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At least 163 records · Page 9Linked to original sources
PubMed2004

Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year.

BACKGROUND: Proximal humeral fractures, particularly in osteoporotic patients, remain an unsolved problem as regards the durability of the osteosynthesis. The AO/ASIF group has developed a new technique which aims to preserve the biological integrity of the humeral head and secures the reduction using multiple locking screws with angular stability (Philos), thus allowing an early mobilization. PATIENTS AND OUTCOME: We retrospectively reviewed the complications and functional outcome after a minimum follow-up of 1 year in 72 patients treated with this new method. 2 fractures failed to unite, and 3 patients developed an avascular necrosis of the humeral head. In addition, 2 implant failures were observed due to a technical error. According to the Constant score, the functional outcome was acceptable even in elderly patients. INTERPRETATION: The Philos method appears to be safe and can be recommended for the treatment of proximal humeral fractures in patients with poor bone quality.

Adult↗
PubMed1999

[Experimental comparative study of 3 systems of osteosynthesis for proximal humeral fractures. Preliminary study of the mechanical properties of conserved trabecular bone].

PURPOSE OF THE STUDY: We have compared three systems for osteosynthesis of proximal humeral fractures on a four-fragment fracture model: Plate with tuberosity screwing (P), Kirschner wires with bone sutures (K) and an original implant, the "bilboquet" (Stryker) (B), composed of a hook for the head supported on a diaphyseal stem. MATERIAL AND METHODS: Because of the unavailability of fresh human material, we have turned to embalmed bones after having shown, on cancellous femoral head bone, the little influence of our method Vs freezing conservation. Settings were tested in compression. We measured their mechanical resistance judged on the ultimate strength and on the slope (displacement/load), to this limit. We similarly analyzed by video recording displacement of the different fragments according to four components (head slipping, its lateral displacement, its see-saw and the separation of tuberosities), to show the weak points of the three systems. RESULTS AND DISCUSSION: K was more deformable (p < 0.001) that P and B (average slopes in mm/100N to 0.67 for K, 0.42 for P and 0.43 for B). The ultimate strength differed but not significantly (average values in Newton to 1223 for K, 1601 for P and 1721 for B). We also showed for the three techniques, the significant correlation between slopes and bony densities. Video analysis showed that P opposed lateral displacement of the head and separation of tuberosities better, the resistance to slipping and see-saw seems to be improvable by greater divergence of screws or a modification of the plate (mini canon). B opposed slipping and see-saw better but its weak point was the risk of articular break-in of the hook, by defect of resistance to lateral displacement, that for us could be limited by a less peripheral position of teeth or a modification of their form. K is indeed the least effective of the four components but we think that it would be improvable by using, for example, a centro-medullary technique, allowing an internal cortical support.

Bone Density↗
PubMed2003

Internal fixation of displaced proximal humeral fractures with two one-third tubular plates.

BACKGROUND: Operative treatment of displaced proximal humeral fractures often results in poor functional outcome. We report a technique that provides improved rotational stability of the fracture and thus allows early functional treatment. METHODS: Seventy-one consecutive patients (67 +/- 18 years) with displaced fractures of the proximal humerus (two-part, n = 10; three-part, n = 41; four-part, n = 20) were treated by open reduction and internal fixation using two one-third tubular plates on the anterior and lateral aspects of the proximal humerus. Passive motion was started on the third postoperative day, followed by actively assisted exercises on day 6. RESULTS: Seven patients (12%) had complications (fracture redisplacement, avascular necrosis of the humeral head, frozen shoulder, subacromial impingement, and implant loosening) that required further surgical intervention. Sixty patients (85%) were available for follow-up evaluation 17 +/- 10 months after the injury. Using the Constant score, 34% of the patients had very good results, 29% had good results, 25% had fair results, and 12% had poor results. Age (< 60 years or > or = 60 years) and fracture type had no influence on functional outcome. CONCLUSION: These results demonstrate the high stability of internal fixation with two one-third tubular plates that allowed early mobilization of the shoulder in all patients and emphasize this technique as a preferred treatment option for displaced fractures of the proximal humerus.

Activities of Daily Living↗
PubMed2001

[Intramedullary interlocking nailing for humeral fractures: report of 38 cases treated by Russel and Taylor nail].

