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PubMed1983

Bilateral central dislocation of the hip. A case report.

Bilateral posterior shoulder dislocations and vertebral fractures are well described complications of convulsive activity. A 72-year-old woman with osteoarthritis of both hips and knees centrally dislocated both hips during a tonic-clonic seizure. Bilateral central fracture dislocation of the hip, although rare, must be suspected in the postictal patient who complains of hip and knee pain.

Aged↗
PubMed1983

[Angled 1/3-tubular plate for osteosynthesis of dislocated humeral fractures through the collum anatomicum].

Stable osteosynthesis of dislocated fractures of the head of the humerus by lag screws cannot be granted because the avascular head fragment is small. Alternatively the fixation can be performed by means of an angled 1/3-tubular plate with 8 holes. The plate is inserted similar to the condylar plate after preparing a seat with 3 drills of 2 mm ø. The angle-point depends on the diameter of the head fragment. The angle should be approximately 110 degrees. The free part is fixed to the shaft under tension. A successful case of total dislocation for more than one day is demonstrated where no head necrosis occurred.

Adult↗
PubMed1976

[Prosthesis control by traction instead of myoelectricity in upper arm amputations].

This paper is concerned with the provision of an upper limb prosthesis in the presence of an axillaris nerve paralysis and additional injuries such as clavicular and scapular fractures, dislocation of the shoulder and major psychological changes. Such paralysis and injuries exclude the use of a myoelectric prosthesis. The shoulder muscles were trained to provide traction forces which controlled an MGH-S hand (VIENNATONE).

Amputation, Surgical↗
PubMed1996

Treatment of humeral shaft fractures with the Seidel intramedullary nail.

BACKGROUND: The use of intremedullary nails for the management of humeral shaft fractures has been controversial. Recently, the Seidel nail has become available. The purpose of this study was to review our initial experience with the Seidel nail. METHODS: A retrospective clinical and radiographic review of 25 consecutive patients treated with Seidel intramedullary humeral nail was performed. The nail was used for non-union in 10 patients, delayed union in four, acute fracture in eight and pathological fracture in three. Eighteen of the 19 survivors were clinically reviewed at an average of 15 months (range 8-15). Pain, function, satisfaction, shoulder power, range of motion and clinical outcome were graded using the UCLA shoulder score. RESULTS: Pain was present at the shoulder in four patients and at the fracture site in nine. Average shoulder abduction was 99 degrees and nine patients could not abduct the shoulder past 90 degrees. Sixty-six percent of patients reviewed were graded as only fair or poor using the UCLA shoulder score. In three patients rotational control was not achieved with the distal locking device at the time of surgery. Complications included non-union in 10 patients and three intra-operative fractures. CONCLUSIONS: Non-union was more likely to occur if rotational control was not obtained, or if the patient had the nail inserted for a previous non-union. Use of the Seidel nail frequently leads to shoulder pain and dysfunction. The distal locking device is unreliable and predisposes to non-union. We do not recommend the continued use of the Seidel nail.

Adolescent↗
PubMed1987

Locked posterior dislocation of the shoulder.

Of forty patients with forty-one locked posterior dislocations of the shoulder, the diagnosis had been missed by the initial physician in the majority. A motor-vehicle accident, a seizure, an alcohol-related injury, or electroshock therapy had caused the dislocation in these patients, and the average interval from injury to diagnosis was one year. Twenty-five of the forty-one dislocations had been diagnosed in less than six months. An axillary radiograph confirmed the diagnosis in all shoulders and demonstrated the approximate size of the impression defect. There were no associated displaced fractures of the humerus, but in twenty of the shoulders there was an undisplaced fracture of the proximal part of the humerus. The average length of follow-up was 5.5 years. For seven shoulders the deformity was accepted. Treatment in the others consisted of closed reduction, which was attempted in twelve shoulders and was successful in six of the twelve; transfer of the subscapularis tendon, which was attempted in nine shoulders and was successful in four; transfer of the lesser tuberosity, which was successful in all four shoulders that were so treated; hemiarthroplasty, which was performed in nine shoulders and was successful in six (the other three required revision); and total arthroplasty in ten shoulders, one of which dislocated postoperatively and was not treated. Once the diagnosis is established, the majority of patients with this lesion can be successfully managed.

