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At least 163 records · Page 9Linked to original sources
PubMed2005

A Mid-Upper Palaeolithic human humerus from Eel Point, South Wales, UK.

We report here on a human humerus directly dated to 24,470 +/- 110 BP, placing it within the Gravettian, or Mid-Upper Palaeolithic. The partial humerus is an isolated find and can be attributed (with some caution) to the Pleistocene 'bone cave' of Eel Point on Caldey Island, Wales (UK). The humerus is probably male, similar in robusticity to other Gravettian right humeri. The apparent absence of stone tools and presence of hyaena bone and coprolites suggest that the element may not derive from an intentional burial. After a maxilla from Kent's Cavern and the Gravettian Paviland 1, Eel Point represents the third oldest anatomically modern human known from Britain. Stable carbon and nitrogen isotope measurements do not support certain use of marine foods but highlight the need for more research on contemporary faunal remains in order to better interpret human values from this period.

Adult↗
PubMed2003

Straining of the intact and fractured proximal humerus under physiological-like loading.

Surgical treatment of proximal humeral fractures remains challenging in elderly patients, primarily due to insufficient implant fixation. Both bone quality and physiological-like loading conditions are commonly overlooked during pre-clinical in vitro evaluation. However, this knowledge is necessary in order to improve surgical treatment of the proximal humerus and the mechanical behavior of implants, particularly in patients with complex fractures and weak bone stock. We hypothesize that the bone quality has a high influence on the bone straining, independent of the arm position. The goal of this study was to determine the straining of the intact and fractured proximal humerus under physiological-like loading conditions. Furthermore, the impact of augmentation on tissue straining was evaluated. Two representative humeri were selected for this study, one osteoporotic and one reference quality, and scanned using both QCT and DEXA (average DEXA value=0.26 and 0.49 g/cm2 respectively). Subcaptial defects were generated, then stabilized with a plate prior to mechanical stiffness testing. From the QCT data, finite element models were generated and the in vitro stiffness tests analytically simulated. Under physiological-like loading conditions, the straining of the bone and implant were analyzed for 0 degrees, 90 degrees forward flexion, and 90 degrees abduction. Maximal strain values were found for the intact and fractured bone at 90 degrees abduction. This study demonstrates that the straining in a fractured bone of poor quality leads to considerably higher bone strains (up to +30%) than in a more healthy bone. Augmentation of a central void under physiological-like loading with commercial cement led to mechanical failure at the bone-cement interface. New concepts for the surgical treatment of complex fractures of the proximal humerus should take bone distribution into account and thereby allow effective treatment of fractures in osteoporotic patients. The ultimate salvage procedure of augmentation has mechanical limitations as long as current cement materials are used in osteoporotic patients.

Activities of Daily Living↗
PubMed2005

[Shoulder arthrodesis with vascularized fibular graft after tumor resection of the proximal humerus].

PURPOSE OF THE STUDY: Resection of malignant tumors of the proximal humerus often requires dissection of the rotator cuffs and the deltoid muscle. There is no consensus on the ideal method for shoulder reconstruction. We report the functional outcome in a homogeneous series of eight patients treated by arthrodesis using a vascularized free fibular flap. MATERIAL AND METHODS: Eight patients were included in this study. All had an aggressive tumor of the upper humerus. Tumor resection was associated with a rotator cuff and deltoid muscle resection in all patients. All patients then underwent shoulder arthrodesis using a free vascularized fibular flap fixed with a plate. Clinical and radiological evaluation was available for six patients at mean 28 months. The Musculoskeletal Tumor Society function score was used to assess overall function of the upper limb. The cosmetic outcome and radiographic bone healing as well as hypertrophy of the fibular graft were noted. RESULTS: Active abduction and active flexion were 82 degrees on average. All patients could bring their hand to the mouth. Circumduction was possible but limited in amplitude. The mean function score was 26.5/30 with an excellent functional outcome in all patients. The cosmetic outcome was considered poor by all patients. Radiographically, bone healing was achieved at last follow-up in all patients but there was one case of failed fusion between the fibular graft and the scapula which required secondary iliac grafting. Mean fibular graft hypertrophy was 32.8% at last follow-up. DISCUSSION AND CONCLUSION: Two reconstruction methods have been described for patients who require tumor resection of the upper humerus: reconstruction with preservation of glenohumeral joint function and shoulder arthrodesis. Many techniques have been described for each method. It is however difficult to compare the different series reported in the literature because rotator cuff and deltoid muscle resection was not systematically performed and reconstruction methods varied between patients. An analysis of the literature shows that preservation of motion of the scapular glenoid joint can give good functional results when the rotator cuff and deltoid muscle can be preserved. If they cannot, results favor shoulder arthrodesis which provides the patient with very satisfactory upper limb function. Use of a vascularized fibular flap has provided very good arthrodesis results. The patient must however be informed of the probable poor final cosmetic result.

