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PubMed1992

Repair of a glenoid fracture using a powered stapler.

Scapular fractures account for only 1% of all fractures, and displaced intra-articular glenoid fractures are very rare. This report describes the operative treatment of a displaced intra-articular fracture of the glenoid in a 33-year-old man. The fracture was repaired by open reduction and internal fixation, using a pneumatically powered stapler for initial stabilization of the fracture fragment and anatomic reduction of the articular surface.

Adult↗
PubMed2006

[Distraction osteogenesis for adjusting humeral length difference due to premature closure of the proximal growth plate in a simple bone cyst].

Complications after pathological fractures of simple bone cysts of the humerus are refracture, cyst recurrence, and in rare cases premature closure of the physeal plate with resulting shortening of the arm. Length discrepancies of the lower limbs beyond physiological limits need early compensation in children as well as adults to avoid interference with the pelvis and spine. However, surgical treatment of length differences of the humerus is usually cosmetic, because even considerable discrepancies do not lead to functional deficits. We report the long-term course of a complicated bone cyst of the proximal humerus and resolving a severe length difference of 7 cm by distraction osteogenesis in a young adult. The cause of the premature physeal closure and the primary therapeutical concept are discussed.

Adolescent↗
PubMed2004

Fractures of the proximal humerus in osteoporotic bone.

The purpose of this article was to review critically the current treatment options for fractures of the proximal humerus in patients with severe osteoporosis. The main difficulties lie in correctly diagnosing the fracture and hence selecting the most appropriate method of treatment. The reliability of the diagnosis can be increased by systematically appending additional information to a basic fracture classification. Classification is best carried out on a morphological basis, whereby a descriptor of bone quality can be added in order to introduce the degree of osteoporosis into the decision-making algorithm. Any classification system that claims to provide both treatment and prognosis is inappropriate, because prognosis will depend hopefully on the treatment. Approaches to treatment differ widely amongst centers and surgeons. It is still unclear as to what would be the optimal treatment. Factors such as the individual's functional requirements and ability to cooperate should be given careful consideration. At our institution, hemiarthroplasty is the method of choice for ischemic humeral heads and/or when anatomic reconstruction cannot be obtained. In all other displaced fractures, the main objective is preservation of the head since the best functional results can generally be obtained with internal fixation. Selection of a balanced osteosynthesis, adapted to the weak bone, is mandatory. Bulky, stiff implants are inadequate and may cause additional damage. Load sharing, not load bearing, compound constructions are the aim. Obtaining metaphyseal elastic buttressing is the key element in achieving the necessary load-sharing fixation. The system should allow controlled impaction and be forgiving towards occasional load peaks that will occur and are beyond patient control. Thin and flexible implants are required to realize this type of fixation. Given the polypragmatic approach that is current in clinical practice there is room for further improvement of techniques and implants.

Arthroplasty↗
PubMed1998

Level of physical activity in elderly patients after hemiarthroplasty for three- and four-part fractures of the proximal humerus.

We report on 13 physically active patients who performed sports activities at a weekend or recreational level when they suffered a severe proximal humerus fracture or fracture dislocation. All patients were treated using the NEER II hemiarthroplasty, 9 patients within 4 weeks after trauma and 4 patients 2, 5, 10 and 15 months after trauma. At an average follow-up of 50 (range 6-98) months, all patients were evaluated, both by clinical review and radiographs. Patients obtained 69.0 points using the HSS score (Hospital for Special Surgery) for evaluation. Subjectively, 85% of the patients evaluated the result as 'good' or 'excellent' on a visual analogue scale for satisfaction. There was no radiographic evidence of implant loosening. At an average period of 33 (range 16-52) weeks 10 patients started with their physical activities again without a change in their participation level.

Aged↗
PubMed2002

Refractures in patients at least forty-five years old. a prospective analysis of twenty-two thousand and sixty patients.

BACKGROUND: Individuals who sustain a low-energy fracture are at increased risk of sustaining a subsequent low-energy fracture. The incidence of these refractures may be reduced by secondary preventative measures, although justifying such interventions and evaluating their impact is difficult without substantive evidence of the severity of the refracture risk. The aim of this study was to quantify the risk of sustaining another fracture following a low-energy fracture compared with the risk in an age and sex-matched reference population. METHODS: During the twelve-year period between January 1988 and December 1999, all inpatient and outpatient fracture-treatment events were prospectively audited in a trauma unit that is the sole source of fracture treatment for a well-defined local catchment population. During this time, 22,060 patients at least forty-five years of age who had sustained a total of 22,494 low-energy fractures of the hip, wrist, proximal part of the humerus, or ankle were identified. All refracture events were linked to the index fracture in the database during the twelve-year period. The incidence of refracture in the cohort of patients who had sustained a previous fracture was divided by the "background" incidence of index fractures within the same local population to obtain the relative risk of refracture. Person-years at-risk methodology was used to control for the effect of the expected increase in mortality with advancing age. RESULTS: Within the cohort, 2913 patients (13.2%) subsequently sustained a total of 3024 refractures during the twelve-year period. Patients with a previous low-energy fracture had a relative risk of 3.89 of sustaining a subsequent low-energy fracture. The relative risk was significantly increased for both sexes, but it was greater for men (relative risk = 5.55) than it was for women (relative risk = 2.94). The relative risk was 5.23 in the youngest age cohort (patients between forty-five and forty-nine years of age), and it decreased with increasing age to 1.20 in the oldest cohort (patients at least eighty-five years of age). CONCLUSIONS: Individuals who sustain a low-energy fracture between the ages of forty-five and eighty-four years have an increased relative risk of sustaining another low-energy fracture. This increased risk was greater when the index fracture occurred earlier in life; the risk decreased with advancing age. Secondary preventative measures designed to reduce the risk of refracture following a low-energy fracture are likely to have a greater impact on younger individuals.

Age Factors↗
PubMed1987

Late appearance of arterial injury caused by fracture of the neck of the humerus.

A 65-year-old man sustained a fracture of the humeral neck. Four days later he suddenly developed symptoms of occlusion of the axillary artery. The fracture was reduced and fixated and the torn intima occluding this artery was fixated. Clots were removed with a Fogarty balloon catheter. Late appearance of arterial injury is rare and we found no reports of this complication after fracture of the humeral neck.

Aged↗