PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “SHOULDER FRACTURES”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,225 records · Page 68Linked to original sources
PubMed1991

[Tension band osteosynthesis with absorbable cords in proximal comminuted fractures of the humerus].

We reviewed 25 cases of comminuted fractures of the proximal humerus that were operatively treated from December 1984 to December 1988. Ten patients were treated by a Magerl operation modified by Marti using a metallic wire as a tension band. Twelve patients were operated on using a resorbable PDS (Polydioxanon) thread in the same manner. In this paper the PDS thread technique is described. The two groups are clinically and radiologically comparable. Using a PDS thread as a tension band has evident advantages: the relatively simple technique and the absence of implant removal.

Adult↗
PubMed1990

Isolated avulsion fracture of the lesser tuberosity of the humerus.

Three cases of isolated avulsion fracture of the lesser tuberosity are described together with a review of six previously reported cases. Of the total cases, six had a well-documented mode of injury, in which a strong abducting force was applied to the medial aspect of the upper arm, causing exaggerated abduction and external rotation. The contracting subscapularis muscle displaces the avulsed bony insertion to a position below the glenoid to give a characteristic appearance on the radiograph. This appearance should not be confused with calcific tendonitis. The lesion may warrant surgical intervention which has been successful in half the cases.

Adult↗
PubMed1988

Proximal humeral defects in Gaucher's disease.

Defects in the medial aspect of the proximal humeral metaphysis of two patients with Gaucher's disease are reported and their aetiology discussed. Similar cortical irregularities have been described as a normal variant in children and their presence in patients with an infiltrative disorder suggested as being coincidental. The two reported cases indicate that there is a causal association in Gaucher's disease since the defect persisted post-skeletal maturity in one case and progressed to bilateral pathological fractures of the proximal humeri in the other case. A review of the radiographs of 50 patients, pre-skeletal maturity, presenting with idiopathic scoliosis revealed a defect of the proximal humeral metaphysis in only one case, to give an estimated incidence of this anomaly in the "normal" population of 2%. It is suggested that the presence of this defect is non-specific with a spectrum of occurrence from the normal variant to the clearly pathological. The presence, however, of subtle abnormalities in the underlying bone tend to indicate a pathological entity.

Adolescent↗
PubMed2002

Blood transfusion in proximal humerus fractures.

This article is the first to specifically address blood transfusions associated with surgical treatment of proximal humerus fractures. In our study, we retrospectively reviewed charts of all patients admitted to our institution with a diagnosis of proximal humerus fracture from January 1, 1994, to December 31, 1997. The transfusion rate for patients who sustained a proximal humerus fracture was 15%. Compared with patients treated nonoperatively, patients who underwent a surgical procedure were not at increased risk for requiring transfusion. Age, hematocrit level on admission, treatment method, and estimated amount of blood loss in patients who underwent a surgical procedure varied significantly between those who received a transfusion and those who did not. Certain characteristics placed patients at increased risk for requiring transfusion--age older than 60, admission hematocrit level less than 33%, and hemiarthroplasty as definitive surgical treatment. This information is important both in educating patients and their families and in making management decisions.

Aged↗
PubMed1996

Isolated avulsion fracture of the lesser tuberosity of the humerus. Report of two cases.

We describe two cases of isolated avulsion fracture of the lesser tuberosity: this is an extremely rare pathology, and to our knowledge only 34 cases have been reported in the literature. In the present cases, standard radiography and computed tomography clearly evidenced the detached bone fragments. As the patients refused surgical reduction, they were treated conservatively. Outcomes were successful, and three months after injury both of them returned to normal activity with only slight limitation in external rotation. At their check-up six-months after injury the patients continued to carry on normal activity, in both cases their limitation in external rotation had decreased even further. Both patients were pain-free and satisfied with their treatment outcome.

Female↗
PubMed1987

External fixation of displaced fractures of the proximal humerus. Technique and preliminary results.