Adolescent↗
PubMedDate not supplied

Nonunions of the surgical neck of the humerus: surgical treatment with an intramedullary bone peg, internal fixation, and cancellous bone grafting.

Twenty patients with pseudarthrosis of the upper humerus underwent surgery with the intramedullary bone peg technique. A 6 to 10 cm corticocancellous autogenous bone graft (11 iliac crest, 6 anterior tibial crest, 3 middle-third of the fibula) was pegged] into the humerus and bridged the pseudarthrosis. Stability of the fracture site was obtained by plate osteosynthesis; an additional peripheral cancellous graft was performed. Our patient series included 15 women and five men with an average age at operation of 58 years; the dominant side was involved in 12 cases. Eleven had undergone 22 previous operations. The average delay between fracture and surgery was 12 months, (range 6 to 72 months). The patients were monitored an average of 42 months (range 12 to 120 months). Union was confirmed in 19 cases; the last case demonstrated no peripheral callus. No necrosis of the humeral head was seen. Active anterior elevation of the shoulder improved from an average of 60 degrees to an average of 131 degrees. According to Constant's scale adjusted according to age and sex, the results obtained averaged 81.2%. Subjectively, 65% of patients were very satisfied, 30% were satisfied, and 5% were disappointed. The rate of union (96%) is in contrast with the results reported in the literature, underlining the importance of an intramedullary bone graft in association with peripheral osteosynthesis in the treatment of pseudarthrosis of the surgical neck of the humerus.

Adult↗
PubMedDate not supplied

Valgus osteotomy of the humeral neck: a technique for the treatment of humerus varus.

Proximal humerus varus is defined by both its radiographic and clinical characteristics. Clinically significant humerus varus has a proximal humeral neck-shaft angle less than 140 degrees and causes limited active abduction or forward flexion as a result of impingement of the greater tuberosity on the acromion. Weakness of the shoulder girdle is often present as well. The condition may be congenital, developmental, idiopathic, or posttraumatic in origin. Previous treatments for humerus varus have included acromionectomy and wedge osteotomy with placement of the extremity in a shoulder spica cast. This article describes a technique for treatment involving valgus osteotomy of the humeral neck and tension-band fixation. Correction of the deformity allows markedly improved function of the extremity with significant increases in active and passive abduction, forward flexion, and internal rotation.

Adolescent↗
PubMed2003

Low-grade fibrosarcoma of the proximal humerus.

We present the clinical, radiographical and pathological features of low-grade fibrosarcoma of the left proximal humerus in a 23-year-old man in whom it was necessary to distinguish the tumor from desmoplastic fibroma, malignant fibrous histiocytoma and intramedullary well-differentiated osteosarcoma. The patient presented with a 10-day history of pain in his left upper arm sustained when trying to break his fall with his left hand when slipping in the street. Plain radiography revealed an expanding multilobular osteolytic lesion from the proximal metaphysis to the diaphysis of his left humerus, accompanied by a pathological fracture at the distal portion of the lesion. Open biopsy of the lesion was performed twice; however, a conclusive diagnosis could not be obtained. The patient underwent wide excision and prosthetic replacement of the left proximal humerus. Histologically, the resected tumor was composed of both cellular areas and hypocellular areas. Cellular areas revealed a proliferation of bundles of uniform fibroblastic spindle-shaped cells with minimal cellular atypia, mixed with abundant intercellular collagenization. Mitotic figures were occasionally seen. Hypocellular areas showed myxoid features with loose bundles of collagen fibers. The patient demonstrates no evidence of disease 42 months after surgery. It is important to detect the scant atypical cells for the differential diagnosis of low-grade fibrosarcoma and desmoplastic fibroma of bone.

