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At least 847 records · Page 47Linked to original sources
PubMed1995

Semiconstrained elbow replacement for distal humeral nonunion.

We have reviewed 36 of 39 consecutive patients with an average age of 68 years who had semiconstrained elbow replacement for distal humeral nonunion at an average follow-up of 50.4 months (24 to 127). Of these, 31 (86%) had satisfactory results, three (8%) had fair, and two (6%) had poor results; 32 patients (88%) had moderate or severe pain before and 91% had no or only mild discomfort after the procedure. Motion had improved from a mean arc of 29 degrees to 103 degrees before operation to 16 degrees to 127 degrees after surgery. All five flail extremities were stable at last assessment. There were seven complications (18%): two patients had deep infection, two had particulate synovitis, two had ulnar neuropathy and one had worn polyethylene bushes. Five of these seven, excluding the two with transient nueropathy, required reoperation (13%). Joint replacement arthroplasty can be a safe and reliable treatment for this difficult clinical condition, seen most commonly in elderly patients. This is a significant advance, since repeated osteosynthesis has been shown to be ineffective in most patients.

Activities of Daily Living↗
PubMed1994

[Intramedullary nailing of the humerus shaft fracture].

The current retrospective study refers to 61 fractures and nonunions of the humeral shaft that were treated operatively between 1980 and 1990 in the Department of Surgery of the University of Zürich Medical School. All fractures were stabilized with thin noninterlocking AO tibial nails. The follow-up included 48/61 patients. The predominant fracture localization was the middle third of the humeral shaft (52 consecutive cases), and most of these fractures were of the simple transverse type A3 according to the AO classification (29 cases). The incidence of initial radial nerve palsy was 9/61 and that of postoperative palsy 1/61. No preoperative evaluation of radial nerve function was obtained in 4 multiply injured patients. Upon follow up, the function was found to have returned to normal in 8 patients. No infectious complications were observed. In 4/56 patients the final result was nonunion. In 41/48 a good result was obtained in terms of shoulder function. There were 7 patients (5 of them multiply injured) with poor shoulder motion with less than 100 degrees in abduction and anteversion.

Adolescent↗
PubMed1994

[The Seidel humeral nail in limited indications: pathological fractures, delayed union, pseudarthrosis and reconstruction].

The authors report 10 cases of Seidel locked intramedullary nailing of the humeral shaft for borderline indications (5 delayed unions, 2 complex nonunions, 2 reconstructions for tumor and a panmetastatic humerus). All delayed unions went to union in spite of unscrewing of the expanding screw in 2 cases. In cases of segmental reconstruction, union never occurred due to unlocking of the distal bolt by bone incompetence. Diaphyseal straightening was obtained, but not rotational stability. These elderly patients, in whom the osteoporotic bone is inadequate for plate osteosynthesis, were pleased with the result in comparison with their preoperative status. For pathological fracture, a painfree status is obtained. No subacromial impingement was observed.

Adult↗
PubMed1993

[Design of the scorpion-like dynamic nitinol osteo-connector and its use in the treatment of fractures and the nonunion of the upper extremity tubular bones].

Preparation of the scorpion-like dynamic nitinol osteo-connector (NT-SDOC) and its clinical application in 57 cases were reported. The apparatus was designed with two longitudinal pressure hooks and two to eight semicircular fixation hooks, which could exert an axial continuing stress of 24-56kg on the fracture ends until bone union. Of the 57 cases 31 were fracture and 26 were nonunion, as no plaster cast was applied postoperatively, all patients could exercise their injured arms early. Follow-up was 4 to 32 months with an average of 13.7 months. The osteo-plate substitution was shown at the fracture site at an average of 2.2 months in 31 cases, and at the nonunion site with an average of 3.64 months in 26 cases. No postoperative infection, nonunion and other complications were observed NT-S DOC was removed in 46 cases at about 6 months postoperatively. No refracture occurred at the osteo-plate substitution site.

Adult↗
PubMed1994

[Results of closed pinning of supracondylar humerus fractures using Kirschner wires].

In the Department of Traumatology of the County Hospital "Kaposi Mór" 150 children with supracondylar fracture of humerus were treated during 10 years (1980-1989). 119 cases reduced and pinned with percutaneous Kirschner wire are dealt with. 98 cases could be controlled 2-10 years after the accident. The importance of urgent treatment is stressed. The urgent reduction and the closed pinning with Kirschner wire are thought to be an efficient prophylaxis against Volkmann's ischaemic contracture and varus deformity, caused by secondary movements.

