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PubMed1989

Isolated avulsion fracture of the lesser tuberosity of the humerus: report of two cases.

Isolated avulsion fractures of the lesser tuberosity of the humerus are exceptionally rare. Two cases are reported here, each involving a 12-year-old boy. The mechanism of injury appears to be a strong external rotatory force applied while the arm is at maximum external rotation and approximately 60 degrees of abduction. In children and adolescents the fracture most likely occurs through the apophyseal plate of the lesser tuberosity (traction epiphysis). In adults, clinical differentiation from the far more common calcific peritendinitis of the rotator cuff can be difficult. Whereas large, displaced fractures can be easily demonstrated on anteroposterior radiographs with internal and external rotation of the humerus, the axillary view is often necessary to detect smaller fragments with little displacement.

Accidental Falls↗
PubMed1983

[Evaluation of Neer's hemi-arthroplasty in the treatment of humeral fractures].

Eighteen patients with fractures of the proximal humerus with at least four fragments, with or without dislocation (group IV, V and VI of Neer's classification), were treated by hemiprosthetic replacement. The average age was 59 years. The follow-up was from 1 to 7 years. Patients were assessed on two occasions by two evaluators using Neer's protocol. The glenohumeral and the scapulothoracic movements, using the other shoulder as control, were measured radiologically at 0 degrees, 45 degrees and maximal abduction. Pain, function and range of motion were recorded. No complication was encountered. By radiologic assessment, it was possible to classify results in three groups. In all of the unsatisfactory results, the centre of motion of the prosthesis was displaced proximally. Satisfactory and excellent results were obtained in 66%. The best results are obtained if patients are operated on early; repair of the rotator cuff is important. The centre of rotation of the prosthesis must be in precise biomechanical relation to the glenoid fossa; such a relation is of prognostic value.

Adult↗
PubMed2005

The arteries of the humeral head and their relevance in fracture treatment.

Bone vascularisation has gained increased interest in relation to the blood supply of bone fragments during treatment of fractures. In the current study the pattern of vascular supply of the proximal humerus was studied in six cadavers by the corrosion technique. Furthermore, the effect of fractures on the vascular supply was also investigated. In all preparations the intraosseous arteries of the humeral head arose from the circumflex arteries, which surrounded the humerus and dispatched branches towards the proximal end. The main vessel was the branch of the anterior circumflex artery, penetrating the major tubercle in six of six cases. Due to the intraosseous arch shape of this vessel it is referred to as the arcuate artery. Besides other smaller vessels, there was also a vascular network arising from the posterior circumflex artery. Their branches penetrated medially at the cartilage bone interface in five of six preparations. The medial bone arteries appear to gain distinctive importance in humeral head fractures by their impact on the vascularisation of the fracture fragments. After disruption of the arterial supply from the arcuate artery, the vascularisation of the head fragments is most likely ensured by this group of vessels. Therefore, necessary repositioning manoeuvres during open reduction of the fracture should be conducted with care in order to preserve these arteries.

Aged↗
PubMed1980

Fractures of the neck of the humerus: a review of the late results.

Eighty patients with fractures of the proximal part of the humerus were reviewed not less than 18 months later. The severity of the fracture, the duration of initial rest in a sling and the duration of physiotherapy all independently affected the result. A total of 81 per cent had satisfactory results. The patients with undisplaced fractures had better results (94 per cent satisfactory), but spent longer before beginning physiotherapy which necessitated a longer course. Early active movements within the limits of pain and discomfort are suggested in order to improve the ultimate result.

Follow-Up Studies↗
PubMedDate not supplied

Isolated fractures of the greater tuberosity of the proximal humerus.

This review addresses isolated greater tuberosity fractures of the proximal humerus. The important aspects of the epidemiology, anatomy, fracture classification, associated injuries, and treatment are discussed. Although isolated greater tuberosity fractures are well recognized, there are few studies that specifically evaluate the outcome of these injuries. Our experience and review of the recent literature suggest that more precise evaluation of diagnostic criteria, treatment selection, and outcome is required.

Humans↗
PubMed1993

Acute compartment syndrome of the triceps. A case report.

A case of an acute compartment syndrome of the triceps muscle complicating a surgical neck fracture of the humerus is presented. Diagnosis was suspected because of pain with passive elbow flexion and pain out of proportion to the clinical situation. Diagnosis was confirmed with intracompartmental pressure measurements. An emergency fasciotomy was performed. The patient had an excellent result.

