PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “SHOULDER FRACTURES”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 613 records · Page 34Linked to original sources
PubMed1989

Objective evaluation of the shoulder dystocia phenomenon: effect of maternal pelvic orientation on force reduction.

This report describes the use of maternal pelvic and fetal models, a tactile sensing glove, and a microcomputer data acquisition system to measure fetal shoulder extraction forces. Sixty-nine experiments were carried out in the laboratory setting to simulate vaginal delivery of the aftercoming fetal shoulders. The tests were conducted using a variety of fetal biclavicular diameters (10-13 cm) and maternal pelvic angle positions (McRoberts, 10 degrees; lithotomy, 25 degrees). When comparing lithotomy versus McRoberts positioning, there was a consistent reduction in force needed to extract the fetal shoulders with the latter maneuver. No simulated clavicles were fractured during shoulder delivery until a biclavicular diameter of 12.0 cm was reached. At this point, five of eight clavicles (63%) were fractured at 25 degrees and zero of seven (0%) were fractured at 10 degrees (P less than .025). For all 69 experiments, fetal neck extension readings were consistently lower than the total traction forces recorded by the tactile sensing glove. This suggests that, in addition to the axially oriented fetal neck forces, a component of flexion (lateral force) was also present. As the difficulty of shoulder delivery increased, the impact of these inadvertent flexion forces became most pronounced at the level of the brachial plexus. This is the first study to measure shoulder extraction forces reproducibly using a laboratory model for shoulder dystocia and to describe the pathophysiology of specific neonatal injuries from a force perspective. The results document objectively that McRoberts positioning reduces shoulder extraction forces, brachial plexus stretching, and the incidence of clavicular fracture.

Delivery, Obstetric↗
PubMed2006

Proximal humerus Salter type III physeal injury with posterior dislocation.

Salter type 3 fractures of the proximal humerus are rare injuries. We report the first case of a Salter type 3 physeal fracture with posterior dislocation of the proximal humerus in a 16-year-old boy. The fracture pattern could not be evaluated by simple radiography, but was possible with the aid of MRI. The dislocated humeral head was locked behind the glenoid labrum. Open reduction was mandatory. Sixteen months after the operation, avascular necrosis of the humeral head was detected by simple radiography and MRI. Even though the patient had a full range of motion of the shoulder and no pain, a long-term follow-up is believed necessary.

Adolescent↗
PubMedDate not supplied

Surgical anatomy of multipart fractures of the proximal humerus.

The gross fracture anatomy was recorded in a cohort of 22 consecutive patients who underwent open surgery for 3-part and 4-part fractures of the proximal humerus and was compared with preoperative radiographs in a blind manner. It was noted that 8 of the 22 fractures did not correspond to any category of the Neer or AO/Orthopaedic Trauma Association/Jakob classification. These fractures had 3 displaced segments in terms of surgical anatomy, but the humeral head was free of soft tissue. In addition, the soft-tissue attachments to the head were closely related to the articular surface orientation on radiographs (medially oriented or not), rather than to the number of displaced segments or to the grouping of the AO/Orthopaedic Trauma Association/Jakob classification. Thus, in our study population, the current classification systems were inaccurate for realizing the fracture anatomy, particularly humeral head status. They would be accurate if the articular surface orientation was taken into account.

Aged↗
PubMed2006

Shoulder impairment following treatment of diaphysial fractures of humerus by functional brace.

