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At least 1,207 records · Page 67Linked to original sources
PubMed2003

Straining of the intact and fractured proximal humerus under physiological-like loading.

Surgical treatment of proximal humeral fractures remains challenging in elderly patients, primarily due to insufficient implant fixation. Both bone quality and physiological-like loading conditions are commonly overlooked during pre-clinical in vitro evaluation. However, this knowledge is necessary in order to improve surgical treatment of the proximal humerus and the mechanical behavior of implants, particularly in patients with complex fractures and weak bone stock. We hypothesize that the bone quality has a high influence on the bone straining, independent of the arm position. The goal of this study was to determine the straining of the intact and fractured proximal humerus under physiological-like loading conditions. Furthermore, the impact of augmentation on tissue straining was evaluated. Two representative humeri were selected for this study, one osteoporotic and one reference quality, and scanned using both QCT and DEXA (average DEXA value=0.26 and 0.49 g/cm2 respectively). Subcaptial defects were generated, then stabilized with a plate prior to mechanical stiffness testing. From the QCT data, finite element models were generated and the in vitro stiffness tests analytically simulated. Under physiological-like loading conditions, the straining of the bone and implant were analyzed for 0 degrees, 90 degrees forward flexion, and 90 degrees abduction. Maximal strain values were found for the intact and fractured bone at 90 degrees abduction. This study demonstrates that the straining in a fractured bone of poor quality leads to considerably higher bone strains (up to +30%) than in a more healthy bone. Augmentation of a central void under physiological-like loading with commercial cement led to mechanical failure at the bone-cement interface. New concepts for the surgical treatment of complex fractures of the proximal humerus should take bone distribution into account and thereby allow effective treatment of fractures in osteoporotic patients. The ultimate salvage procedure of augmentation has mechanical limitations as long as current cement materials are used in osteoporotic patients.

Activities of Daily Living↗
PubMed2007

[Prolonged vascular complications with subsequent finger necrosis after humeral head luxation fracture in the elderly].

Fractures of the proximal humerus represent a typical injury of the elderly. Additional lesions of nerves or arteries are rare and there is only little information in the literature on the co-occurrence of proximal humerus fractures and compromised peripheral circulation which could lead to the loss of the upper extremity. To prevent damage to the injured limb, it is necessary to invent and initiate a standardized algorithm involving trauma care matching the special needs of this combined injury.

Aged, 80 and over↗
PubMed2003

[Control of the firmness of fixation of fragments with a plate for fractures of the humerus condyle of CII and CIII types].

The intra-articular comminuted fractures of the condyle of the Cii and Ciii types (by AO classification) were modeled in cadaverous humeral bones of the distal end of the humerus. Mechanical tests of the fixing properties of Y-shaped whole and combined plates as well as of two plates adapted to the fractures were performed by the method recommended by AO. The stabilizing properties of the whole Y-shaped plate were found to be the best. A more simple operative technique and less traumaticity with sufficiently optimal fixing properties as compared with the AO method allows osteosynsthesis with the Y-shaped plate to be considered preferable.

Aged↗
PubMed2005

Complications of humeral head replacement for proximal humeral fractures.

Humeral head replacement has been widely used for the treatment of complex proximal humeral fractures. The procedure is associated with a high rate of patient satisfaction as well as reliable relief of pain. The functional outcomes, however, have been variable. Reported complications include infection, neurologic injury, intraoperative fracture, instability, tuberosity malunion and nonunion, rotator cuff tear, heterotopic ossification, glenoid erosion, and stiffness. When technical factors such as tuberosity malunion or component malpositioning are considered as postoperative complications, the incidence of complications is relatively high. This high rate of complications, in turn, may be related to the wide range of reported functional outcomes.

Arthroplasty, Replacement↗
PubMed1979

[Therapy of fracture-dislocations of the humerus head].

Dislocated fractures of the head of humerus are rare and prognostically unfavourable. In elderly patients only functional therapy should be practiced. Surgery attempts to make operative reduction of the dislocation and careful fixation of the head of humerus. Endoprotheses may relieve the patient from pain, but cannot restore active mobility due to the lack of muscle insertion.

Female↗
PubMed2001

The translated two-part fracture of the proximal humerus. Epidemiology and outcome in the older patient.

We have undertaken a five-year prospective study of 126 translated two-part fractures of the proximal humerus and present an analysis of the epidemiology and of the factors which affect outcome in elderly patients. The fracture has a unimodal age distribution and rarely affects adults under the age of 50 years. Analysis showed that patients with two-part translated fractures of the surgical neck tended to be independent and relatively fit, despite the fact that their mean age was 72 years. Outcome was determined by the age of each patient and the degree of translation on the initial anteroposterior radiograph. Surgery did not improve the outcome, regardless of the degree of translation.

