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At least 19 recordsLinked to original sources
PubMed2004

Fixion nails for humeral fractures.

Humeral fractures in the setting of multi-trauma are usually managed with internal fixation. We prospectively followed nine patients treated with an expandable nail (Fixion, DiscoTech, Medical Technologies, Herzliya, Israel), until union. Internal fixation rapidly stabilises the injured limb, and the lack of distal cross-bolting in this device markedly reduced our operative time. There were no complications in our series and there was evidence of clinical and radiological union within 6 months. We found the nail easy to use and effective in this clinical setting.

Adolescent↗
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↗
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↗
PubMed2001

Interventions for treating proximal humeral fractures in adults.

BACKGROUND: Proximal humeral fractures are common yet management varies widely. In particular, the role and timing of any surgical intervention have not been clearly defined. OBJECTIVES: To collate and evaluate the scientific evidence supporting the various methods used for treating proximal humeral fractures. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, MEDLINE, PubMed, the Cochrane Controlled Trials Register, CINAHL, the National Research Register and bibliographies of trial reports. The search was completed in July 2000. SELECTION CRITERIA: All randomised studies pertinent to the treatment of proximal humeral fractures were selected. DATA COLLECTION AND ANALYSIS: Independent quality assessment and data extraction were performed by two reviewers. Although quantitative data from trials are presented, trial heterogeneity prevented pooling of results. MAIN RESULTS: Nine randomised trials were included. All were small trials; the largest study involved only 85 patients. Bias in these trials could not be ruled out. Six trials evaluated conservative treatment, two compared surgery with conservative treatment and one compared two surgical techniques. In the 'conservative' group there was very limited evidence indicating that the type of bandage used made any difference in terms of time to fracture union and the functional end result. However, an arm sling was generally more comfortable than a body bandage. There was some evidence that mobilisation at one week instead of three weeks alleviated pain in the short term without compromising long term outcome. Two trials provided some evidence that patients, when given sufficient instruction to pursue an adequate physiotherapy programme, could generally achieve a satisfactory outcome if allowed to exercise without supervision. Operative reduction improved fracture alignment in two trials. However, in one trial, surgery was associated with a greater risk of complication, and did not result in improved shoulder function. Fracture fixation of severe injuries was associated with a high rate of re-operation in one trial, comparing tension-band wiring fixation with hemi-arthroplasty. REVIEWER'S CONCLUSIONS: Only tentative conclusions can be drawn from the available randomised trials, which do not provide robust evidence for many of the decisions which need to be made in contemporary fracture management. It is unclear whether operative intervention, even for specific fracture types, will produce consistently better long term outcomes. There is a need for good quality evidence for the management of these fractures.

Adult↗
PubMed1993

Radial and humeral fractures as predictors of subsequent hip, radial or humeral fractures in women, and their seasonal variation.

Hip fractures are common in elderly women, and early risk assessment of future hip fractures is relevant in relation to prevention. We studied the predictive value of radial and humeral fractures in women. The influence of weather conditions on the risk was also studied. Women aged 20-99 years with a fracture of the distal radius (n = 1162) or proximal humerus (n = 406) were followed for 0 to 9 years. The relative risk (RR) and 95% confidence limits (CL) of subsequent fracture among women suffering radial or humeral fractures compared with the background population were calculated. Women 60-79 years of age who had suffered a fracture of the distal radius or proximal humerus had relative risks of sustaining a hip fracture of 1.9 (1.3-2.6, 95% CL) and 2.5 (1.3-3.6, 95% CL) respectively. The relative risk of hip fracture was highest within the first years following a fracture of the radius or the humerus. Women suffering an upper extremity fracture (radius or humerus) in snowy or icy weather had a marginally increased risk (RR = 1.3, 0.4-2.3, 95% CL and RR = 1.8, 0.3-3.4, 95% CL) for a later hip fracture. A woman 50 years old with a radial or a humeral fracture had an estimated residual lifetime risk of sustaining a subsequent hip fracture of 17% and 16% respectively compared with 11% for the background population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Treatment of displaced proximal humeral fractures in elderly patients.

We randomised 40 elderly patients of mean age 74 years with displaced three- or four-part fractures of the humerus to either conservative treatment or tension-band osteosynthesis. At one year and after three to five years, clinical follow-up showed no functional differences between the two groups of patients, with optimal function achieved within one year. There were major complications only in the surgically-treated group. Radiological review showed that surgery had improved the position of the fractured humeral head, but this was not reflected in improved function. Semi-rigid fixation with tension-band wiring of displaced multifragment fractures of the proximal humerus in the elderly did not improve the functional outcome when compared with conservative treatment.

Aged↗
PubMed2006

A clinically applicable fracture classification for distal humeral fractures.

