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PubMedDate not supplied

Avulsion fractures of the lesser tuberosity of the humerus in adolescents: review of the literature and case report.

Isolated fracture of the lesser tuberosity is an unusual phenomenon in children and adolescents. These injuries are difficult to diagnose acutely and often present as chronic shoulder pain. In this study, we report on 1 case of a displaced lesser tuberosity apophysis avulsion fracture in an adolescent treated with open reduction and internal fixation, as well as a review of the literature. A 14-year-old adolescent male presented to the senior surgeon complaining of left shoulder pain and weakness 10 days after a wrestling injury. He was diagnosed with a displaced, isolated fracture of the lesser tuberosity apophysis for which he underwent open reduction and internal fixation. A combination of sutures passed through drill holes in the proximal humerus and bioabsorbable suture tacks were used to anatomically fix the lesser tuberosity fragment and subscapularis tendon. Postoperatively, he underwent a progressive physical therapy regimen. At 4 months follow-up, he had full range of motion, complete return of strength, and returned to competitive athletics. We report here on the successful surgical treatment of a fracture of the lesser tuberosity apophysis in an adolescent.

Adolescent↗
PubMed2005

Complex coronal shear fractures of the distal humerus.

This is a retrospective review of nine coronal shear fractures of the distal humerus. Two were isolated fractures and seven were associated with other peri-articular elbow injuries, termed "complex" coronal shear fractures. All cases underwent immediate open reduction and internal fixation (ORIF) and were then followed for an average of 14 months (range: 6.5 to 23 months) with outcomes evaluated using the Mayo Elbow Performance Scoring system. There was a significant difference found between injuries limited to the radiocapitellar (RC) joint (isolated coronal shear fractures, or those associated only with radial head fractures) and the complex injuries extending beyond the RC joint. Scores for the RC injuries were 100 and other complex injuries had an average score of 69 (range: 35 to 95; p = .025). All complications were limited to the group with the complex injuries, including stiffness, nonunion, pain, and gross instability. Much of the current thinking in treatment of this fracture was upheld in this study; computed tomography aids in diagnosis, ORIF is a necessity, and there is a need for anatomic reduction. When a coronal shear fracture is complicated by a concomitant injury outside the RC joint, both the surgeon's and patient's expectation need to be adjusted accordingly.

Adolescent↗
PubMed1992

[Distal intra-articular humerus fractures in adults. Results of surgical treatment].

Intra-articular fractures of the distal end of the humerus are severe injuries because stable anatomic reduction is difficult to achieve even operatively. They are often accompanied by nerve lesions and often lead to heterotopic para-articular ossifications. Functional recovery is only rarely complete. Follow-up of 54 cases of operatively treated fractures of this kind showed 56% excellent and good late results. In immediate operations we observed fewer infections, less ossification, and better functional results than after delayed operative treatment. We therefore recommend careful examination for nervous deficits, immediate stable internal fixation of the fractures displaying the ulnar nerve, and handling the soft tissue as gently as possible to avoid additional damage. Postoperative physiotherapy should also be started immediately.

Elbow Joint↗
PubMed2005

Medial approach for fixation of displaced supracondylar fractures of the humerus in children.

This study aimed at evaluating our protocol for displaced Gartland Type 3 supracondylar fractures of the humerus in children. Forty-eight children had 49 fractures during the study period, from 1997 to 2002; they were included in the study. Their mean age was 7.02 years. They all were treated with crossed K-wires. The medial wire was always put under direct vision through a medial approach. All fractures were manipulated maximum twice. Ten patients (23.25%) required open reduction which was done through the same medial approach which we use for medial pin placement. No patient had iatrogenic ulnar nerve neuropathy. At final review radiographs were taken of the normal and operated sides and films were compared with immediate post-op films. The postoperative mean value of Bauman's angle in the affected elbow was 76.7 degrees with a range of +/- 1.0 degrees and 74.8 degrees with a range of +/- 0.6 degrees on the unaffected elbow. Carrying angle and movements of operated and normal sides were measured at review. According to Flynn's criteria, all patients showed satisfactory results. We conclude that cross K-wiring gives excellent results; the medial approach provides an excellent view of the supracondylar area, leaves a cosmetically acceptable scar and enables to avoid iatrogenic injury to the ulnar nerve.

Adolescent↗
PubMed1992

[Complex injuries of the proximal humerus treated with humeral head prosthesis. Apropos of 21 cases reviewed after a median 4-year follow-up].