A new technique for the treatment of displaced fractures of the proximal humerus is described. Twelve fractures in 11 patients were managed by transcutaneous reduction using a Steinmann pin, and external fixation with a Hoffmann-type neutralising bar connected to two half-pins in the humeral head and three half-pins in the shaft. The pins were removed after four weeks. Two patients sustained redisplacement after a further injury, but in the others reduction was maintained. Two cases of pin-track infection resolved after antibiotics, but delayed union resulted. There were no neurovascular injuries and at follow-up of 6 to 12 months no refractures had been seen. The early functional results were excellent or satisfactory in nine cases.

Adult↗
PubMed2006

Arthroscopic treatment of glenoid fractures.

The patient was placed in the lateral decubitus position. The arthroscope was introduced through the posterior approach. The probe hook was introduced through a working cannula through the anterosuperior portal performed in an inside-out technique. The mobilization possibilities of the osteochondral fragments were then assessed. The use of a shaver was always necessary to clean the fracture site and evacuate clots. A nonabsorbable suture was passed through the labrum and the capsule tissue of the displaced articular fragment in its superior edge. The first suture was used as a traction stitch and allowed replacing the fragment in its original position and maintaining it during the placement of others sutures. A hole was made in the anterosuperior edge of the nonfractured glenoid and then a long drill was passed backward according to the transglenoid suture technique of Caspari or Morgan. Stitches were passed through the glenoid to the infraspinatus fossa. When articular congruity was judged satisfactory, the stitches were tied on the fascia of the infraspinatus muscle. The patients were immobilized in a sling for 3 weeks.

Adult↗
PubMed1995

[The magnetic resonance tomographic findings following the resection arthroplasty of the caput humeri].

PURPOSE: The resection of the humeral head is normally carried out only with respect to four-part and dislocation fractures in elderly patients. The purpose of this study was to examine whether there is a correlation between the clinical results and the MRI findings. MATERIAL AND METHODS: 8 patients underwent clinical and MR examination two to 6 years after resection. RESULTS: A cartilage-like tissue formation between the remaining humeral head and the glenoid fossa, with signal intensities comparable to hyalin cartilage was found in all patients. CONCLUSION: The good functional results following resectional surgery of the humeral head can partially be related to new substitute cartilage resulting from a chondroid metaplasia.

Aged↗
PubMed1999

3D-radiographic analysis does not improve the Neer and AO classifications of proximal humeral fractures.

The Neer and AO fracture classifications for fractures of the proximal humerus have shown poor reproducibility based on plain radiography. We wanted to investigate whether the addition of 3-dimensional (3D) reconstructions would increase the reproducibility of classification. 7 observers independently classified 24 fractures of the proximal humerus using both plain radiographs, CT and 3D and the classification was repeated 2 months later. There was a moderate interobserver agreement when using the Neer classification, but only a fair agreement with the AO classification. The Neer system had a mean kappa value of 0.44 and the AO had a value of 0.32 for the first assessment. In the second assessment, the mean kappa values were 0.49 and 0.34, respectively. Intraobserver reproducibility was fair to substantial agreement for Neer (kappa range 0.27-0.73) and for AO (kappa range 0.29-0.74). In conclusion, the addition of CT and 3D to plain radiographs did not improve the reproducibility of the classifications of Neer and AO of the proximal humerus.

Humans↗
PubMed1979

[Fractures of the head and tuberosities of the humerus: treatment of malposition (author's transl)].

Fractures of the head and tuberosities of the humerus combine "horizontalisation" with impaction of the head of the humerus into the cortical funnel of the upper metaphysis which then forms a "buffer" with a sub-acromial "camshaft effect". In addition, there may be a subjacent metaphyseal comminution or even a split in the head. These various factors render surgical treatment difficult, when it is sought to restore normal anatomical conditions by osteosynthesis, with uncertain anatomical and functional results because of the double risk of early separation of the fragments and of secondary necrosis. There exists the possibility of operation vis a transdeltoid approach which combines resection of the cortical cuff and lateral transposition with bringing down of the capsulo-tendinous layer. This simple technique has the advantage of almost invariably offering a satisfactory functional result.

Humans↗
PubMed2001

An individualized approach for the implantation of a humeral prosthesis with the proper retroversion in fractures.