The purpose of this study was to design a clinically applicable classification for distal humeral fractures that would provide guidance to the surgeon with regard to surgical approach and operative management. The new classification was assessed by use of the original radiographs from a study comparing distal humeral fracture classifications undertaken in Oxford, England, and was validated by use of the exact methodology of that study. Nine independent assessors were asked to classify 33 sets of radiographs on 2 separate occasions using the classifications of Riseborough and Radin, Mehne and Jupiter, and the AO, as well as the new classification system. With the use of the kappa statistic, the level of interobserver and intraobserver agreement was determined. The new classification system was found to be both substantially reliable (kappa, 0.664) and reproducible (kappa, 0.732). The new classification achieved superior interobserver and intraobserver agreement compared with the other 3 classification systems, with a low proportion of unclassifiable fractures. Used in conjunction with a management algorithm, we believe that the new classification aids the surgical decision-making process for these complex fractures.

Adult↗
PubMed2006

Diagnosis and treatment of common fractures in children: femoral shaft fractures and supracondylar humeral fractures.

Femoral shaft fractures and supracondylar elbow fractures are two of the most common major pediatric injuries managed by the general orthopedic surgeon. Therapeutic choices frequently are influenced by many factors, including associated injuries, fracture type, and the child's age, social situation, and economic issues. Nonsurgical management of femoral shaft fractures has been a preferred and cost-effective treatment for most age groups, but recently the use of surgical techniques has gained popularity with the overall goal of rapid mobilization of the child. Supracondylar elbow fractures are diagnostically challenging and can result in severe acute and long-term complications. An understanding of fracture presentation, anatomic detail, and surgical applications will optimize the chances for successful outcomes.

Bone Plates↗
PubMed1994

Percutaneous intramedullary pinning of proximal humeral fractures.

Proximal humeral fractures can usually be treated closed. However, even with an adequate closed reduction, these fractures are occasionally unstable, fail to remain reduced, and require operative intervention. A percutaneous intramedullary pinning technique is effective in stabilizing these fractures. Two cases that illustrate the adult and pediatric techniques for pin placement/application are presented. In the pediatric population, however, large multiple pins often cannot be used due to the size of the intramedullary canal, and fewer or smaller diameter pins are used.

Adolescent↗
PubMed2004

Nonprosthetic management of proximal humeral fractures.

Many proximal humeral fractures can be treated without the need for hemiarthroplasty. Treatment choice is affected by fracture location and pattern, as well as by patient factors including age, activity level, quality of bone, and ability to comply with a regimen of therapy. Successful diagnosis and treatment of proximal humeral fractures is dependent on good-quality radiographs, but in some cases, intraoperative assessment of the fracture pattern is required for a complete and accurate diagnosis of the fracture pattern and severity. A discussion of nonsurgical and surgical treatment options and techniques needed to achieve anatomic reduction and stable fixation is important.

Fracture Fixation, Internal↗
PubMed2001

[Osteosynthesis techniques in proximal humeral fractures].

Although proximal humeral fractures are common injuries, there is no generally accepted strategy as to how unstable and displaced two- to four-part fractures should be managed. Surgical therapy is in a conflicting situation between the requirement for anatomical fracture reduction and stable fixation, on the one hand, and the necessity for minimal intraoperative damage to the soft tissue and arterial vascularization of the humeral head in order to avoid avascular necrosis on the other. Whereas minimally invasive procedures using closed or percutaneous reduction and fixation techniques are advantageous for protection of the arterial blood supply of the proximal humerus, plate fixation provides superior fixation stability. Plate fixation seems to be associated with a reduced risk of avascular necrosis when indirect reduction techniques are used. Poor results in the operative management of humeral head fractures are often seen in association with malunion. There is therefore a tendency towards the use of implants with angular stability in order to reduce the risk for secondary loss of reduction during functional after treatment. Innovative new plates and intramedullary nails that provide superior stability of fixation of the humeral head fragment have been actually introduced into clinical practice. Together with the specific patient and fracture characteristics, the final result of operative management, however, remains mainly related to the knowledge and operative skills of the trauma or orthopaedic surgeon who deals with these proximal humeral fractures.

Bone Plates↗
PubMed2003

Locked nailing of severely comminuted or segmental humeral fractures.

Some comminuted or segmental humeral fractures have been well-treated by functional bracing, but some also have been reported to have a bad outcome. If surgery is required, unlocked nailing has the disadvantage of unstable fixation, and plating has the disadvantage of extensive soft tissue injury. In the current study, closed locked nailing was used to treat 23 Orthopaedic Trauma Association Type C humeral fractures (C1, five; C2, three; C3, 15). The patients were 12 men and 11 women with a mean age of 42.4 years. There were 16 closed fractures and four Type I, two Type II, and one Type IIIA open fractures. Eight fractures were in the proximal third, seven in the middle third, and eight in the distal third. With one nailing, 21 of 23 (91%) fractures achieved solid union in an average of 13.2 weeks. The two nonunions eventually united after another revision nailing and bone grafting. No patients had significant impairment of elbow function. Excellent or satisfactory shoulder function was obtained in 20 patients. Closed locked nailing showed reliable treatment results for severely comminuted or segmental humeral fractures. The keys to success include compression of the fractures, static locking, postoperative external support, and experienced surgical technique.

