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At least 991 records · Page 55Linked to original sources
PubMed1993

[Displaced proximal humeral fracture--conservative treatment].

The results of 42 patients with displaced proximal humeral fractures treated by conservative methods were reviewed. Follow-up evaluation included clinical and radiographic examination median two years after the trauma. The results were assessed using Neer's protocol. The patients were asked to assess the results. The patients assessed the results better than the Neer score (p < 0.001). The patients' response to non-operative treatment was satisfactory. It is concluded that the Neer classification of the results underestimates the degree of satisfaction achieved by the patients. It is concluded that displaced proximal humeral fractures can be treated satisfactorily by non-operative methods.

Adult↗
PubMed1996

[Proximal humeral multiple fragment fractures--failures after T-plate osteosynthesis].

Dislocated compound fractures of the proximal humerus are often difficult to treat. The choice of treatment influences the final functional result. From 1984-1991 108 patients with dislocated compound fractures of the proximal humerus were operated with a T-plate osteosynthesis, retrospectively examined and classified according to the Neer-Classification. At an average follow up time of 5 years 72 patients had a clinical and radiological examination. 68% of these patients with 3-fragment fractures and 80% with 4-fragment fractures showed a modest to unsatisfactory result caused by fracture biology, imprecise fracture reduction or poor surgical procedure. Incorrect position of T-plates and inadequate material were distinguishable. The T-plate which was widely used in the late eighties for internal fixation has to be considered a failure for these particular types of fractures and should be limited for Collum chirurgicum fractures.

Adult↗
PubMed1997

[T-plate osteosynthesis in dislocated proximal humerus fractures].

From 1988 through 1995 we operated 48 patients with dislocated humeral fractures using the T-Plate (median age 66 years [20 to 90 years], 32 male, 16 female). After a median 22 months (9 to 60 months) 33 patients were followed up clinically and radiologically. Six patients had suffered a 2-part fracture, 17 a 3-part fracture, and 10 a 4-part fracture. Judged by the Constant score 6 patients reached a very good result, 8 had a good result, 4 a satisfactory and 15 a poor result. Radiologically we saw an arthrosis in 31%, an axial deviation in 50%, and a dislocation of the fragments in 72%. The rate of necrosis of the humeral head was 39%. MRI (17 patients) provided additional relevant information about soft tissue and bone quality and is valuable in the early detection of necrosis of the humeral head. Functionally poor results correlated rather to dislocated fragments and persisting axial deviation than to the type of fracture or the necrosis of the humeral head. The T-plate osteosynthesis is one way to treat dislocated fractures of the proximal humerus, if early operation, correct reposition, and biological principles are respected.

Adult↗
PubMed1998

Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation.

Displaced fractures of the glenoid fossa are an uncommon and anatomically diverse group of injuries. Failure to restore anatomy in these fractures results in poor outcome in most cases. The success of a treatment protocol that encompasses appropriate preoperative imaging, injury pattern assessment, prudent approach choice, and a comprehensive reduction and fixation tactic was evaluated. Twenty-seven patients were assessed clinically and radiographically at a mean followup interval of 43 months from surgery. Anatomic reconstruction was achieved in 24 (89%) patients. Three patients had residual joint incongruities measuring 2 mm or less. The only perioperative complication was a partial superficial wound dehiscence. Two additional patients had infraspinatus palsies of indeterminate origin. Functional rating revealed six (22%) excellent, 16 (60%) good, three (11%) fair, and two (7%) poor outcomes. The fair and poor outcomes largely were related to associated injuries. These findings show that anatomic surgical reconstruction with a low complication rate and good functional outcome can be obtained for most patients with glenoid fossa fractures.

Adolescent↗
PubMed1998

[Surgical treatment of proximal humerus fractures--international multicenter study].

To receive an overview of the presently used methods for the operative treatment of fractures of the proximal humerus a prospective controlled multicenter study was arranged. 146 fractures from 145 patients (76 females, 69 men) were assessed, documented with the AO standard sheets and radiographs and with a one year follow-up examination. Each of the nine clinics used his own treatment scheme. They applied: K-wires (27%) for adaptation and for intramedullary fixation; tension band wires (16%) or sutures (11%) alone or in combination with K-wires; osteosynthesis with screws alone (7%) or with plates (22%). In 17% the humeral-head was acutely replaced with a prosthesis. 11 fractures (8%) had to be reoperated because of instability or loss of fixation. 109 patients were available for clinical review, one patient could be questioned by letter and six patients had died after one year (follow-up 80%). In 38% of patients full limb function was restored, slight impairment persisted in 45% and 17% remained severely handicapped. 96 fractures (89%) were consolidated, 30% with a deformity. 35% of patients still were unable to work full time. The treatment of fractures of the proximal humerus is generally difficult. More over the various operative methods and problematic fracture classification make a differentiate statistical analysis impossible. Still many questions remain. For answers a new trial is mandatory. For this future series fixed guidelines for indications and operative treatment modalities are required to allow a meaningful comparison of results and a scoring system for evaluation of functional outcome is necessary.

Adult↗
PubMed2000

Functional results of braced humeral diaphyseal fractures: why do 38% lose external rotation of the shoulder?

A total of 67 humeral diaphyseal fractures treated with functional bracing was studied. The median follow-up was 30 weeks. Sixty-one fractures (91%) healed and 6 fractures (8.9%) progressed to non-unions. Fifty-four fractures could be functionally classified according to a modified Wasmer score. Pain, range of motion in the shoulder and elbow, and changes in activities of daily life were recorded. Loss of external rotation in the shoulder was most prominent, being present in 21 (38%) of the fractures. To evaluate the cause of loss of external rotation, 21 of the patients were selected for two groups to be studied with computed tomography (CT). Twelve patients had normal clinical findings without a loss of external rotation, while 9 patients had subnormal external rotation in the shoulder of the injured limb. Fracture consolidation in malrotation was seen frequently, and a linear correlation between the clinical loss of external rotation and CT findings was indicated, but no statistical agreement could be proved. The time between injury and brace application could possibly contribute to consolidation in malrotation.

Adolescent↗
PubMed1980

The treatment of fractures of the proximal humerus.

Fractures of the proximal humerus, which can not be kept in place after reposition--and therefore not acceptable for conservative treatment--can be sufficiently fixed by a thin and long Rush-pin percutaneously introduced. So the damaged arm can be moved early. No inflammation and no pseudarthrosis was observed in 124 cases. The follow up examination of 98 patients after 6 to 12 months revealed good results. In 4 children the fractured neck of the humerus could not be reposed into a proper position (Interposition of periosteum and joint capsule). After open reduction fixation was performed by Kirschner's wires. We observed fast and complete healing in all cases.

Adolescent↗