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 1,621 records · Page 90Linked to original sources
PubMed2005

Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.

BACKGROUND: We conducted a randomized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications. METHODS: We randomly assigned women between 24 and 34 weeks' gestation who had gestational diabetes to receive dietary advice, blood glucose monitoring, and insulin therapy as needed (the intervention group) or routine care. Primary outcomes included serious perinatal complications (defined as death, shoulder dystocia, bone fracture, and nerve palsy), admission to the neonatal nursery, jaundice requiring phototherapy, induction of labor, cesarean birth, and maternal anxiety, depression, and health status. RESULTS: The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group (1 percent vs. 4 percent; relative risk adjusted for maternal age, race or ethnic group, and parity, 0.33; 95 percent confidence interval, 0.14 to 0.75; P=0.01). However, more infants of women in the intervention group were admitted to the neonatal nursery (71 percent vs. 61 percent; adjusted relative risk, 1.13; 95 percent confidence interval, 1.03 to 1.23; P=0.01). Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group (39 percent vs. 29 percent; adjusted relative risk, 1.36; 95 percent confidence interval, 1.15 to 1.62; P<0.001), although the rates of cesarean delivery were similar (31 percent and 32 percent, respectively; adjusted relative risk, 0.97; 95 percent confidence interval, 0.81 to 1.16; P=0.73). At three months post partum, data on the women's mood and quality of life, available for 573 women, revealed lower rates of depression and higher scores, consistent with improved health status, in the intervention group. CONCLUSIONS: Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman's health-related quality of life.

Adult↗
PubMed2004

Orthopedic considerations in Gaucher disease since the advent of enzyme replacement therapy.

Gaucher disease, the most prevalent lysosomal storage disorder, is characterized by hepatosplenomegaly, hypersplenism, and rarely, neurological involvement. The most variable symptoms relate to skeletal disease, and both onset and progression are difficult to predict on the basis of genotype. This review describes findings from a large referral clinic (> 500 patients) and from the literature in the decade since the advent of specific enzyme replacement therapy. Such therapy is effective in reducing visceral and hematological involvement, but its greatest advantage as regards the skeleton is prevention of irreversible damage. Avascular necrosis of the joints-particularly the hips but also the knees and shoulders-and pathological fractures of the long bones including the ribs, as well as episodic "crises' of bone pain in children and young adults, are common manifestations. Various imaging modalities should be performed at baseline for life-long monitoring, and then as required because of specific complaints. Surgical interventions such as joint arthroplasties are important adjuvant treatments in this population; presurgical hematological profiling plus antibiotic cover and postoperative pain control are equally critical. Opportunities for orthopedic consultations with senior surgeons are not abused by our patients. These reflect disease-related morbidity, with greater numbers of requests being made by patients requiring enzyme therapy, who by definition have more severe disease characteristics.

Adolescent↗
PubMed1988

What anatomy shall we teach medical and dental students in a primary health care curriculum?

The opinions of 142 doctors on the relevance of anatomy to the diagnosis and management of common clinical problems in their current medical and dental practice were analysed. This was in a bid to determine the relevant anatomy course content for the new primary health care oriented medical and dental curriculum of the College of Medicine, University of Lagos. The respondents gave high scores to the relevance of anatomy knowledge to the management of acute abdomen (mean = 3.5), dislocated shoulder (3.3), Colles' fracture (3.2), palmar space abscess (3.2), obstructed labour (3.2), carcinoma of the breast (3.2), ectopic pregnancy (3.1), flail chest (3.1) and upper respiratory obstruction (3.0). They gave minimal scores to helminthiasis (mean = 1.5) common cold and anaemia (1.6), sickle cell disease (1.7), gastroenteritis (1.8), dental abscess (2.0), hypertension (2.2) and asthma (2.2). A basis for selecting relevant anatomy course content is deduced for an undergraduate curriculum in which the responsibilities and competence of the graduates is known. A nationwide extension of the study, especially amongst general practitioners and first-line doctors in rural areas, would be useful for identification of health problems that require little or no knowledge of anatomy and which can be safely managed by lower cadres of health personnel, traditional practitioners and members of the lay community.

Anatomy↗
PubMed2005

Correlation of birth injury with maternal height and birthweight.