PURPOSE OF THE STUDY: We assessed outcome after intramedullary interlocking nailing for humeral fractures to identify problems and indications in comparison with reports in the literature. MATERIAL AND METHODS: We implanted the Russel and Taylor nail to treat 38 fresh humeral shaft non-pathological fractures using 33 anterograde insertions and 5 retrograde insertions. RESULTS: All patients were examined at a mean follow-up of 16.3 months. Problems and complications involved 3 open procedure conversion, 3 peroperative re-fractures, 2 locking errors, 2 secondary dismantelings, 2 regressive iatrogenic palsies, and 4 cases of pain due to protruding material. First intention bone healing was achieved in 34 cases and following a revision procedure in 2. Two cases of nonunion were not reoperated. The Neer and Constant scores, used to assess functional outcome, identified 5 non-satisfactory results. DISCUSSION: The risk of infection with locking nails is low, as is the risk of nervous complications which are generally related to traction manoeuvres during reduction. Bone healing is easily achieved if the assembly is perfectly stable. The risk of disassembly or nonunion is related to technical errors: defective locking, insufficient hold in the bone fragments. The risk of stiffness or rotator cuff tears is low, generally related to protrusion of the material and not to insertion through the cuff muscles. Retrograde insertion can be recommended for fractures of the distal third of the humeral shaft. CONCLUSION: Insertion of the Russel and Taylor intramedullary locking nail requires a learning curve to minimize the risk of iatrogenic complications. It can be proposed for fractures of the mid-third of the humeral shaft and can be discussed for the proximal and distal thirds if perfect stability can be obtained on the short bony fragment.

Adolescent↗
PubMedDate not supplied

Vascular injuries and their sequelae in pediatric supracondylar humeral fractures: toward a goal of prevention.

Between 1988 and 1994, 128 consecutive children with grade III supracondylar humeral fractures presented for treatment at our hospital. Seventeen had absent or diminished (detected with Doppler but not palpable) radial pulses on initial examination. Fourteen of these 17 children recovered pulse (palpable) after reduction and stabilization of their fractures. The remaining three had persistent absence of radial pulse. Each of these three children was explored immediately and found to have a significant vascular injury requiring repair. Two of the 14 children who had initially regained their pulses had a progressive postoperative deterioration in their circulatory status during the first 24-36 h, including loss of the radial pulse. Both of these children had arteriograms that identified vascular injuries. Both underwent exploration and bypass grafting. One of these two children had been transferred 48 h after injury, resulting in delay of management of his vascular impairment. Despite exploration, vascular repair, and fasciotomy, he ultimately developed Volkmann's ischemic contracture. All five children with significant vascular injuries had absent or diminished radial pulses on presentation. Immediate reduction and fixation followed by careful evaluation and treatment of ischemia were associated with excellent outcome in four of the five children.

Adolescent↗
PubMed1998

Treatment of humeral fractures by closed reduction and retrograde intramedullary Ender nails.

A retrospective review of 94 humeral shaft fractures stabilized with retrograde Ender nails was performed to determine the safety and efficacy of this technique. Follow-up averaged 71 weeks. Eighty-six (91.5%) healed with no additional intervention (average: 14 weeks). There were eight (8.5%) nonunions. The functional results were good in 74 (81%), fair in 12 (13%), and poor in 5 (6%). There was one radial nerve palsy secondary to the operative procedure. The reoperation rate, including the repair of nonunions, was 19%. We conclude that intramedullary Ender nail fixation is a relatively simple and quick procedure, especially for the multiply injured patient, that adequately stabilizes most humeral fractures, yielding overall good results.

Adolescent↗
PubMed1998

Use of an elastic intramedullary nail in difficult humeral fractures.

Debate continues over implant selection when surgical intervention is deemed necessary in the management of diaphyseal fractures of the humerus. We present a series of patients in which we used an elastic intramedullary nail to manage a variety of difficult humeral fractures and discuss the theoretical advantages which we feel this method offers.

Adolescent↗
PubMed2007

Intraoperative radiation exposure in displaced supracondylar humeral fractures: a comparison of surgical methods.

Crossed K-wires, descending elastic stable intramedullary nailing and radial external fixator are alternatives in the operative treatment of displaced supracondylar humeral fractures. Only little knowledge of intraoperative radiation exposure exists in those procedures. We found average image intensifier times of 30.7 s for K-wires, 41.4 s for the external fixator and 80.0 s for elastic stable intramedullary nailing. Extensively increased fluoroscopy times was seen in cases switched from closed to open reduction intraoperatively. To avoid unnecessary intraoperative radiation exposure for patient, surgeon and staff, limits of radiation time are recommended as an additional indicator to change the surgical procedure to another fixation method or open reduction.

