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PubMedDate not supplied

Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus.

The purpose of this study was to evaluate predictors of fracture-induced humeral head ischemia. Between February 1998 and December 2001, 100 intracapsular fractures of the proximal humerus, treated by open surgery, were included in a prospective surgical evaluation protocol (mean age, 60 years; minimum, 21 years; maximum, 88 years; 45 men; 57 right shoulders). Fracture morphology was assessed following a structured questionnaire and based on radiographic and intraoperative findings. Perfusion was assessed intraoperatively by observation of backflow after a borehole was drilled into the central part of the head in all shoulders and by intraosseous laser Doppler flowmetry in 46. Good predictors of ischemia were the length of the metaphyseal head extension (accuracy, 0.84 for calcar segments <8 mm), the integrity of the medial hinge (accuracy, 0.79 for disrupted hinge), and the basic fracture pattern (accuracy, 0.7 for combined types 2, 9, 10, 11, and 12). Moderate and poor predictors of ischemia were fractures consisting of four fragments (accuracy, 0.67), angular displacement of the head (accuracy, 0.62 for angulations over 45 degrees ), the amount of displacement of the tuberosities (accuracy, 0.61 for displacement over 10 mm), glenohumeral dislocation (accuracy, 0.49), head-split components (accuracy, 0.49), and fractures consisting of three fragments (accuracy, 0.38). When the above criteria (anatomic neck, short calcar, disrupted hinge) were combined, positive predictive values of up to 97% could be obtained. The most relevant predictors of ischemia were the length of the dorsomedial metaphyseal extension, the integrity of the medial hinge, and the basic fracture type determined with the binary description system.

Adult↗
PubMed1995

Bilateral posterior fracture-dislocation of the shoulders: management by bilateral shoulder hemiarthroplasties.

Bilateral posterior fracture-dislocation of the shoulders is rare, with only 26 reported cases in the literature. We present the case of a patient who sustained bilateral posterior fracture-dislocations after a first time seizure. Due to significant articular surface involvement, bilateral hemiarthroplasties were performed. The literature on this injury and current treatment options is also reviewed.

Adult↗
PubMed1983

Revascularization of the humeral head. A report of two cases of fracture-dislocation of the shoulder.

Two cases of fracture-dislocation of the shoulder are reported in which the humeral heads were found at open reduction to be without soft tissue attachments. The patients were followed up clinically and radiologically and by technetium-99m scintigraphy for at least two years. In the case of a three-part fracture-dislocation, revascularization of the humeral head was complete three months after surgery, whereas the humeral head in the four-part fracture-dislocation did not appear totally revascularized scintigraphically until nine months after surgery. Radiologic signs of avascular necrosis of the humeral head were not encountered. Both patients were pain-free, and the shoulders functioned well, although suboptimal ranges of motion were recorded. It was concluded that open reduction and internal fixation is indicated initially rather than conservative treatment and before use of a prosthetic device is considered, in view of the acceptable results obtained. It appears that revascularization of the humeral head occurs by creeping substitution.

Female↗
PubMed2005

Opposite-direction bilateral fracture dislocation of the shoulders after an electric shock.

Injuries after an electric shock, such as dermal burns, motor and sensory nerve deficits, fractures and dislocations, are reported in the literature. Posterior dislocation of the shoulder after electric-shock is the common musculoskeletal injury. Bilateral dislocation, either anterior or posterior, is rarely seen and reported. We report a case of bilateral shoulder fracture dislocation in opposite directions following an electric-shock and discuss the mechanism, the diagnosis and the treatment.

Adult↗
PubMed2006

What factors are associated with neonatal injury following shoulder dystocia?

