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PubMed2003

Concomitant nonunion of the distal humerus and olecranon.

Concomitant nonunion of an operatively treated fracture of the distal humerus and the olecranon osteotomy used for exposure is an unusual and complex situation which compromises ulnohumeral function on both sides of the joint. Operative treatment restored good elbow function in a series of six patients with this problem. An average of 110 degrees of ulnohumeral motion was restored, arthrosis was none (four patients) or mild (two patients) at an average follow-up of 50 months, and outcome measures documented good upper extremity specific (DASH) and general (SF-36) health status.

Adult↗
PubMed1992

[Surgical treatment of dislocated 3 and 4-segment fractures of the proximal humerus].

Twenty-eight three- and four-segment fractures of the proximal humerus were treated by plate fixation (n = 22), screw or Kirschner wire stabilization (n = 5), and primary endoprothesis (n = 1). There were no early postoperative complications. Fourteen months after the operation, 80% of the patients examined showed good results; 4 cases had poor results. In comparison to other reports our results are positive and support plate fixation as the method of choice in these situations.

Aged↗
PubMed2003

The management of anterior dislocation of the shoulder with proximal humerus fracture, bony Bankart lesion, and associated glenoid labrum avulsion: a report of 2 cases.

Proximal humerus fractures are common in the older population. These fractures can be associated with dislocation of the shoulder. Four-part fracture-dislocations and head-splitting 3-part fractures are generally indicated for shoulder hemiarthroplasty in the older population. When such surgery is warranted, inspection of the glenoid during the procedure is indicated, as loss of evaluation may lead to postoperative shoulder instability. There is value in alerting orthopedic surgeons to the possibility of anterior glenoid rim fracture in association with proximal shoulder fracture-dislocation. We focus on this issue and advise that the lesion can be visualized and confirmed at open reconstruction and does not need multiple radiographic views.

Accidental Falls↗
PubMed1992

Late ulnar nerve injury following Kirschner wires fixation of the supracondylar fracture of the humerus.

Most supracondylar fractures of the humerus can be treated by closed methods. Open reduction and internal fixation by wires or pins are indicated in a difficult fracture (Kekomaki et al 1984) or in vascular injury following the fracture. This fixation should be temporary and removed immediately upon obtaining the desired purpose. To increase surgeons awareness of inadvertently leaving the implant for too long, we are reporting an unusual complication of migration of the Kirschner wire resulting in late ulnar nerve injury.

Adolescent↗
PubMed1992

[Paralysis of the radial nerve and supracondylar fractures of the humerus in children. A study of a series of 11 cases].

Eleven radial nerve paralyses, associated with supracondylar fractures of the humerus in children, are reported: 2 incomplete motor, 5 complete motor, 2 complete motor and partial sensory and 2 complete motor and total sensory. The palsy was noticed before any treatment in 8 cases. In the 3 other cases, the palsy was secondary to difficult and repetitive closed reduction manoeuvers. The fractures were all of the extension type, grade III in 2 cases and IV in 9 cases. The displacement of the distal fragment was posterior and medial in 8 cases. Initial treatment of the fracture was conservative in 5 cases with 2 failures and surgical in 6 cases. Nerve function recovery always followed the same sequence: extensor muscles of the wrist, then extensor muscles of the fingers and at last, extensor muscles of the thumb. Time required for full recovery varied from 4 to 6 months. Open reduction and nerve control did not seem to be better than closed reduction with regard to the required time for neurological recovery and its quality. The indications depend on the extension of the paralysis. If radial palsy is incomplete, the first therapeutic step is closed reduction, followed by surgical reduction if not possible. A primary surgical approach is proposed in cases of complete sensory and motor paralysis because of the operative findings of contusion and incarceration of the nerve which may be aggravated by blind manoeuvers.

Child↗
PubMed1992

Percutaneous pinning of displaced supracondylar fractures of the humerus in children. Case report.

The authors report their experience with closed reduction and percutaneous pinning of twenty-two supracondylar fractures of the humerus in children. In cases with neurovascular complications there was a marked regression within six hours following reduction. The results after 15 months to 13 years were satisfactory (excellent + good) in 90% of the cases, avoiding the risks and possible cicatricial complications of incisions and the discomfort of orthopaedic treatment in traction and subsequent thoracic-brachial plaster cast.

Adolescent↗
PubMed1992

[Drill wire osteosynthesis in subcapital humerus fractures: percutaneous or open procedure?].

