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PubMed2003

[Locking plate osteosynthesis for fractures of the proximal humerus].

BACKGROUND: Beside non-operative treatment the therapeutic options for proximal fractures of the humerus range from closed reduction and transcutaneous K-wiring to total joint replacement. While the first is regarded as minimally invasive the latter is a rather complex intervention. Plating has been disregarded as combining the disadvantages of an extended approach with too often insufficient primary postoperative stability. The new concept of completely angle stabile plate fixation aims on improving this balance by achieving greater stability even in osteoporotic fractures. STUDY DESIGN: This retrospective analysis compares 51 patients treated with a partially (39) or complete (12) angle stabile humeral plate (Königseeplatte in two modifications) with 32 patients treated according to surgeons preference with conventional plates or K-wires. Both groups were treated at the same department during the same period and did not differ in their age nor sex distribution. RESULTS: Until discharge there were 2 secondary dislocations discovered in group 1 and 7 in group 2. The follow-up rate was 47.1 % (24/51) in group 1 and 46.8 % (15/32) in group 2. The time interval from surgery amounted to 1.2 (0.66-1.75) and 1.0 (0.72-1.32) years respectively. Among the patients available for follow-up in group 1 8 had sustained a two-, 8 a three- and 3 a four-part fracture according to Neer's classification. In group two there were accordingly 2 two-, 8 three- and 1 four part fractures. Clinical assessment using Neer's score revealed an average of 71,8 (63.9-79.8) points in group 1 and 67.6 (47.3-78.7) in group 2. When the results of Neer's scores were expressed in percentage of the unaffected arm a mean of 73.6 (65.6-81.8) in group 1 and 69.3 (51.8-86.9) was obtained. The only statistically significant difference was observed within the sub-group of three-part fractures: treated by angle stabile plates (group 1) these patients (n = 8) achieved a mean Neer-Score of 81 (77-86) compared to 68 (52-84) (n = 8). In group 1 70.8 % of patients followed-up presented an "excellent" or "good" result according to Neer's criteria, in group 2 60 % did so. CONCLUSION: We conclude from our first experience with angle stabile plates for fractures of the proximal humerus that particularly in three part fractures this method might improve functional outcome and is worth further consideration and testing.

Aged↗
PubMed1983

Luxatio erecta.

A case of luxatio erecta associated with a fracture of the greater tuberosity and a mixed nerve lesion is presented. The arm is abducted with the elbow flexed and the hand above the head, and there are creases on the shoulder. Reduction may be accomplished by upward traction on the extended arm with countertraction on the top of the shoulder and carrying the arm through an arc to the side of the body.

Accidents↗
PubMed1999

[The functional treatment of transcondylar and epicondylar fractures of the humerus in children].

Functional treatment of 275 children with epicondylar and transcondylar fracture of shoulder bone with II-IV degree dislocation was done. The conventional method of functional treatment was applied using dissected in articulation ulnaris plaster bandage, the Blaunt bandage and the elaborated method using the external fixation apparatuses--hinge-rotational apparatus (HRA). The highest efficacy of functional treatment using HRA was noted.

Casts, Surgical↗
PubMed2003

Arthroscopy-assisted reduction and percutaneous fixation of a multiple glenoid fracture.

Glenoid fractures are rare. The traditional method for treating them is open reduction and internal fixation in arthrotomy. Arthroscopic reduction with percutaneous fixation is used in selected fractures (of tibial plateau, ankle, distal radius). We describe the surgical technique adopted to treat a multiple, Y-shaped articular glenoid fracture using arthroscopy and percutaneous fixation.

Adult↗
PubMed1983

Fluorogenic substrate assay of antithrombin III: a clinical study.

The fluorogenic substrate assay of antithrombin III (AT III) was compared with a thrombin inhibition (two-stage) clotting test and a radial immunodiffusion assay. Normal ranges based on a population of 25 individuals were 88-121% (fluorogenic substrate), 72-111% (clotting) and 22.5-35.3 mg/dl (RID). A clinical comparison of the methods showed a linear relationship between the fluorogenic substrate and immunologic methods (r = 0.69, p less than 0.005), as well as between the fluorogenic substrate and clotting methods (r = 0.75, p less than 0.005). The fluorogenic substrate assay reflected the highest incidence of low AT III levels in all three clinical groups included (36 patients with arteriosclerosis, 18 with fractures and 37 with thrombosis/embolism).