Of a total of 35 complex fractures of the upper humeral epiphysis treated by Neer arthroplasty, 21 were evaluated at a mean of 4 years after operation. The shoulder function according to Constant was 70% of the contralateral one. The internal and external rotations were rarely symmetric. Clinical improvement was possible during the first 2 years. Late breakage and migration of wires used to fix the tuberosities caused failure of this method of fixation. Dynamic radiographs revealed significant gleno-arthroplastic movement and a constant medialization of the prosthetic humerus.

Adult↗
PubMedDate not supplied

Surgical treatment of sequelae of fractures of the proximal third of the humerus. The role of osteotomies.

Between 1996 and 2003 a total of 19 humeral head osteotomies were performed to treat post-traumatic malunion of the proximal humerus. Mean age was 46 years, ranging from 17 to 71 years. The period of time between traumas and surgeries ranged from 6 to 22 months. Osteotomy procedure was as follows: one after two-part fracture of the greater tuberosity, three after two-part fracture of the surgical neck, five after three-part fracture of the greater tuberosity, eight after four-part fracture, two after complex head splitting fracture, one after two-part fracture with anterior dislocation. Three different types of osteotomies were performed: osteotomy of the humeral neck for varus deformity, isolated osteotomy of the greater tuberosity, and a new osteotomy technique (two-plane and three-plane osteotomy) for three- and four-fragment fracture sequelae. At the time of follow-up evaluation, all 19 patients were questioned regarding pain and function. Excellent results in 14 patients and satisfactory results in 5 were obtained. None of the patients required revision surgery. Findings were recorded using the Constant rating scale. All patients had had significant pain relief after shoulder osteotomy. Range of motion was increased in all patients treated by osteotomy. The success of osteotomy in these cases was based on: patient selection, extensive preoperative evaluation, surgical technique and postoperative rehabilitation.

Adolescent↗
PubMedDate not supplied

Partial prosthetic replacement of the shoulder in fractures and fracture-dislocations of the proximal humerus.

A total of 48 patients submitted to partial shoulder replacement for fracture and fracture-dislocation of the proximal humerus were evaluated after a mean follow-up of 5.2 years (range 2 to 10 years). The absolute mean Constant score was 57.8, relative score 76.8% and corrected score 80.4%. A mean of 8.8 points were totalled in the Simple Shoulder Test. Out of 45 patients evaluated radiographically, tuberosity consolidation in the anatomical site was evident in 25 shoulders (55%) and the subacromial space appeared to be preserved in 20 shoulders (44%). More than 90% of the patients declared that he or she was satisfied with treatment. A comparative study on subgroups of patients in an attempt to identify the prognostic value of several factors was conducted. Better functional results were obtained in subjects aged under 70 years, in fracture-dislocations, in shoulders with whole rotator cuffs, in patients with dedicated modular prostheses.

Aged↗
PubMed2006

Intact radial and median nerve after open third degree distal fracture of the humerus.

A 54 year old man sustained a third degree open fracture at the distal part of the right humerus with massive soft tissue defect involving most of the upper arm. The radial and median nerves were completely bared and exposed by 6 cm for radial and 3 cm for median nerve. The nerves were in continuity, but there was complete rupture of surrounding muscles: biceps, triceps and brachialis. The fracture was stabilized by external fixation method--reinforced by wires. Preoperative and postoperative sensorimotor status of the right hand was good. One year later sensory and motoric status of right hand showed no deficiencies, but flexion and extension in elbow were limited to 100 and 180 degrees respectively. Pronosupination was restricted. This case report is consistent with results of biomechanical studies in vitro confirming high tolerance of radial and median nerve to stretching injury.

Biomechanical Phenomena↗
PubMed1991

Conservative treatment of displaced supracondylar humerus fractures of the extension type in children.

Numerous methods for the treatment of displaced supracondylar humerus fractures of the extension type are described in the literature. From 1974 until 1988, we treated conservatively 33 children with such fractures with Dunlop traction. Twenty-nine patients (88%) were re-examined. Four patients (12%) were interviewed by telephone. Good or excellent results were obtained in 31 patients. The Dunlop method is a simple, well-tolerated and safe method that permits surveillance for possible complications. In comparison with other methods, it yields good and reproducible results.

Adolescent↗
PubMed1991

[Spiral fracture of the humerus during arm wrestling].

The authors present the case of a body-builder who sustained a spiral fracture of the humerus during arm wrestling (Indian wrestling). The cause of the fracture and the underlying mechanism are discussed and it is concluded that it appears appropriate to warn body-builders and weight-lifters against arm wrestling.

