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PubMed1988

Management of displaced extension-type supracondylar fractures of the humerus in children.

The cases of 230 patients who had a displaced extension-type supracondylar fracture of the humerus were reviewed retrospectively. The results of treatment by four different methods were assessed clinically and compared. The mean length of follow-up was 4.6 years (range, one to nine years). The highest percentages of excellent results were achieved by percutaneous Kirschner-wire fixation (78 per cent), skeletal traction (67 per cent), and open reduction with internal fixation (67 per cent). Closed reduction and application of a cast was associated with a significantly lower percentage of early and late complications, including Volkmann ischemic contracture and cubitus varus. It is recommended that treatment with a cast be reserved for undisplaced fractures only. Percutaneous Kirschner-wire fixation is advocated as the method of choice for the majority of displaced fractures.

Adolescent↗
PubMed1987

Ender nailing of acute fractures of the humerus. A study of closed fixation by intramedullary nails without reaming.

A prospective study of closed intramedullary fixation of fractures of the shaft of the humerus, using Ender nails, was performed over a six-year period. Eighty-nine fractures in eighty-eight patients were treated with no immobilization postoperatively. Three patients were lost to follow-up. Eighty-five of the remaining eighty-six fractures healed, the average time to clinical union being 7.2 weeks. Non-union of one fracture occurred and there were no infections or malunions. Six of the nine preoperative and two postoperative radial-nerve palsies were lesions in continuity and healed spontaneously. The remaining three radial nerves that had been severed by a missile needed further attention. One of the nails backed out in eight patients, requiring revision in five. The average lack of complete extension of the elbow was 4 degrees and flexion of the elbow was 132 degrees. Abduction of the shoulder averaged 91 degrees; external rotation, 54 degrees; and internal rotation, 68 degrees. We conclude that closed intramedullary Ender nailing can be performed safely and effectively in selected fractures of the humeral shaft. However, only fractures that are recalcitrant to closed reduction and immobilization or fractures in the non-compliant patient should be considered for this form of operative treatment.

Acute Disease↗
PubMed1979

[Conservative treatment of supracondylar humerus fractures in children with Blount's method (author's transl)].

Author treated during the period of 1971--78, 84 patients with supracondylar humerus fractures using the method of Blount for fixation. Based on experiences gained by follow up examination 2--5 years after the first treatment, author states, that this method yielding good functional results, by its simplicity and efficiency is an excellent and feasible procedure for selected supracondylar humeral fracture cases.

Bandages↗
PubMed1987

[Compound fractures of the proximal humerus].

This paper stresses the importance of considering reconstructive measures when dealing with complex fractures, including fracture dislocations of the proximal humerus. Mainly, we try to use "biological" techniques with minimal exploration and internal fixation for stabilization. Indications for internal fixation are compared with prosthetic replacement and primary fusion.

Bone Plates↗
PubMed1987

[Replacement of the head of the humerus as a rescue operation following dislocated compound fractures of the shoulder joint].

Results after conservative or surgical treatment of comminuted fractures of the head of the humerus are often unsatisfactory and complicated by pain and a severely decreased range of motion. In these patients good results have been obtained by replacement of the humeral head with the Isoelastic Humeral Head Prosthesis. Fourteen cases are reported and their results discussed.

Adult↗
PubMed1986

Irreducible supracondylar fracture of the humerus complicated by anterior interosseous nerve palsy.

Supracondylar fractures of the humerus are common injuries in childhood and constitute greater than 50% of fractures involving the elbow joint. Neurovascular compromise is not infrequent and has been variously reported as occurring in 5%-17% of displaced fractures. A seven-year-old girl with isolated involvement of the anterior interosseous branch of the median nerve, an uncommon complication, is reported, along with a review of the literature.

Child↗
PubMed1986

[Our concepts of treating recent fractures of the lower end of the humerus in children].

After a brief description of the classification of fractures of lower and of humerus in children, methods are described for the application of different orthopedic and surgical procedures developed over the years. Treatment of supracondylar fractures remains very conventional (Judet's method), experience lacking in the use of contention in strong flexion for these fractures. Emphasis is placed on two points: the need for perfect reduction under all circumstances, since growth will have little impact on correction of residual faults, and the quality and reading of review radiographic images to avoid major mistakes in reduction.

Child↗
PubMed1986

[Posterior approach to the elbow preserving the extensor apparatus. Its value in the osteosynthesis of humerus plate fractures].

The authors describe a median posterior approach of the elbow with preservation of the triceps mechanism in continuity. Such an approach provides an excellent exposure of the elbow and of the lower part of the humeral shaft which can be used for the osteosynthesis of complex supra and intercondylar fractures. This approach can also be extended to the midshaft of the humerus, the radial head and the ulnar shaft. The repair is easy and strong enough to allow a rapid rehabilitation.

Elbow Joint↗
PubMed1987

Intraarticular fractures of the distal humerus in the adult.

Intraarticular fractures of the distal humerus are notoriously difficult to treat. Three basic treatment methods are available: closed reduction, traction, and open treatment. In the past, functional results with all these methods generally have been poor because of disabling limitations of elbow motion. Thirteen adult patients were treated by open reduction and application of medial and lateral buttress plates providing rigid internal fixation and early motion. The patients were evaluated for range of motion, infection, nerve injury, avascular necrosis, myositis ossificans, varus/valgus deformity, pain, instability, weakness, and degenerative changes. Ten of the 13 patients were available for follow-up study for an average of two years. Nine of the ten achieved good or excellent results. Based on these observations, the treatment of choice is internal fixation with dual plates combined with early active postoperative motion.

Adolescent↗
PubMed1986

[Fractures of the lower end of the humerus in adults: influence of per- and postoperative tactics on results. Apropos of 70 osteosyntheses].

