Combined fracture of the greater and lesser tuberosities with intact connection of the humeral head to the shaft.
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Adult↗
Biomedical subjects
Ralph Hertel
Publications and source records attributed to Ralph Hertel.
Acromioclavicular joint cyst: nine cases of a pseudotumor of the shoulder.
OBJECTIVE: (1) To analyse the imaging appearances of nine patients with acromioclavicular joint cysts presenting as shoulder masses for tumor staging with operative, histopathological and joint aspiration findings. DESIGN AND PATIENTS: Retrospective review of imaging and correlation with clinical, operative and surgical notes. Images were reviewed by two musculoskeletal radiologists by consensus. Nine patients who presented clinically with a shoulder mass were evaluated by radiographs (n=9), ultrasound (n=1), conventional arthrography (n=3), MRI (n=6; with direct MR arthrography n=2, indirect MR arthrography n=4). RESULTS: All patients had a focal mass superior to the AC joint, with a size ranging from 1.5 cm to 6 cm and a mean of 3.27 cm. Correlation was available with surgery (n=7), histopathology (n=2) and cyst aspiration (n=2). Two patients were managed conservatively. Geyser sign was positive in all three arthrograms. All MRIs revealed extensive rotator cuff tears with a column of fluid extending from the glenohumeral joint through the rotator cuff tear into the acromioclavicular joint and acromioclavicular cyst. Chondrocalcinosis was seen in the acromioclavicular joint cyst (n=2) and in the glenohumeral joint (n=1). Aspirate in two patients contained calcium pyrophosphate dihydrate crystals. CONCLUSION: Acromioclavicular joint cysts may present as a tumor mass. They are associated with extensive rotator cuff tears and there is usually communication of the cyst with the joint space. This feature excludes a diagnosis of tumor. AC joint cysts may be associated with calcium pyrophosphate dihydrate deposition disease.
Acromioclavicular Joint↗
Latissimus dorsi tendinosis and tear: imaging features of a pseudotumor of the upper limb in five patients.
OBJECTIVE: The objective of our study was to determine the imaging appearances of a pseudotumor of the upper limb, latissimus dorsi tendinosis and tear, in five patients and to correlate those imaging findings with clinical history and histopathology. CONCLUSION: Tears or reactive tendinosis of the latissimus dorsi tendon at its insertion on the proximal humerus may present as a pseudotumor. Awareness of the imaging findings may allow accurate diagnosis and conservative management.
Adolescent↗
Prevention of pressure-induced skin ischemia and impending skin penetration in a displaced clavicle fracture.
This article presents a quick and effective method using adhesive tapes to prevent ischemia or penetration of the skin in clavicle fractures.
Bandages↗
Fractures of the proximal humerus in osteoporotic bone.
The purpose of this article was to review critically the current treatment options for fractures of the proximal humerus in patients with severe osteoporosis. The main difficulties lie in correctly diagnosing the fracture and hence selecting the most appropriate method of treatment. The reliability of the diagnosis can be increased by systematically appending additional information to a basic fracture classification. Classification is best carried out on a morphological basis, whereby a descriptor of bone quality can be added in order to introduce the degree of osteoporosis into the decision-making algorithm. Any classification system that claims to provide both treatment and prognosis is inappropriate, because prognosis will depend hopefully on the treatment. Approaches to treatment differ widely amongst centers and surgeons. It is still unclear as to what would be the optimal treatment. Factors such as the individual's functional requirements and ability to cooperate should be given careful consideration. At our institution, hemiarthroplasty is the method of choice for ischemic humeral heads and/or when anatomic reconstruction cannot be obtained. In all other displaced fractures, the main objective is preservation of the head since the best functional results can generally be obtained with internal fixation. Selection of a balanced osteosynthesis, adapted to the weak bone, is mandatory. Bulky, stiff implants are inadequate and may cause additional damage. Load sharing, not load bearing, compound constructions are the aim. Obtaining metaphyseal elastic buttressing is the key element in achieving the necessary load-sharing fixation. The system should allow controlled impaction and be forgiving towards occasional load peaks that will occur and are beyond patient control. Thin and flexible implants are required to realize this type of fixation. Given the polypragmatic approach that is current in clinical practice there is room for further improvement of techniques and implants.
Arthroplasty↗
Observations on retrieved glenoid components.
To obtain more information on the pattern of damage of prosthetic glenoid components, we analyzed 7 retrieved glenoid components. The consecutive series included 2 standard polyethylene components and 5 highly crystalline polyethylene glenoids (Hylamer; DePuy Dupont Orthopaedics, Warsaw, IN) retrieved 3 to 12 years after implantation. At revision, 4 of 5 Hylamer components were fractured. Common wear patterns were i) deformation and crumbling of the rim, particularly at the inferior hemicircumference, probably caused by direct contact of the humerus with the prosthetic component; ii) roughening (abrasion and scratching) of the adjacent articulating surface; and iii) concentric and congruous wear centered posteriorly. Available glenoid components may cover an excessive sector of the head. This can result in mechanical restriction of glenohumeral motion and abutment of the humerus against the glenoid rim. Abutment may cause major shear forces and therefore cause glenoid loosening. The value of articular surface mismatch is questionable because retrieved glenoids were worn to a conforming joint.
Adult↗
Femoral osteotomy and iliac graft vascularization for femoral head osteonecrosis.
The objective of this study was to determine the long-term clinical and radiologic outcomes of patients with osteonecrosis treated by a combination of intertrochanteric osteotomy and pedicled iliac bone block transfer. Between 1978 and 1986, 41 patients (52 hips) with a mean age of 33 years were operated on for Ficat Stages II and III disease. Thirty-three patients (44 hips) were assessed clinically and radiologically at a mean followup of 13.5 years (range, 5-20 years). Fifteen hips (15 of 44; 34%; 13 patients) had conversion surgery to a total hip arthroplasty because of progressive arthritis or collapse, or both. Six patients died and two were lost to followup. Preoperatively, the patients with failed revascularization had significantly more pain and decreased gait function than patients without failure. In the patients without failure, postoperative pain sensation and gait function improved significantly. However, flexion became restricted mainly because of progressive degeneration of the hip. Radiographically, 31% of the hips (nine hips; six patients) had severe arthritis, 59% (17 hips; 12 patients) had moderate arthritis, and only three hips (two patients) had mild arthritis. Ninety percent of patients without hip failures (26 of 29 hips; 18 patients) considered the functional outcome, including pain relief and gait function, to be successful. Despite the subjective success, this surgery could not restore normal hip anatomy, and arthritis progressed with time. Intertrochanteric osteotomy and vascularized iliac bone block transfer should be considered only in young symptomatic patients with good preoperative clinical function and Ficat Stage II disease.
Adolescent↗
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↗