We applied a new methodology in 7 patients with a fracture of the upper humeral head that required hemiarthroplasty, to implant a humeral prosthesis with an individualized posterior version. Our goal was to determine preoperatively the distance from the posterior edge of the bicipital groove where the lateral fin of the humeral prosthesis should sit, in order to reproduce the individual retroversion during surgery. Using three computed tomography scan sections of the upper humerus and image processing software, we estimated the above-mentioned distance in the sound humerus and implanted the prosthesis in each patient accordingly. The differences in retroversion between the left and right humeral heads permit a better approximation to normal applying this methodology than inserting the prosthesis in a standard retroversion.

Humans↗
PubMed2002

Risk factors for fractures of the proximal humerus: results from the EPIDOS prospective study.

Fracture of the proximal humerus is one of the most frequent fractures attributable to osteoporosis; yet, it has seldom been studied. Two types of factors (related to bone fragility and falls) were evaluated to identify risk factors for proximal humerus fractures as well as to examine possible interactions between them. Subjects were 6901 white women aged > or =75 years and all participated in the EPIDOS study of risk factors for osteoporotic fractures (France, 1992-1998). The baseline examination included measurements of femoral neck bone mineral density (BMD) and calcaneal ultrasound parameters (speed of sound [SOS] and broadband ultrasound attenuation [BUA]), a functional clinical examination, and completing a questionnaire on health status and lifestyle. During a mean of 3.6 (0.8) years of follow-up, 165 women had a humeral fracture. Using multivariate Cox regression models, we identified three predictors related to bone fragility-low BMD (relative risk [RR] = 1.4; 95% CI, 1.1-1.7), low SOS (RR = 1.3; 95% CI, 1.0-1.6), and maternal history of hip fracture (RR = 1.8; 95% CI, 1.0-3.0)-and four fall-related predictors-a previous fall (RR = 3.0; 95% CI, 1.5-6.1), a low level of physical activity (RR = 2.2; 95% CI, 1.1-4.4), impaired balance (RR = 1.8; 95% CI, 1.1-2.9), and pain in lower limb extremity (RR = 1.4; 95% CI, 1.0-2.1). The effect of these fall-related predictors varied according to the BMD level; they were significantly associated with proximal humerus fractures in women with osteoporosis (BMD T score < -2.5) but not in nonosteoporotic women. The incidence of proximal humerus fracture in women with osteoporosis and a low fall risk score (5.1 per 1000 woman-years) was only slightly higher than in nonosteoporotic women (4.6 per 1000 woman-years) and similar to the incidence in women without osteoporosis but a high fall risk score (5.3 per 1000 woman-years). On the other hand, the incidence in women who had both types of risk factors was more than two times higher (12.1 per 1000 woman-years) than in women with only one of the two risk factors. These results suggest that women who have both types of risk factors should receive the highest priority for prevention.

Accidental Falls↗
PubMedDate not supplied

Severely displaced proximal humeral epiphyseal fractures: a follow-up study.

Forty-eight patients with severely displaced proximal humeral epiphyseal fractures were reviewed. Twenty-one patients were followed up for an average of 9 years after injury with a personal interview, examination, and radiographs. Average age was 14.1 years, half of whom were age 15 years or older. Initial head-shaft displacement averaged 80%, and 31 fractures were displaced by > or = 80%. All underwent attempted closed reduction. Radiographs for all except three were sufficient to judge the adequacy of reduction. Twenty-six of 45 attempted closed-reductions failed to improve displacement significantly. Nine patients underwent operative treatment, and the remainder had a closed reduction. In the operative group, complications occurred in three of nine patients. No complications occurred in the nonoperative group. No patients seen at late follow-up identified any activity or employment restrictions as a result of their injuries. Several patients incurred humeral shortening or imperfect radiographic remodeling, but this did not correlate with clinical outcome. Comparing the operative complications with the excellent late results after nonoperative treatment in this series supports previous recommendations to avoid operative intervention with few exceptions. The magnitude of displacement alone does not appear to justify operative treatment.

Adolescent↗
PubMedDate not supplied

Reconstruction of the valgus-impacted humeral head fracture.