Results in 70 cases of osteosynthesis of lower end of humerus in adults were analyzed as a function of the fracture line, and the operative (approach route, type of support, attitude towards ulnar nerve transposition) and postoperative (with or without plaster immobilization) tactics. Best results were obtained in simple joint fractures (condyles, capitellum, Hahn Steinthal) with a good outcome in 89% of cases, while prognosis was poorer (68.5% of delayed good results) in more or less comminuted supra- or inter-condylar fractures (41 cases). Results are better in these latter types of fracture when an extra-articular trans-olecranon posterior approach is used. Ulnar nerve transposition was performed 43 times without adverse effects and osteosynthesis by 2 posterior screw plates (one on external and one on internal column) in 50% of cases. Valid comparison of results with or without postoperative plaster immobilization was not possible since only 8 patients were not plastered.

Adolescent↗
PubMed1985

Intercondylar fractures of the humerus. An operative approach.

In this paper we review a series of thirty-four intercondylar fractures of the distal end of the humerus that were treated by open reduction over a ten-year period. The fracture patterns were classified according to the system of Müller et al. and a strict rating scale incorporating subjective data, objective motion, and the functional status of the involved elbow was used for the results. At a mean follow-up of 5.8 years, thirteen results were rated as excellent; fourteen, as good; four, as fair; and three, as poor. Complications included postoperative neuritis in five patients; three non-unions; and refracture, heterotopic bone, and deep sepsis in one patient each.

Adolescent↗
PubMed1985

Anatomical and functional results after treatment of dislocated supracondylar fractures of the humerus in children.

From 1972 to 1983 105 patients were admitted with a dislocated supracondylar fracture of the humerus. The average follow-up was five years. In general the functional results of treatment were good. The anatomical results were less satisfactory, and most times concerned varus deformities of the elbow, which did not influence the elbow function. Lesions of arteries and nerves only occurred in seriously dislocated fractures. The isolated nerve injuries were reversible. Two patients developed a Volkmann's ischemic contracture; their case history is discussed. In 24 cases a second reduction was performed and/or a new therapy instituted. Closed reduction with plaster necessitated alteration of the therapy in 10 out of 23 cases. Based on this experience and the long average duration of hospitalization of 14 days, closed reduction under general anaesthesia with percutaneous K-wire fixation seems to be the treatment of choice.

Adolescent↗
PubMed1985

Fracture of the greater tubercle of the humerus in a filly.

A fracture of the caudal portion of the greater tubercle of the humerus was diagnosed in a 16-month-old Thoroughbred filly. Initially the fracture caused severe lameness. Radiography of the affected shoulder revealed the fracture fragment to be extra-articular, with a surrounding bony callus and no evidence of joint disease. After 5 weeks rest in a stall and 11 months at pasture, the filly was trained and raced without lameness.

Animals↗
PubMed1985

Surgical treatment of infected pseudarthrosis of the humerus.

The authors report 16 cases of infected lesions of the humerus with delayed consolidation or pseudarthrosis. The treatment consisted of radical surgical debridement, freshening of the bone fragments with removal of all necrotic tissue, and stabilisation with a Hoffmann-Vidal external fixation device. Healing occurred between 3 and 6 months after operation. The one case of failure was attributable to inappropriate technique (inadequate resection of the ends of the fragments).

Debridement↗
PubMed1979

Supracondylar fractures of the humerus. A comparative study of Dunlop's traction versus percutaneous pinning.

A retrospective comparative study was done of two groups of patients with displaced supracondylar fractures of the humerus. The patients in the first group were treated with Dunlop's traction, while those in the second group were treated by percutaneous pin fixation. There were thirty-six patients in the group treated with Dunlop's traction, of whom twenty-seven were seen in follow-up with an average time of 2.7 years. Twenty-eight patients were in the group treated with pin fixation, of whom twenty were seen in follow-up with an average time of 2.9 years. In each case the chart and roentgenograms were reviewed and the patient was examined. The results showed a 33 per cent incidence of cubitus varus (so-called gunstock deformity) in the patients treated with Dunlop's traction as compared with 5 per cent in those pinned percutaneously. The range of elbow motion was also slightly better in the group treated with pin fixation. Furthermore, the costs and hospital stays were significantly less in those treated by pinning. Complications in both groups were few.

Child↗
PubMedDate not supplied

[Complications of supracondylar fractures of the humerus in children].

Vascular, neurological and bony complications of sopracondylar fractures of the humerus in children are discussed in detail. A series of cases seen and treated at the Orthopaedic Clinic of the University of Padua are reviewed. Most cases were treated conservatively with good results. Neurological and vascular complications cleared completely, functional recovery was most satisfactory with minimal axis deviation after manipulation of the supracondylar area. In conclusion, conservative treatment remains the treatment of choice for this injury. Local conditions or complications can, in a very limited number of cases, require surgical intervention.

Adolescent↗
PubMed1979

[Percutaneous medial transcondylar osteosynthesis in supracondylar fractures of the humerus].

The authors describe their own method of fragments using Kirshner Wire in supracondylar extension fractures of the humerus. Of a total of 118 extension fractures 74 were of a III degree dislocation type. In 16 of these, the medial percutaneous fixation method was implemented. Indications for surgical intervention included those cases in which good positioning of the fragments could not be maintained due to edema, in cases in which flexion at the elbow caused a loss of the radial pulse, and in cases of manifested primary injury of the ulnar nerve. Following the repositioning of the fragments, 2--3 Kirshner wires were placed immediately above the olecranon along the medial line and through the lower and upper fragments. These wires were left in place for 14 days during which time the arm was kept immobilized. Rehabilitation was begun immediately following the removal of the wires. The end results were excellent and no early or late complications occurred.

Child↗