Age Factors↗
PubMed1993

Applications of the Ilizarov method in the humerus. Lengthenings and nonunions.

Between 1982 and 1992, Ilizarov's method was used in 68 lengthenings and 29 nonunions of the humerus. Special rings along with the arches similar to those used for femoral lengthening were used to allow unrestricted motion at the elbow and shoulder. These patients were followed for an average of 5.1 years. In cases of lengthening, average length achieved was 9 cm, with duration of treatment being 5 to 14 months. Overall results in most cases were excellent. In cases of nonunion, the duration of treatment averaged 226 days. Of the 29 nonunions, 25 healed. Our results, including no major complications, support the continued use of Ilizarov's technique in humeral lengthening and nonunions of the humerus.

Adolescent↗
PubMed1993

Fibular transport in conjunction with Hoffman external fixation of the tibia.

Tibiofibular synostosis is a salvage procedure commonly used for difficult nonunions of the tibia. It may be carried out by means of transfixion screws, a bone graft, or fibular transfer using Ilizarov (Smith and Nephews Richards, Memphis, Tennessee) or Monticelli-Spinelli (Howmedica Inc, Rutherford, New Jersey) devices. This paper describes fibular transfer employing the Hoffmann external fixator, which is commonly used in the management of tibial fractures or nonunions.

External Fixators↗
PubMed1995

Healing rate of transverse osteotomies of the olecranon used in reconstruction of distal humerus fractures.

To determine the rate of healing of the osteotomy, we studied the cases of 10 patients who had transverse osteotomy of the olecranon for surgical exposure of a complex distal humerus fracture. The average age of the patients was 48 years, and the average follow-up was 24 months. Nine of the fractures were complex supracondylar/intercondylar fractures. All of the humerus fractures were treated with bone plates and screws, and nine of the osteotomies of the ulna were reconstructed with a large lag screw and tension band wire. Smooth pins and a tension band wire were used in 1 patient with osteoporotic bone. Union of the ulnar osteotomy occurred in 7 patients, and 3 of the patients had a nonunion. The average time of healing of the distal humerus fractures was 3.5 months, and the average time of healing of the ulnar osteotomies was 5.2 months. Six of the patients developed a gap at the osteotomy site by displacement or resorption of it, and two of these progressed to a nonunion. The patients whose ulnar osteotomy healed had an average extension lag of 33 degrees, and the average flexion at their elbows was 122 degrees. The patients who had a fibrous nonunion of the ulnar osteotomy had an average extension lag of 27 degrees at the elbow, and all 3 patients had full flexion of the elbow joint. Because of the nonunion rate of 30% in our patients, we no longer use a transverse osteotomy of the olecranon to expose distal humerus fractures at surgery.

Adolescent↗
PubMedDate not supplied

Seidel locked nailing for the treatment of unstable fractures and nonunion of the humerus.

The results of treatment by Seidel locked nailing in 13 recent fractures and 4 nonunions of the humerus are reported. The feature common to all of the fractures was instability consequent to comminution or in the site of the fracture center. The 4 nonunions were originally fractures synthesized by Rush intramedullary nailing. The surgical method used an entry approximately 1 cm from the greater tuberosity through a well-vascularized area of the rotator cuff. All of the cases achieved consolidation and in 70% of the patients results were excellent with complete recovery of range of movement of the shoulder. Thus, the Seidel nail appears to be an intramedullary means of synthesis particularly suited to the treatment of unstable fractures and nonunion of the humerus because it guarantees stability, especially in rotation, superior to any other intramedullary means of synthesis.

Adult↗
PubMed1997

Treatment of humeral diaphyseal nonunions in patients with severely compromised bone.

Twenty-eight patients were treated for humeral shaft nonunions. Host factors associated with humeral nonunion included a high rate of significant medical problems and significant local tissue trauma from the initiating injury. Comminuted fractures and fractures that were either long oblique or spiral in configuration were also heavily represented in this series. Midshaft was the most common anatomic location (n = 17). Previous surgery had been unsuccessful in 22 of the patients. All the humeral nonunions were treated by either standard AO compression plate technique with iliac crest bone grafting or, in patients with severely compromised bone from osteoporosis or multiple fixation attempts, a reconstruction using an intramedullary fibular graft and dynamic compression plate with screws, obtaining four cortices of fixation (quadricortical). This construction was also augmented with iliac crest bone graft. In this difficult subgroup of patients, our technique of intramedullary quadricortical fixation yielded an 89% union rate (17/19). Patients with humeral union were satisfied and had functional range of motion of the shoulder and elbow.

Adolescent↗