Adolescent↗
PubMed2002

Intramedullary interlocking nail stabilisation of 21 humeral fractures in 19 dogs and one cat.

OBJECTIVE: To assess the suitability of the intramedullary interlocking nail to stabilise humeral diaphyseal fractures in dogs and cats. METHOD: This multi-centre study retrospectively examined medical records, between June 1994 and May 2001, of 19 dogs and one cat, in which a total of 21 humeral fractures were stabilised with intramedullary interlocking nails. RESULTS: Animals ranged in body-weight from 4 to 97 kg. Eighteen (86%) of the fractures were comminuted. Adjunctive stabilisation was used in twelve (57%) fractures and bone grafts in nine (43%) fractures. A rapid return of function was noted in the majority of animals, with 14 (67%) having good or excellent function within four days of surgery. In two fractures the repair collapsed when a single proximal transcortical screw was placed cranial to the tricipital line of the humerus. This suggests that if a single transcortical screw is placed proximally the screw should be distal or caudal to the tricipital line in order to engage sufficient cortical bone. Eighteen (86%) of the fractures healed when stabilised with intramedullary interlocking nails. Three fractures did not heal. One was in a dog where a pathological fracture was temporarily stabilised with an intramedullary interlocking nail, one in a dog that died of an abdominal crisis three weeks after surgery and one in a dog in which fracture stabilisation collapsed due to incorrect implant selection. CONCLUSION: Intramedullary interlocking nails are well suited to the stabilisation of humeral diaphyseal fractures in dogs and cats.

Animals↗
PubMed1993

K-wire fixation of supracondylar humeral fractures in children: results of open reduction via a ventral approach in comparison with closed treatment.

The morbidity and functional outcome of K-wire fixation of dislocated supracondylar humeral fractures in children after open reduction through a ventral approach were studied, using the results after closed reduction as a golden standard. A series of 49 children were evaluated retrospectively. Of these, 46 children could be included in the study, of whom 35 were treated with closed reduction (group A) and 11 were treated with open reduction via a ventral approach (group B). All fractures were splinted in plaster for 3 weeks postoperatively. Thereafter free active motion of the elbow was permitted. Our data show that open reduction via a ventral approach carries no morbidity. The time for full functional recovery was equal in both groups. Only one out of 11 patients showed mild varus deformity after open reduction, while this slight malalignment occurred in five of 35 patients after closed reduction. The final anatomical and functional results did not differ between the two groups. It can be concluded that K-wire fixation of dislocated supracondylar fractures in children gives excellent results and that open reduction via a ventral approach is a logical, safe and elegant alternative, if closed reduction fails.

Adolescent↗
PubMed1988

Healing of transverse humeral fractures in pigeons treated with ethylene oxide-sterilized, dry-stored, onlay cortical xenografts and allografts.

Transverse humeral fractures were created in adult male pigeons (Columbia livia). They were bridged with an allograft or a xenograft, or they were allowed to heal without treatment. Tissues were examined for wound healing, bony union, infection, and sequestration of the graft at 28, 43, 85, 106, and 168 days after surgery. Neither allografts nor xenografts contributed to nor interfered with bone healing. In nontreated pigeons (controls), bony union with marked callus formation developed between misaligned fragment ends. When onlay grafts were used, bone fragments remained aligned, with minor callus formation. There was a significant (P = 0.0001) increase in the number of wounds opening after surgery and infections of the surgical site (xenograft, P = 0.0026; allograft, P = 0.0021) associated with graft use. A significant (P = 0.0001) frequency of graft sequestration was observed, regardless of graft type. A significant (P = 0.0001) frequency of foreign body reaction also was observed. Under these circumstances, the application of a graft should be considered as an alignment device, rather than a stimulus to healing.

Animals↗
PubMed2005

Best evidence topic report. Humeral fractures and non-accidental injury in children.

A short cut review was carried out to establish whether proximal humeral fractures in children are indicative of non-accidental injury. Altogether 44 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

Child Abuse↗
PubMed2001

[Conservative treatment of dislocated proximal humeral fractures].

