[Late results of surgically and conservatively treated humerus head and subcapital humerus fractures].
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Adolescent↗
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Distal humerus in hominoid evolution.
Multivariate analysis of 16 measurements of the distal humerus in samples of hominoids, cercopithecoids, Tertiary hominoid fossils, and early hominids shows the following results: (1) there is a substantial and functionally interpretable difference between the distal humerus of cercopithecoids and hominoids (excluding Hylobates); (2) the Tertiary hominoid fossils resemble the cercopithecoids more than the hominoids although they are in some ways intermediate; (3) the hominid fossil from Kanapoi resembles Homo sapiens very closely; (4) the Kromdraai humerus is intermediate in shape between Pan and other hominoids; and (5) the large fossil hominid from East Rudolf (KNM-ER 739) is unique among the hominoids.
Animals↗
Condylar fractures of the distal humerus in adults.
Condylar fractures of the distal humerus are serious and in many instances pose a difficult treatment problem for the orthopedist. From 1969 to 1974, 24 condylar fractures of the distal humerus were treated at the University of Alabama Hospitals. Twenty of the fractures were closed and four were open. Eighteen fractures were treated open and fixed with a variety of K-wires and screws, and six fractures were treated closed. One postoperative wound infection occurred. Based on the 18 cases in which follow-up was sufficient to assess end result, we concluded that in comminuted fractures of the distal end of the humerus in adults, it may be technically very difficult to restore anatomic continuity. When secure fixation cannot be obtained or when the injury is of such a nature that internal fixation is contraindicated, such as a gunshot wound, traction may provide a functional range of motion. In fractures where good continuity and firm fixation can be obtained, open reduction and internal fixation give a superior functional range of motion.
Adolescent↗
Percutaneous pinning of supracondylar fractures of the humerus.
Six cases of supracondylar fracture of the humerus in children were treated by closed reduction and percutaneous pinning with two Kirschner wires inserted laterally through the capitellum of the humerus. This treatment has the same advantages as the commonly used percutaneous pinning with crossed Kirschner wires inserted through the epicondyles of the humerus, and it further eliminates the risk of damaging the ulnar nerve by the insertion of the medial Kirschner wire.
Adolescent↗
Epidemiology of fracture of the upper end of the humerus.
The age and sex specific indicence was calculated in 729 cases of fracture of the upper end of the humerus. The prevalence of other fractures and conditions in these patients was investigated. The age and sex specific incidence is as that of femoral neck fracture with a rapid increase with age, twice as fast in women as in men. Only fractures which include evulsion of the greater tuberosity deviate somewhat from that pattern. The more displaced fractures have a tendency to occur later in life. The prevalence of other fractures is about doubled in patients with fracture of the proximal end of the humerus as compared to age and sex matched controls. This is true for fracture of the distal end of the forearm and fracture of the upper end of the femur but also for other fractures. The prevalence of severe alcoholism was significantly greater than in controls. A history of gastric resection was in these patients about three times as frequent as in a control sample. We conclude that fracture of the upper end of the humerus must be assigned a prominent place in the category of bone fragility fractures.
Adolescent↗
The surgical treatment of fractures of the upper end of the humerus by blind pinning (author's transl).
During a period of five years, the authors have treated 250 fractures of the upper end of the humerus. Fifty-one were treated by blind pinning. Six to eight Kirschner wires are passed up to the head of the humerus under X-ray control through a hole made on the posterior aspect of the lower end of the humerus just above the olecranon fossa. The functional results were satisfactory in 70% of cases. The indications for pinning were for severely displaced fractures, comminuted fractures, either impacted or not, or slipping of the upper humeral epiphysis. The results were less satisfactory in cases with an elevated greater tuberosity. The technique cannot be applied to fracture-dislocations.
Adolescent↗
A bioceramic endoprosthesis for the replacement of the proximal humerus.
In patients with malignant tumors in the region of the shoulder, radical resection can avoid amputation in most instances. To improve the function of the arm, endoprosthetic replacement of the defect is desirable. A three-component endoprosthesis made of a bioceramic material (aluminium oxide) was designed, implanted without bone cement. Fast anchorage to bone is achieved by using a conical sleeve, fixed upon the previously conically reamed humerus shaft. A stable primary fit is always feasible. Subsequent bone in growth into grooves inside the conical sleeve provides a permanent anchorage of the endoprosthesis. The authors experiences are based on implantations of 38 endoprostheses. The original diseases were primary malignant bone tumors in 19 patients, one case of "solitary" plasmocytoma and metastases into the proximal humerus in 16 patients. In two women, resection was made because of posttraumatic subcapital humeral pseudarthrosis. The follow-up study includes only those 27 cases operated on at least one year ago. 12 of the 14 patients with primary tumors have been surviving for 12-55 months (range 27.4) without signs of metastases or recurrent disease. Seven patients with metastases died of their original diseases after 7.7 months on the average. Owing to extensive resection of the shoulder musculature the mobility in the shoulder joint is considerably reduced. All the patients have good movement of the elbow joint and free function of the hand.
