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At least 595 records · Page 33Linked to original sources
PubMed2000

Is there a place for external fixation in humeral shaft fractures?

There is a good indication for unilateral axial dynamic external fixation in fractures of the humeral shaft when the fracture appears in the distal third or in cases of bilateral fractures. A non-union or a posttraumatic paralysis of the radial nerve may be indications for external fixation as well as fractures associated with multiple injuries. Further indications include osteitis, infected non-union and comminuted fracture. There is maximum protection of the soft tissue with this method of treatment. External fixation combines the advantages of conservative and operative treatment by influencing callus formation by dynamizing, distraction or compression. Minimizing soft tissue damage facilitates the decision for early exploration of the radial nerve in cases of palsy. A safer positioning technique of the distal screws of the fixator is described.

Adult↗
PubMed2000

The use of interlocked 'customised' blade plates in the treatment of metaphyseal fractures in patients with poor bone stock.

Balanced and stable fixation in metaphyseal fractures and nonunion can be difficult because of osteoporosis, disuse osteopenia, comminution, joint proximity or malignant infiltration. Five patients with nonunion and four with comminuted or pathological acute fractures of metaphyseal areas of the tibia or humerus were treated with a 'customized' interlocked blade plate. The plates are standard AO dynamic compression plates of a suitable length that are bent to an acute angle in an industrial vice and 'interlocked'. The nine patients with a mean age of 62.2 years (range 30-91) were followed up for a mean of 7.2 months. At follow-up all fractures had healed with a single complication of subacromial impingement in a patient with a proximal humeral fracture.

Adult↗
PubMed2000

Proximal humerus malunions.

Malunion of a proximal humerus fracture often is painful and debilitating. Operative management of this deformity is technically demanding and frequently results in a relatively high rate of complications. Reconstruction involves a spectrum of procedures including excision of bony prominences, tuberosity osteotomy and realignment, and shoulder arthroplasty. This article covers the etiology, classification, diagnosis, and management of these complex injuries. A successfully performed reconstruction diminishes the patient's pain and potentially increases function.

Fractures, Ununited↗
PubMed2000

Management of surgical neck nonunions.

A surgical neck nonunion is a seriously debilitating complication of a proximal humerus fracture. Patients have virtually no functional use of their shoulders and experience pain. Successful treatment is reliable in relief of pain and potentially can restore function. The diagnosis is not difficult, however, a CT scan may be necessary to identify tuberosity or head-splitting fractures. Successful treatment for these nonunions is difficult but gratifying because the percent improvement is immense.

Aged↗
PubMed2000

Complications with humeral head replacement.

Humeral head replacement has been shown to be an excellent surgical option for a variety of debilitating shoulder conditions. New techniques and advances in prosthetic design have furthered the success of this procedure. When performed without appropriate indications, exacting technique, and a tailored rehabilitation program, however, complications often result. Early recognition and appropriate management of these complications aid in achieving a satisfactory result.

Aged↗
PubMed2000

The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions.

Adequate exposure is a prerequisite for treatment of distal humeral fractures, as with most surgical procedures. Challenging as they may be to reduce and fix, these fractures can be made more or less difficult to treat based on exposure; complications of successful treatment may arise as a result of the exposure. In this article the authors describe the triceps-reflecting anconeus pedicle (TRAP) approach to the distal humerus, which provides an extensile and versatile approach for treatment of fractures and nonunions. The TRAP approach provides almost the same exposure as an olecranon osteotomy, without the complications of the osteotomy, and has the added advantage of retaining the whole olecranon to use as a template against which to assemble the articular fragments of the trochlea.

Fractures, Ununited↗
PubMed1992

Fractures of the tibia.

ESF is an ideal fixation for most tibial fractures. Many ESF configurations have been used in repair of tibial fractures including ESF supplementation of intramedullary pin or interfragmentary screw fixation. Tibial fractures are often comminuted or open, and the tibia is prone to postoperative infections after open reduction and internal fixation. ESF is ideal for stabilization of open tibial fractures and management of associated soft tissue injury.

Animals↗
PubMed2000

The application of arthroscopic principles to bone grafting of delayed union of long bone fractures.

The purpose of this study was to explore the potential of applying arthroscopic techniques to autogenous bone grafting of long bone fracture delayed union. There were 9 patients in this initial series, including 4 patients (average age, 37 years) with humeral lesions and 5 patients (average age, 25 years) with tibial fractures. There were 6 men and 3 women. Techniques customarily employed in arthroscopy were used to visualize, expose, and deliver the onlay cancellous bone grafts. Bony union occurred in all but 1 patient in an average of 4 months. This patient had a fibrous union and sustained a reinjury that led to successful repeat open bone graft surgery. The arthroscopic approach for bone grafting of certain long bone delayed union appears to be a safe and effective procedure. The procedure is best suited for patients with mechanically stabilized fragments, and it lends itself to those with overlying skin or soft tissue compromise. There are some relative contraindications: grossly unstable fragments, severe malunion, and/or infection.