OBJECTIVE: To identify factors associated with the development of neonatal injury in the setting of shoulder dystocia. STUDY DESIGN: Medical record ICD-9 codes and a computerized perinatal database were reviewed to identify cases of shoulder dystocia from January 1996 to January 2001 in a tertiary care center. For confirmation of the diagnosis and collection of data, both maternal and neonatal charts were then reviewed and neonatal injuries categorized as either neurological (brachial plexus injury) or skeletal (clavicular fracture, humeral fracture). Shoulder dystocia cases were divided into groups based on the presence of neonatal injury at delivery or at discharge (with or without Erb's palsy). The group with neonatal injury was compared for demographic and obstetrical factors to the group without injury (control). chi (2) test, Mann-Whitney test and logistic regression were used as appropriate. RESULTS: During this 5-year period, there were 25,995 deliveries and 206 (0.8%) confirmed cases of shoulder dystocia. Of these cases, 36 (17.5%) had neonatal injury diagnosed at delivery and 25 (12%) remained with significant residual injury at discharge. Of these there were 19 cases of Erb's palsy and six cases of clavicular fracture. No association was found between neonatal injury and maternal age, ethnicity, diabetes, operative vaginal delivery or number of obstetrical maneuvers. However, maternal body mass index >30 kg/m2, a second stage of labor >20 min and a birth weight >4500 g were all associated with an increased risk of neonatal injury at delivery and at discharge, including Erb's palsy. After logistic regression analysis, only a second stage of delivery >20 min remained significantly associated with neonatal injury at discharge. CONCLUSION: In our population, maternal obesity was associated with an increased risk of neonatal injury after shoulder dystocia. In addition, a short second stage of labor (<20 min) was associated with a lower rate of neonatal injury.

Adult↗
PubMed2004

Combined anterior and posterior shoulder dislocation as a manifestation of a brain tumour.

Seizures are sometimes the first manifestation of a brain tumour. They may give rise to shoulder fractures or fracture-dislocations. When bilateral, these lesions tend to be symmetrical. The patient reported here suffered from a previously undiagnosed brain tumour, the first manifestation of which were seizures, which provoked a bilateral shoulder dislocation in opposite directions. The posterior dislocation was recognized with a delay of 16 days. After an episode of seizures, shoulder dislocation can occur in either direction, and bilateral shoulder dislocations may not be symmetrical.

Accidental Falls↗
PubMed1996

[Intramedullary nailing of open fractures].

The goal of treatment of open fractures is to prevent infection, promote fracture healing, and restore normal limb alignment and function. The initial treatment of these fractures includes: debridement, soft tissue coverage, antibiotic therapy, and fracture stabilization. Four different techniques for intramedullary nailing for the fixation of open fractures have been employed: (1) unreamed, unlocked nails (i.e., Ender and Lottes, which have low infection rates, but are mechanically insufficient); (2) reamed unlocked nailing (which relies on overreaming to provide stability through bone-nail surface contact, but is associated with high infection rates); (3) reamed locked nailing (which may rely on limited reaming because of the interlocking screws); and (4) unreamed nailing (which always relies on interlocking screws and is associated with function better than and infection rates similar to those with external fixation, but has an increased incidence of screw breakage). In contrast to the biological problems in the tibia, those problems encountered in the femur are more predominantly mechanical in origin. For humeral shaft fractures, shoulder problems associated with the antegrade approach are frequent, and bypassing the rotator cuff with a retrograde approach appears advantageous.

Anti-Bacterial Agents↗
PubMed1998

[Indications for shoulder prosthetics in degenerative and inflammatory diseases].

Shoulder arthroplasty has since it's more widespread introduction in the early seventies found a general acceptance as an excellent tool for treating late stage arthritis of the shoulder joint. The indications will vary from primary osteoarthritic disease to inflammatory diseases such as rheumatoid arthritis, or psoriatric arthritis. It is also used as a primary tool in multifragmented shoulder fractures, which can not be restored anatomically, or are felt at risk for avascular necrosis. The surgeon setting out for this procedure has to decide whether a total arthroplasty is required in cases with glenoid destruction, or at risk of developing secondary degenerative changes in the glenoid early on. A hemiarthroplasty will only replace the humeral side of the joint, but while well accepted in the fracture patient, the arthritic patients tend to fare better with a total joint replacement for pain relief.

