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At least 523 records · Page 29Linked to original sources
PubMed2006

Posterior dislocation of the shoulder with ipsilateral humeral shaft fracture: A case report and review of literature.

Isolated posterior dislocation of the shoulder with ipsilateral humeral shaft fracture is a rare combination. Three cases of such co-existence have been reported so far. We report a fourth case and review the literature. Our aim is to highlight the importance of this rare co-existence. A high index of suspicion is necessary to diagnose posterior dislocation of the shoulder as most concentration is on the humeral shaft fracture. Delayed diagnosis has a poorer prognosis.

Humans↗
PubMedDate not supplied

Shoulder arthroplasty for late sequelae of proximal humeral fractures.

Twenty-eight patients with sequelae of proximal humeral fractures were treated with shoulder arthroplasty and were reviewed with a mean follow-up of 47 months. There were 8 malunions, 7 osteonecrosis, and 2 nonunions of the proximal humerus. Degenerative joint disease without any distortion of the tuberosities had developed in 11. We performed 8 total shoulder arthroplasties and 20 hemiarthroplasties. On the basis of the Neer criteria, the results were satisfactory in only 64%. Fifteen patients had superior migration of the implant. One patient had to be reoperated on because of deep infection. The prognosis was influenced positively by the integrity of the rotator cuff at surgery, whereas the need for greater tuberosity osteotomy worsened the final result. The data suggest that malunion of the greater tuberosity can be tolerated if it does not compromise acceptable positioning of the humeral component. However, if there is a malunion of the greater tuberosity with major displacement, an osteotomy must be performed, with unpredictable results.

Adult↗
PubMed1987

Complex fractures of the proximal humerus: role of CT in treatment.

The authors reviewed the computed tomography (CT) scans, plain radiographs, and subsequent treatment of 17 patients with complex proximal humeral fractures. CT scans and radiographs were compared in the demonstration of fracture lines, displacement of fracture fragments, rotation of fragments relative to their normal positions, and status of the head and articular surface of the humerus. The impact of CT findings on the decision to treat with surgery versus closed reduction and on the choice of surgical procedure was assessed. Surgery was not performed in nine patients because CT scans showed no significant displacement of fragments previously judged displaced or "indeterminate" on radiographs. Surgery was performed in eight patients; CT demonstrated significant abnormalities not definitely shown with radiography. In six of these eight patients, CT scans demonstrated unsuspected abnormalities that directed the choice of surgical procedure. CT scans provide clinically useful information for the treatment of complex proximal humeral fractures when radiographs provide inadequate or indefinite information.

Adult↗
PubMed1988

Complex shoulder trauma: three-dimensional CT imaging.

Volumetric three-dimensional imaging is a new technique for CT image processing which generates realistic, three-dimensional models of complex musculoskeletal anatomy from routine transaxial CT data. Volumetric three-dimensional imaging is particularly helpful in evaluating complex shoulder trauma, demonstrating significant advantages over plain film radiography. Multipartite fractures involving the shoulder girdle are displayed in a comprehensive fashion with 3D imaging. With volumetric imaging as implemented on a Pixar Imaging Computer, a 3D model of the injured shoulder can be generated with overlapping structures removed from view, and then rotated about the vertical and horizontal axis for better understanding of abnormal anatomy prior to surgical correction.

Humans↗
PubMed2003

[Fractures of the humeral head].

Fractures of the humeral head are very common in elderly people, with 70% of all such fractures being seen at an age of more than 60 years. For the radiological examination of the fracture, x-rays from two levels are mandatory. The number and position of the fragments, assessment of intact or ruptured periosteum between the fragments and muscle forces acting on the fragments have to be determined from the x-rays. A 3-D CT scan can be very useful for better understanding of the character of the fracture. The remaining displacement between fragments after reduction have to be evaluated according to their location. Even small incongruities between fragments in the subacromial space will impair the gliding mechanism, whereas remaining displacements between the head and shaft can be accepted to a much larger extent. According to the fracture mechanism, we can basically differentiate between avulsion fractures and depression fractures. The avulsion fractures are characterised by a varus tendency of the humeral head,whereas the depression fractures are characterised by a valgus position of the head fragment. This has to be taken into consideration when choosing the implant for fixation. The indication for reconstructive surgery or prosthetic replacement depends on the type of fracture, on the quality of bone and on the familiarity of the surgeon with the treatment of humeral head fractures. The implants currently used for fixation can basically be differentiated between rigid and semi-rigid. The indication for the one or the other depends on the fracture type and the bone quality. In general, for simple fractures and in case of poor bone quality semi-rigid implants are indicated. Despite the fact that an understanding of the character of the fractures and implants has improved over the last few years, there are still types of fractures which need primary prosthetic replacement.

Age Factors↗
PubMed1995

A slowly evolving brachial plexus injury following a proximal humeral fracture in a child.

The association of fractures and neurological injuries is well recognized, especially with certain upper limb fractures. Typically, the nerve injury occurs at the time of initial fracture displacement. A case is reported of an unusual combination of fracture and nerve injury in a child, with the extremely rare occurrence of a slowly evolving nerve injury. The potential for delayed nerve injury following a fracture needs to be appreciated to prevent delays in diagnosis and treatment.

Brachial Plexus↗
PubMedDate not supplied

Comminuted humeral head fractures: a multicenter analysis.

Three centers' experience with 93 comminuted humeral head fractures were clinically (Constant score) and radiologically (Neer) analyzed. The results revealed fundamental differences between the various types of fractures depending on the number of fragments. For three-part fractures open reduction and internal fixation (mean Constant scores 83 and 91 points, respectively) or conservative treatment (78 points) seem to be indicated. The prognosis for four-part fractures is determined largely by the vascular supply of the head fragment with a high risk of humeral head osteonecrosis. For this reason primary prosthetic replacement (mean Constant score, 74 points compared with 54 points for conservative treatment and 52 points for open reduction) should be recommended for this type of fracture. In conclusion, we stress the importance of fracture type directing the therapeutic modality.

Aged↗
PubMed1975

Fractures of the proximal humeral epiphysis.

Displacements of the proximal humeral epiphysis at the epiphyseal plate result from extension injuries. The configuration of the epiphyseal plate and the thickness of the periosteum surrounding the epiphysis make slight to moderate displacements relatively stable injuries, which can be treated successfully with external support. In patients with more severe displacement, flexion, abduction, and slight external rotation of the distal fragment bring the metaphysis into alignment with the proximal fragment, correcting the anterior angulation. The thick periosteal sleeve attached to the physis through which the metaphysis tears out anteriorly has great potential for remodeling the persistant bowing that remains after healing of the fracture. Although shortening and residual angulation results from closed treatment are almost always good and open surgery is rarely indicated.

Adolescent↗