Adolescent↗
PubMedDate not supplied

Surgical management of diaphyseal humeral nonunion after intramedullary nailing: Wave-plate fixation and autologous bone grafting without nail removal.

Six patients with a nonunion of the humeral diaphysis after intramedullary nailing were treated with a wave plate and autologous bone graft but without removal of the intramedullary implant. The mean duration of the nonunion was 19 months (range, 6-36 months). At a mean follow-up of 12 months (range, 6-18 months), all six nonunions had healed, and patient satisfaction was high. Five patients had regained full shoulder function. One patient, who was treated for a rotator cuff tear before the humeral fracture, had a satisfactory functional outcome. Elbow motion was full in all but one patient. One patient had a postoperative radial nerve palsy, which recovered partially but did not require further surgery. This report suggests that healing of humeral nonunions can be achieved in the presence of intramedullary hardware.

Adult↗
PubMedDate not supplied

Treatment of post-traumatic humeral diaphyseal nonunion with bone loss.

Four patients with post-traumatic nonunion and shortening of the humeral diaphysis were treated with a hybrid advanced Ilizarov technique. The mean age of the patients was 32 years, and the mean total amount of humeral shortening was 6.63 cm. Three nonunions were atrophic and infected, and one was hypertrophic. All patients obtained union of the humeral fracture with resolution of infection at a mean external fixation time of 8 months. Restoration of normal humeral length was achieved in two patients, with a third having a residual discrepancy of 1 cm. The final patient, who had an infected nonunion with 11 cm of total humeral shortening, had a residual limb length discrepancy of 3 cm. All had improvement in shoulder and elbow motion after treatment. Superficial pin tract infections were seen in all patients, but all responded to pin-site care and oral antibiotics. Two patients had three refractures after removal of the fixator, two of which were treated by a second application of an Ilizarov frame and one by a cast. All patients had reduced pain and improved function at completion of the treatment. The Ilizarov method, though not a panacea for all humeral nonunions with extensive bone loss, does offer a viable salvage procedure in this unusual and often complex clinical problem.

Adult↗
PubMed2005

Treatment of nonunion of humeral shaft fracture with dynamic compression plate and cancellous bone graft.

BACKGROUND: This study was conducted to evaluate the treatment of aseptic nonunion of the humeral shaft with a dynamic compression plate (DCP) and cancellous bone graft. METHODS: One hundred and five cases of nonunion of a humeral shaft fracture between 1982 and 2001 were analyzed retrospectively. The study population comprised 66 males and 39 females with an average age of 46.2 years (range, 17-81 years). Sixty-seven fractures were defined as atrophic nonunion, and 20 as hypertrophic nonunion, whereas 18 could not be defined clearly. All the fractures were managed by open reduction and internal fixation with DCP and cancellous bone graft. The mean follow-up period was 20 months (range, 14-28 months). RESULTS: All nonunion fractures united within an average of 16 weeks (range, 10-26 weeks). Complications included 4 patients with temporary radial-nerve palsies, and 3 patients with wound infections. At the final follow-up, shoulder and elbow functions of the operated limbs were all satisfactory. CONCLUSION: Fixation by DCP with supplemental cancellous bone graft is a reliable and effective treatment for nonunion of a humeral shaft fracture.

Adolescent↗
PubMed2002

Good results with unreamed nail and bone grafting for humeral nonunion: a retrospective study of 21 patients.

21 patients with humeral shaft nonunions were treated by retrograde nailing with the unreamed humeral nail. In all cases, we reamed the fracture site and performed a bone graft. Union of the fracture occurred in every case. The mean healing time was 4.2 (4-6) months. The range of motion of the shoulder and elbow was excellent in 14 patients, that of the shoulder moderate in 6 and poor in 1, and that of the elbow moderate in 7. The functional results were excellent in 13 patients, good in 5 and fair in 3. Given the good functional results in this series, retr grade locked nailing and bone grafting appears to be a good method for treating humeral shaft nonunions.

Adolescent↗
PubMed2003

Recalcitrant posttraumatic nonunion of the humerus: 23 patients reconstructed with vascularized bone graft.

We treated 23 patients with recalcitrant posttraumatic humeral shaft nonunion with vascularized bone grafts (fibula 10, femur 10 and scapula 3). 21/23 patients healed primarily. Venous thrombosis in the graft necessitated postoperative thrombectomy in 2 patients. Complications at the donor site were trivial. We used a vascularized fibular graft in patients with a large bone defect and with poor intrinsic stability of the nonunion site and a corticoperiosteal femoral graft in atrophic nonunion without a substantial bone defect. The scapula graft is easy to transfer to the surgical neck of the humerus on its pedicle.

Adult↗