Adult↗
PubMed2002

[Age- and gender-related distribution of bone mineral density and mechanical properties of the proximal humerus].

PURPOSE: To evaluate age- and gender-related mechanical properties and bone mineral density (BMD) of the proximal humerus at different levels and regions. MATERIALS AND METHODS: Mechanical indentation testing, DXA, QCT, pQCT and the radiogrammetry (Cortical Index, CI) were carried out in 70 freshly harvested humeri from 46 human cadavers (23 females, 23-males; median age 70.5 years). RESULTS: In the female group, a high correlation between age and BMD was found (rho = 0.62 to -0.70, p < 0.01) with statistically significant differences between specimens of patients 69 years or younger, and 70 years or older (p < 0.05). In the group of female specimens of age 70 years or older, BMD values were found to be significantly lower compared to their male counterparts (p < 0.05). Regardless of the specimen's age, the highest BMD and bone strength were found in the proximal aspect and in the medial and dorsal regions of the proximal humerus. CONCLUSION: These findings provide an insight into the fracture mechanism of the proximal humerus and should be the basis for designing structure-oriented implants with improved implant-bone stability in osteoporotic patients.

Absorptiometry, Photon↗
PubMedDate not supplied

[Clavicula pro humero--a new surgical method for malignant tumors of the proximal humerus].

In the majority of cases with malignant tumors in the proximal part of the humerus a limb saving tumor resection is possible. Reconstruction of the defect is necessary to maintain the length of the arm and to create a fulcrum for elbow flexion and extension. Several methods of reconstruction have been described in the literature including the fixation of distal humerus to the second rib or to the clavicle by means of Küntscher-nails, the implantation of a proximal humerus prosthesis without or with accompanying bone transplantation, a bridging of the defect using an allograft or an arthrodesis of the shoulder joint using free or vascularized bone transplants. The following paper describes a new surgical procedure whereby the vascularization of the clavicle is preserved and the clavicle used to bridge the defect. Although the follow-up period of the patients operated on so far in this way is relatively short, the functional advantages of this operation over the other forms of reconstruction can already be observed.

Adult↗
PubMedDate not supplied

Geometry of the proximal humerus and implications for prosthetic design.

The purpose of this study was to add critical information to the data already available on anthropometry of the proximal humerus. Two hundred macerated humeri were examined. Measurements were taken either directly on the bones or on standardized radiographic projections. The methodology was validated and showed a mean interobserver correlation of 0.94 +/- 0.067. Results were expressed in mean values, first SD, and minimum and maximum values, as well as the 10th and 90th percentiles. The frontal radius of the head ranged between 21 and 26.5 mm (10th respectively 90th percentile). The frontal diameter of the base of the head ranged between 39.4 and 50 mm. The head height ranged between 14.4 and 18.8 mm. The frontal radius-head height ratio ranged between 0.64 and 0.77. The inclination of the head ranged between 132 degrees and 142 degrees. The medial offset ranged between 3.9 and 8.6 mm. The posterior offset ranged between -0.4 and 3.2 mm. The greater tuberosity offset (distance between the axis of the proximal humerus and the most medial insertion point of the supraspinatus tendon) ranged between 2.5 and 9.2 mm. Retrotorsion ranged between 7 degrees and 38.5 degrees. The distance from the bicipital groove to the head equator ranged between 6 and 10.5 mm. The anatomy of the proximal humerus showed a wide range for variables such as the medial offset and the greater tuberosity offset but was surprisingly constant for the inclination and relative dimensions of the head. The implications for prosthetic design are as follows: stem design and insertion should respect the insertion facet of the supraspinatus, a constant head inclination is an adequate approximation, only one head height per radius is required, and the capability for adjustment of medial offset is mandatory.

Humans↗
PubMed2006

Improved comfort and function of arm prosthesis after implantation of a Humerus-T-Prosthesis in trans-humeral amputees.

