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 865 records · Page 48Linked to original sources
PubMed2006

Proximal humerus fractures.

Proximal humerus fractures are common injuries. Knowledge of local anatomy is paramount in the evaluation and treatment of these injuries. Information regarding humeral head vascularity, fracture patterns, bone quality, and overall geometry have direct implications for nonoperative treatment, internal fixation, and hemiarthroplasty. The ascending branch of the anterior circumflex artery perfuses most of the humeral head. When fractured, the greater tuberosity tends to displace posterosuperiorly, the lesser tuberosity and the shaft displace medially, and the head may be pulled by the attached tuberosity, impacted into valgus, or in more severe cases dislocated, impacted, or divided. Internal fixation of two-part, three-part, and selected four-part fractures may be compromised by local osteopenia; knowledge of the location of the strongest bone in the proximal humerus combined with the use of fixed-angle devices and occasionally bone graft or substitutes has improved the outcome of osteosynthesis. When the humeral head cannot be preserved, successful hemiarthroplasty requires tuberosity union and anatomic restoration of the overall geometry of the proximal humerus in terms of height, retroversion, and head-tuberosity relationships.

Fracture Fixation, Internal↗
PubMed1985

Rheumatoid arthritis: skeletal manifestations observed on portable chest roentgenograms.

This report describes the thoracic skeletal radiographic findings of rheumatoid arthritis, observed on portable chest examinations of 21 patients. Their pathophysiology is reviewed and additional examples of a recently described finding are illustrated: erosion of the medial surface of the proximal humerus with subsequent pathologic fracture, associated with superior and medial migration of the humeral head. It has been proposed that erosion of the medial aspect of the proximal humerus is due to impingement wear, and that pathologic fracture results from the fulcrum effect of the inferior lip of the glenoid on the humerus. Rheumatoid arthritis is often diagnosed by the clinician rather than the radiologist. However, in acutely ill patients receiving portable chest radiographs, complete history and laboratory findings are often unavailable. Attention to the thoracic skeleton may clarify pleural and/or parenchymal lung disease in these patients.

Adult↗
PubMed1986

Comminuted fractures of the proximal humerus treated with hook plate.

Good results were obtained using a hook plate to fix bone in 18 cases of fracture of the proximal humerus in which the bone was greatly comminuted or dislocated. The hook plate protects the fixed area against rotation, shear stress and flexion much better than other fixation methods.

Adolescent↗
PubMed1994

Bone mineral density predicts non-spine fractures in very elderly women. Study of Osteoporotic Fractures Research Group.

To determine the ability of bone density to predict fractures in very elderly women, we examined the association of bone density with non-spine, hip, wrist and humerus fractures in 8699 Caucasian women aged 65-79 years and 1005 women aged 80 years and older who were participants in the prospective Study of Osteoporotic Fractures. Follow-up averaged 4.9 (+/- 1.0) years after baseline measurement of appendicular bone density (single-photon absorptiometry; Osteon-Osteo Analyzer) and 2.9 (+/- 0.6) years after measurement of hip and anteroposterior lumbar spine bone density (dual-energy X-ray absorptiometry; Hologic QDR 1000) at a later examination. In general, measurements of bone density in the oldest women retained their predictive value for fractures. Among women aged 80 and over a 1 standard deviation decrease in bone density of the distal radius was associated with an increased risk of non-spine (relative risk: 1.6; 95% confidence interval: 1.3, 1.8), wrist (1.7; 1.2, 2.4) and humerus fracture (2.9; 1.8, 4.7), while a 1 standard deviation decrease in femoral neck bone density was associated with an increased risk of non-spine (1.9; 1.6, 2.4), humerus (2.4; 1.2, 4.7) and hip fracture (2.1; 1.4; 3.2). However, only trochanteric but not femoral neck fractures were associated with low bone density in these oldest women. The excess risk of fracture in women with below-median bone density was greater in those aged 80 years and over compared with the younger women: 38.4 v 20.4 per 1000 woman-years for non-spine fracture and 12.2 v 3.2 per 1000 woman-years for hip fracture.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed2004

[Treatment of dislocated 3- and 4-part fractures of the proximal humerus with an angle-stabilizing fixation plate].