INTRODUCTION: Treatment of humeral shaft fractures by functional bracing has been reported to be effective in achieving high rate of fracture union and good function of the adjacent shoulder and elbow joints. Since our previous clinical impression indicated an occurrence of shoulder function impairment following this treatment, we investigated the shoulder function in a consecutive series of patients treated by functional bracing for fractures of humeral shaft in order to estimate their residual shoulder function. MATERIALS AND METHODS: We followed 15 consecutive patients with humeral shaft fractures treated by functional brace. The mean follow up was 30 months (range 12-57 months); seven patients with midshaft fracture, four patients with proximal third, and four patients with fractured distal third of the humeral diaphysis. All the patients were evaluated by the Constant score of the injured limb in comparison to the contra-lateral not injured shoulder and by the Oxford shoulder score of the injured limb. RESULTS: We found that all the fractures were united with mean varus angulation of 13 degrees and with mean angulation in the saggital plane of 9 degrees antecurvatum, Constant scores were significantly lower in the injured shoulders (P < 0.001) and the function of the shoulders in the injured extremities were estimated as having mean Oxford shoulder score of 34 (range 17-54). CONCLUSIONS: The evaluation of the present series revealed an impaired functional outcome in the shoulders after humeral shaft fracture. Our results indicate that although the fracture union is usually achieved following the functional bracing of humeral shaft fractures, the shoulder function in the injured limb may remain impaired.

Adult↗
PubMed2001

Interventions for treating proximal humeral fractures in adults.

BACKGROUND: Proximal humeral fractures are common yet management varies widely. In particular, the role and timing of any surgical intervention have not been clearly defined. OBJECTIVES: To collate and evaluate the scientific evidence supporting the various methods used for treating proximal humeral fractures. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, MEDLINE, PubMed, the Cochrane Controlled Trials Register, CINAHL, the National Research Register and bibliographies of trial reports. The search was completed in July 2000. SELECTION CRITERIA: All randomised studies pertinent to the treatment of proximal humeral fractures were selected. DATA COLLECTION AND ANALYSIS: Independent quality assessment and data extraction were performed by two reviewers. Although quantitative data from trials are presented, trial heterogeneity prevented pooling of results. MAIN RESULTS: Nine randomised trials were included. All were small trials; the largest study involved only 85 patients. Bias in these trials could not be ruled out. Six trials evaluated conservative treatment, two compared surgery with conservative treatment and one compared two surgical techniques. In the 'conservative' group there was very limited evidence indicating that the type of bandage used made any difference in terms of time to fracture union and the functional end result. However, an arm sling was generally more comfortable than a body bandage. There was some evidence that mobilisation at one week instead of three weeks alleviated pain in the short term without compromising long term outcome. Two trials provided some evidence that patients, when given sufficient instruction to pursue an adequate physiotherapy programme, could generally achieve a satisfactory outcome if allowed to exercise without supervision. Operative reduction improved fracture alignment in two trials. However, in one trial, surgery was associated with a greater risk of complication, and did not result in improved shoulder function. Fracture fixation of severe injuries was associated with a high rate of re-operation in one trial, comparing tension-band wiring fixation with hemi-arthroplasty. REVIEWER'S CONCLUSIONS: Only tentative conclusions can be drawn from the available randomised trials, which do not provide robust evidence for many of the decisions which need to be made in contemporary fracture management. It is unclear whether operative intervention, even for specific fracture types, will produce consistently better long term outcomes. There is a need for good quality evidence for the management of these fractures.

Adult↗
PubMed1994

The use of computed tomography with two- and three-dimensional reconstructions in the diagnosis of three- and four-part fractures of the proximal humerus.

Spiral computed tomography (CT) with three-dimensional and multiplanar reconstructions was used to assist in the diagnosis of three- and four-part fractures of the proximal humerus in 10 patients. CT added important information to that obtained by conventional radiography in four patients. It verified impaction of the capital fragment in two patients. In a patient with a four-part fracture metaphyseal attachment to the head fragment was demonstrated and in a patient with a three-part anterior fracture dislocation an osseous Bankart lesion was shown. In all patients CT clearly visualized the degree of displacement of tuberosity fragments which can be valuable when planning open reduction and internal fixation.

Adult↗
PubMed2003

Relevance of the restoration of humeral length and retroversion in hemiarthroplasty for humeral head fractures.