Adult↗
PubMed1991

Current trends in conservative treatment of fractures of the proximal humerus.

Forty-nine fractures treated conservatively with 30 days of immobilization in a Desault bandage or a suspension cast (3 cases) are discussed. The diaphyseal index was used to check for correlation between the degree of osteoporosis and the extent and type of fracture. After an average follow-up of 6.7 months, 67% of the 36 patients reviewed had a satisfactory clinical and radiographic result and adequate healing, even those with a high degree of osteoporosis. There was no significant correlation between the type of fracture (location and degree of displacement) and the severity of bone resorption. We would emphasize that 33% of the unsatisfactory results were mostly due to the radiographic findings which, scored using the Neer system, were rated unsatisfactory even though the corresponding results were satisfactory as far as the clinical symptoms and signs. In our opinion, proximal humeral fractures in elderly patients should be treated conservatively, especially in cases of slight or moderate displacement.

Adult↗
PubMed2005

The effect of greater tuberosity placement on active range of motion after hemiarthroplasty for acute fractures of the proximal humerus.

Union of the greater tuberosity to the humeral shaft after hemiarthroplasty for acute fractures of the proximal humerus is a critical factor in the restoration of glenohumeral function. A retrospective review was undertaken to examine 23 consecutive patients who underwent hemiarthroplasty for the treatment of acute three- and four-part fractures of the proximal humerus. The study was conducted to examine the relationship between the position of the healed greater tuberosity and postoperative range of motion. The average age of the patients was 66.5 years. The average follow up was 3.8 years with a range of 24 to 108 months. Active range of motion was measured in forward elevation, external rotation, and internal rotation. Postoperative radiographs were examined to determine the position of the united greater tuberosity in relation to the top of the replaced humeral head. The tuberosity was fixed at an average of 15.4 mm below the top of the humeral head (range: 3 to 26 mm). A radiographic assessment of a control population of 50 normal proximal humeri demonstrated an average tuberosity position of 6.7 mm (range: 2 to 12 mm) below the superior aspect of the humeral head. Polynomial regression analysis demonstrated a polynomial relationship for active range of motion and tuberosity height. ANOVA testing demonstrated statistically significant differences in all ranges of motion. Active forward elevation for Group I (3 to 9 mm) was 88 degrees, Group 11 (10 to 16 mm) was 126 degrees, and Group III (17 to 26 mm) was 85 degrees (p = 0.04). Active external rotation for Group I was 19 degrees, Group II was 48 degrees, and Group III was 29 degrees (p = 0.01). Active internal rotation for Group I was to L2, Group II was to T10, and Group III was to L2 (p = 0.01). Although many factors affect the final ranges of motion in patients who undergo prosthetic replacement for acute proximal humeral fractures we believe that placement of the greater tuberosity 10 to 16 mm below the humeral head will assist in the maximum recovery of glenohumeral motion.

Adult↗
PubMed2004

Risk factors for proximal humerus fracture.

This case-control study of proximal humerus fracture included 448 incident female and male cases and 2,023 controls aged 45 years or older identified in five Northern California Kaiser Permanente Medical Centers in 1996-2001. Data were collected by using an interviewer-administered questionnaire. Some factors related to low bone mass, including number of fractures since age 45 years and low dietary calcium intake, were associated with increased risks of fracture, and factors thought to protect against bone loss, such as menopausal hormone therapy and calcium carbonate tablet use, were associated with reduced risks. Fall-related risk factors included previous falls, diabetes mellitus, and difficulty walking in dim light. Possible fall-related risk factors suggested for the first time in this study were seizure medication use (adjusted odds ratio (OR) = 2.80, 95% confidence interval (CI): 1.45, 5.42), depression (OR = 1.34, 95% CI: 0.98, 1.84), almost always using a hearing aid (OR = 1.92, 95% CI: 1.12, 3.31 vs. never prescribed), and left-handedness (OR = 2.36, 95% CI: 1.51, 3.68 vs. right-handedness). Difficulty with activities of daily living and lack of physical activity tended to be associated with increased risk. Prevention of falls among frail, osteoporotic persons would likely reduce the frequency of proximal humerus fracture.

Age Distribution↗
PubMed2006

Update in the epidemiology of proximal humeral fractures.

