[Osteosynthesis using Kirschner pins in dislocation fractures of the head of the humerus].
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Lesions of the nerves are a relatively frequent complication after humeral shaft fractures, the nerve most commonly affected being the radial nerve. In the case of proximal fractures of the humerus, particularly dislocation fractures and luxated fractures, lesion of the axillary nerve and irritation of the plexus, are most frequent. In distal humeral fractures the ulnar nerve is most frequently first place and shows a serious complication. The therapy of the fracture must differ in most of these cases from conventional procedure. We believe that primary paresis of the radial nerve is a relative indication for surgery and secondary paresis of the radial nerve, an absolute indication for operation. When we find a subcapital humeral shaft fracture with rare paresis of the nervus axillaris we wait with an operation, but if remission does not occur within approximately 8 weeks a revision should be done. Fracture luxations with irritation of the plexus are an acute indication for operation, because repositioning or displacement of the head fragment can afford relief.
111 patients with humeral fractures of the surgical neck were examined 10 months after trauma. In cases of minor dislocation no significant difference between conservative and operative therapy could be observed, whereas in cases of major dislocation operative intervention lead to better functional results. Thus fractures of the surgical neck with major dislocation should be operated upon.
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The diagnosis of a sport injury or a sport damage is usually made by the clinical investigation. However, the X-ray examination is indispensable. In addition to standard projections further radiologic techniques such as passive motion, tomography, computed tomography, arthrography or angiography are necessary. The relevant use of these X-ray methods with regard to sport injuries or damages of the particular regions of the locomotor system are described.
The authors have treated 7 fracture-dislocations of the humeral head by blind pinning. The fractures were reduced by traction under general anaesthesia. 3 or 4 pins were then introduced into the olecranon fossa and driven up through the humeral head. After an average follow up of 29 months, the results were excellent in 9 cases, good in 5 and fair in 3. In 3 cases only, necrosis of the humeral head was noted.
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In proximal humeral fractures with first degree displacement and in fractures with second degree displacement, which primarily prove to be stable, reduction is not necessary. Closed reduction is indicated in unstable fractures with second degree displacement and in all fractures with third degree displacement. If closed reduction fails to improve the position of the fracture, open reduction and Kirschnerwire transfixation should be performed. Retention for two to three weeks is sufficient.
We have treated almost 700 proximal humeral fractures, and selected from them a series of 16 cases which required operative intervention in the form of semiclosed reduction and internal fixation with the Rush pin because of the marked amount of displacement and risk on nonunion. We favor the 3/16 inch Rush pin for this operation. Fractures of the surgical neck comprise the vast majority of cases operated upon in this series. They are the easiest to reduce and fix by the Rush pin technique. Certain comminuted severely displaced fractures involving the anatomic neck of the humerus and/or greater and lesser tuberosities also lend themselves to this operation with comparable results to other methods of treatment. There have been no postoperative motalities and minimal morbidity. The operation can be performed rapidly and requires only a short period of immobilization and hospitalization.