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At least 919 records · Page 51Linked to original sources
PubMed1995

Closed reduction and percutaneous pinning of displaced supracondylar humerus fractures in children: description of a new closed reduction technique for fractures with brachialis muscle entrapment.

A retrospective review of 43 displaced extension-type supracondylar humerus fractures in children was performed. Thirty-four fractures were completely displaced (type III). Ninety-one percent (39 of 43) of the fractures were managed by immediate closed reduction and percutaneous pinning. Ten type III fractures exhibited clinical or radiographic evidence of brachialis muscle penetration. A closed reduction maneuver designed to "milk" the entrapped brachialis muscle off of the proximal fracture spike was developed and was successful in all eight cases in which it was attempted. At mean follow-up of 35 months, 97% (38 of 39 patients) achieved a good or excellent result based on the Flynn grading scale.

Child↗
PubMed1995

Analysis of tardy ulnar nerve palsy associated with cubitus varus deformity after a supracondylar fracture of the humerus: a report of four cases.

Four cases of tardy ulnar nerve palsy associated with a cubitus varus deformity of the elbow secondary to a supracondylar fracture of the humerus are presented. All patients had surgical management of their ulnar nerve palsy. In two patients, the ulnar nerve was entrapped by scar tissue at the abnormal position and the nerve developed a sharp V-shaped kink when the elbow was flexed. In one patient, the ulnar nerve displaced anteriorly with elbow flexion and spontaneously reduced into the ulnar nerve groove with elbow extension. In one patient, the ulnar nerve remained in the ulnar nerve groove; however, it was entrapped by fibrous bands arising from the flexor carpi ulnaris. It is speculated that malunion resulting in cubitus varus deformity will alter the anatomy at the elbow and that this can have a direct effect on the position and instability of the ulnar nerve. Incongruity of the elbow joint due to cubitus varus deformity also may cause osteoarthritis changes. As a result, ulnar neuropathy may develop from irritation to the ulnar nerve from the posttraumatic osteoarthritic changes at the elbow joint.

Adolescent↗
PubMed1995

Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children.

From 1985 to 1991, 623 cases of supracondylar fracture of the humerus in children were admitted to one center, of which 403 were analyzed in detail. Of these, 180 cases were classified as Gartland type III extension fractures, and 111 were treated via primary closed reduction and percutaneous smooth Kirschner wire pinning, of which 82 were followed up for an average of 3.5 years and were studied in detail clinically and radiologically. There were two cases of superficial pin tract infection and one of ulnar nerve palsy associated with the pinning. Nineteen fractures (10.5%) had an initial nerve palsy related to the injury. All recovered completely from 4 weeks to 40 weeks postinjury. Only one of nine cases (5%) with absent radial pulse required exploration. Eighty percent of all cases had excellent or good function according to the Flynn criteria of elbow assessment. The most important factor correlating with the final varus deformity was found to be the difference in Baumann's angle between the injured and the normal side after closed reduction and pin fixation. The results of cross pinning in eight cases were not found to be different from those of the lateral pinning group (74 cases). Ipsilateral fracture of the same limb occurred in 4.4% of the cases, the majority being a fracture of the distal radius. The average anesthetic time for the procedure was 54 min, and the average hospital stay was 2.9 days. Our study shows that cross or lateral percutaneous pinning was found to be effective in the treatment of Gartland type III extension fractures with a high success rate and minimal complications.

Bone Wires↗
PubMed1997

Radial nerve palsy associated with slightly angulated pediatric supracondylar humerus fracture.

This report reviews a case of radial nerve palsy associated with a supracondylar fracture of the right humerus. The patient was a four-year-old boy. Radiographs of the injury showed simple extension and a slightly angulated fracture. Complete radial nerve palsy was observed at the first consultation. After three months of conservative treatment without any obvious improvement, an operative exploration of the right radial nerve was conducted. Intraoperatively, the nerve was found to be transected, with both ends of the ruptured nerve buried in scar tissue at the fracture site. Five months after the nerve suture operation, the palsy was cured completely. This case shows that even a minimal displacement fracture can be associated with severe nerve injury that requires surgical treatment.

