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At least 883 records · Page 49Linked to original sources
PubMed2004

Intramedullary pinning with tension-band wiring for surgical neck fractures of the proximal humerus in elderly patients.

Most proximal humeral fractures in the elderly population are related to osteoporosis. Several methods have been proposed to treat surgical neck fractures of the proximal humerus in elderly people. This study investigates a new method of intramedullary pinning with tension-band wiring. From June 1998 to March 2001, 10 female patients with a mean age of 73.0 years and displaced two- or three-part surgical neck fractures of the proximal humerus were studied. Two intramedullary pins were used with tension-band wiring via a deltopectoral approach with minimum dissection. The mean follow-up was 20.6 months. Final outcome was evaluated using the constant score, visual analog scale (VAS) score, questionnaire, and an outcome assessment form. The outcome was excellent in four patients, good in five, and fair in one. The mean Constant score was 80.8 and the VAS score was 83.0. There was no nonunion, avascular necrosis, deep infection, or pin migration. No patient needed further revision open reduction with internal fixation or prosthesis replacement. We therefore concluded that intramedullary pinning with tension-band wiring is a safe, reliable method, with few complications, for treating surgical neck fractures of the proximal humerus in elderly patients.

Aged↗
PubMed2003

[New concepts for stabilizing proximal humeral fractures].

The treatment of proximal humerus fractures is overshadowed by problems like avascular humeral head necrosis, implant failure in osteopenic bone and moderate outcome, especially in the elderly. More precise imaging, a better understanding of the vascularity of the humeral head leading to indirect reduction techniques and new implants which allow for saver fixation even in osteopenic bone, allowing early functional aftercare, are the new promising factors which have the potential to ameliorate fracture treatment of the humeral head. A prerequisit for sucessful treatment is a thoroughful imaging which allows adequate preoperative planning. The type of stabilisation depends more on the surgeons preference and there are pros and cons with all implants. Functional after treatment however depends on the applied stabilisation principle and should be carefully monitored and adapted according to the bone healing process, monitored by regular postoperative x-ray controls.

Aged↗
PubMed2004

Displaced fractures of the proximal humerus in children require open/closed reduction and internal fixation.

Fractures of the proximal humerus in children are rare and constitute only 3% of all epiphyseal injuries. From 1992 to 2002 sixteen patients aged 4 - 15 years with a displaced fracture of the proximal humerus were treated at our level I trauma unit. The mean follow-up of the patients was 23.8 months (8 - 72). Ten children had a metaphyseal fracture and six a Salter and Harris Type II injury. Only one metaphyseal fracture was treated conservatively; the other patients underwent surgery (ORIF [= open reduction internal fixation] in ten patients, CRIF [= closed reduction internal fixation] in five patients). Follow-up examination showed no shortening or major angulation of the humerus in any of the sixteen cases. Fifteen children showed excellent and good results. There was only one average result in a polytraumatized child with additional injuries in both upper extremities. Based on the results of this study we suggest performing ORIF/CRIF in displaced fractures of the proximal humerus in children.

Child↗
PubMedDate not supplied

[Isolated bilateral Sternocostoclavicular Hyperostosis (SCCH) with a pathological clavicular fracture--a 10-year follow-up].

The presented case demonstrates the clinical and radiological course of a woman suffering from bilateral sternocostoclavicular hyperostosis (SCCH) from early changes to a spontaneous clavicula fracture after 10 years. SCCH is characterised by a chronic recurrent painful swelling of the sternoclavicular region due to an aseptic inflammation and hyperostosis of the clavicula, sternum, upper ribs and the adjacent soft tissues. Frequently the picture is accompanied by cutaneous and other skeletal symptoms. The disease can be part of the SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome. The chronic process is represented by the typical "bull horn sign" in a bone scan. NSAIDS should represent the first line treatment.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2004

Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year.

BACKGROUND: Proximal humeral fractures, particularly in osteoporotic patients, remain an unsolved problem as regards the durability of the osteosynthesis. The AO/ASIF group has developed a new technique which aims to preserve the biological integrity of the humeral head and secures the reduction using multiple locking screws with angular stability (Philos), thus allowing an early mobilization. PATIENTS AND OUTCOME: We retrospectively reviewed the complications and functional outcome after a minimum follow-up of 1 year in 72 patients treated with this new method. 2 fractures failed to unite, and 3 patients developed an avascular necrosis of the humeral head. In addition, 2 implant failures were observed due to a technical error. According to the Constant score, the functional outcome was acceptable even in elderly patients. INTERPRETATION: The Philos method appears to be safe and can be recommended for the treatment of proximal humeral fractures in patients with poor bone quality.

Adult↗
PubMedDate not supplied

The treatment of supracondylar fractures in children with an absent radial pulse.