The use of arm prosthesis in trans-humeral amputees is limited; due to the cone form of the amputation stump. A Humerus-T-Prosthesis was implanted in three patients to create artificial humerus condyles. Two of the patients were successfully rehabilitated with the application of a new type trans-humeral arm prosthesis. This arm prosthesis had a socket which is suspended and stabilized by the humerus and implant only. Traction and rotational stability were secured by adjustable pressure adaptation around the artificial condyles. The third patient developed a pressure wound over the lateral part of the artificial condyle that later healed. He also was subject to a new trauma with a fracture of the ipsilateral scapula and until now has had limited the use of his new arm prosthesis. It was concluded that this new concept for prosthesis fitting of trans-humeral amputees looks promising, but alternative designs of the implant should be tested.

Adult↗
PubMed1990

Lesions of the mid-shaft of the humerus presenting as shoulder capsulitis.

We describe three patients who presented with pain and restriction of movement at the shoulder suggestive of capsulitis, but proved to have lesions of the mid-shaft of the humerus. It is important to be aware of the possibility of this cause of a 'frozen shoulder', since radiographs of the shoulder are usually cropped at the mid-humerus and lesions at this level may easily be missed. A radiograph of the entire humerus, or an isotope bone scan, may be more useful than repeated shoulder radiographs in patients whose shoulder symptoms do not respond to standard treatment.

Adult↗
PubMed2002

Osteosarcoma of the proximal humerus: long-term results with limb-sparing surgery.

The purpose of the current study was to analyze the long-term oncologic and functional results and complications associated with limb-sparing surgery and endoprosthetic reconstruction for 23 patients with osteosarcoma of the proximal humerus. There was one Stage IIA lesion, 18 Stage IIB lesions, and four Stage III lesions in this study group. Twenty-two patients were treated with an extraarticular resection that included the deltoid and rotator cuff and one patient was treated with an intraarticular resection that spared the shoulder abductors. In all these patients, the proximal humerus was reconstructed with a cemented endoprosthetic replacement that was stabilized via a technique of static suspension (Dacron tapes) and dynamic suspension (muscle transfers). At latest followup (median, 10 years), 15 patients (65%) were alive without evidence of disease. There were no local recurrences. Prosthetic survival was 100% for the 15 survivors. The Musculoskeletal Tumor Society upper extremity functional score ranged from 24 to 27 (80%-90%). All shoulders were stable and pain-free. Elbow and hand function were preserved in all patients. The most common complication was a transient neurapraxia (n = 8). En bloc extraarticular resection and endoprosthetic reconstruction is a safe and reliable method of limb-sparing surgery for patients with high-grade extracompartmental osteosarcoma of the proximal humerus.

Adolescent↗
PubMed2005

Functional recovery after a reverse prosthesis for reconstruction of the proximal humerus in tumor surgery.

UNLABELLED: An alternative treatment for primary bone tumors of the proximal humerus was assessed. Four patients, who made full functional recovery after complete resection of the proximal humerus inclusive of the rotator cuff and subsequent reconstruction with a reverse shoulder prosthesis, were examined clinically and radiographically. Distinct medialization of the center of rotation of the glenohumeral joint (28 mm) and elongation of the remaining deltoid muscle (116%) were measured. Increased scapular rotation (118%) was observed. The radiologic results and thoracoscapular rhythm analyses were implemented in a three-dimensional computerized model of the glenohumeral joint. This allowed us to calculate a doubling of the moment of the deltoid abductor muscle in the true scapular plane. After tumor surgery, in which the proximal humerus is resected without reinserting the rotator cuff, full functional recovery of the shoulder can be obtained with a total shoulder prosthesis, medializing the glenohumeral center of rotation and elongating the remaining deltoid muscle. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series-no, or historical control group).

Adult↗
PubMed2006

The deltoid muscle: an anatomic description of the deltoid insertion to the proximal humerus.