Activities of Daily Living↗
PubMed2004

Complete, superior labral radial tear and type II slap tear associated with greater tuberosity fracture.

This case report presents a unique variant of superior labral-bicep complex injury. The combination of a complete anterior-superior radial tear of the labrum and bicep anchor instability has not been described in previous classifications of these injuries. The injury was traumatic in nature and was associated with a displaced fracture of the greater tuberosity. The labral pathology was treated by an anatomic repair technique as described. Rationale for the repair performed, as well as implications of the injury treated by debridement alone, are discussed. Clinicians should be aware of different patterns of superior labral-bicep complex injuries and the implications on function and stability of the glenohumeral joint.

Adult↗
PubMed1998

Brown-Sequard syndrome caused by a Kirschner wire as a complication of clavicular osteosynthesis.

A case of spinal cord injury caused by delayed migration of a Kirschner wire is reported. Some cases of distant injuries caused by bone wires, and acupuncture needles have been published, but this is the first reported case of delayed thoracic spinal cord damage caused by the migration of a clavicular wire. A 22-year-old male patient was admitted with a clinical picture of spinal shock after performing physiotherapeutic exercises. Two months prior to this, the patient had undergone surgical treatment for a clavicular fracture in a different clinical center. Imaging showed a clavicular wire had migrated into the spinal canal. An early prescription of a spinal cord methyl-prednisolone protective treatment (NASCIS II), the surgical extraction of the foreign body and the rehabilitation exercises were the keys to a quick recovery.

Adult↗
PubMed1992

[Patterns of injuries: a guideline for evaluation of multiple injuries?].

By means of 468 patients with polytrauma the pattern of injuries were analysed. Separated into body regions the combinations of injuries to skeleton/thorax and skeleton/thorax/abdomen were found most often. A high lethality was evaluated for the combination of skeletal and abdominal injuries. 362 patients of the examined collective survived, 106 patients died. Among the deceased patients with head-injuries intracranial bleeding could be seen much more than in the group of survivors. Patients who died had also more ruptures of liver and other gastrointestinal injuries. Concerning the skeletal patterns of injuries they surprisingly had more fractures of shoulder, forearm and lower leg than the survivor-group. The statistic demonstrates clearly that in pattern of head or abdominal injuries the single diagnosis determines the rate of lethality. This correlation could not be seen in skeletal injuries. The pattern of injuries cannot be used as a guideline for the assessment of therapy of the severe trauma patient.

Abdominal Injuries↗
PubMed2003

Complications after hemiarthroplasty for fractures of the proximal humerus.

Humeral head replacement is frequently used in the treatment of selected fractures of the proximal humerus. This technique is usually successful in terms of pain relief and patient satisfaction. However, complications may occur and can adversely affect outcome. Careful preoperative planning, meticulous surgical technique, and appropriate postoperative rehabilitation are the best methods to promote a successful result. Potential complications and methods to avoid them at initial surgery should be reviewed.

Arthroplasty, Replacement↗
PubMed1999

Two-prong splint in the treatment of proximal humeral fracture.

Twenty-nine patients with two-, three- and four-part proximal humeral fractures were treated by two-prong splint. At the latest follow-up, 22 patients had excellent and satisfactory results according to the Neer criteria, with only two failures. Avascular necrosis was detected in only one patient. Given these results, we conclude that the present method can be the treatment of choice for these injuries.

Adolescent↗
PubMed2004

Valgus impacted proximal humeral fractures and their blood supply after transosseous suturing.

We treated 16 patients (11 women and five men, average age 45 years), all having four-part valgus impacted fractures of the proximal humerus, with transosseous suturing. All had preoperative angiography performed 6-12 h after admission. The average impaction angle was 43 degrees , and the mean lateral displacement of the humeral head was 1.4 mm. Postoperative angiography was performed 8-10 weeks after the operation followed by digital image processing using the segmentation technique. No statistically important reduction in the length and area of large (>0.5 mm) vessels was seen. Union was confirmed by the reduction in the length and area of small vessels (<0.5 mm). At a mean follow-up of 40 months, avascular necrosis was only found in one patient. The average Constant-Murley score was 87 (67-100) points, whereas the functional score in comparison with the unaffected shoulder was 94% (89-100%). Despite the small number of patients, transosseous fixation seems to preserve the remaining blood supply of the humeral head.