Activities of Daily Living↗
Total subperiosteal resection treatment of solitary bone cysts of the humerus.
The solitary bone cyst is most frequently located in the upper arm and the average age of the affected patients is between 7 and 9 years, thus perceptibly lower than in cases where solitary bone cyst occurs elsewhere, where the average age is 15. The tendency towards recurrence before 10 years of age is twice as great as the tendency after that age. Investigation of the results obtained from the treatment of 26 patients suffering from solitary bone cyst of the humerus showed a recurrence rate of 55% after curettage and filling-in of the defect with cancellous bone grafts, whereas after total subperiosteal resection and bridging the defect with an autologous tibia graft the corresponding recurrence frequency was 7%. The average duration of the plaster cast fixing period after resection treatment was 18 days longer than after curettage, but the low rate of recurrence in the first-mentioned case makes up for this disadvantage. It is absolutely essential to retain the periosteum in cases of cyst resections. The defect is bridged over by an autologous tibia graft, but fibula grafts are also suitable for bridging the defect. Osteosyntheses are not necessary with latent cysts. In the case of active cysts screws, wire loops, Kirschner wires, and thin Küntscher nails can be used as temporary stabilisation means. Plate osteosyntheses constitute an exception. Complete removal of the cyst by resection is the most certain prophylactic method against recurrence, and hence the most reliable form of treatment of the solitary bone cyst of the humerus.
Adolescent↗
Stature estimation from femur and humerus by regression and autometry.
Estimation of stature from a single extremity bone is a common forensic practice and many regression equations are given by various workers. In India, Pearson's formula is the most commonly used method to determine the height. These regression equations were subjected to verification on 194 (97 pairs) femora and 102 (51 pairs) humeri from India. It was seen that the Pearsonian formulae did not give exact results. The regression formulae differed statistically in both sexes in femur and humerus. These are calculated and given. This finding once again proves the necessity of having norms or formulae for the specific groups, when reliable results are required. In addition, the proportion between humerus length and femur length is also verified. This has evolutionary significance. In addition to the usual method as above, a method of the proportion these bones individually bear to the stature of the same person to which the bones belong is worked out both as a multiplication factor and percentage proportion to the body stature. It has been amply demonstrated and concluded that this method be called "autometry" and further that this seems to be more reliable method than the tedious yet variable and unreliable results the various formulae give. This autometry seems to have a consistency, being constant in both sexes and all races, thus evolving a "human race autometry".
Anthropometry↗
Cortical desmoid-like lesion of the proximal humerus and its occurrence in gymnasts (ringman's shoulder lesion).
Eighteen gymnasts were interviewed and examined radiographically for a cortical irregularity of the proximal humerus simulating malignancy. Fifty percent of the gymnasts had the lesion which is considered to be a benign reactive lesion secondary to excessive forces at the pectoralis major insertion to the proximal humerus. All patients were asymptomatic. The lesion is probably unique to gymnasts, particularly those involved with strength moves.
Adult↗
Effect of rotation on radiographic dimensions of the humerus and femur.
Ten humeri and ten femora were radiographed in nine positions of longitudinal rotation. In each position total, medullary and cortical widths of the diaphyses (TW, MW, CW) were measured to assess the effect of rotation on these dimensions. The results were expressed as differences from the values in the neutral position (delta TW, delta MW, delta CW). In the humerus, medial rotation produced greater changes than lateral rotation. Though rotation in either direction increased CW, the systematic error due to medial rotation to only 5 degrees (approximately +0.0058 cm per degree) was more than double that due to lateral rotation. In the femur, lateral rotation had the greater effect, producing a marked decrease in CW (approximately -0.0072 cm per degree). Medial rotation produced only a slight increase in CW. The ratios CW/TW ("cortical index") and CA/TA ("area ratio") were calculated and expressed as differences from the values in the neutral position (delta CW/TW, delta CA/TA). Rotation affected these variables much less than the linear dimensions. Furthermore, through the variance of delta TW, delta MW and delta CA/TA increased only slightly or not at all. These results suggest that if radiographic morphometry is to be applied to the humerus and femur, these ratios rather than transverse dimensions should be used. Sequential changes in CW may be totally obscured by small rotational errors.
