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At least 865 records · Page 48Linked to original sources
PubMed1997

Treatment of humeral shaft fractures by retrograde locked nailing.

From 1992 to 1994, 29 middle and 19 distal humeral shaft fractures (39 acute fractures, six nonunions, and three pathologic fractures) in 48 patients were treated by retrograde locked nailing. The first eight acute fractures were treated with Seidel nails, the other 40 fractures with specially designed humeral locked nails. Nails were inserted from the supracondylar (6) or the olecranon fossa (42) entry portal. With a single operation, all acute fractures and nonunions achieved osseous union without serious complications. The average time to union was 8.2 weeks for acute fractures and 14.2 weeks for nonunions. Recovery of shoulder function was complete. Elbow motion was excellent in all but one nonunion that resulted from a Type IIIB open fracture. Two patients with supracondylar entry had apex to posterior angular malunion. One patient with a distal comminuted fracture had varus malunion. Three patients had an iatrogenic bony split, but healing was unaffected. Patients with pathologic fractures maintained satisfactory arm function postoperatively. Given the few complications and good functional recovery seen in this study, retrograde locked nailing appears to be a good alternative treatment in middle and distal humeral shaft fractures. The olecranon fossa approach, with more linearity to the humerus, is preferred. In the authors' experience, humeral locked nails are inserted more easily and are associated with fewer complications than are Seidel nails.

Adolescent↗
PubMed1997

Operative treatment of humeral shaft fractures.

The results of the operative treatment of 27 humeral shaft fractures treated at the University of Louisville during a 2-year period were reviewed. The aim of this study was to analyze 1) the indications and results of surgical treatment, 2) the indications for nailing versus plating, and 3) the failures and their treatment (especially surgical nonunions). Indications for surgery were polytrauma patients (including open fractures, associated neurovascular injuries, associated ipsilateral forearm injuries) and isolated unstable fractures in which closed reduction failed. Plate and screw osteosynthesis was used in patients with proximal and distal fractures, in the presence of neurovascular injuries, progressive radial nerve palsy and failure of closed reduction due to interposition of soft tissue. Intramedullary antegrade nailing was preferentially used in polytrauma patients. Seven patients (25%) needed further surgery because of nonunion. The frequency was higher after plating (30%) than after nailing (20%), it was more common in comminuted fractures, middle third fractures and after insufficient distal locking. Exchange nailing resulted in union in 5 of the 7 cases. Although excellent results with low complication rates are reported in the recent literature following plate and screw osteosynthesis or locked intramedullary nailing, we found that operative treatment of difficult humeral shaft fractures is still fraught with a high complication rate.

Bone Nails↗
PubMed1997

Open fractures caused by high velocity missiles: the outcome of treatment of 39 fractures followed for 1-3 years.

Between 1993 and 1995, thirty-three patients having 39 fractures caused by missiles fired from a high velocity rifle were reviewed retrospectively between 1 and 3 years after injury and the outcome of treatment assessed. Majority (33 out of 39) were Grade III. Union was achieved in 35 out of 39 fractures, there was deep infection and delayed union in one case each. Non-union occurred in three fractures. The fractures were stabilized using different techniques, but highest complication rate was seen with the use of the static external fixator. This was related to the severe nature of the injury as well as the inherent limitations of the external fixator. Revision of the external fixator with internal fixation after healing of the soft tissues seems to be the direction of the future.

Adolescent↗
PubMed1998

Operative management of diaphyseal fractures of the humerus. Plate versus nail.

Although nonoperative treatment is indicated and successful for the majority of diaphyseal humeral fractures, operative intervention is indicated in several situations. Either intramedullary nail or plate fixation commonly is used for the operative management of this problem. Familiarity with the surgical techniques and application of both types (and subtypes) of implants is necessary to allow optimal treatment for the widest range of fracture patterns. In most indications for operative management, internal fixation with plates is preferred. Stable fixation, sparing adjacent joints from iatrogenic injuries, and direct visualization and protection of the radial nerve are of critical importance in maximizing postoperative function and in most cases outweight the potential advantages of a loadsharing implant inserted through a more limited incision.

Biomechanical Phenomena↗
PubMed1998

Repair of nonunion lateral humeral condyle: a case report.

Epiphyseal injury of the lateral condyle of distal humerus is found commonly in children. Complications following such an injury can result in nonunion with late development of angular deformity and ulnar nerve neuritis. Nonunion at this area is extremely troublesome and difficult to treat. Controversy exists as whether late open reduction and fixation can restore the anatomy of the elbow joint and improve the function. We describe a technique of corrective osteotomy to correct the cubitus valgus deformity and repair the nonunion. The patient was treated successfully with 4 years follow-up.

Child↗
PubMed1989

Retrograde Herbert screw fixation for treatment of proximal pole scaphoid nonunions.

Most nonunions of the carpal scaphoid bone can be treated with a high rate of success by use of conventional bone grafting techniques. However, fractures with a small proximal pole fragment may be difficult to treat by use of these techniques. Nine patients with nonunion and three patients with unstable proximal pole fractures were treated with retrograde dorsal Herbert screw fixation and adjunctive bone grafting. Follow-up averaged 25 months. Of the 12 patients, the fracture healed in 11 and one fracture remained ununited. This technique has been successful in our practice and should be considered in the treatment of small proximal pole nonunions and displaced proximal pole fractures.

Adolescent↗
PubMed1985

Attritional flexor tendon rupture due to a scaphoid non union imitating an anterior interosseous nerve syndrome: a case report.

A case is presented of acute loss of function of flexor pollicis longus and profundus tendon to the index finger. Although the aetiology was obscure, the acute onset suggested a mechanical cause rather than a nerve compression disorder such as anterior interosseous nerve palsy. X-rays showed an ununited scaphoid fracture related to an injury many years previously. Surgical exploration revealed attritional rupture of flexor pollicis longus and partial division of profundus tendon to index finger by a spicule of ununited scaphoid which had eroded through the volar capsule. Removal of the spicule and tenodesis of flexor pollicis longus gave a good long term result.

Aged↗