Child, Preschool↗
PubMed1998

Use of a hybrid external fixator for a severely comminuted juxta-articular fracture of the distal humerus.

Severely comminuted, juxta-articular fractures present a difficult management dilemma for orthopaedic surgeons. Recently, hybrid external fixators have been used for treatment of such fractures in the lower extremity, particularly in the tibial plateau and the tibial plafond. The same technique may be applied to the upper extremity with gratifying results. This technique has the advantage of minimal dissection while restoring limb alignment and permitting immediate joint motion. The proximity of neurovascular structures to the humerus requires careful attention to anatomic detail when placing such a fixator.

Adolescent↗
PubMed1999

The Monteggia lesion and ipsilateral supracondylar humerus and distal radius fractures.

Ipsilateral elbow and forearm fractures are quite rare in children. We present a Monteggia lesion with ipsilateral supracondylar humerus fracture in a 13-year-old girl. Through early surgical management, a successful result was achieved. We believe that, to minimize any initial or subsequent complications in such fractures, early surgical management should be the first treatment choice.

Adolescent↗
PubMed2002

Pediatric supracondylar humerus fractures: the anterior approach.

OBJECTIVES: To evaluate the efficiency of the anterior approach for displaced supracondylar pediatric humeral fractures. DESIGN: A retrospective analysis. SETTING: Clinical and outpatient clinic care. PATIENTS: The anterior approach group consisted of twenty-six patients. The historical group consisted of thirty-two patients. All had a completely displaced extension-type supracondylar humerus fracture (Gartland Type III). All were operated within six hours of admission. All patients were contacted; twenty-five of the twenty-six and twenty-nine of the thirty-two patients were re-examined at the outpatient clinic. The other patients were contacted by telephone. INTERVENTION: All fractures in the anterior approach group were operated through a ventral approach: An incision was made in the cubital fossa of only the skin and subcutaneous tissue, and reduction was performed with the thumb and index finger. The fractures in the historical group were approached through a lateral or a combined lateral and medial approach. For each case in both groups fixation was done with crossed percutaneous K-wires followed by plaster of Paris splinting for two weeks. Radiographic and clinical results were evaluated in follow-up examinations. MAIN OUTCOME MEASUREMENTS: Functional and anatomic measurements were obtained at follow-up. RESULTS: In both groups no compartment syndrome or Volkmann's ischemic contracture was seen. Two in the anterior approach group and one in the historical group had an associated brachial artery injury. Early postoperative fracture displacement occurred in one of the twenty-six anteriorly approached and in four of the thirty-two historical group patients. One of the four patients in the historical group with early displacement had no cosmetic or functional loss during follow-up examinations. One patient in the anterior approach group and two patients in the historical group had a rotational deformity, one of whom also suffered a functional loss. The only other functional losses were found in two patients in the anteriorly approached group and in three patients in the historical group. CONCLUSIONS: The results of this study show that the anterior approach is safe, simple, and easy to perform. The anterior approach has good and excellent results by Flynn's criteria in 84 percent versus 75 percent in the control group (p = 0.56).

Adolescent↗
PubMed2002

Ipsilateral intercondylar distal humerus fracture and Monteggia fracture-dislocation in adults.

We present two cases of ipsilateral Monteggia fracture-dislocations and intercondylar distal humerus fractures in adults. To our knowledge, this combination of injuries has not been described in skeletally mature individuals. Both patients were treated with rigid internal fixation of the bony injuries as well as early rehabilitation protocols. Despite the severity of the injuries, both patients had satisfactory results. Adherence to established internal fixation protocols is critical in the treatment of complex upper extremity injuries.

Adolescent↗
PubMed2003

Prognostic factors in prosthetic replacement for acute proximal humerus fractures.

