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PubMedDate not supplied

Bicipital groove orientation: considerations for the retroversion of a prosthesis in fractures of the proximal humerus.

The bicipital groove anatomy is well documented, and this groove is used as a landmark to guide retroversion during implantation of a shoulder prosthesis. Whereas the proximal part of the groove is used in osteoarthritis, the distal part is used in fractures. If used in 4-part fracture cases, we must assume that the bicipital groove orientation is constant from proximal to distal. We measured the groove orientation in 40 cadaveric humeri using 3 superimposed computed tomography sections. The reference axis was the transepicondylar axis at the elbow level. The measured angle of the bicipital groove was 55.8 degrees +/- 4.5 degrees at the anatomic neck and 65.1 degrees +/- 3.5 degrees at the surgical neck. This difference (mean of 9.3 degrees, with extremes of -3 degrees and 22.5 degrees) was statistically significant. We confirmed a wide range of variation from 22 degrees to 89 degrees in the orientation of the groove. Because the values listed in the literature for lateral fin placement of a prosthesis have not been measured at the surgical neck level and because of the great variation in groove orientation, we caution surgeons about the use of the bicipital groove as a reliable landmark in shoulder replacement for fractures. Considering the risk of over- or under-retroversion of the prosthesis, we recommend the use of a fracture jig with retroversion set to 20 degrees.

Arthroplasty, Replacement↗
PubMed2001

Retrograde fixation of fractures of the neck and shaft of the humerus with the 'Halder humeral nail'.

The Halder humeral nail is a new intramedullary device designed for displaced two part humeral neck and shaft fractures. It is inserted retrograde from the olecranon fossa and a unique trio wire is inserted through the nail to provide good proximal fixation. This avoids the use of proximal screws and damage to the rotator cuff thereby ensuring good rotator cuff function. The results of 100 cases are presented. At 6 weeks, 95 patients could perform the majority of daily tasks. There were four non-unions, one following a deep infection.

Adult↗
PubMed1998

Olecranon screw traction for displaced supracondylar fractures of the humerus in children.

Twenty six children with severely displaced supracondylar fractures were treated with closed reduction and vertical osseous traction with an olecranon screw. Four children required a second operation in the form of open reduction and K-wire fixation for failure to achieve a satisfactory reduction. After a mean follow up of 48 weeks, 20 children (91 per cent) had an excellent result with no significant loss of movement. Two children (9 per cent) had minimal cubitus varus (av. 8 degrees) which did not require a corrective osteotomy. All four children who had a second operation had an excellent result. The average hospitalisation time was 19 days. The method of olecranon screw traction is technically easy to perform and carries few risks of complications.

Bone Screws↗
PubMed2003

Tumor implantation in mouse humerus evokes movement-related hyperalgesia exceeding that evoked by intramuscular carrageenan.

In this paper we compare two innovative models of movement-related pain: tumor-induced nociception following implantation of fibrosarcoma cells into bone and muscle inflammation-induced nociception following injection of the irritant carrageenan into muscle. Importantly, using the grip force test, an assay of movement-related hyperalgesia, both non-malignant and malignant pain are examined in parallel. Movement-related hyperalgesia, known clinically as a specific type of 'breakthrough pain', is a common feature of bone cancer and is thought to be a predictor of poor response to conventional analgesic pharmacotherapy (Bruera et al., 1995, J. Pain Symptom. Manage. 10 (1995) 348; Mercadaute et al., 1992, Pain 50 (1992) 151; Pain 81 (1999) 129). Implantation of NCTC 2472 sarcoma cells in both humeri or injection of carrageenan (4%) in both triceps of C3H/He mice produced apparent forelimb hyperalgesia that was not associated with mechanical hyperalgesia in the forepaw, whereas carrageenan at 6 and 8% did evoke significant cutaneous hyperalgesia of the forepaw as well. Control groups receiving implants of vehicle or no treatment at all did not manifest this forelimb hyperalgesia. B6C3/F1 mice implanted with non-lysis-inducing G3.26 melanoma cells or vehicle did not manifest significant hyperalgesia when compared to B6C3/F1 mice receiving fibrosarcoma cells, indicating a dependence on bone involvement for induction of hyperalgesia in this model. Histological examination at days 3, 7, and 10 post-implantation showed a clear correlation of tumor growth-induced bone destruction with behavioral hyperalgesia. Morphine was more potent in decreasing the maximal hyperalgesia induced by carrageenan than that induced by tumor implantation. Acutely administered morphine (3-100mg/kg, i.p.) attenuated peak hyperalgesia of carrageenan-injected mice (ED(50) 6.9 mg/kg) and tumor-bearing mice (ED(50) 23.9 mg/kg) in a dose-related manner with a difference in potency of 3.5. Tumor-implanted mice with a level of hyperalgesia comparable to that induced by carrageenan required almost three times more morphine (ED(50) 18.5mg/kg) for equivalent attenuation of forelimb hyperalgesia. These animal models of movement-related hyperalgesia may aid in discerning the peripheral and central mechanisms underlying pain that accompanies bone metastases and distinguishing it from the pain associated with muscular inflammation. Importantly, they may also aid in predicting differences in analgesic efficacy in different types of musculoskeletal pain.

