conservative-treated group. However functional results of our operative group are comparable to those from other studies in literature. CONCLUSION: Displaced three- or four-part proximal humeral fractures can be treated by intramedullary nailing. Familiarity with the fracture deformity and experience with the surgical techniques are critical for successful operative treatment outcome. Most complications in the operative treatment group can be avoided; inadequate reduction can lead to wrong insertion place with secondary problems (dislocation and subacromial impingement). Also future improvements in osteosynthesis like angle stable screw fixation (osteoporosis) and minimally invasive device will probably decrease the complication rate.

Adult↗
PubMed2002

[Stabilization of proximal humeral fractures with the intramedullary dynamic titanium helix wire].

The implant Helix-Wire is a treatment device that is used since 1997. It provides minimally invasive stabilization of subcapital humeral fractures. The implant is inserted through a small lateral entrance and a cortical hole drilled into the intramedullary space of the proximal humeral shaft and drilled into the humeral head for fracture stabilization. After careful preoperative planning and successful repositioning of the fracture the technique can be performed without difficulty. A review of 35 patients with subcapital humeral fractures, who were operated using the titanium wire helix between 1998 and 2000, was carried out. Clinical and radiological results were documented. After an average time of 11.5 months 13 patients were examined according to the Constant Score: 5 good or excellent, 4 fair and 4 bad results were achieved. We conclude that this implant provides sufficient stabilization of subcapital humeral fractures classified as AO 11 A2, 11 A3.1, 11A3.2, 11B1.1, 11B1.2. It does not offer an advantage for the treatment of unstable fractures with multiple fragments or cancellous bone deficiency (11 A3.3, 11 B2.2, 11 B2.3).

Aged↗
PubMed1994

Intramedullary interlocking nailing for humeral fractures: experiences with the Russell-Taylor humeral nail.

The Russell-Taylor intramedullary interlocking nail has been used on 39 patients with fractures that occurred at various levels of the humerus. Thirty patients had acute fractures and nine had pathological fractures. Twenty-five patients with acute fractures were re-examined after their fractures had united and assessed according to Neer's classification of shoulder function. Twenty-two (88 per cent) had excellent and satisfactory shoulder function. Pain relief was achieved in all pathological fractures. Shoulder pain encountered in a few patients in this series, where nailing was performed by the antegrade route, was mainly due to problems associated with the proximal interlocking screw.

Adolescent↗
PubMed1998

Humeral fracture secondary to civilian gunshot injury.

Violence is the leading cause of death in the USA. The cost of violence due to gunshot wound is about $425 billion. While the closed fracture of the humerus is common, humeral shaft fractures caused by gunshot wound occur infrequently. There is much controversy regarding their management, i.e. should these injuries be treated surgically or can they be safely treated with minimal intervention. The aim of this study is to review our experience in the management of fourteen patients with a humeral fracture due to gunshot wounds. Of fourteen, seven patients were treated with local debridement, oral antibiotics and fracture brace. The remaining seven patients underwent surgical stabilization of the fracture. The time to union was similar in both groups (6 weeks in non-operative to 9 weeks in open treatment). In conclusion, fracture of the humeral shaft secondary to low velocity gunshot wound in the civilian setting can safely be treated as a closed fracture with local wound care and oral antibiotics.

Adolescent↗
PubMed1992

Displaced proximal humeral fractures: results of conservative treatment.

The results of 42 patients with displaced proximal humeral fractures treated by conservative means were reviewed. The system advocated by Neer was used to classify the fractures. Of the patients, 16 had two-fragment fractures, 17 three-fragment fractures and 9 four-fragment fractures. In 21 patients, fractures were treated with a sling for 1 week, and in 21 with a hanging cast for 1 week. All patients received physiotherapy after immobilization. Follow-up evaluation included clinical and radiographic examination at a median of 2 years after the trauma. The results were assessed using Neer's protocol. The patients were asked to assess the results. The patients assessed the results better than the Neer score (P less than 0.001). The patients with two-fragment fractures assessed the results as excellent or satisfactory and better than the three- and four-fragment ones (P less than 0.01). The patient response to non-operative treatment was satisfactory. It is concluded that the Neer classification of the results underestimates the degree of satisfaction achieved by the patients. It is concluded that displaced proximal humeral fractures can be treated satisfactorily by non-operative methods.