Antithrombin III↗
PubMed2001

[Angle- and rotation-stable internal fixation of proximal humerus fractures with the humerus fixator plate. Early clinical experience with a newly developed implant].

INTRODUCTION: The Humerus Fixator Plate is presented as a new implant for angle- and rotation-stable internal fixation for the operative treatment of proximal humerus fractures at the surgical neck. METHODS: In an ongoing two-centre study, 47 patients were treated with the new implant. To date, 31 patients had clinical and radiological postoperative follow-up examinations with a mean interval of 10 months (range: 6-14 months). RESULTS: In 46 patients (97.9%), complete angle and rotational stability was achieved without limiting the range of motion or requiring immobilization. Good pain relief was obtained in 43 patients (91.5 %), and 3 patients (6.4%) showed moderate pain relief following surgery. There was one implant failure. Utilizing the Constant-Raw score (without any correction factors), a mean result of 82.8 points (range: 46-100 points) was ascertained. The majority of the patients (87.1%) achieved "excellent" or "good" clinical results. X-ray analysis revealed no non-union nor humerus head necrosis. In 4 cases (12.9%), protrusion of a humerus head screw was observed which mandated removal of the implant. CONCLUSION: The first clinical investigations of the novel Humerus Fixator Plate are encouraging and provide essential advances in the treatment of unstable proximal humerus fractures.

Adult↗
PubMed2003

[Humeral head fractures].

Humeral head fractures generally may be treated in a non-operative concept with early physiotherapy when fragment dislocation is minor. Dislocated 2-part fractures (head and shaft fragment) may be treated with closed reduction. If the fracture persists unstable, K-wire, cerclage, intramedullary nailing or plate osteosynthesis are the eligible methods. Particularly isolated K-wire osteosynthesis is associated with a high risk of implant or fragment dislocation. Dislocated 3- or 4-part fractures need additional reduction and fixation of the tubercles. In osteoporotic fractures, intraosseous fixation may lead to complications. Especially cerclage and/or isolated screws (eventually additional K-wires) osteosynthesis allows good reduction for functional treatment in the older patient. Sufficient results in long-term outcome are achieved by minimal invasive techniques even in partial avascular head necrosis. In 4-part fractures prosthetic replacement should be considered. Especially when old patients have severe destruction or luxation of the humeral calotte prosthetic treatment may be indicated. Early functional physiotherapy is important after all types of osteosynthesis or prosthesis.

Adult↗
PubMed2006

Surgical treatment of comminuted, displaced fractures of the greater tuberosity of the proximal humerus: a new technique of double-row suture-anchor fixation and long-term results.

Conventional techniques of internal fixation of displaced fractures of the greater tuberosity may be insufficient in presence of comminution. A new surgical technique of internal fixation using a double-row of suture-anchors is described. Long-term results of this technique are evaluated in 21 patients with an isolated, displaced and comminuted greater tuberosity fracture at an average of 3.5 years (range 1-5 years) after surgery. The average age of the patients in the study was 51 years (range 17-93 years). Twenty fractures healed without post-operative displacement. The result was rated as excellent in 8, good in 10, satisfactory in 2 and unsatisfactory in 1 patient. Post-operative bicipital impingement in two patients and reaction to fixation material in one patient resulted in persistent, severe pain in the rehabilitation period, necessitating additional surgery.

Adolescent↗
PubMed2005

Characteristics of an isolated greater tuberosity fracture of the humerus.

BACKGROUND: Most classification systems tend to include isolated greater tuberosity fractures in the group of proximal humeral fractures. The purpose of this study was to elucidate demographic differences between isolated greater tuberosity fractures and the other proximal humeral fractures. METHODS: Altogether, 610 proximal humeral fractures were divided into isolated greater tuberosity fractures of the proximal humerus (group I) and all other proximal humeral fractures (group II). The two groups were analyzed according to their incidence, age and sex distribution, presence of dislocation, and associated chronic medical problems. RESULTS: Group I comprised 18.9% and group II 81.1% off all fractures. The mean age of group I was 42.8 years, and that of group II was 54.2 years. Of the 115 (67.8%) patients in group I, 78 (67.8%) were male. In contrast, most of the group II patients were female (332/495, 67.1%). A higher incidence of glenohumeral dislocation occurred in group I (6.9%) than in group II (3.4%). Of the 495 group II patients, 175 (35.4%) had medical problems, including endocrine, cardiovascular, pulmonary, hepatic, and renal disease, whereas only 15 of the 115 (13%) patients in group I had such problems. CONCLUSIONS: Patients with isolated greater tuberosity fractures of the proximal humerus were different demographically, and their treatment and classification should be considered separately from that for other proximal humeral fractures.