The purpose of this study was to determine the outcome of patients with a supracondylar fracture and an absent radial pulse. All children with displaced extension-type supracondylar fractures from 1984-1992 were eligible. Of 326 children with supracondylar fractures, 22 had an absent radial pulse on admission. Fifteen of the 22 children had a well-perfused hand after closed reduction and K-wire fixation. Five had no pulse but a well-perfused hand after reduction and immobilization of the elbow in slight flexion; none had any problem at final review. Seven patients who had a cold white hand after closed reduction received open reduction of fracture and arterial exploration. In conclusion, the initial treatment for children with displaced supracondylar fractures with an absent radial pulse should be closed reduction, K-wire fixation, and immobilization in < 90 degrees of flexion. Children who have a well-perfused hand but an absent radial pulse after satisfactory closed reduction do not necessarily require routine exploration of the brachial artery.

Child↗
PubMed1996

Surgical neck fractures of the proximal humerus: a laboratory evaluation of ten fixation techniques.

OBJECTIVE: A biomechanical cadaver study was performed to compare the stability and ultimate strength of ten standard fixation techniques used for the treatment of surgical neck fractures of the proximal humerus. DESIGN: One hundred twenty (60 fresh frozen, 60 embalmed) proximal humerus specimens were selected and divided into two groups: fresh frozen specimens represented a nonosteopenic group and embalmed specimens an osteopenic group. Simulated fractures were created at the level of the surgical neck, reduced, and randomly assigned to one of ten methods of fixation (six fresh frozen and six embalmed specimens per fixation group). These constructs were then mechanically tested with the humeri oriented to create primarily shear loading of the fixation. RESULTS AND CONCLUSIONS: The T-plate and screws provided significantly stronger fixation (p < 0.005) in the fresh frozen specimens than all other methods. The Ender nails/tension band construct was the second strongest fixation technique, providing significantly stronger fixation (p < 0.01) than all the remaining techniques. Four Schanz pins with one pin placed through the greater tuberosity followed by the T-plate and screws provided the strongest fixation in embalmed specimens. Tension band fixation in both humeral groups was shown to provide the least effective fixation.

Biomechanical Phenomena↗
PubMed1998

Closed management and percutaneous fixation of unstable proximal humerus fractures.

BACKGROUND: In dealing with displaced proximal humerus fractures, there is still much controversy in treatment modalities. The latest investigations emphasize the concept of minimal exposure and rigid fixation. METHODS: The technique of closed reduction and percutaneous fixation with cannulated screws and k-pins was performed on 19 patients with two- and three-part proximal humerus fractures. The outcomes were evaluated with a mean follow-up of 21 months. RESULTS: All except one case had a solid union of the fracture. Sixteen of 19 patients (84%) acquired good or excellent results according to Neer's classification. No further collapse or avascular necrosis was found. CONCLUSION: The method of closed reduction and percutaneous fixation, although technically demanding, yields satisfactory results in displaced proximal humerus fracture. Cannulated screws provided rigid fixation that was the underlying tenet for early functional retrieval.

Adolescent↗
PubMed2000

Intrathoracic migration of Steinmann pins.

The migration of surgical wires and pins placed for repair of orthopedic injury is well recognized. Such migration usually follows a retrograde path and the wires protrude near their entry point into the native bone. Occasionally, the migration occurs in an antegrade manner and produces injury. We describe a case where three Steinmann pins placed for fixation of a humeral neck fracture migrated, one slipping backwards towards the humeral entry point and two pins migrating into the thorax.

Bone Nails↗
PubMed2006

Two-part surgical neck fractures of the proximal part of the humerus. A biomechanical evaluation of two fixation techniques.

BACKGROUND: Successful internal fixation of fractures of the surgical neck of the humerus can be difficult to achieve because of osteopenia of the proximal aspect of the humerus. The purpose of this study was to compare the biomechanical stability of a proximal humeral intramedullary nail and a locking plate for the treatment of a comminuted two-part fracture of the surgical neck in a human cadaver model. METHODS: Twenty-four cadaveric humeri were instrumented with use of either a titanium proximal humeral nail (PHN) or a 3.5-mm locking compression plate for the proximal part of the humerus (LCP-PH). The specimens were matched by bone mineral density and were separated into four experimental groups with six humeri in each: PHN bending, LCP-PH bending, PHN torsion, or LCP-PH torsion. Comminuted fractures of the surgical neck were simulated by excising a 10-mm wedge of bone. Bending specimens were cyclically loaded from 0 to 7.5 Nm of varus bending moment at the fracture site. Torsion specimens were cyclically loaded to +/-2 Nm of axial torque. The mean and maximum displacement in bending, mean and maximum angular rotation in torsion, and stiffness of the bone-implant constructs were compared. RESULTS: In bending, the LCP-PH group demonstrated significantly less mean displacement of the distal fragment than did the PHN group over 5000 cycles (p = 0.002). In torsion, the LCP-PH group demonstrated significantly less mean angular rotation than did the PHN group over 5000 cycles (p = 0.04). A significant number of specimens in the PHN group failed prior to reaching 5000 cycles (p = 0.04). The LCP-PH implant created a significantly stiffer bone-implant construct than did the PHN implant (p = 0.007). CONCLUSIONS: The LCP proximal humeral plate demonstrated superior biomechanical characteristics compared with the proximal humeral nail when tested cyclically in both cantilevered varus bending and torsion. The rate of early failure of the proximal humeral nail could reflect the high moment transmitted to the locking proximal screw-bone interface in this implant. CLINICAL RELEVANCE: The high failure rate in torsion of the proximal humeral nail-bone construct is concerning, and, with relatively osteoporotic bone and early motion, the results could be poor.