OBJECTIVE: This study was designed to describe the anatomic insertion point of the deltoid to the proximal humerus. DESIGN: Gross anatomic study. SETTING: Level one academic trauma center. PATIENTS: Cadaveric study. MAIN OUTCOME MEASUREMENTS: Bilateral humeri were stripped of soft tissue except the deltoid insertion point. The length of the humeri was recorded. The distance from the greater tuberosity to the proximal most aspect of the tendinous insertion point and the distal most tendinous attachment was measured. The humeri were cross-sectioned 5-mm distal to the proximal insertion point, 5-mm proximal to the distal insertion point, and midway between these 2 points. The circumferential proportion of humerus into which the tendon inserted at each point was recorded. RESULTS: The mean length of the deltoid insertion was 97 (range, 83-111) mm. The mean distance from the greater tuberosity to the proximal insertion point was 61 (range, 55-75) mm and to the distal insertion was 158 (range, 142-172) mm. The deltoid occupied on average: 8% of the humeral circumference 5 mm from the proximal insertion point, 39% at the mid point of the insertion, and 31% of the humeral circumference 5 mm from the distal insertion point. CONCLUSIONS: The deltoid insertion is long and broad. A 4.5-mm plate would result in detaching 13.5 mm of the insertion, leaving at least half of the original insertion attached to the humerus.

Bone Plates↗
PubMedDate not supplied

Operative lengthening of the humerus: indications, benefits, and complications.

The purpose of this study was to determine the benefits and risks of humeral lengthening procedures. Distraction osteogenesis was performed in 19 humeri on 16 patients (9 males, 7 females). The mean age at the time of lengthening was 11.5 years (range 3-24 years) and average follow-up was 8.7 years (range 2-21 years). Etiologies for short humeri included infection in six patients, congenital anomaly in six patients, unicameral bone cysts involving the physis in five patients, and posttraumatic growth disturbance in two patients. The average lengthening was 5 cm. The benefits from humeral lengthening include increased performance in daily activities, improved sports performance, and significantly better self-image. Complications included temporary radial nerve palsy in three cases, drainage from the pin tracts in two cases, elbow flexion contracture in three cases, and late humerus fracture in two cases. All the complications resolved over time and did not affect the outcome. Eleven lengthening procedures were not associated with any complications. Although the humerus is surrounded by complex neurovascular structures and muscles, humerus lengthening provided satisfactory results with temporary minor complications.

Activities of Daily Living↗
PubMed2007

Lengthening of a free fibular graft after sarcoma resection of the humerus.

We report a patient who had resection of the humerus for osteosarcoma, initial reconstruction with a free fibular graft of the humerus, and subsequent lengthening of the graft. A 9-cm (100% of free fibula length) lengthening was achieved to equalize the humerus length. A complication of regenerate fracture was treated successfully with plating. Four years after the initial surgery for lengthening, the patient presented with a new radial neuropathy.

Adolescent↗
PubMed2005

Chondrosarcoma of the proximal humerus in a cat.

Chondrosarcoma of the proximal humerus was diagnosed in a four-year-old, castrated male, domestic shorthair cat that was presented with a slowly growing solid mass in the region of the proximal humerus. Forequarter amputation was advised, but declined by the owners. Following surgical debulking clinical signs resolved, but two months after surgery the cat was readmitted because the mass had recurred in the same region. The forequarter was amputated. Histopathological evaluation of the tumour confirmed the diagnosis of chondrosarcoma. Follow-up examinations performed over a period of 15 months from initial presentation revealed that the cat was doing well and had no signs of metastatic disease. To the authors' knowledge, this is the first reported case of chondrosarcoma of the proximal humerus in a cat to be diagnosed and surgically treated. This case demonstrates that animals with such tumours may recover well after complete excision.

Amputation, Surgical↗
PubMed1997

The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design.

We have studied the three-dimensional geometry of the proximal humerus on human cadaver specimens using a digitised measuring device linked to a computer. Our findings demonstrated the variable shape of the proximal humerus as well as its variable dimensions. The articular surface, which is part of a sphere varies individually in its orientation as regards inclination and retroversion, and it has variable medial and posterior offsets. These variations cannot be accommodated by the designs of most contemporary humeral components. Although good clinical results can be achieved with current modular and non-modular components their relatively fixed geometry prevents truly anatomical restoration in many cases. To try to restore the original three-dimensional geometry of the proximal humerus, we have developed a new type of humeral component which is modular and adaptable to the individual anatomy. Such adaptability allows correct positioning of the prosthetic head in relation to an individual anatomical neck, after removal of the marginal osteophytes. The design of this third-generation prosthesis respects the four geometrical variations which have been demonstrated in the present study. These are inclination, retroversion, medial offset and posterior offset.

Aged↗