In the presented prospective study 35 consecutive patients with displaced 3- and 4-part fractures of the proximal humerus, including fracture dislocations, were treated with a fixator plate comprising angular stability between May 2001 and December 2002. After 18.5 (8-29) months 31 (89%) fractures were available for follow-up. Good and very good results were obtained in 64%. A poor result was documented in 23%. 64% of the patients had no or mild pain, 71% were able to abduct the arm over 90 degrees . Fracture classification according to Neer and AO had no influence on the outcome, with a mean Constant Score of 76 points. Partial avascular necrosis (AVN) of the humeral head was seen in 16% of all cases representing 4% of the fractures without dislocation and 80% of the fracture dislocations. Fracture dislocation (p=0.02) and AVN (p=0.005) had a negative effect on the Constant Score, with AVN being a predictor for a high level of pain (p=0.04). Secondary dislocation of the greater tuberosity was seen in two patients, loosening of screws in one patient and a fracture below the plate in another one. Secondary dislocation or loss of reduction of the head was not recorded. Angle stable plate fixation with tension band wiring of the tuberosities is an effective and safe option to treat this difficult fractures, also in elderly patients with osteoporotic bone. Because 40% of the 4-part fractures with fracture dislocation yielded a satisfactory or better result, the plate fixator with angular stability may be an alternative to prosthetic replacement in selected cases.

Adult↗
PubMed2005

[ Intramedullary nailing (ESIN) in clavicular pseudoarthroses. Results of a prospective clinical trial].

This prospective clinical trial was performed to assess healing, clinical outcome and complications after intramedullary nailing of midshaft clavicular nonunions. Over 2.5 years, 14 patients were included. Exclusion criteria were pathological fractures, bony defects, previous operative therapy, atrophic and infection pseudarthrosis and the patient's age: <18 years or >70 years. Results were evaluated after 3, 6, 12 and 18 months. Beginning 3 months after the operation, pain (VAS), subjective satisfaction, Constant score and DASH score were significantly better than preoperatively during the follow-up period (p<0.001). There were no infections, no implant displacements or refractures.Intramedullary fixation of midshaft clavicular nonunions with an elastic titanium nail is a safe, minimally invasive surgical technique, producing excellent functional and cosmetic results without additional bone grafting.

Adult↗
PubMed2005

[Kirschner wire migration in the contralateral lung after osteosynthesis of a clavicular fracture].

A 59-year-old patient was admitted complaining breathing-dependent pain in the lower right chest and increasing dyspnoea. Diminished breath sounds in the right lung and dullness in the lower right chest were found. Chest x-ray and complementary CT scan showed an intrapulmonary Kirschner wire and a large haematothorax but no pneumothorax. At 6 weeks before admission, the patient suffered a fracture of the medial left clavicle which was treated by closed reduction and percutaneous osteosynthesis with two Kirschner wires. The migrated K-wire and the haematoma were removed by video-assisted thoracoscopy without complications. Migration of Kirschner wires after clavicle fracture osteosynthesis is rare but dangerous. Migrations into the heart, lung, pulmonary vein or the cervical spinal cord have been recorded. Patients with K-wire osteosynthesis should be informed of the risk of wire migration and should undergo regular postoperative follow-ups including radiography every 2-4 weeks.

Bone Wires↗
PubMed1989

Treatment of displaced fractures of the proximal humerus: transcutaneous reduction and Hoffmann's external fixation.

Experience with transcutaneous reduction and external fixation of displaced fractures of the proximal humerus is presented in a series of 28 cases followed for 1 year or more. In 18 cases near-anatomical fracture reduction was obtained, while no improvement of fracture position was seen in two cases. Loosening of the pins was a major complication in five cases, all in patients with severe osteoporosis or head splitting fractures, where fracture reduction was unsatisfactory. The functional results were satisfactory, and the method is considered a useful alternative in the treatment of these difficult fractures.

Adult↗
PubMed1996

Incidence of five common fracture types in an institutional epileptic population.

We have reviewed 4521 patient-years and analysed 185,066 seizures to calculate the incidence of five common fractures in an epileptic population. Only 25.0 per cent of these fractures were known to have occurred during a seizure. When age and sex matched against a 'normal population', there was an increased incidence of femoral neck fractures (5.2 x), inter-trochanteric fractures (9.9 x), ankle fractures (9.9 x) and proximal humerus fractures (4.2 x). Surprisingly, there was no increased incidence of wrist fractures. Overall, there was a 4.3 x increased risk for all fractures and 3.2 x increased risk of fractures not related to fits. There was no evidence for the first fracture occurring at a younger age in this population. The possible causes of this greatly increased risk are discussed.

Adolescent↗
PubMed2006

Percutaneous insertion of a proximal humeral locking plate: an anatomic study.