Adult↗
PubMed2000

Use of a hinged external fixator for elbow instability after severe distal humeral fracture.

The authors report the case of a forty-year-old man who developed acute elbow instability after fixation of an open, comminuted distal humeral fracture. Treatment with a hinged, external elbow fixator was successful in reestablishing elbow stability and a functional range of elbow motion. To the best of the authors' knowledge, the use of this device for acute elbow instability after distal humeral fracture fixation has not been previously reported.

Acute Disease↗
PubMed2000

[Operative treatment of displaced proximal humeral fractures: follow-up and analysis of 31 patients'].

OBJECTIVE: To study the methods and the results of operative treatment of displaced proximal humeral fractures. METHODS: We reviewed thirty-one patients who had been diagnosed as having displaced proximal humeral fractures and had been operated on from July 1989 to December. 1998 in our hospital. The mean follow-up time was 40.5 months (8 - 124 months). Their age ranged from 15 to 62 years (average, 36.8 years); 18 patients were male and 13 female. Neer fracture classification system and rating system were used. In all patients, delto-pectoral approach was adopted. Twelve fractures were fixed with plates, fifteen fractures with screws, and four fractures with Kirschner wire and plaster. RESULTS: Of two-part surgical neck fractures, nine of thirteen patients (69%) were excellent or good with no necrosis and un-union. In three-part or four-part fractures, the rate of satisfaction with open reduction and internal fixation (ORIF) was rather lower. In three-part fractures, the rate of humeral head necrosis was 44%, and in four-part fractures, over 75%. CONCLUSIONS: In two-part and three-part fractures, ORIF is a better treatment, but care should be taken to avoid using plates. As for classic four-part fractures, the rate of satisfaction with ORIF is poor and the rate of necrosis is higher.

Adult↗
PubMed2001

[Surgical treatment of proximal humeral fractures. Is the T-plate still adequate osteosynthesis procedure?].

No general agreement exists on the operative therapy of displaced proximal humeral fractures. The purpose of this study is to evaluate different internal fixation techniques (plate fixation, figure-of-eight tension wiring, lagscrew) and to verify if the plate fixation is still an adequate therapy in the treatment of displaced proximal humeral fractures. A follow-up investigation was conducted in 51 patients after an average of 4.2 years. A T-plate fixation was performed in 62.7%, a minimal invasive technique in 21.6% and a shoulder prosthesis in 15.7% of these patients. At follow-up 60.7% of the patients with a 3- or 4-part fracture had good or excellent results in the Constant score (59% T-plate, 66% minimal invasive). Humeral head necrosis was seen in 15.9% of the patients with a T-plate fixation and in 9.1% of the patients with minimal invasive techniques. Based on our results and the reviewed literature we can confirm advantages of the minimal invasive techniques in the treatment of 4-part fractures. However, good results can be obtained with T-plate fixation in 2- or 3-part fractures especially in younger patients.

Age Factors↗
PubMed1998

Comminuted supracondylar humeral fractures repaired with a modified type I external skeletal fixator construct.

Highly comminuted supracondylar humeral fractures were stabilised in six large-breed dogs with a modified type I external fixator using a craniomedial acrylic connecting column and an intramedullary pin which was incorporated into the connecting frame. This construct provided sufficient stability to allow satisfactory bone healing in five of the six dogs, while premature removal of the intramedullary pin and external fixator resulted in subsequent refracture of the humerus in the remaining dog. Limb function at the time of final assessment was considered excellent in two dogs, good in three dogs and poor in one dog. The craniomedial acrylic connecting column simplified application of this modified type I(a) configuration to the humerus by reducing the number of clamps required; the acrylic column also facilitated contouring of the craniomedial connecting column to the brachium and was readily extended proximally to engage the intramedullary pin. In addition, the acrylic connecting column allowed placement of intramedullary pins of varying diameter.