Adult↗
PubMed1997

External skeletal fixation for stabilisation of comminuted humeral fractures in cats.

Thirteen feline humeral fractures were stabilized using external skeletal fixation alone or in combination with supplementary devices. Eleven of the 13 fractures healed. Pins placed in the distal humerus should be angled to avoid the supracondylar foramen and radial nerve. An intramedullary pin in combination with external skeletal fixation is indicated for mildly comminuted reconstructable fractures. For severely comminuted humeral fractures, closed application of an external skeletal fixator may be preferable to open reduction and internal fixation to provide healing and is recommended as an alternative to amputation.

Animals↗
PubMed2003

[Descending intramedullary nailing for the treatment of displaced supracondylar humeral fractures in children].

BACKGROUND: Supracondylar humeral fractures are the most common lesions in childhood. Severely displaced fractures are commonly treated by crossed K-wire osteosynthesis. Such stabilized fractures require a cast and often involve postoperative complications such as iatrogenic lesions of the n. ulnaris and secondary displacements,sometimes leading to a consecutive cubitus varus. This study analyzed possible advantages of elastic stabile intramedullary nailing (ESIN) with postoperative release of motion. PATIENTS AND METHOD: All children aged 1-14 years suffering from a supracondylar humeral fracture, with a displacement in at least two planes,were included in this study (period: 1 June 1999-30 April 2001). Movement was permitted for all patients postoperatively. A follow-up examination was scheduled at least 6 months after trauma. RESULTS: This study included 20 female and 30 male patients. Neither iatrogenic lesions of the n. ulnaris nor secondary displacements occurred. Five slight technical pitfalls (perforating wire, gapping with consecutive axis deviation) occurred. Postoperative X-rays most often revealed a remaining axis deviation in the sagittal plane. Comminuted fractures with corresponding zones resulted in cubiti vari and valgi. Of the 50 patients, 47 appeared for follow-up (94%). The ROM coincided with the acquired radiological data. Only one patient (2%) showed a functional deficit greater than 10 degrees. CONCLUSION: As soft tissue swelling does not hinder the surgeon, ESIN shows a high rate of closed stabilizations. No cast has to be applied and free ROM can be permitted for all patients. Avoidance of iatrogenic lesions of the n. ulnaris and secondary displacements are other advantages of this method.

Adolescent↗
PubMed1986

Distal humeral fractures in the adult.

Distal humeral fractures in the adult often are complicated by pseudarthrosis, pain, and limitation of motion. Of 29 adult patients with distal humeral fractures treated in teaching hospitals, 22 obtained acceptable results. Twenty-two percent of those treated by open methods and 36% of those treated by closed methods had unacceptable results. Ninety percent of the patients starting physiotherapy within six weeks of injury recovered well, while over half of those starting physiotherapy after six weeks had unsatisfactory results. Even comminuted fractures healed when treated by internal fixation and started early on exercises. The most important indicator of end result was the starting time of physiotherapy. Rigid internal fixation is recommended for this fracture, but if stability is not likely to be accomplished by open reduction, nonoperative measures are preferable.

Activities of Daily Living↗
PubMed2000

Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients.

Distal humeral fractures are difficult to treat. In the elderly population, the problems are compounded by osteoporosis and gross comminution. Open reduction and internal fixation for such fractures is sometimes difficult and may be associated with poor results. Total elbow arthroplasty has been suggested as a last-ditch effort to salvage functional use for such difficult fractures in the elderly. We followed seven patients (seven elbows) with a mean age of 81.7 years at the time of injury. Open reduction and internal fixation was considered a difficult option for these fractures. They were treated with a total elbow arthroplasty using the semi-constrained Coonrad-Morrey elbow replacement prosthesis. The duration of follow up at present is between 2 and 4 years. At the latest follow up the mean arc of flexion is 20-130 degrees. Six patients have no pain while one complains of mild pain. All elbows are stable. The Mayo elbow performance score for five elbows is excellent and two scored good. All but one patient are satisfied with the result. One patient developed superficial wound infection which resolved after antibiotic therapy. One patient has developed post-operative triceps weakness. There have been no cases of deep infection, ulnar nerve neuritis or component failure. The rarity of this procedure suggests its very narrow spectrum of indication. We feel that the short-term results do suggest an important role for semi-constrained total elbow arthroplasty in managing carefully selected comminuted distal humeral fractures in the elderly, especially those that cannot be treated by conventional open reduction and internal fixation.

Aged↗
PubMed1999

Humeral fracture following shoulder arthroplasty.

Fracture of the humeral shaft after total or hemiarthroplasty of the shoulder occurs infrequently but has serious consequences. This article reports on five patients with ipsilateral humeral fractures following shoulder hemiarthroplasty who were treated either conservatively or surgically. Fractures in the three patients treated conservatively healed on average by 7 months. The results were satisfactory in one patient and unsatisfactory in two patients. Both of these patients complained of pain and limitation of shoulder motion. Fractures in the two patients treated by open reduction and Mennen plate fixation healed on average by 2 months, resulting in a better outcome for these patients treated surgically.

Aged↗