Sixteen patients, with a fracture of the upper humerus treated with hemiarthroplasty, were followed-up for 45.7 +/- 15.1 (20-72) months after surgery. The results were assessed using the Constant-Murley scale. The mean score was 75.8 +/- 15.7 (54-96) points out of a possible maximum of 100. At the time of their last follow-up they underwent CT of the fractured and contralateral humerus. Humeral length and retroversion were measured and evaluated. A very good final outcome (Constant score more than 71) was achieved in patients with a difference in retroversion less than 10 degrees and a difference in length less than 14 mm, between fractured and sound humerus. The mean difference in retroversion was 8.7 degrees and the mean difference in length was 0.65 cm, between fractured and sound humerus. We attribute the very good clinical outcome in our series to the quality of the anatomical reconstruction that was performed.

Adult↗
PubMed1988

The lever arm in glenohumeral abduction after hemiarthroplasty.

Fourteen cases of hemiarthroplasty for four-part fractures of the proximal humerus were reviewed. Pain relief was satisfactory, but function was limited, mainly due to loss of glenohumeral abduction despite electromyographic proof of actively contracting abductors in all cases. Analysis of special radiographs of nine cases showed a direct relationship between the clinical results and the "humeral offset", or distance between the geometric centre of the humeral head and the lateral aspect of the greater tuberosity. This offset affects the lever arms of the glenohumeral abductor muscles. The implications for surgical technique and for the design of shoulder prostheses are discussed.

Adult↗
PubMedDate not supplied

Hemiarthroplasty for severe fractures of the proximal humerus.

Twenty-two patients were followed up at a mean of 33 months after hemiarthroplasty for proximal humeral fractures. Of these, 13 underwent surgery within 30 days of injury and 9 after a mean of 13 months. Outcome was assessed by pain, range of motion, function, stability, and strength. Results were comparable to those from specialist centers. Pain relief was the most predictable outcome. Mean active forward flexion was 93 degrees, active external rotation 24 degrees, and internal rotation to L1. Most patients were satisfied with the outcome. The results were better in younger patients. One patient required a revision after 7 years for aseptic loosening. The severity of the fracture and timing of the operation did not appear to have a bearing on the outcome. Technical problems at surgery, greater tuberosity displacement, late rotator cuff rupture, and poorly motivated patients were the main reasons for failure.

Aged↗
PubMedDate not supplied

Outcome after hemiarthroplasty for three- and four-part fractures of the proximal humerus.

We reviewed 27 patients who had sustained displaced three- or four-part fractures of the proximal humerus and who were treated with a humeral hemiarthroplasty. Seventeen patients had a three-part fracture, and 10 had a four-part fracture. The mean follow-up period was 39 months (12 to 94 months). All fractures were classified according to Neer's classification. The Constant score was used for their follow-up evaluation. The median Constant score at follow-up was 51 for the three-part fractures and 46 for the four-part fractures. The median range of movement for all the patients in flexion was 70 degrees, abduction 70 degrees, internal rotation 50 degrees, and external rotation 45 degrees. Nine patients still had moderate or severe pain. Eight patients had moderate or severe disability. Our results were disappointing, and further studies on open reduction and fixation are therefore justified.

Aged↗
PubMed1975

[Fractures of the scapula in pigs intended for slaughter (author's transl)].

Fractures may be observed in the scapulae of those pigs intended for slaughter, which have undergone electrical stunning. These fractures may be classified into three types. That type in which the fracture is localized in the glenoid cavity is the most injurious one as it is accompanied by haemorrhage and therefore will result in loss of meat. This is liable to cause injuries to the employees engaged in boning out. It was concluded from an inquiry as well as from experimental exposure to stress that fractures of the shoulder are due to the marked tonic contractions of mainly antagonistic muscles, resulting in excessive strain on the shoulder blade and its joints. It is a striking fact that fractures of the shoulder were not observed in pigs stunned electrically while they were in a restraining apparatus.

Abattoirs↗