OBJECTIVES: To investigate the effect of some epidemiological and radiologic factors on the outcome of prosthetic replacement in acute proximal humerus fractures. DESIGN: Retrospective clinical study. PATIENTS: Thirty-two patients [mean age 58 (range 37-83 years)] with a mean follow-up period of 35 months (range 8-80 months). Fifteen cases had Neer type IV, 2 had type III, and 15 patients had fracture-dislocations. MAIN OUTCOME MEASUREMENTS: Neer's criteria, Constant score, and elevation degree were used. Radiological parameters were union and position of the tuberosities, bone stock, and position of the prosthesis. RESULTS: Excellent or good results according to Neer's criteria were obtained in 24 of the 32 cases (75%), and unsatisfactory results in 8 cases (25%). Mean Constant score was 68 (range 19-98) and mean elevation degree 113 (range 30-180). Thirty-one cases (97%) had no or mild pain. Cases operated within 14 days following injury had a better general outcome (p = 0.005). The humeral offset was directly correlated to the elevation degree (p = 0.011) and Constant score (p = 0.002), whereas the head height was inversely correlated to the same parameters (p = 0.001 for both). The cutoff point for the humeral offset-general outcome correlation was calculated as 23 mm using ROC curve analysis. The most common complications were problems concerning the tuberosities (50%), and they adversely affected the clinical outcome (p = 0.002). CONCLUSIONS: Preoperative delay, problems of tuberosity fixation, and position of the tuberosities were parameters influencing the clinical outcome. Lateralization of the tuberosities results in better scores, whereas their distal transfer can be related to a poorer outcome.

Adult↗
PubMedDate not supplied

A biomechanical evaluation of methods of distal humerus fracture fixation using locking compression plates versus conventional reconstruction plates.

OBJECTIVES: To examine the biomechanical behavior of 2 techniques of double-plate osteosynthesis for fractures of the adult distal humerus using conventional reconstruction plates and locking compression plates. DESIGN: Basic science study. SETTING: Experimental in vitro study. PATIENTS/PARTICIPANTS: Forty fresh-frozen human distal humeri specimens. INTERVENTION: Four matched groups with 10 humeri each, median age 74 years (46-95), were created using similar bone mineral density values. Two standard configurations of double-plate osteosynthesis (dorsal or 90 degrees configuration) with either conventional reconstruction plates or locking compression plates were studied for biomechanical properties of the constructs. A fracture model with a 5-mm supracondylar osteotomy gap simulating metaphyseal comminution (AO type 13-A3.3) was used. MAIN OUTCOME MEASUREMENT: Stiffness testing of the constructs in anterior/posterior bending, torsion, and axial compression loading. Evaluation of alterations of the bone-implant interface and failure patterns under cyclic loading and strength testing. RESULTS: The study demonstrates that primary stiffness in anterior/posterior bending and torsional loading is significantly increased by using locking compression plates in a 90 degrees configuration (P < 0.05) as compared with dorsally applied plates. The differences between the different plate types are insignificant if applied in the same configuration. It is demonstrated that none of the tested implants failed under cyclic loading within the number of cycles expected for 3 months of use. The bone-implant interface is less likely to fail during strength testing with locking compression plates. CONCLUSION: The biomechanical behavior of the osteosynthesis depends more on plate configuration than plate type. Advantages of locking compression plates are only significant if compared with dorsal plate application techniques. Nevertheless, locking compression plates are helpful supplementary tools for achieving primary stable fracture fixation. This might be of considerable clinical relevance in patients with diminished bone mineral quality or in the presence of metaphyseal comminution.

Aged↗
PubMed2005

Posterior fracture-dislocation of the proximal humerus: treatment by closed reduction and limited fixation: a report of four cases.

Four cases of posterior fracture dislocation of the proximal humerus were treated with closed reduction followed by immobilization and/or limited surgical fixation. All patients were adult males and sustained these isolated injuries in low-energy sporting trauma. Three patients followed for an average of 40 months postinjury had excellent results. These cases demonstrate the importance of adequate radiologic examination to avoid missed or delayed diagnosis and that closed reduction of these unusual injuries is frequently possible.