Analgesics, Opioid↗
PubMed1991

Reconstruction of the humerus by soft tissue distraction and vascularized fibula transfer.

We report a case of reconstruction of the humeral shaft by soft tissue lengthening according to the method of Ilizarov, followed by skeletal reconstruction with a vascularized fibular graft. Skeletal union and initiation of functional activity were achieved within 4 months. Lengthening of the soft tissue and the vascular tree by slow distraction did not compromise the subsequent reconstructive microsurgical procedure.

Adult↗
PubMed1998

Handedness identification from intertubercular sulcus of the humerus by discriminant function analysis.

The accurate determination of skeletal handedness is a critical requirement in physical anthropology and forensic science. To differentiate handedness, discriminant function analysis is applied using the parameters of right and left intertubercular sulci. A total of 200 matched unpaired adult humeri (100 right and 100 left), collected from the Department of Anatomy, were used to measure four parameters of the intertubercular sulcus namely, width (X1), depth (X2), angle of medial wall (X3) and angle of lateral wall (X4) and to note the presence of supratubercular ridge of Meyer (X5). The discriminant function obtained with the significant variables, angle of medial wall (X3), angle of lateral wall (X4) and presence of the supratubercular Meyer (X5) is: Y = 0.093X3 + 0.056X4 + 0.775X5 - 13.46. The accuracy of correct classification using the discriminant function is 89% which is the best starting point for handedness determination approach. The methodology of using discriminant function can be crucial for medicolegal jurisprudence.

Adult↗
PubMed1996

Fractures of the humerus.

The treatment of humeral fractures in ruminants remains a challenge to the large animal surgeon. Often the recommendation is to euthanize the animal. This article reviews four different treatment techniques: stall confinement, intramedullary pinning, interlocking nails, and plate fixation. Clinical cases are drawn from both the literature and personal experience to demonstrate the potential application of each treatment modality.

Animals↗
PubMed1989

[Osteosynthesis using the "palm-tree" nail technic in fractures of the surgical neck of the humerus].

Presented in 1974, this technique consists of internal fixation of the humeral neck by means of three divergent K-wires. These are introduced through a proximal entry point located on the lateral aspect of the humeral diaphysis at the lower end of the "V" shaped insertion of the deltoid which is one of the three subcutaneous areas of this bone. The two principles of this technique are: anchorage of the epiphysis by three divergent pins driven into the cancellous bone of the head and introduction of the pins from a very proximal point that allows easy access across the fracture without the disadvantages of nerve and joint proximity, as in other techniques involving other pins through the olecranon fossa (April), or medial epicondyle or lateral (Vichard). Moreover, this technique is quite different from the Hackethal technique by nails introduced through the olecranon fossa. An oblique hole is drilled at the selected point, and three 2 mm K-wires, after bending their ends are introduced into the medullary canal. After reduction of the fracture, they are driven into the cancellous humeral head bone. By turning the handle, the pins are made to diverge. Exceptionally, operative reduction is necessary by a separate axillary approach. X-ray control or the use of an image intensifier permits one to see if a K-wire is too long and to pull it out somewhat. No cast, no operation splinting, is used. Active and passive mobilization is possible the next day so the functional results are excellent in most cases. Pin removal is possible after 3 weeks in children and 5 in adults. The indications are all the upper extremity humeral fractures, and especially in children (epiphyseal fractures); in adults and aged people, except comminuted fractures.

Adolescent↗