BACKGROUND: Infant or maternal injury during vaginal delivery is a constant threat to all involved, but difficult to predict. OBJECTIVE: To estimate the risk of birth injuries in an institution favouring trial of vaginal birth when there was doubt of the best mode of delivery. DESIGN: A retrospective cohort study. SETTING: University Hospital. POPULATION: Singleton 14,359 vaginal deliveries in cephalic presentation during 5(1/2) years. METHODS: The total caesarean section rate during this period was 9%. The likelihood of injury was evaluated by logistic regression analysis with injury as the dependent variable and maternal height and child birthweight as explanatory variables in birth injury risk estimation. MAIN OUTCOME MEASURES: Infant injury defined as one of the following: shoulder dystocia, clavicle fracture or brachial plexus injury; and maternal injury as anal sphincter rupture (ASR). RESULTS: There were a total of 318 infant injuries in 282 infants and 423 ASRs. A strong correlation was found between injury and both fetal macrosomia and short maternal stature, but macrosomia was a stronger indicator of injury. Birth injury risk estimation curves were constructed based on maternal height and birthweight. CONCLUSIONS: The present results confirm a strong correlation between fetal macrosomia and short maternal stature and the likelihood of injury during vaginal birth. Risk estimation curves were constructed that might be of great value for the obstetrician in choosing the mode of delivery in these cases.

Anal Canal↗
PubMed1994

Osteoporosis and the jaws: questions remain to be answered.

Osteoporosis is a major health issue in later life, which translates the age-associated increased risk of falls into a hip, shoulder or wrist fracture. The same pathology may result in vertebral crush fracture after minor loading of the axial skeleton. The health burden is enormous. Over a five year period, 10% of the female population of the United Kingdom, over 70 years of age, will suffer a fractured femoral neck, from which up to 20% may die and only a third of the survivors will be fully mobile at six months.

Aged↗
PubMed2002

Orthopedic issues after cerebrovascular accident.

Patients who have had a cerebrovascular accident with resultant hemiplegia often present to the orthopedic surgeon with characteristic complaints and deformities. The most common of these include muscle spasticity and contracture, shoulder pain, hip fracture, and heterotopic ossification. Although some of these disorders are clinically evident, others may be easily overlooked. The purpose of this article is to summarize the most common orthopedic aspects of hemiplegic patients who have had a cerebrovascular accident.

Activities of Daily Living↗
PubMed2004

Infraclavicular brachial plexus stretch injury.

OBJECT: The authors report the surgery-related results obtained in 143 patients with stretch-induced infraclavicular brachial plexus injuries (BPIs). The entire series comprised 1019 operative BPIs managed at the Louisiana State University Health Sciences Center between 1968 and 1998. METHODS: Infraclavicular lesions represented 143 (28%) of the total of 509 stretch injuries involving both the infra- and supraclavicular brachial plexus, of which 366 (72%) were supraclavicular lesions. The operative approach is thoroughly outlined, and common patterns and combinations of involvement of nerves peculiar to the infraclavicular area are presented. Overall, the results of suture and graft repair were favorable for the lateral and posterior cord and their outflows. Repair of medial cord-median nerve also yielded acceptable results. The results of medial cord and medial cord-ulnar nerve, however, were poor. The incidence of associated injuries in the infraclavicular as opposed to the supraclavicular area, including shoulder dislocation and fracture and humeral fractures as well as vascular injuries including axillary artery injury was higher. Results of a literature search supported the finding that vascular injuries were increased due to the juxtaposition of vessels among the brachial plexus elements. CONCLUSIONS: Thus, although less common than their supraclavicular counterpart, infraclavicular stretch injury lesions when they occur are technically more difficult to treat and are associated with a higher incidence of vascular and dislocation/fraction injuries. Favorable results were obtained for lateral and posterior cord lesions and their outflows, with acceptable outcome after medial cord-median nerve stretch injury repair. The results of medial cord and medial cord to ulnar nerve, however, were poor.

Action Potentials↗
PubMed1989

[Injuries caused by parasailing].