Adult↗
PubMed1983

Operative treatment of severe proximal humeral fractures.

Results after the operative treatment of 41 severe proximal fractures of the humerus are reported. The fractures were classified according to Neer (1970a). The aim of treatment was accurate reduction and stable fixation of the fracture with screws or with screws and a plate. When scored according to Neer's (1970a) functional assessment, results in the 31 patients re-examined more than 1 year postoperatively were excellent or satisfactory in 23 patients. Results were excellent or satisfactory in 14/15 patients with type III fractures, in 7/11 with IV, and 2/4 with type VI. In the only re-examined patient with a type V fracture the result was unsatisfactory. The most common technical error was a too high positioning of the AO plate and persistent varus deformation of the head of the humerus. High positioning of the plate caused post-operative restriction in the movements of the glenohumeral joint because the implant impinged under the acromion during abduction. No aseptic necrosis of the humeral head was observed. Of the patients of working age all but one returned to their preoperative occupations within a mean of 3.5 months after surgery.

Adolescent↗
PubMedDate not supplied

Osteosynthesis with percutaneous wiring in fractures of the proximal humerus.

The authors report the preliminary results of osteosynthesis with percutaneous wiring in the treatment of fractures of the proximal humerus. This method which is still described in very few cases, is characterized by several advantages such as its minor invasiveness, and respect for vascularization of the fragments that guarantee good functional results. The application of threaded pins or pins of large diameter guarantees excellent hold with a low incidence of loosening secondary to loss of reduction. The use of a traction device applied to the surgical table simplifies reduction maneuvers and osteosynthesis.

Adolescent↗
PubMed2002

Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus.

BACKGROUND: Controversy persists concerning the preferred treatment of displaced fractures of the proximal part of the humerus. The present study was undertaken to evaluate the results of open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus and the functional limitations of patients in whom avascular necrosis of the humeral head develops as a complication of this fracture. METHODS: We assessed the intermediate and long-term results for sixty patients with a three or four-part fracture of the proximal part of the humerus who had undergone open reduction and internal fixation with cerclage wires or a T-plate. The Constant score and a visual analog score for pain were calculated, and radiographs of the proximal part of the humerus were evaluated. RESULTS: After an average of ten years of follow-up, fifty-two patients (87%) had a good or excellent result on the basis of the Constant score whereas eight patients (13%) had a poor result. Fifty-one patients (85%) were satisfied with the result at the time of the most recent examination. Twenty-two patients (37%) had development of avascular necrosis of the humeral head, and seventeen (77%) of these twenty-two patients had a good or excellent Constant score. CONCLUSIONS: Open reduction and internal fixation with cerclage wires or a T-plate yields good functional results in most patients. This option should be considered even for patients with fracture-dislocation patterns that are associated with a high risk for avascular necrosis of the humeral head, as this complication did not preclude a good result.

Adult↗
PubMed2004

Nonprosthetic management of proximal humeral fractures.

Many proximal humeral fractures can be treated without the need for hemiarthroplasty. Treatment choice is affected by fracture location and pattern, as well as by patient factors including age, activity level, quality of bone, and ability to comply with a regimen of therapy. Successful diagnosis and treatment of proximal humeral fractures is dependent on good-quality radiographs, but in some cases, intraoperative assessment of the fracture pattern is required for a complete and accurate diagnosis of the fracture pattern and severity. A discussion of nonsurgical and surgical treatment options and techniques needed to achieve anatomic reduction and stable fixation is important.

Fracture Fixation, Internal↗
PubMed2004

[A new method of preoperative modeling of perosseous osteosynthesis for fractures of the humerus bone and forearm bones].

The aim of the investigation was to improve results of treatment of patients with fractures of the humerus and forearm bones by complex treatment using numerical processing of video-information and computed modeling of the operation of perosseous osteosynthesis. A personal computer equipped with means for lead-in and visualization of the image was used for an analysis of rentgenograms. Among 144 patients treated for fractures of the humerus and forearm bones there were 83 treated using the method of perosseous osteosynthesis. The numerical computed modeling of the operation was fulfilled in 41 patients. The method allowed to improve the anatomical and functional results, to shorten the duration of the treatment, to reduce the number of complications and unsatisfactory outcomes, to optimize the method of perosseous osteosynthesis as a whole.

Adolescent↗