Adolescent↗
PubMed2005

[Effects of margin designs on fracture strength and pattern of endodontically-treated teeth with no coronal tooth structure].

PURPOSE: To determine the importance of margin design on fracture strength and pattern of endodontically-treated teeth with 0 mm of coronal tooth structure. METHODS: Using the CELAY system (MIKRONA, Switzerland), 168 human maxillary central incisors, identical in size and shape, were replicated from bovine teeth. The fracture strength and pattern of 5 types of margin design, three core materials and two levels of remaining coronal tooth structure were examined after 24 hours of water immersion (37 degrees C) under 16 conditions and 83 hours under 6 conditions without cyclic loading, as well as after 83 hours of water immersion with 300,000 cyclic loading under 6 conditions. RESULTS: In the case of cast metal post-and-cores with 0 mm of coronal tooth structure, both beveled and shouldered shoulder margin designs resulted in a higher fracture strength than chamfer and shoulder ones, achieving almost the same strength of chamfer margin design with 1 mm of coronal tooth structure. In addition, pinhole preparation on the root surface increased the fracture strength of chamfer margin design to the level of those of the above-mentioned two desirable margin designs. From a fracture pattern viewpoint, however, all margin designs were unsuitable for re-restoration of the tooth. CONCLUSIONS: Both beveled and shouldered shoulder margin designs improve fracture strength of endodontically-treated teeth with 0mm of remaining coronal tooth structure.

Animals↗
PubMed1999

Antegrade locked nailing for humeral shaft fractures.

Treatment results of antegrade locked nailing of acute humeral shaft fractures, including union rate and recovery of shoulder function, have been inconsistent. This led the current authors to hypothesize that implant design and surgical techniques might account for this inconsistency. In the current study, 47 fractures (38 acute; nine pathologic) in 47 patients achieved union with the techniques of closed nailing, short to long segment nailing, and fracture compression. Satisfactory recovery of shoulder function occurred because of minimal surgical trauma, prevention of impingement by the nail or locking screws, and prevention of axillary nerve injury or comminution of the humeral head. Forty-seven patients with 38 acute fractures and nine pathologic fractures were treated with humeral locked nails. Mean followup time was 21.4 months. With a single operation, all 38 acute fractures proceeded to eventual union; the average time to union was 7.8 weeks. Thirty-five patients had excellent or satisfactory recovery of shoulder function. Complications included slipout of the proximal screw, nail breakage, fragment displacement, and transient postoperative radial nerve palsy. All nine patients with pathologic fractures had substantial pain relief and increased arm function after surgery. The current study shows the reliability of antegrade locked nailing for proximal and middle third fractures of the humeral shaft.

Adult↗
PubMed2006

Biomechanical comparison of a unique locking plate versus a standard plate for internal fixation of proximal humerus fractures in a cadaveric model.

BACKGROUND: Newer internal fixation devices with a locking mechanism between the plate and the screw have recently been released. The efficacy of these plates in the proximal humerus has yet to be fully described. There is a need to compare the biomechanical properties of efficacy of plate fixation with or without locking screws for surgery of two-part proximal humerus fractures. Multiple-plane locking plate and cloverleaf plate designs were tested to determine their ability to maintain fixation on the humeral head. METHODS: Eight matched pairs of cadaveric shoulders with 7-millimeter osteotomy defects at the surgical neck simulating two-part fractures of the proximal humerus were loaded to failure in thirty degrees of glenohumeral abduction. One side was repaired with a proximal humerus locking plate and the other with a cloverleaf plate. The rotator cuff musculature was then loaded via a servo-hydraulic testing machine under displacement control to simulate the deforming forces present in vivo. FINDINGS: The average maximum load to failure was greater in proximal humerus locking plates than in cloverleaf plates (876 versus 712; P=0.04). INTERPRETATION: In the cadaveric, two-part proximal humerus fracture model that was created, the locking plate displayed significantly greater holding power of the humeral head. Clinical relevance is unproven but may be manifested in vivo as improved early range of motion exercises and functional outcome.

