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PubMed1994

[A simple method for stabilizing the supracondylar humerus fracture].

Supracondylar fracture of the humerus occurs most often in fairly young persons. The incidence rate decreases during adolescence and is then seen to an increased degree again at an advanced age. Conservative treatment of this fracture leads in elderly patients often to restricted function of the elbow and shoulder. Even operative fixation by means of screws in combination with a semitubular or DC plate may be associated with difficulties. Combined use of tension banding and drill wiring is a good alternative.

Adolescent↗
PubMed1994

Intercondylar fractures of the distal humerus: routine anterior subcutaneous transposition of the ulnar nerve in a posterior operative approach.

Intercondylar fractures of the distal humerus in adults are rare and notoriously difficult to treat. The goals of open reduction are to preserve the articular surface and restore elbow function. We treated 20 patients by open reduction with dual-plate internal fixation and routine anterior subcutaneous transposition of the ulnar nerve. The follow-up period ranged from 15 to 35 months. The fractures were classified according to Muller's system. The results were evaluated using the Cassebaum rating system and subjective functional status. Excellent or good results were achieved in 15 elbows (75%), two had a fair result, and three, poor. A clearer understanding of fracture patterns, rigid dual-plate internal fixation, and early rehabilitation are needed to improve the results from this vexing injury. We recommended routine ulnar nerve anterior subcutaneous transposition using a posterior approach. Compared with published reports, our preliminary results demonstrated no postoperative ulnar nerve compression syndrome at follow-up. Routine anterior subcutaneous transposition of the ulnar nerve to avoid the postoperative ulnar nerve compression syndrome is required.

Adult↗
PubMed1994

Reconstruction after malunion and nonunion of intra-articular fractures of the distal humerus. Methods and results in 13 adults.

We reviewed the results of 13 adults of secondary reconstruction of malunited and ununited intraarticular distal humeral fractures. Their average age was 39.7 years, and preoperatively all had pain, loss of motion and functional disability; the average arc of motion was only 43 degrees and the average flexion contracture was 45 degrees. Nine patients had ulnar neuropathy. Elbow reconstruction, at an average of 13.4 months after the original injury, included osteotomy for malunion or debridement for nonunion, realignment with stable fixation and autogenous bone grafts, anterior and posterior capsulectomy and ulnar neurolysis. The elbows were mobilised 24 hours postoperatively. There were no early complications and all nonunions and intra-articular osteotomies healed. After a mean follow-up of 25 months, the average arc of motion was 97 degrees with no progressive radiographic degeneration. Ulnar nerve function improved in all cases and clinical assessment using the Morrey score showed two excellent, eight good and three fair results. Reconstruction of intra-articular malunion and nonunion of the distal humerus in young active adults is technically challenging, but can improve function by restoring the intrinsic anatomy of the elbow.

Adolescent↗
PubMed1994

Supracondylar humerus fractures. Current trends and controversies.

Supracondylar fractures of the humerus are one of the largest sources of serious problems and treatment controversy in childhood fractures. Improved understanding of the injuries to both the bone and soft tissue has contributed to improved outcomes. These fractures remain challenging to even the most experienced physician. This article reviews the pertinent biomechanics, outlines treatment principles, illustrates our reduction and percutaneous pin fixation technique, and highlights the major areas of controversy.

Biomechanical Phenomena↗
PubMed1994

Tension-band wiring supplemented by lag-screw fixation of proximal humerus fractures: a modified technique.

Many of the current techniques of internal fixation of proximal humerus fractures employ tension-band wires to achieve secure fixation, allowing immediate postoperative exercise of the affected limb. The addition of a cancellous lag screw placed from the humeral shaft into the humeral head may have several advantages. In particular, this lag screw does not violate the subacromial space and provides for impaction and initial stability between the head and shaft. The technique described herein has been used in 13 patients aged 54 to 86 years with two- and three-part fractures. This technique uses a deltopectoral approach with manual impaction of the humeral head and shaft. A 6.5-mm AO screw is used for lag-screw fixation, and two 18-gauge stainless steel wires are passed beneath the rotator cuff and secured to the shaft distally through drill holes. Passive range of motion of the involved shoulder is begun on postoperative day 1, and active range of motion and strengthening are allowed after the fourth postoperative week. Tension-band wiring combined with lag-screw fixation affords sufficient fracture stability to allow early, aggressive rehabilitation. As a method of internal fixation, this technique may have particular advantages in elderly patients with osteoporosis.