This cadaveric study sought to evaluate the feasibility of applying a locking proximal humerus plate with a novel minimally invasive technique. A unique pre-contoured locking plate was placed on cadaveric proximal humeri through a described minimally invasive approach. Proximity of the plate and screws to the axillary nerve and their respective surgical tracks were quantified. Safe screw hole placement with respect to the axillary nerve was determined. Risk of entrapment of the nerve beneath the plate was evaluated. Three of the holes near the middle of the locking plate consistently intersected the course of the axillary nerve and were unsafe for percutaneous placement of the screws. The axillary nerve could be palpated during the course of surgery and easily protected from injury. No entrapment of the axillary nerve occurred using this minimally invasive technique. The screw-in locking guide cannot be used with this technique as it caused tenting of the axillary nerve. Placement of a locking proximal humerus plate via a minimally invasive lateral trans-deltoid approach is safe if the locking screws are limited to superior and inferior holes. This can be done safely without entrapment of the axillary beneath the plate. Plate fixation of proximal humerus fractures may now be more desirable with the use of this approach.

Acromion↗
PubMedDate not supplied

Locking plates improve torsional resistance in the stabilization of three-part proximal humeral fractures.

This study quantified the torsional resistance provided by locking plates and angled blade plates used to stabilize proximal humeral fractures. Three-part proximal humeral fractures were created in 6 pairs of cadaveric humeri. One specimen of each pair was reconstructed with a proximal humeral locking plate, whereas the other specimen was reconstructed with an angled blade plate. An external rotation torque, varying from 0 to 5 N-m, was applied to the humeral head until the head rotated 30 degrees or 10,000 loading cycles were applied. The mean initial torsional stiffness was significantly larger for the locking plates (0.99 N-m/degree) than for the blade plates (0.59 N-m/degree). For each pair, the maximum rotation was larger for the blade plate than for the locking plate. For this in vitro model of a reconstructed 3-part proximal humeral fracture, the locking plate provided better torsional fatigue resistance and stiffness than the blade plate.

Aged↗
PubMed2006

Proximal humeral fractures: regional differences in bone mineral density of the humeral head affect the fixation strength of cancellous screws.

The purpose of this study was to investigate the 3-dimensional trabecular bone mineral density (BMD) in the humeral head and determine the effects of trabecular BMD on the pullout strength of cancellous screws. Five regions of interest (ROIs) were defined in the humeral head (superior- anterior, superior-posterior, central, inferior-anterior, and inferior-posterior). The trabecular BMD of each ROI was determined by use of peripheral quantitative computed tomography. Cancellous screws were inserted in each ROI and cyclically loaded. The superior-anterior ROI had a lower trabecular BMD than all other ROIs (P < .001). The central ROI had a higher trabecular BMD than the inferior-anterior ROI (P < .01), whereas no differences were found between the inferior-posterior, superior-posterior, and central ROIs. Pullout strength was lower in the superior-anterior ROI compared with all other ROIs (P < .01). The trabecular BMD and pullout strength were significantly correlated (P < .01). Placement of screws in regions with a higher trabecular BMD may help to prevent implant loosening and may improve patient outcome.

Aged↗
PubMed2006

Locking plate fixation for proximal humeral fractures: initial results with a new implant.

Treatment of proximal humeral fractures remains controversial, with multiple reported techniques and variable results. Recently, locking plates have become available for fixation of osteopenic and comminuted fractures. This study reports our initial experience with a new locking plate designed specifically for proximal humeral fractures. We observed 16 patients until union or revision with a mean of 12 months' follow-up. Of the 16 patients, 9 had high-energy injuries. There were nine 3-part, five 2-part, and two 4-part fractures. Twelve of sixteen patients healed without complications. There were 4 nonunions; all occurred in patients with 3-part fractures with metadiaphyseal comminution, 3 of whom were heavy smokers. In patients with united fractures, mean elevation was 132 degrees and mean external rotation was 43 degrees, with mean internal rotation to T11. Locking plate fixation achieved union in 75% of patients in this series. Risk factors for delayed union or nonunion included comminution, smoking, and 3-part fractures. These fractures remain challenging despite the availability of locked plating systems.

Adolescent↗
PubMed2000

Humeral blade plate fixation of intercalary allografts and segmentally comminuted proximal humeral fractures: a preliminary report.

The AO 90 degrees humeral blade plate is a relatively new device, whose primary indication and previously described use is for proximal humeral fracture non-union. This study describes the use of the humeral blade plate for extended indications-fixation of segmentally comminuted proximal humeral fractures in two patients and fixation of humeral intercalary allografts after primary humeral neoplasm resection in three patients. A mean follow-up of 20 months revealed union in both fractures and five of the six allograft-host junctions. One patient required subsequent bone grafting for non-union at a proximal allograft-host junction. Functional results were excellent in three patients, good in one, and fair in one. Problems encountered intraoperatively were directly related to the limited array of implants. The long plates which were needed had blades which were too long and required intra-operative trimming in three cases. In four cases, additional plates were used to supplement the blade plate for distal fixation. In conclusion, the humeral blade plate is a useful device for fixation in these extended indications, but longer plates with 30.0 and 40.0-mm blade lengths should be made available.

Adult↗