Adult↗
PubMed1991

[Functional results of Neer II type hemi-arthroplasty joint replacement of multi-fragment humerus head fractures].

Among the fractures of the proximal humerus--a typical kind of injury affecting elderly people, as well as gainfully employed patients, the comminuted and dislocated humeral head fractures have a specific position because of therapeutical reasons. By means of a retrospective analysis, a review is given of the results of 26 comminuted humeral head fractures type IV-VI according to Neer, treated with a Neer prosthesis type II at the surgical clinic of the Kantonsspital Lucerne between 1983 and 1989. Our interest is mainly concentrated on the functional results and on their correlation with biomechanical and perioperative factors. We use the fracture-classification and functional evaluation as described by Neer. For the results classified as "failures" (13 cases) the functional deficits of the glenohumeral joint mobility are essential. The scores reveal no significant correlation to the age of the patients, to the time interval between trauma and operation, as well to the duration of the postoperative physiotherapy. On the other hand the scores of patients with preoperative manipulation of the fractured joint (i.e. osteosynthesis, reduction attempts, physiotherapy) were significantly worse than those with primary prosthetic replacement. Furthermore, because of the insufficient restitution of the lever arm conditions, the implantation of the small-head component (15 mm) leads to significantly less favorable functional scores, with a corresponding radiological hyperpression in the cranial articular space. Our analysis leads to the following conclusions: 1. Under the condition of a conclusive preoperative diagnosis a primary prosthetic procedure is recommended depending on the type of fracture.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

[Functional conservative treatment of humerus shaft fracture with the plaster brace].

The functional-conservative treatment of fractures of the humerus shaft is the most efficient method today. It is an uncomplicated and reliable method for outpatient therapy. In our opinion only second degree open fractures and vessel injuries are a contraindication. A few guidelines taken into consideration enable everybody to learn the handling of plaster brace in a short time period. All fractures we treated in this way showed an osseous fracture healing.

Ambulatory Care↗
PubMed1991

[Considerations concerning the treatment of pseudarthrosis of the humerus].

A humeral shaft fracture results in a nonunion in less than 10% of cases, regardless of the technique used. The treatment of such cases must be different from the initial treatment. In a pseudarthrosis of the medial shaft of the humerus with a transverse or short oblique line, a suitable procedure is medullary filling with Hackethal nails or a Küntscher nail. If the fracture line is long and oblique, spiral, fragmented or distant from the narrow part of the humeral shaft, a modified interlocking intramedullary nail is recommended.

Adult↗
PubMed1991

Internal and external fixation in complex diaphyseal and metaphyseal fractures of the humerus.

The treatment of diaphyseal and metaphyseal fractures of the humerus is often controversial, especially when these fractures are complex and/or unstable (i.e. comminuted, segmental, or with a butterfly fragment). The authors review the indications, advantages, and disadvantages of various open and closed procedures, concluding that a combination of internal and external fixation is a valid treatment for these fractures. The purpose of the external fixation is immediate stabilization of the fracture, which is difficult if not impossible with intramedullary internal fixation alone. Internal fixation devices (Rush rods or "anchor" nails introduced by closed means) make it possible to align the fracture, facilitating application of the external fixator, and at the same time promote rapid healing. Fractures treated by this method healed in an average of 2 1/2 months, without residual functional limitations of the shoulder or elbow.

External Fixators↗
PubMed1991

[Tension band osteosynthesis with absorbable cords in proximal comminuted fractures of the humerus].

We reviewed 25 cases of comminuted fractures of the proximal humerus that were operatively treated from December 1984 to December 1988. Ten patients were treated by a Magerl operation modified by Marti using a metallic wire as a tension band. Twelve patients were operated on using a resorbable PDS (Polydioxanon) thread in the same manner. In this paper the PDS thread technique is described. The two groups are clinically and radiologically comparable. Using a PDS thread as a tension band has evident advantages: the relatively simple technique and the absence of implant removal.

Adult↗
PubMed1990

[Management of dislocated subcapital fractures of the humerus by intramedullary wiring].

Author treated 24 subcapital dislocated humeral fractures with wire fixation of the medullary cavity. The fractures were classified according to Neer. The operation was begun in general anaesthesia with closed reduction; the fixation was made with K-wires through the bone window prepared on the dorsal side of the humerus, above the fossa olecrani. Gymnastics were begun on the 2-3 week. The results were assessed using the point system of Neer. Functional restitution followed in 2-4 months in every patient.

Anesthesia, General↗