Between 1978 and mid-1990, 135 patients suffering from dislocated, non-luxated fracture of the humerus at the anatomical neck (fractura colli anatomici) were treated by means of open or closed percutaneous drill wire osteosynthesis. Follow-up examination after an average of 9 months did not show any significant differences between the two surgical approaches in 117 patients, independent of the shape of the fracture. However, in about 30% of the cases it was impossible to employ the percutaneous approach due to the presence of an obstacle to reduction, so that open reduction and fixation was the only choice. A great majority of the functional results must be considered as good, fractures of the tubercles having the most unfavourable prognosis independent of the surgical technique. It is, therefore, recommended to first try closed reduction with percutaneous drill wire osteosynthesis. If there are any obstacles to reduction, open reduction should be restored to during the surgery session.

Adult↗
PubMed2004

Treatment of non union of humerus using G. A. Ilizarov technique.

The management of the non union of humerus is one of the most challenging problems that the surgeon confronts in his practice. The procedures traditionally used are: I.M. Nailing, interlocking, plating, transplantation of allograft. In our series, 36 cases with non union has been treated by G.A. Ilizarov technique. The age range were: 21-62 years with an average of 32 years. The initial treatment were done by DCP, rush nails & plates with screw fixation. The duration of treatment ranged from 5-11 months (average 8 months). With the application of Ilizarov fixator a good range of elbow & shoulder motion were achieved. The average follow up period was 5 years with a range of 1-8 years. Union was achieved in all the 36 cases.

Adult↗
PubMed1992

[Fractures of the proximal humerus. Classification and treatment principles].

The therapeutical strategy for fractures of proximal humerus is pointed out both by Neer's and by AO classification. Thus closed functional treatment is indicated in case of all undislocated or minimally displaced fractures. Conservative management is indicated for all reducible fractures as well. Severe and irreducible bone lesions i.e. three and four part fractures with or without dislocation are to be handled primarily by operation. Dislocated fractures require an emergency procedure. The operative strategy has to be suitable for the type of fracture. Stable T-plate osteosynthesis is preferred for simple fractures (i. e. Type A2 or A3 according to the AO classification). Serious bifocal and articular bone lesions are sufficiently managed by minimal internal fixation (osteosynthesis) especially in regard to the biological aspects. The sincere contact of bone fragments accompanied by sufficient anatomical axis should be the aim of the operative strategy. Manifold expedients for reduction like temporarily applied Steinmann pins are necessary. Larger lesions of spongiosa can mostly be substituted by autoclaved spongiosa transfer. As minimal osteosynthesis led rarely to necrosis of the humeral head it is preferred especially in case of severe fractures. According to our therapeutical draft head preserving procedure had the priority to primary humeral prosthetic arthroplasty.

Follow-Up Studies↗
PubMed2003

[Control of the firmness of fixation of fragments with a plate for fractures of the humerus condyle of CII and CIII types].

The intra-articular comminuted fractures of the condyle of the Cii and Ciii types (by AO classification) were modeled in cadaverous humeral bones of the distal end of the humerus. Mechanical tests of the fixing properties of Y-shaped whole and combined plates as well as of two plates adapted to the fractures were performed by the method recommended by AO. The stabilizing properties of the whole Y-shaped plate were found to be the best. A more simple operative technique and less traumaticity with sufficiently optimal fixing properties as compared with the AO method allows osteosynsthesis with the Y-shaped plate to be considered preferable.

Aged↗
PubMed1992

[Humerus reconstruction after gunshot fracture].

High-velocity bullits can cause severe blast injuries with shattering and defects of the large bones. Initial external fixation is followed by rebuilding of the bone, which is difficult due to concomitant infection, poor revascularization and lack of a suitable bone bed. A case report of an injured African soldier shows the follow-up and difficulties of reconstruction of the shattered humerus by repeated spongious bone grafting. After successful remodeling of the bone, external fixation is followed by ASIF dynamic compression-plate osteosynthesis.

External Fixators↗
PubMed2004

[Biomechanical study of percutaneous pinning as the treatment of proximal humerus fractures].

OBJECTIVE: To investigate the influence on fracture stability by different pin construct during percutaneous pinning for the treatment of proximal humerus fractures. METHODS: Eighteen pairs (36) adult fresh-frozen humeri were match-paired and divided into 4 groups. Dual-energy bone density scan had been used in order to rule out the influence by different degrees of osteoporosis of the cadaver. Two-part surgical neck fracture model was carried out unanimously in all 36 humeri. Four terminal threaded pins (2.5 mm in diameter) were used in fixation for all specimen. Parallel type pinning (box type) were carried out in 2 groups and convergent type pinning (fan shape) in the other 2 groups. Instron5566 biomechanical tester was applied in determining both anti-shear and anti-torsion ultimate load of each specimen. RESULTS: There was no statistical difference between parallel pin construct and convergent construct in regard of anti-shear resistance (P = 0.73). But by mean of anti-torsion resistance, the parallel construct had significant advantage over the convergent construct (P = 0.04). CONCLUSION: According to our biomechanical data, parallel pin construct seems to have better torsional stability. We suggest that parallel pin fixation should be applied whenever possible. Convergent pin construct should be considered when parallel construct is not possible or the distance between pins are too small (< 1 cm).