Arthritis, Psoriatic↗
PubMed1984

Anterior fracture-dislocations of the shoulder: pitfalls in treatment.

Fracture-dislocations of the shoulder can present difficulties in treatment. Two cases are described to illustrate the complications that can occur when an inexperienced examiner attempts a closed reduction of a two-part anterior fracture-dislocation of the shoulder. Careful clinical and radiologic evaluation (A-P and transcapular or axillary lateral X-rays) followed by appropriate management can help to prevent these problems from occurring. If there is evidence that the fracture is displaced by manipulation, immediate open reduction and internal fixation are recommended.

Female↗
PubMedDate not supplied

Shoulder function after displaced fractures of the proximal humerus.

It is difficult to predict the outcome of comminuted fractures of the proximal humerus and give guidelines for optimal treatment. Different treatment modalities are available, and there are various scoring systems for postoperative evaluation. The aim of this study was to assess the functional outcome after three- and four-part fractures of the humeral head in 38 patients, with a 3-year follow-up. Twenty-eight patients were treated conservatively, seven were operated on with open reduction and internal fixation, and three received a hemiarthroplasty. All patients were examined clinically and radiographically. Neer and Constant scoring systems were used. The functional outcome after three-part fractures was generally good. Twenty-five of 26 patients with a three-part fracture could accept their shoulder situation. Range of motion was significantly lower in the four-part fracture group. Mean flexion was 89 degrees compared with 120 degrees in the three-part fracture group. Necrosis of the humeral head was found in 2 cases, both four-part fractures. Osteoarthrosis developed in 13 cases (6 with a three-part fracture, 7 with a four-part fracture). No disability was found in 16 of 24 patients with three-part fractures, and in 4 of 11 patients with four-part fractures. There was strong agreement between the Constant score and the patients' opinions.

Activities of Daily Living↗
PubMed1999

Electromyographic findings in shoulder dislocations and fractures of the proximal humerus: comparison with clinical neurological examination.

There is no consensus of opinion about the frequency of associated nerve lesions in anterior shoulder dislocations and fractures of the proximal humerus. We undertook a prospective study to assess the incidence, the severity of the nerve injury and the diagnostic value of electromyographic examination; 215 patients were included. We performed neurological examination and needle electromyography (EMG). Nerve injury was graded according to a denervation score at the EMG. EMG disorders were seen in 133 patients (62%). Testing of sensibility and clinical reflexes proved not to be a reliable indicator for EMG abnormalities. Detection of axonal lesions by grading muscle strength based on the MRC score after these shoulder traumas is difficult. The findings of this study imply that by clinical examination alone a large number of axonal lesions remain undetected.

Adolescent↗
PubMed2003

Posterior dislocation of the shoulder associated with fracture of the humeral anatomical neck with 11-year follow-up after early open reduction and internal fixation.

BACKGROUND: . The combination of posterior dislocation and fracture of the anatomical neck represents an extremely rare injury. METHODS: . A patient with posterior dislocation of the shoulder and ipsilateral fracture of the humeral anatomical neck was treated with open reduction and internal fixation with two Kirschner wires. He was followed up for 11 years. RESULTS: . The functional results were excellent, and X-ray and MRI investigations revealed the absence of avascular necrosis of the humeral head. CONCLUSION: . Early and accurate open reduction with minimal osteosynthesis resulted in excellent function of the injured shoulder without avascular necrosis.

Adult↗
PubMed2005

Purtscher's retinopathy after fracture dislocation of shoulder joint.

Purtscher described sudden blindness in patients with severe head trauma due to a remote retinopathy, characterised by bilateral retinal haemorrhages, cotton wool spots, and optic disc swelling seen on fundoscopy. A similar retinopathy has been reported in compressive chest trauma, long bone fractures, and acute pancreatitis. It is less well recognised that Purtscher's retinopathy can occur unilaterally and following less severe trauma. We present a case of unilateral remote traumatic retinal angiopathy following a fracture dislocation of the shoulder joint.

Accidents, Traffic↗