The new sport of parasailing seems to be set to go through the same stages of enthusiasm, disillusionment and consolidation as hang gliding did some years ago. The high number of injuries we see in our clinic, which is in one of the areas of Germany where parasailing is most popular, shows that the phase of enthusiasm is still in full swing. A total of 48 injuries sustained during parasailing and treated in our clinic within 6 months were analyzed with reference to causes, patterns, and frequencies. Most of the injuries occurred with unfavorable wind and weather conditions; 58% of them occurred in the start phase as the result of falls on uneven ground, on rocks, or trees; 10% during the flight phase as a result of turbulence or collisions with obstacles; and 32% during the landing phase, mainly by falling on the back from some height while landing too slowly, or by falling forward while landing too fast with back wind. As to the sites of the injuries, 60% were to the lower extremity, 26% to the upper extremity, and 14% to the body. The most serious injuries were fractures (42%), contusions (26%), ligamentous lesions (19%), luxations (6%), and deep wounds (6%). The most frequent injuries were ligamentous lesions and fractures of the upper ankle (14), spine contusions (5), radial fractures (4), knee contusions (4), hand fractures (3), calcaneus fractures (2) and shoulder luxations (2). We classed 56% of the injuries as mild, 42% as moderate, requiring subsequent operation or hospital treatment, and 1 as severe, with 2 months' hospital inpatient treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Emergency versus delayed repair of severe brachial plexus injuries.

Emergency or early surgery for brachial plexus injury is advisable because emergency nerve surgery is technically easier and because the overall results are better. In cases involving vascular injury, preoperative arteriography is indispensable. The blood supply must be reestablished and the brachial plexus completely explored and, if possible, repaired. In cases not involving vascular injury, violent trauma with fractures of the shoulder often produces lesions in the same brachial plexus. Regardless of associated vascular or bone injuries, brachial plexus lesions should be repaired within the first days after injury (provided that there are no contraindications related to age or general health). If combined vascular and nerve injuries are involved, immediate emergency surgery is mandatory. With early surgery, exploration is easier, shorter grafts are needed, and neurotization is possible in lesions in which the roots have been pulled out.

Angiography↗
PubMed1997

Reconstruction of the health status in a past human population: the Iron Age necropolis of Monte Bibele (Bologna, Italy).

This paper examines the condition of health of an iron age population from Monte Bibele (Bologna, Italy). The vertebral spine is the site most frequently affected by disease: cleft atlas, spina bifida of the sacrum, sacralization of the 5th lumbar spine, arthrosis. Arthrosis is also present in the hip, elbow, shoulder and knee. Fractures are common. Periostitis and osteoporosis and a probable case of acromegaly are present. The majority of the pathologic changes observed in the population of Monte Bibele appears to be related to senescence or to occupational causes.

Female↗
PubMed1998

Role of electron beam treatment in postoperative management of carcinoma of the breast.

The aim of post operative radiotherapy to chest wall and drainage areas in advanced breast cancer is to sterilize the possible microscopic disease. Fifty cases of post surgical breast cancers were evaluated in a prospective study of chest wall radiation therapy by electrons. Fifty women of histologically proved post operative invasive breast cancers underwent simple mastectomy with axillary dissection followed by post-operative radiotherapy (Electron) to chest wall +/- drainage area. The chest wall and IMC was treated by a direct electron beam (9/12 MeV and 12 MeV) at fixed angle. 6 MV X-ray beam was used to treat axillary apex and supraclavicular area. In some cases, supplement RT was given by 6 MV X-rays through small posterior axillary portal. The energy of electron beam was 9 MeV or 12 MeV depending on the thickness of treated area. The supraclavicular and axillary lymphatic regions were treated, by direct custom shaped anterior portal. The dose delivered was 50 Gy over 5 weeks at 2 Gy per fraction. Adjuvant chemotherapy was given to patients who were pre-menopausal with histologically proved axillary node involvement as Cyclophosphamide, Methotrexate and 5-Fluorouracil (CMF) after radiotherapy. Post menopausal patients received adjuvant tamoxifen 10 mg.bid. The overall time varied from 26 to 87 days with a median of 41.5 days (SD 11.7). The followup period varied from 4-32 months with a mean of 22 months (SD 6.4). All the fifty patients developed dense pigmentation towards the end of radiation therapy, along with patchy dry desquamation. Moist desquamation occurred in 6 patients. The median OTT in the patients who developed moist desquamation was 34.5 days. The moist reaction healed over 10-15 days after completion of radiotherapy. Lung Fibrosis (Apical lobe) occurred in four patients. The fibrosis was evident at a median of 12 months of follow up. Lymphoedema of the ipsilateral arm occurred in six patients. None of 50 patients developed late sequalae like Cardiac effects, Rib fracture, Brachial Plexopathy, Shoulder joint impairement and Soft tissue effects. Local control in this study was 96% (48 patients). The two year actuarial overall survival was 80%. In early stages survival was significantly better compared to late stages. The actuarial two year DFS was 72%. In early stages DFS was significantly better compared to late stages.