Biomechanical Phenomena↗
PubMed1992

[Long-term results of treatment of supra-condylar humerus fractures in children].

From 1982 to 1986, a total of 106 children with supracondylar fractures of the humerus were treated at the trauma surgery clinic in Braunschweig. Undisplaced or slightly displaced fractures were treated with plaster casts. More severely displaced fractures were initially treated by closed reduction under general anesthesia and percutaneous Kirschner wiring. In 72 cases (= 85.7%) a follow-up examination revealed a very good or good result. In 9 cases (= 10.7%) satisfactory results were found and in 3 cases (= 3.6%) unsatisfactory results. The most common complication prejudicing the result was cubitus varus. It was found in 27 cases (= 32.1%), most often with a varus under 10 degrees (19 of the 27 cases). A retrospective study of the 12 cases in which the results were classified as satisfactory or unsatisfactory showed 8 insufficient reductions in fractures with severe instability.

Adolescent↗
PubMed2004

The surgical management of severely displaced supracondylar fracture of the humerus in childhood.

A total of 28 children with severely displaced supracondylar fractures of the humerus were operated between January 1997 and December 2001 using the posterior approach raising a tongue of triceps and stabilisation of the fractures with two crossed Kirschner wires. All the supracondylar humeral fractures were extension type. The mean age was 6.9 years with male/female ratio 1.5:1. Fall at home accounted for 85.7% of the cases while 67.9% presented with injury to the left elbow. In 92.9% of the children the triceps muscle power was grade 5, 71.4% could flex the elbow joint beyond 120 angle and only 10.7% had 15 degrees of extension lag at the elbow joint at six months. All had within normal carrying angle with 64.3% having carrying angle between 0 degrees - 10 degrees. The scar was cosmetically acceptable in 27 patients (96.4% ) at six-months.

Child↗
PubMedDate not supplied

[Severe fractures of the lower end of the humerus in adults (author's transl)].

The authors have treated sixty six cases of severe comminuted fracture of the lower end of the humerus. Five main types have been distinguished: 1. Supracondylar fractures. 2. T-shaped fractures. 3. Trans-condylar fractures in which the fracture line is distal, detaching only the articular surfaces. 4. Diaphyso-epiphysial fractures. 5. Trans-columnar fractures similar to transcondylar fractures but with additional fractures detaching a fragment of lateral or medial epicondyle and a fracture through the trochlea separating the articular surface into two parts. Fifty-four patients were operated on to apply internal fixation. Analysis of the results based on critical criteria shows 53 p. 100 of satisfactory results. The authors emphasise the frequency and severity of damage to the ulnar nerve. They conclude that the results are better after surgical treatment than with conservative treatment which should be reserved for distal and comminuted fractures. A new type of plate has been designed to be applied and fixed to the lateral aspect of the bone.

Adolescent↗
PubMed2005

Elevated, straight-arm traction for supracondylar fractures of the humerus in children.

Between January 1995 and December 2000, 112 children with a closed displaced supracondylar fracture of the humerus without vascular deficit, were managed by elevated, straight-arm traction for a mean of 22 days. The final outcome was assessed using clinical (flexion-extension arc, carrying angle and residual rotational deformity) and radiographic (metaphyseal-diaphyseal angle and humerocapitellar angle) criteria. Excellent results were achieved in 71 (63%) patients, 33 (29%) had good results, 5 (4.4%) fair, and 3 (2.6%) poor. All patients with fair or poor outcomes were older than ten years of age. Elevated, straight-arm traction is safe and effective in children younger than ten years. It can be effectively used in an environment that can provide ordinary paediatric medical care and general orthopaedic expertise. The outcomes compare with supracondylar fractures treated surgically in specialist centres.

Child↗
PubMed1992

Supracondylar fractures of the humerus in children: treatment by overhead skeletal traction.

A total of 120 children with severely displaced supracondylar fractures of the humerus in the absence of neurovascular deficit were treated by overhead skeletal traction. The results were assessed according to Flynn's criteria. After a mean follow-up period of 3.5 years, 68 children (56%) had an excellent result, 40 (34%) had a good result, 4 (3.5%) had a fair result, and 8 (6.5%) had a poor result. Cubitus varus was present in only 4 cases, which compares favorably with the results of operative treatment. The indications for overhead traction and the satisfactory results of this method are discussed.

Child↗