Age Factors↗
PubMed1993

[Plate osteosynthesis of the diaphyseal humerus shaft. Indications--risks--results].

Fractures of the shaft of the humerus can be treated conservatively with very good results. In certain situations operative treatment is mandatory. Between 1984 and 1989 25 diaphyseal upper arm fractures were treated operatively, mostly via plate osteosynthesis. The indications for operation in the first place were primary nerve lesions, open fractures and patients with polytrauma for easier nursing. In 24 cases very good and good functional results were achieved. Nevertheless two transitory paresis of the radial nerve due to the operation are mentioned. Possibilities and limits of the conservative and operative treatment of upper arm fractures are discussed.

Adult↗
PubMed1994

Deformity after internal fixation of fracture separation of the medial epicondyle of the humerus.

We reviewed 24 displaced fractures through the physis of the medial epicondyle of the distal humerus. One was a Salter-Harris type-II fracture-separation of the whole distal humeral epiphysis; the others involved only the medial epicondylar centre of ossification. Two cases had presented as pseudarthroses. One fracture had been treated closed in a plaster slab and 21 had had open reduction and internal fixation with sutures, Kirschner wires or Palmer nails. At 2 to 13 years later we found five types of deformity of the epicondyle: pseudarthrosis, an ulnar sulcus, a double-contoured epicondyle, hypoplasia or hyperplasia. Pseudarthrosis had developed after either no treatment, closed reduction and plaster, or open reduction and suturing. Hypoplasia followed nailing, as did a trend to varus tilting of the joint surface. One very young patient, with fracture-separation of the whole distal epiphysis treated by nailing, developed marked cubitus varus.

Adolescent↗
PubMed1993

The dinner fork technique for treating displaced lateral condylar fractures of the humerus in children.

A simple, inexpensive fracture-reduction instrument and guide for Kirschner wire insertion can be constructed using a "dinner fork" and pliers. The modified dinner fork is particularly useful as an aid for reducing, compressing, and fixing displaced lateral condylar fractures of the distal humerus in children. This device is effective and simple to use; it can be applied to other pediatric fractures as well.

Bone Wires↗
PubMed1994

[Results of closed pinning of supracondylar humerus fractures using Kirschner wires].

In the Department of Traumatology of the County Hospital "Kaposi Mór" 150 children with supracondylar fracture of humerus were treated during 10 years (1980-1989). 119 cases reduced and pinned with percutaneous Kirschner wire are dealt with. 98 cases could be controlled 2-10 years after the accident. The importance of urgent treatment is stressed. The urgent reduction and the closed pinning with Kirschner wire are thought to be an efficient prophylaxis against Volkmann's ischaemic contracture and varus deformity, caused by secondary movements.

Age Factors↗
PubMed1976

[Supracondylar fracture of the humerus in childhood. Complications, possibilities of treatment and late results (author's transl)].

At the Chirurgische Universitätsklinik Köln-Lindenthal, 103 children were treated for supracondylar fracture of the humerus from 1955 to 1975. The method of choice for treatment was Baumann's vertical suspension. Lesions of the brachial nerve were found to be the primary complication in 7% of the children and circulatory disorders in 10%. While the nerve injuries were treated conservatively, except for one case, 9 children had to be operated on because of ischemia of the forearm. The circulatory disorders could be rectified by thrombectomy and reconstruction of the brachial artery. In one child in whom the indication for operative revision in good time was missed, an ischemic muscle contracture developed.

Adolescent↗
PubMed1993

Supracondylar fractures of the humerus in children. Technique and results of crossed percutaneous K-wire fixation.