Adolescent↗
PubMed2005

Outcome after treatment of proximal humeral fractures with humeral head replacement.

After its initial description by Neer and associates, humeral head replacement has been widely used to treat complex fractures of the proximal humerus. Many studies have confirmed that the treatment of proximal humeral fractures with humeral head replacement is associated with reliable pain relief as well as good patient satisfaction. A limited number of studies have also suggested that the prostheses have reasonable longevity, with the rate of prosthesis survival at 83% to 94% at 10 years. The functional outcome after the procedure, however, has not been as predictable. Using various outcomes scoring instruments, multiple studies have reported a wide range of results. Some authors have reported mostly disappointing outcomes, whereas others have reported generally satisfactory results. The most critical factor influencing the long-term outcome appears to be the position of the greater tuberosity. Other factors that are also associated with a good outcome include younger age, minimal delay between the traumatic event and the surgical procedure, and the absence of any neurologic deficit. For young patients with a complex proximal humeral fracture, humeral head replacement still remains a viable treatment option. However, whenever possible, most authors favor open reduction and internal fixation because of the issues affecting the longevity of the prosthesis. By understanding and minimizing the risk factors leading to a poor result, a reasonable functional outcome, reliable pain relief and a high rate of patient satisfaction can be expected after treatment of proximal humeral fractures with humeral head replacement.

Adult↗
PubMed1995

[Perinatal risk in significant macrosomia. A study based on the databank of the Professional Society of Swiss Gynecologic Clinics 1983-1992].

A comparison of a group of births with severe macrosomia with a group of normal birth weight was made based on the data from the "Arbeitsgemeinschaft schweizerischer Frauenkliniken" (ASF), a work group of Swiss departments of obstetrics and gynaecology. During the period from 1983 to 1992 there were 2911 births of infants weighing more than 4500 g and 222,336 births of infants weighing between 3000 and 4000 g. Overall, the births of the macrosomic infants were more difficult, the rates of secondary Caesarean sections higher and the fetal outcomes poorer. The rates of shoulder dystocia, fracture of clavicle and palsy were higher. Only the last three complications were dependent on the mode of birth. In order to avoid, at least partially, palsy as the most serious of the complications of shoulder dystocia, it has been proposed to perform primary Caesarean section whenever the estimated birth weight is over 4500 g. Indeed, in our study, a part of the palsies had not occurred if all newborn weighing more than 4500 g had been delivered by Caesarean section. However, due to the difficulty in estimating the birth weight in utero, the high occurrence of spontaneous recovery from palsy and the high incidence of palsy in the comparison group, we could not find a clear proof of the necessity to perform primary Caesarean sections of all infants having estimated birth weights of over 4500 g.

Adolescent↗
PubMed2001

[Conservative or operative treatment of humeral head fractures in the elderly?].

The humeral head fracture in the elderly represents an unresolved problem, which is reflected by the variety of existing therapeutic strategies ranging from conservative treatment to humeral head replacement. The main factors influencing the prognostic outcome are the fracture type, age of the patient and biologic criteria such as osteoporosis, blood supply at the fragments, and the degree of soft tissue trauma. For selection of the optimal treatment, the general condition of the patient, additional injuries and chronic diseases have to be respected as much as the patient's compliance and personal demands. According to experimental and clinical findings, for displaced two- and three-part fractures of the elderly patient minimal osteosynthesis and in the future plate osteosynthesis with angular stability should be preferred. For these fracture types, conservative treatment must be included in the therapeutic spectrum. In contrast, displaced four-part fractures and fracture dislocations are indications for primary humeral head replacement. This is explained by the fact that neither conservative treatment nor surgical reconstruction procedures meet the main goal of primary therapy, aiming for early painless mobilization and for timely discharging the elderly patients in their social environment.

Aged↗