Animals↗
PubMed2006

Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures.

INTRODUCTION: The aim of this study was to describe early results of a new internal locking system, PHILOS, used for the treatment of proximal humeral fractures. MATERIALS AND METHODS: A chart and radiographic review of 25 cases that had proximal humeral internal locking system (PHILOS) plate for the treatment of proximal humeral fractures was performed. RESULTS: Of the 25 cases, 20 went to union with a mean neck/shaft angle of 127.2 degrees . Five cases required or were considered for revision surgery for non-union or implant failure. Of the 25 implants, 4 had screw protrusion into the gleno-humeral joint, 4 had screw loosening and backing out, and 1 plate broke without further trauma. CONCLUSIONS: Our results suggest that PHILOS is an effective system for providing fracture stabilisation to bony union but awareness of potential hardware complications is essential.

Adult↗
PubMed1981

[Humeral fracture caused by arm wrestling].

Humeral shaft fractures may occur as a result of arm wrestling ("Indian wrestling," "iron arm"), a contest in which the antagonists sit face-to-face, grip hands with their elbows on a table, and try to force the opponent's arm back. A case of this type is reported.

Adult↗
PubMed1997

[Distal humeral fracture in adults: functional evaluation and measurement of isometric strength].

PURPOSE: The purpose of the study was to determine prognostic parameters in adult distal humeral fracture. MATERIAL: Thirty patients were reviewed retrospectively at a mean follow-up of 5 years. According to the AO classification there were 5 type A, 5 type B and 20 type C fractures, of which 7 were open. An internal fixation was performed in 27 patients while 3 cases were treated conservatively. An olecranon osteotomy was performed in 8 patients. A bilaterotricipital approach according to Alonso-Llames was performed in 8 cases while 6 times a V-shaped section of the triceps and 3 times a transtricipital approach were performed. A lateral approach and a combined medial and lateral approach were performed one time each. Active-assisted motion begun in 19 patients before the fifth post-op day. Three secondary displacements required reoperation. METHOD: The assessment included a questionnaire, a physical as well as radiological examination and measurements of isometric flexion and extension strength of both elbows. Statistical correlations were performed using non parametric tests at a P < 0.05 level. RESULTS: Average flexion was 127 degrees, while there was an average lack of extension of 29 degrees. Pronation and supination were respectively 68 degrees and 85 degrees. Twenty-two patients were subjectively satisfied with their elbow. The measurements of isometric strength of the fractured elbow showed that the right side which was dominant in the whole population was statistically weaker at follow-up than the left side. This difference was significant for flexion strength (Wilcoxon test P = 0.028) and highly significant for extension strength (Wilcoxon test P = 0.0002). The surgical approaches also influenced strengths. The Alonso-Llames approach was thought to give a better result than the other approaches. Patients mobilized before the fifth post-op day showed a statistically better flexion than patients mobilized later on (exact Fisher test P = 0.013). The difference was not statistically significant for the extension. DISCUSSION AND CONCLUSION: The distal humeral fracture produces a decrease of the elbow strength which is more severe for the dominant side. The reason is unknown. The Alonso-Llames approach seems to be the most favorable approach while the V-shaped section of the triceps shows a deleterious effect on strength. Early post-op exercises seem to have a positive effect on the long term ROM. Neither the fracture type (classification) nor the ROM, nor the strength are correlated with the subjective feeling of the patient. On the other hand statistical correlations show that unsatisfied patients are heavy workers (exact Fisher test P = 0.033) and patients younger than 60 years old (exact Fisher test P = 0.029).

Adult↗