Between 1985 and 1991, 22 patients (average age 52 years, range 26 to 65 years) with severely impacted humeral head fractures were operated on with the aim of preserving the humeral head. All 22 cases showed no significant lateral displacement. Thus it was assumed that the periosteum leading medially to the humeral head was intact and that the vessels passing through the periosteum would ensure survival of the humeral head segment. All patients underwent treatment with open reduction. The impacted segment of the humeral head was raised, the tuberosities were relocated, and the void was filled with chips of cancellous bone. This procedure provided fixation with minimal osteosynthesis. At follow-up evaluation (minimum 18 months, average 36 months) one patient had sequestration of the head segment, and another patient had clinically asymptomatic partial necrosis. None of the remaining 20 patients showed signs of necrosis. Slight arthrosis was present in two patients, and moderate arthrosis was present in one. A correlation was found between the functional result and the quality of reduction. Where anatomic reconstruction had been successful, the long-term functional result was almost identical with the nontraumatized side.

Adult↗
PubMed1988

Traumatic brachial plexus palsy in the adult. Retro- and infraclavicular lesions.

The author reviewed 420 adults treated with surgery for traumatic palsy of the brachial plexus. The results of 105 patients (25%) who suffered plexus injury behind or beyond the clavicula are presented. In 69 patients, lesions affected secondary trunks and in the other 36 affected terminal branches. Simultaneous fractures or vascular injuries were not uncommon and often influenced overall prognosis. Decision criteria for nerve grafting or neurolysis are presented. Surgery is generally performed three weeks to six months after injury. Most patients present extensive damage due to traction lesions. Although secondary sutures can be performed on some injuries, nerve grafting is usually necessary. Such a procedure depends on the length of the gap and the quality of surrounding tissues. Among distal lesions a distinction must be made between (a) injuries located close to effectors on axillary, suprascapular, musculocutaneous, or radial nerves where good recovery can be expected in 70% to 80% of grafted patients and (b) injuries involving lateral or medial cords or the median or ulnar nerves far from effectors, where results are less satisfactory. Sixty percent of such patients recovered wrist flexion but no intrinsic muscle function in the hand. Reinnervation nevertheless generally provided a protection sensibility particularly in the area controlled by the median nerve. Multiple injuries may occur, mainly posterior cord lesions combined with lesions of the musculocutaneous, median, or ulnar nerves. The overall prognosis of infra- or retroclavicular plexus injuries is nevertheless better than that of supraclavicular lesions.

Adolescent↗
PubMed2003

Spiral fracture of the radius: an unusual case of shoulder dystocia-associated morbidity.

BACKGROUND: The most common neonatal complications associated with shoulder dystocia include transient brachial plexus palsy, clavicular fracture, and humeral fracture. Fracture of the fetal radius has not been previously reported. CASE: We encountered a shoulder dystocia with the fetal head in the right occiput anterior position that necessitated the McRoberts maneuver, suprapubic pressure, the Wood and Rubin maneuvers, and extraction of the posterior fetal arm to effect delivery. The 4610-g infant experienced a spiral fracture of the right (anterior) radius and a fracture of the left (posterior) midhumeral shaft. CONCLUSION: Neonatal radial fracture can result from shoulder dystocia or the maneuvers employed for the alleviation of the shoulder dystocia.

Adult↗
PubMed1998

[Indications and results of shoulder prosthetics in complex proximal humerus fractures].

Complex fractures of the proximal humerus are uncommon injuries and a therapeutic challenge to the orthopaedic surgeon. Successful treatment requires proper evaluation of the patient and analysis of standardized high-quality radiographs. The trauma series of radiographs (including true anteroposterior and lateral views in the scapular plane, and axillary view) is essential for accurate fracture assessment. Generally, joint-preserving reconstructive techniques are emphasized, aiming at restoration of the anatomy of the proximal humerus. In young individuals with excellent quality of the bone fragments, careful techniques of reduction and fixation, avoiding additional surgical devascularization, should be performed, even in case of possible impairment of the vascular supply to the humeral head. In elderly individuals with osteoporotic bone and limited compliance throughout aftercare, humeral head replacement may be indicated less restrictively. In the latter group hemiarthoplasty generally can be expected to result in painfree shoulders. However, recovery of function and range of motion are much less predictable.

Adult↗