Displaced extension type supracondylar fractures of the humerus are associated with neurovascular injuries and malunion (cubitus varus). Reduction is not usually difficult during the first few hours, but it is a problem to maintain. After reduction, the shoulder is placed in abduction external-rotation with the elbow flexed under the C-arm. This position locks the proximal segment of the fracture, and the posteromedially rotated distal segment can then be brought back into an anatomic position under the "medial pillar." In this position, an excellent lateral view is obtained and the "fish tail" deformation can be corrected. Crossed percutaneous K-wires are introduced to maintain reduction. An anteroposterior radiograph can then be freely obtained, and there is no need for hyperflexion at the elbow. Twenty-six children were treated between 1987 and 1992. Excellent results were obtained.

Bone Wires↗
PubMed1977

Rush pin intramedullary fixation for fractures of the proximal humerus.

We have treated almost 700 proximal humeral fractures, and selected from them a series of 16 cases which required operative intervention in the form of semiclosed reduction and internal fixation with the Rush pin because of the marked amount of displacement and risk on nonunion. We favor the 3/16 inch Rush pin for this operation. Fractures of the surgical neck comprise the vast majority of cases operated upon in this series. They are the easiest to reduce and fix by the Rush pin technique. Certain comminuted severely displaced fractures involving the anatomic neck of the humerus and/or greater and lesser tuberosities also lend themselves to this operation with comparable results to other methods of treatment. There have been no postoperative motalities and minimal morbidity. The operation can be performed rapidly and requires only a short period of immobilization and hospitalization.

Adolescent↗
PubMed1993

[Interlocking nailing of the humerus].

Within a 3-year period a total of 42 humeral fractures were treated. Nineteen of these were operated on with the Seidel intramullary interlocking nail. Most of the fractures could be classified into group A (AO classification); three type B and four type C fractures occurred. Two patients had pathological fractures due to bone metastases. Mean hospital inpatient treatment was 24 days. Besides two infections seven system-specific complications occurred. A discrepancy between the diameter of the nail and the width of medullary cavity was the reason in one case for an additional fracture and in another case for nonunion because of loosening of the nail tip in the distal fragment. Three further intraoperative fractures occurred during impaction of the nail, the reasons are also device-specific and are carefully analyzed. In two cases we were forced to remove the nail because of subacromial impingement due to an overranging proximal nail end. Finally, a normal intraoperative and postoperative course with good functional results could only be observed in approximately half the cases. Thus, our initial optimism with respect to the outstanding theoretical concept was dampened, so that the interlocking humerus nail is now just applied in pathological shaft fractures.

Adult↗
PubMed1993

[Osteosynthesis of subcapital humerus fracture with unconventionally applied implants].

The osteosynthesis of proximal humerus fractures with the commonly used plates is often critical because of the small space subacromial, the irritation of the blood supply by the broad plates and the poor proximal anchorage without angle stability. The osteosynthesis with a children hip plate or a angle plate like modified DC-plate is thought to be a reliable alternative.

Adult↗
PubMed1993

Bicondylar intraarticular fractures of the distal humerus in adults.

Bicondylar intraarticular fractures of the distal humerus, because of their rarity and often associated significant displacement, comminution, and osteopenia, present the orthopedist with a difficult injury to reliably treat successfully. As with any displaced intraarticular fracture, the principles of anatomic restoration of the articular surface, stable fixation, and early motion are the optimal treatment goals. To obtain reproducible results, an established treatment protocol is required and is described in detail here. The average excellent-to-good results with surgical treatment for Type C fractures ("T" or "Y" bicondylar fractures) is 75% (range, 65-100%). Complications include heterotopic ossification (4%), infection (4%), ulnar nerve palsy (7%), failure of fixation (5%), and non-union (2%).

Adult↗
PubMed1995

[Osteosynthesis of subcapital humerus fractures with unconventional use of implants].

The osteosynthesis of subcapital humerus fractures with the commonly used plates is often critical because of the little space subacromial, the irritation of the blood supply by the broad plates and the poor proximal anchorage without angle stability. The osteosynthesis with blade plates (children hip plate or blade plates for small adults) for isolated subcapital fractures or a blade plate like modified DC-plate for subcapital fractures with a shaft component or severe osteoporosis is thought to be a reliable alternative. We treated 34 patients aged between 18 and 85 years (mean 44 years) with blade plates. 33 patients had a good fracture healing and subjectively free shoulder motion after 3 months. One patient had distal implant loosening because of insufficient medial contact. The fracture healed after refixation.

Adolescent↗