Adult↗
PubMed2005

Surgical management of a long segmental defect of the humerus using a cylindrical titanium mesh cage and plates: a case report.

This is a case report of a patient who sustained multiple gunshots resulting in a Gustilo Anderson type IIIB mid-shaft humeral fracture associated with extensive segmental bone and soft-tissue loss. The patient was treated initially by multiple irrigations, wound debridement, and a unilateral external fixator. After the soft tissue healed without infection, the mid-shaft humeral defect of approximately 8 cm segmental bone loss was reconstructed with a cylindrical titanium mesh cage packed with a composite of cancellous allograft and demineralized bone matrix putty and stabilized with limited contact dynamic compression plates. At 13 months follow-up, plain radiographs demonstrated a healed construct with good alignment, and computed tomography images demonstrated bony in-growth through the cage. The patient had full range of motion at the shoulder and the elbow. This technique may be a reasonable alternative when treating large segmental bone defects of the humerus.

Adult↗
PubMed2006

Reduction and pinning of pediatric supracondylar humerus fractures in the prone position.

Supracondylar humerus fractures are common pediatric injuries; the preferred treatment for displaced fractures is closed reduction and percutaneous pin fixation. We present a technique for closed reduction and pinning using prone-patient positioning. Prone positioning facilitates fracture reduction and safe pin placement while avoiding elbow hyperflexion. We prefer this technique to the commonly described method of fracture reduction and pinning with the patient supine.

Bone Nails↗
PubMed1979

Fractures of the humerus, radius, and ulna in the same extremity.

Fracture of the humerus, radius, and ulna is a rare combined injury. In our review of 21 cases, it was found that this injury was usually a result of rather severe trauma. There are frequently associated injuries to other organ systems. The most common associated injury was residual nerve damage, which occurred in over 50% of cases. Of all the different treatment modalities no one was found to be better than the others.

Adolescent↗
PubMed1983

Axillary artery injury with minimally displaced fracture of the neck of the humerus.

A case of axillary artery injury resulting from a minimally displaced fracture of the neck of the humerus is reported. Very few such injuries have been reported previously. The mechanism of injury can be from sharp bony fragments, overstretching of the artery especially when atheromatous, or torn intima. Angiography should be performed, followed by exploration where indicated.

Accidents, Home↗
PubMed1985

Fractures of the proximal humerus in adults.

Fractures of the proximal humerus are a common upper-extremity injury, particularly in the elderly. The literature suggests that the results of treatment of displaced fractures are generally unsatisfactory. Since Neer's articles in 1970 we found little reported in the literature on these fractures. We conclude from our review of 90 fractures that the results of treatment of displaced fractures continue to be unsatisfactory, and we believe that displaced proximal humeral fractures, along with femoral neck fractures, should be classified as unsolved fractures.

Adult↗
PubMed1995

Lateral condylar fractures of the humerus in children: fixation with partially threaded 4.0-mm AO cancellous screws.

Thirty-seven children with fresh, displaced (more than 2 mm in any direction) fractures of the lateral condyle of the humerus were treated by open reduction and internal fixation with a partially threaded 4.0-mm diameter AO lag screw. They were reviewed at a mean follow-up of 4.8 years. Painless, full-elbow movements were obtained in 36 cases. Delayed union, with loss of 10 degrees of elbow motion, was observed in one case (2.72%). Radiologically, less than 4 degrees of varus deviation, compared with the contralateral side, was found in four cases (10.8%). Mild fishtailing was observed in three cases (8.18%). Nonunion, avascular necrosis or clinically significant premature epiphysial fusion was not observed. Elbow function was excellent, irrespective of minor radiologic abnormalities.

Bone Screws↗
PubMed1977

Nonunion of fractures of the proximal humerus: a method of treatment using a modified Moe plate.

Treatment of nonunion of fractures of the proximal or middle third of the humerus by use of a modified Moe plate is described. We have found this treatment to produce more favorable results than other methods using either internal or external immobilization. Simple modification of an existing mechanically sound device has led to a very useful instrument for the internal fixation of this type of fracture.

Aged↗