Aged↗
PubMed1992

Electrotherapy and the management of minimally displaced fracture of the neck of the humerus.

A poor outcome arising from a minimally displaced fracture of the neck of the humerus may be the result of a contracture of the capsule of the glenohumoral joint. Pulsed high frequency electromagnetic energy (PHFE) is an electrotherapy to reduce pain and swelling and to enhance healing. If PHFE is effective, early mobilization of the injured shoulder will be possible, reducing the risk of joint capsule contracture. We therefore conducted a double-blind trial of PHFE in minimally displaced fractures of the neck of the humerus. Early physiotherapy produced an excellent outcome in all cases. The functional outcome depended on age rather than time of starting treatment, although a relationship was found between the time of starting treatment and the duration of therapy required. The use of PHFE did not improve the result further.

Adolescent↗
PubMed2002

[A new locking nail for proximal humerus fractures: the Telegraph nail, technique and preliminary results].

We present a new nail, the telegraph nail, designed for the treatment of proximal fractures of the humerus. This nail has a new locking system providing a self-stabilization of the cancelous screws inserted in small fragments. We discuss the surgical technique and present preliminary results. The anterolateral approach and nail insertion through the medial and well vascularized part of the cuff is described for simple fractures. With the cup and ball technique, this nail can also be used for complex fractures of the proximal humerus with three or four fragments and major displacement. With this method, the nail is inserted before reduction and locked in the distal humerus before fixation of the head and tuberosities around the head once the targeting device removed. We report results for the first 64 nails inserted in our unit during the first year (1998-1999). Outcome was assessed at 11 months mean follow-up using the Constant score. Outcome was favorable, including in patients with complex fractures involving 3 or 4 separate displaced fragments. Besides providing an anatomically stable reconstruction, the telegraph nail has the advantage of allowing early mobilization of the shoulder joint. This method is a useful alternative to prosthetic reconstruction for traumatic fractures of the proximal humerus.

Adolescent↗
PubMedDate not supplied

Open reduction internal fixation after displacement of a previously nondisplaced acromial fracture in a multiply injured patient: case report and review of literature.

SUMMARY: A twenty-eight-year-old multiple trauma patient had a nondisplaced acromion fracture that was not detected until after it had displaced. Open reduction internal fixation was performed without complication and the patient achieved excellent shoulder abduction strength. Nondisplaced acromion fractures may displace if not protected. Open reduction internal fixation of displaced acromion fractures should be considered if deltoid muscle strength is important to the patient.

Acetabulum↗
PubMedDate not supplied

[Complications in the hemiplegic patient in the first year after the stroke].

INTRODUCTION: After a cerebrovascular accident (CVA) a hemiplegic patient is at risk from numerous complications after leaving hospital. OBJECTIVE: To analyze the frequency of occurrence of the commonest complications characteristic of the hemiplegic syndrome, during the first year after the stroke. PATIENTS AND METHODS: We evaluated 73 hemiplegic patients admitted to the rehabilitation department for treatment after a stroke. At each medical consultation, on admission and three, six and twelve months after the CVA, the complications 'belonging' to the hemiplegic syndrome were evaluated. These included contractures, painful shoulder, sympathetic-reflex dystrophy, fractures and thalamic pain. RESULTS: During the first year of the illness 81% of the patients had some type of complication. A painful shoulder was the commonest complication, seen in 40% of the patients, followed by contractures (23%). Sympathetic-reflex dystrophy of the paretic arm occurred in 11 patients (15%). CONCLUSION: The commonest complication in patients during the first year after their stroke are painful shoulder and contractures.

Aged↗

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