Between 11/1989 and 6/1998 52 patients (10 m., 42 f., age median 72 years, 31-88) with proximal humeral fractures have been treated by conservative means (angulation of humeral head > 45 degrees and/or shaft displacement > 1 cm and displacement of greater tuberosity > 0.5 cm). In 37 patients (71%, 31 f., 6 m., age median 75 years, 36-88) a clinical and radiological follow-up could be obtained after median 20 months (3-93). According to the Neer-classification, subcapital 2-part fractures were found in 19 cases and 3-part fractures in 12 cases. 4-part fractures were diagnosed in 6 cases. By using the Constant-Score, the final result was scored "excellent" in 10 patients and "good" in 13 patients. In 7 patients each the results achieved were "moderate" or "poor". The underlying cause for the poor results was primarily due to persisting painful impairment in range of motion and loss of strength. Radiologically, persisting axial deviation was present in 23 cases, arthrosis in 14 patients and humeral head necrosis in 8 patients. Most commonly, poor functional and radiological results occurred in 4-part fractures. However, conservative therapy of displaced 2-part and 3-part fractures is a considerable therapeutical option since the final results are predominantly good. In contrast, due to the poor results after conservative therapy 4-part fractures should be treated surgically.

Adult↗
PubMed1994

A biomechanical analysis of four humeral fracture fixation systems.

A biomechanical study was initiated to compare four fracture fixation devices: the AO dynamic compression plate, a distal fin locking nail, a solid locked intramedullary nail, and paired flexible nails for humeral fracture fixation. Eighteen pairs of fresh-frozen, intact humeri were harvested, standardized midshaft transverse osteotomies were created in each specimen, and left and right specimens were fixed with plates and nails, respectively. The bending properties of the plate-fixed humeri were significantly greater than the nailed humeri in both the anteroposterior and mediolateral planes on a paired basis. The distal fin nail and solid locked nail had comparable bending properties, and both had bending properties superior to those measured for the paired flexible nails. The torsional properties of humeri fixed with plates and solid locked nails were equivalent, except for rigidity and stiffness, which were superior for the nail. Both fixation methods resulted in torsional properties significantly greater to those measured for humeri fixed with paired flexible nails or a distal fin nail.

Biomechanical Phenomena↗
PubMed2005

The treatment of proximal humeral fractures with intramedullary titanium helix wire by 97 patients.

INTRODUCTION: The displaced proximal humeral fracture continues to be a problem and remains the "unsolved fracture". Many guidelines for surgical treatment of different types of these fractures have been described. A conservative functional therapy is recommended as well as a closed or open reposition and internal fixation. Other authors prefer the primary prosthetic replacement of the displaced humeral head. The purpose of this article is to describe a minimal invasive technique--the intramedullary titanium helix wire--and to analyse results and specific problems of this method compared to other techniques. MATERIALS AND METHODS: In a prospective study done over a period of 5 years from 1998 to 2002, 97 patients with two-, three- and four-part-fractures of the proximal humerus were treated with the intramedullary titanium helix wire and given follow-up clinical and radiological checks after 12 months. The functional outcome was evaluated with a 1-year follow-up in 95 of 97 patients. RESULTS: Our 1-year results include: 41 very good, 24 good, 16 satisfactory, 14 poor (average 76 points Constant functional score, 30.7 points UCLA score). CONCLUSION: The advantages of the method arising from the results lie in both the simple operation approach without nerve lesions or wound infections, and also in the indirect, intramedullary splinting of the fracture without damage to the surrounding soft parts, while iatrogenic necroses of the humeral head can be avoided.

Aged↗
PubMed1997

Poor reproducibility of classification of proximal humeral fractures. Additional CT of minor value.

Fractures of the proximal humerus can be described using the Neer and AO fracture classifications. To assess the reproducibility and reliability of these classifications, we investigated 26 proximal humeral fractures with both plain radiographs and CT. 5 specialists in orthopedic surgery and 5 specialists in radiology independently classified all radiographs on 2 occasions. There was a moderate agreement between the observers when using the Neer classification, but only a fair agreement with the AO classification. The Neer system had a kappa value of 0.42 and the AO had a value of 0.31 in the first assessment. In the second assessment the kappa values were 0.45 and 0.30, respectively. Intraobserver reproducibility was slight to almost perfect agreement with Neer (kappa range 0.20-0.85) and slight to moderate agreement with AO (kappa range 0.16-0.60). The observers most familiar with shoulder fracture radiographs and shoulder fracture treatment were more consistent in their classifications. We conclude that even with CT, the fracture classifications of Neer and AO have a low consistency. Neither classification system is reproducible enough to allow comparisons of different studies.

Humans↗