Adult↗
PubMed2002

Use of allograft for large Hill-Sachs lesion associated with anterior glenohumeral dislocation. A case report.

Though Hill-Sachs lesion is a common injury associated with anterior glenohumeral dislocation, there have been only few articles describing specific treatments for the humeral head defects. This paper described the case of an alternative treatment for large defect of the posterior-superior aspect of the humeral head using allograft. The patient was a 69-year-old male and the diagnosis was a chronic anterior dislocation of the right glenohumeral joint with a large impaction fracture of the posterior-superior aspect of the humeral head. The size of this defect was 4 cm by 2.5 cm in diameter with a 2 cm depth. To reduce the impaction fracture of the humeral head, a preserved frozen allograft of the femoral head was selected and configured to fit the defect. The graft was then impacted firmly down into the defect, and appeared to offer excellent stability even without adjuvant internal fixation. Two years after surgery, the patient was doing quite well with no complaints. Radiographs showed humeral head with incorporation of the graft and no evidence of collapse.

Aged↗
PubMed1993

[Osteosuturing with the Mitek anchor system--experiences from the first 17 operations].

In September 1990, the Mitek Anchor System was introduced commercially in Denmark. Since the introduction of the system in our department in October 1991 and until June 1992, we have collected data consecutively from all operations, in which the anchors have been used. The registration has included pre-operative history, type of operation and findings per- and post-operatively. In the above mentioned period, Mitek anchors have been used in seventeen operations: Twelve Bankart-repairs, three fractures of the major tubercle of the humerus, one reattachment of the ulnar collateral ligament of the thumb and one reattachment of the medial collateral ligament of the knee. None of the patients operated for Bankart lesions have had redislocations, and none of the anchors were displaced on X-rays. The three fractures of the major tubercle of the humerus have all remained without dislocation after fixation. No side-instability was found in the operated thumb, and the operated knee was making progress in training. By presenting the patient-data and the temporary post-operative results we conclude, that the anchors seem highly usable not only in Bankart-operations. Follow-up will be continued.

Adolescent↗
PubMedDate not supplied

Fracture separation of the coracoid process associated with acromioclavicular dislocation: conservative treatment--a case report and review of the literature.

Complete acromioclavicular dislocation associated with fracture separation of the base of the coracoid process is uncommon. This is a report of a 51-year-old man with severe emphysema and limited physical demands in whom the acromioclavicular dislocation and coracoid process fracture were treated conservatively with sling immobilization and early motion and exercises. Good power and full, painless range of motion with minimal symptoms was observed at 6 months follow-up. The strong coracoclavicular ligaments, rather than rupture, may avulse the coracoid process near its base and with disruption of the acromioclavicular joint may allow complete dislocation of the clavicle. A satisfactory result may be obtained without operative reduction of either the acromioclavicular joint or the coracoid process.

Acromioclavicular Joint↗
PubMed1996

A regional approach to the classic metaphyseal lesion in abused infants: the proximal humerus.

OBJECTIVE: The purpose of this study was to systematically analyze the spectrum of morphologic alterations of the classic metaphyseal lesion (CML) involving the proximal humerus of abused infants and to identify radiologic features that aid in the diagnosis and assessment of healing. MATERIALS AND METHODS: Thirty-one infants who died with evidence of inflicted skeletal injury were studied with high-detail skeletal surveys, resected specimen radiography, and histologic analysis. In each infant, the number of fractures, the involved portions of the proximal humeral metaphyses, and the age of the lesion were assessed. RESULTS: Seven proximal humeral CMLs were seen in four infants. Radiography of the only infant with an acute injury revealed no fracture; however, evidence of trabecular disruption was found histologically. Radiographic patterns in the six healing injuries included focal corner-fracture appearance, transmetaphyseal radiolucency, irregularity of the metaphyseal margin, and flame-shaped mineralized extensions into the physeal cartilage. Histologically, all CMLs undercut the lateral subperiosteal bone collar, explaining the corner-fracture appearance. Focal and diffuse thickening of the zone of hypertrophic chondrocytes was seen, and peninsulas of primary spongiosa surrounded by hypertrophied cartilage corresponded to the flame-shaped densities revealed radiographically. The fracture morphology was better seen on specimen radiography than on skeletal survey images. CONCLUSION: CML of the proximal humerus has distinctive radiologic and histopathologic characteristics that relate to the anatomy of the region. In our study, changes at the chondroosseous junction revealed by radiography correlated well with histologic evidence of healing. Although the proximal humerus is a less common location for CML than the lower extremity, the proximal humerus should be carefully scrutinized on high-detail radiographs in cases of suspected infant abuse.

Child Abuse↗