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PubMed1975

[Osteosynthese in scapula fractures (author's transl)].

Fractures of the scapula can be mostly conservativly. Dislocated fractures can be easily adjusted by suitable approaches. Rigid fixation allows early mobilisation, which is of very importance for the shoulderjoint. Some dislocated cases have been described and the problems of conservatively treated fractures have been discussed. Follow-up of some with stable fixation treated scapulafractures show that it is possible to gain a perfect functional result and a painless shoulderjoint in some hopeless cases.

Acromion↗
PubMed1984

[Classification of fractures of the proximal end of the humerus following prognostic and therapeutic aspects].

The classification of the proximal humeral fractures according to the four-segment concept of Neer has proven to be very useful. It not only considers the fracture itself but also lesions of the soft tissue. Adapting Neer's concept we propose a modified classification of the proximal humeral fractures which we believe is clearer and more practicable. This classification is illustrated by means of drawings and typical roentgenograms. The description of the different fracture-types includes the mean characteristics such as fragment-displacement, status of the rotator cuff and blood circulation to the head segment.

Fractures, Open↗
PubMedDate not supplied

Fixed-angle plate fixation in simulated fractures of the proximal humerus: a biomechanical study of a new device.

This study was performed to evaluate the biomechanical properties of a new device for displaced fractures of the proximal humerus. The device is a low-profile, fixed-angle plate specially designed for percutaneous application. With the use of embalmed cadaveric humeri, we simulated both noncomminuted and comminuted 2-part surgical neck fractures of the proximal humerus. Each humerus of a pair was then randomly fixed with either the new experimental device or the Association for the Study of Internal Fixation (ASIF) T-plate and mechanically tested to failure in an axial shear-loading model. The two fixation devices were evaluated in paired humeri with regard to mode of failure, stiffness, displacement at physiologic loads, and displacement, load, and energy at the point of ultimate load before failure. In the noncomminuted fracture trials the experimental device exhibited significantly greater stiffness (P <.001; P =.002 for normalized values) and ultimate load before failure (P =.015) and significantly less displacement at higher physiologic loads (P =.031). In the comminuted fracture trials the experimental device exhibited significantly greater stiffness (P =.048), ultimate load (P <.001) and energy absorbed (P =.048) before failure, and significantly less displacement at higher (P =.004) and lower physiologic loads (P =.011). The study demonstrates improved biomechanical properties for the new experimental device over the T-plate in simulated fractures of the proximal humerus. We extrapolate that these improved biomechanical properties may prove advantageous in future clinical investigation.

Aged↗
PubMed1995

[Ultrasound of extremity lesions caused by birth trauma].

With regard to injuries of the extremities caused by birth trauma, ultrasound allows simultaneous direct evaluation of the surface of osseous elements and of cartilaginous and soft-tissue structures as well. Thus, not only fractures, but also concomitant articular fluid collections, respectively haematomas and/or dislocation of an epiphysis are demonstrated in their initial extent and in their course of healing. Additionally, closed repositions, for instance of a displaced epiphysis, can be exactly monitored by ultrasound. A reduced number of roentgenograms as well as renunciation of other imaging modalities are the consequence. Own experiences in 4 patients with birth trauma to the humerus confirm the high validity of ultrasound in this area as well.

Arm Injuries↗
PubMed1989

[Late results of sub-capital humerus fracture in children].

From 1980 until 1984 56 children with a subcapital humeral fracture were treated at the Department of Paediatric Surgery in Zürich. 42 of them could be followed-up 5 years after the accident, all showed a good result. In 21 children a simple immobilisation was successful. 8 cases needed a reposition of the fracture in anaesthesia and immobilisation. 11 cases needed further procedures, in 7 of them an osteosynthesis was done, in 4 cases an extension was necessary to hold the fracture position. One patient was treated primarily by open reduction and pinning of the fracture, another one by an extension. Both patients had polytrauma. The paper presents our long-term results and the different modalities of treatment are discussed in the light of our own results.

Adolescent↗
PubMed2005

Low-energy arterial injury at the shoulder with progressive or delayed nerve palsy.

We describe 20 patients, aged between 43 and 88 years, with delayed nerve palsy or deepening of an initial palsy caused by arterial injury from low-energy injuries to the shoulder. The onset of palsy ranged from immediately after the injury to four months later. There was progression in all the patients with an initial partial nerve palsy. Pain was severe in 18 patients, in 16 of whom it presented as neurostenalgia and in two as causalgia. Dislocation of the shoulder or fracture of the proximal humerus occurred in 16 patients. There was soft-tissue crushing in two and prolonged unconsciousness from alcoholic intoxication in another two. Decompression of the plexus and repair of the arterial injury brought swift relief from pain in all the patients. Nerve recovery was generally good, but less so in neglected cases. The interval from injury to the repair of the vessels ranged from immediately afterwards to 120 days. Delayed onset of nerve palsy or deepening of a nerve lesion is caused by bleeding and/or impending critical ischaemia and is an overwhelming indication for urgent surgery. There is almost always severe neuropathic pain.

Adult↗
PubMedDate not supplied

Displaced three- and four-part proximal humerus fractures: evaluation and management.

Three- and four-part fractures are the most severe injuries in the spectrum of fractures of the proximal humerus. Despite the shortcomings of the currently available imaging techniques, fracture displacement remains an important principle in guiding management. As a result, increasing emphasis has been placed on the use of Neer's criteria in intraoperative decision making. Patients with four-part fractures with valgus impaction of the head fragment should be treated with limited open reduction and minimal internal fixation, as the blood supply to the humeral head is better preserved than with other fracture patterns and the potential for osteonecrosis is less. In the case of displaced three- and four-part fractures, the physiologic age and bone quality also help guide treatment selection. In young patients with good bone quality, attempts to preserve the humeral head by meticulous handling of soft tissues and the use of low-profile implants to secure fracture fragments is recommended. Vertical fixation alone with Rush rods in patients with poor bone quality and in those with four-part fractures is no longer considered adequate and should not be used. For selected patients with three-part fractures and satisfactory bone quality, fixation with Ender rods and tension-band wiring may be appropriate. Elderly patients and those with poor bone quality have a greater risk of loss of reduction after open reduction and internal fixation, and the current consensus is that early hemiarthroplasty is the appropriate treatment. Late reconstruction necessitated by malunion and soft-tissue contracture is technically difficult, and the outcome is less favorable. The outcome of treatment of three- and four-part fractures is dependent on the surgeon's ability to analyze the fracture pattern and execute appropriate techniques to restore anatomy and function. The use of cement for prosthetic fixation and rigorous attention to tuberosity stabilization and anatomic reduction are two factors that will optimize outcome. Adequate pain relief after hemiarthroplasty has been consistently demonstrated, but return of motion and function is less predictable.

Arthroplasty, Replacement↗