UNLABELLED: We sought to determine current trends in the number of fall-related and osteoporosis-related proximal humeral fractures in elderly Finns during last three decades. We collected data from the National Hospital Discharge Register on all patients 60 years or older who were admitted to Finnish hospitals from 1970 to 2002 for primary treatment of proximal humeral fractures. Fractures induced by traffic accidents or other high-energy traumas were excluded. The number and incidence (per 100,000 patients) of fractures increased from 208 (number) and 32 (incidence) in 1970 to 1120 (number) and 105 (incidence) in 2002. The age adjusted incidence of proximal humeral fractures also showed an increase, from 51 (1970) to 129 (2002) in women, and from 14 (1970) to 48 (2002) in men. In women 80 years or older, the age specific incidence of fracture increased from 90 (1970) to 294 (2002), while in the other age groups trend changes were less extensive. The mean patient age also increased, from 73 years (1970) to 78 years (2002) in women and from 70 years (1970) to 73 years (2002) in men. If these trends continue, the number of fractures in elderly Finns will triple during the next three decades. LEVEL OF EVIDENCE: Prognostic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed2004

Severe humeral erosion in a bedridden patient: a comprehensive intervention to prevent bone fracture.

This article reports a 1-yr prospective study related to a bedridden patient with rotator cuff tear arthropathy featuring severe erosion of the proximal part of the humerus. To prevent spontaneous humeral fracture, a comprehensive intervention was planned. This included drug therapy for osteoporosis and pain, nurse team training on patient handling techniques, and patient and caregiver education. After 1 yr, clinical and radiologic findings are stable.

Aged↗
PubMed1995

Role of hemiarthroplasty for proximal humeral fractures.

A thorough understanding of the injury and strict adherence to principles of management are essential to obtain optimal results for the patient with a complex fracture of the proximal humerus. Evolving literature continues to give us better insight into difficult treatment decisions. By applying the appropriate indications, surgical techniques, and modular capabilities, hemiarthroplasty of the proximal humerus has evolved as a valuable treatment option for these injuries.

Aged↗
PubMed1984

Axillary artery injury as a complication of proximal humeral fractures. Two case reports and a review of the literature.

Proximal humeral fractures are commonly seen in orthopedic practice. The vast majority of these fractures are nondisplaced. Infrequently, displaced proximal humeral fractures have associated neurovascular injuries. Injury to the brachial plexus is uncommon; axillary artery injury is rare. This is a report of two displaced proximal humeral fractures in elderly, intoxicated patients following low-energy trauma. Both fractures resulted in axillary artery injury requiring vascular reconstruction. Only nine similar cases were found in a review of the literature. Displaced proximal humeral fractures should be carefully evaluated for vascular injury, and arteriography should be used when necessary. If vascular reconstruction is indicated, the fracture must be internally fixed to prevent redisplacement and potential compromise of the vascular repair. Serial postoperative Doppler examinations are necessary to detect thrombus formation. With prompt diagnosis and treatment, prolonged limb ischemia and its sequelae can be prevented.

Aged↗
PubMed1979

Independent exercises versus physiotherapy in nondisplaced proximal humeral fractures.

42 patients with undisplaced, proximal humeral fractures were randomly assigned into two groups in order to compare the results of instruction to the patient for independent exercises and conventional physiotherapy. No differences appeared between the groups subjectively or as regards functional parameters at 1 as well as at 3 months after the fracture and at a follow up more than 1 year later. As no disadvantage could be found instructions to the patients should in these cases be regarded as a satisfactory after-treatment.

Adult↗
PubMed1998

[Isolated coracoid fracture--open reposition and osteosynthesis--report of 3 cases].

UNLABELLED: Usually coracoid-fractures are "chain-injuries" in association with complex shoulder injuries. Isolated fractures of the coracoid process are uncommon. In the literature there is no consensus about the treatment. The conservative method is generally advocated. For better recognizing the particularities of coracoid-anatomy and fracture-analysis we performed dissections on cadaver shoulders and also evaluated a useful radiologic technique for diagnosis. Between 1995 and 1997 three patients with isolated displaced coracoid-fractures had open surgical repair. The postoperative course was very good in all three cases with complete recovery of shoulder function. DISCUSSION: We believe that isolated coracoid-fractures with infero-lateral dislocation and loss of function should sustain open reduction and internal fixation with functional after treatment.

Adolescent↗
PubMed1996

Late vascular complication after fracture of the proximal humerus.

A case of late vascular complication after a fracture of the proximal humerus is presented. The main clinical feature was neurological loss of the brachial plexus, while angiography showed no rupture or false aneurysm. The long delay before surgical intervention caused irreversible damage to the nerves. Early diagnosis and surgical intervention are emphasized.

Angiography, Digital Subtraction↗