Adult↗
PubMed1991

[Sonographic findings in radiologically non-displaced proximal humerus fractures].

UNLABELLED: In 5 patients with radiological nondisplaced fracture of the proximal humerus and persistent pain of the involved shoulder joint, ultrasonic evaluation was performed statically and dynamically. All patients suffered from a nondisplaced two-part fracture of the greater tuberosity. In four cases we found a significant cranialisation of the greater tuberosity between 1 and 8 mm. Furthermore, we identified a ventral cleft on the fracture side as well as a dorsal dislocation of the fragment. During dynamic examination we observed an impingement of the supraspinatus tendon between the acromion and the greater tuberosity. CLINICAL RELEVANCE: In primary diagnosis of cases with a questionable dislocated fragment and in patients with persistent pain after proximal humeral head fractures, diagnostic ultrasound investigation may yield additional information. This may influence further treatment.

Adult↗
PubMed1996

Shoulder injuries common in alcoholics. An analysis of 413 injuries.

We recorded prospectively all adult patients with a fracture of the proximal end of the humerus, clavicle and scapula or a primary shoulder or acromioclavicular dislocation in the city of Malmö in 1987. Altogether there were 413 injures. The hospital records from the Department of Alcohol Diseases were searched for these patients and for 2 age- and gender-matched controls for each patient. 12% of all patients with a shoulder injury were recorded as alcohol abusers. This number was significantly greater than that of the controls. The difference was more obvious in men than in women. In men between 30 and 64 years, almost half of the proximal humerus fractures and shoulder dislocations, one third of mid-clavicular fractures and two thirds of all lateral clavicle fractures were sustained by alcohol abusers. Our findings emphasize the significance of alcohol abuse in the etiology of shoulder injuries, especially in men. Most of the men with a fracture of the lateral clavicle are registered at the Department of Alcohol Diseases, making this injury a marker of alcohol abuse.

Acromioclavicular Joint↗
PubMed2001

Percutaneous pinning of the proximal part of the humerus. An anatomic study.

BACKGROUND: Closed reduction and percutaneous pinning of unstable proximal humeral fractures is a well-described technique with some theoretical advantages over open techniques. To our knowledge, the risk of injury to neurovascular structures from percutaneous pinning of the proximal part of the humerus has not been studied. We sought to quantify this risk using a cadaveric model. METHODS: In ten fresh-frozen cadaveric shoulders, the intact proximal part of the humerus was pinned under fluoroscopic guidance with use of an identical published technique. A total of five 2.5-mm terminally threaded AO pins, including two lateral, one anterior, and two greater tuberosity pins, were used in each shoulder. The specimens were then dissected to determine the distance of each pin from adjacent neurovascular structures as well as key anatomic relationships. RESULTS: The proximal lateral pins were located at a mean distance of 3 mm from the anterior branch of the axillary nerve. Four of the twenty lateral pins were noted to penetrate the articular cartilage of the humeral head. The anterior pins were located at a mean distance of 2 mm from the tendon of the long head of the biceps (perforating the tendon in three specimens) and of 11 mm from the cephalic vein (perforating the vein in one specimen). The proximal tuberosity pins were located at a mean distance of 6 and 7 mm from the axillary nerve and the posterior humeral circumflex artery (tenting the structures in two specimens with internal rotation), respectively. These pins moved away from the nerve with external rotation of the humerus. CONCLUSIONS: The technique used in this study may be associated with a risk of injury to important anatomic structures about the shoulder. Lateral pins should be distal enough to avoid injury to the anterior branch of the axillary nerve, and multiple fluoroscopic views should be obtained to avoid penetration of the humeral head cartilage. There may be a risk of injury to the cephalic vein, the biceps tendon, and the musculocutaneous nerve with use of anterior pins, and these pins should be employed with caution. Greater tuberosity pins should be placed with the arm in external rotation, should be aimed for a point 20 mm from the inferior aspect of the humeral head, and should not overpenetrate the cortex.

Bone Nails↗