Anthropometry↗
The sub-deltoid approach to the metaphyseal region of the humerus.
In a new surgical approach to the proximal part of the humerus, used in eighteen patients, the distal part of the tendon of the deltoid muscle was divided and the whole muscle was lifted up to give an excellent view of the proximal one-third of the diaphysis, the metaphysis, the surgical neck, and both tuberosities of the humerus. The exposure allowed visualization and protection of the axillary nerve. Postoperatively the deltoid remained functional and only the preoperative condition of the joint seemed to prevent full recovery of function of the muscles in a few patients.
Bone Neoplasms↗
[Humerus varus congenitus (author's transl)].
Two cases of humerus varus congenitus have been treated by lengthening of the humerus using an external distraction device. The first was lengthened by about 6 centimetres and the second by about four centimetres. In one case, primary bone union was obtained and in the second, secondary grafting had to be done. The clinical results were satisfactory.
Adult↗
[The determination of age and sex from measure of the humerus (author's transl)].
On a total of seventy left humeri of persons in their third to ninth decades of life thirty different bone dimensions were determined macroscoically and checked for age dependence. Strong dependence on age was shown only by the weight and volume of the humerus as well as by the areal and thickness dimensins of the center of the shaft. These were used to set up multidimensional linear regression functions by which it is possible for the age of persons past thirty to be estimated with defined accuracy. Also calculated were discriminant functions which allow the sex of a person to be identified to be determined from three dimensions of the left humeral head, and these are the size of the caput at the cartilage-to-bone interface, the transverse and vertical diameters of the caput humeri or head of the humerus. Of the 49 cases studied only three were found to be in the region of overlap of the dimensions used for calculation. Consequently, the formula would not allow unknown humeri or skeletons, respectively, to be identified as belonging to either male or female persons in 6 percent of the cases only. The results of additional examinations made of 198 right humeri were less accurate and showed a decrease of the sexual dimorphism of bone with age.
Adolescent↗
[Therapy of fracture-dislocations of the humerus head].
Dislocated fractures of the head of humerus are rare and prognostically unfavourable. In elderly patients only functional therapy should be practiced. Surgery attempts to make operative reduction of the dislocation and careful fixation of the head of humerus. Endoprotheses may relieve the patient from pain, but cannot restore active mobility due to the lack of muscle insertion.
Female↗
Developmental humerus varus.
Humerus varus, the upper extremity analogue of coxa vara, may be found in association with, and probably as a consequence of hematologic, infectious metabolic, genetic and neurologic disorders. No matter what the etiology, there is a similar pattern of development and progression of the deformity. The medial region of the proximal humeral physis either develops slowly or failed to develop, while the lateral region develops more rapidly, causing varus rotation of the proximal humeral epiphysis and physis. In the more extreme cases, the lateral region of the growth plate is almost parallel to the longitudinal axis of the shaft. In many cases there is a medial lucency, adjacent bony epiphyseodesis, and significant shortening of the humerus. Although abduction is usually decreased, major functional impairment is unusual even in the dominant arm.
Adolescent↗
[Total replacement of humerus including shoulder and elbow joints].
A case of total alloplastic replacement of the humerus, including the neighboring joints, is reported. The method may be used for treatment of large defects of the humerus due to tumor, osteomyelitis, or trauma. The alloplastic replacement seems superior to autoplastic fibula transplantation.
Bone Neoplasms↗
[Causes and treatment of delayed callusformation and pseudarthrosis following fractures of the shaft of the humerus (author's transl)].
In the OHH, during the years 1969 to 1974, 28 patients were operatively treated because of delayed callusformation or pseud-arthrosis, following a fracture of the shaft of the humerus. It was possible to inquire about and to re-examine 20 patients. The operative treatment had, when possible been achieved by osteosynthesis through plates (25 cases). Each of the so treated cases lead to healing of the bone, additional nerve lesion did not in one case occur because of the operation. Objectively seen, there existed in 7 patients a slight, final restriction of movements, for the abduction and outside rotation in the shoulder joint. 6 patients complained of being sensitive to weather changes. The different treatment method of the fracture of the humerus and pseudarthrosis was discussed.
Aged↗