PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Humeral Head”

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 19 recordsLinked to original sources
PubMed2006

Arthroscopic-assisted core decompression of the humeral head.

Humeral head osteonecrosis is a progressive disease that requires prompt diagnosis and treatment. Core decompression is a viable treatment option for early-stage cases. Most surgeons perform core decompression by arthroscopically visualizing the necrotic area of bone and using a cannulated drill to take a core. Several attempts are frequently needed to reach the proper location. In the hip multiple passes are associated with complications. We describe the use of an anterior cruciate ligament (ACL) tibial drill guide to precisely localize the area of necrotic bone. Diagnostic arthroscopy is performed to assess the areas of osteonecrosis. Core decompression is performed by use of an ACL tibial guide, brought in through the anterior or posterior portal to precisely localize the necrotic area in preparation for drilling. Under image intensification, Steinmann pins are advanced into the area of osteonecrosis. Once positioned, several 4-mm cores are made. We treated 3 patients with this technique, and all had immediate pain relief. The use of the ACL guide allows precise localization of the area of humeral head involvement and avoids multiple drillings into unaffected areas. Initial indications are that arthroscopic-assisted core decompression with an ACL guide is an effective alternative to previously used methods.

Adult↗
PubMed2005

Unreduced chronic dislocation of the humeral head with ipsilateral humeral shaft fracture: a case report.

The purpose of reporting this case is to illustrate a treatment plan for a chronically anteriorly dislocated shoulder associated with an ipsilateral humerus fracture, a condition heretofore not addressed in the literature to our knowledge. An 18-year-old female, left hand dominant, injured her left upper extremity and liver in a motor vehicle accident. X-rays at time of injury revealed a diaphyseal facture of her left humerus. No x-rays of the shoulder were taken at time of injury. Treatment consisted of a plaster cast application and discharge at 1 week. The patient was seen again 4 weeks postinjury, at which time only humerus films were taken and the immobilization was continued. At 45 days postinjury, the patient complained of left shoulder pain, and shoulder x-rays at that time revealed an anterior subcoracoid dislocation of the left humeral head. At surgery 52 days postinjury, the humeral shaft fracture was found to be unstable and external fixation of both the fracture (2 pins above and below the fracture) and the reduced but still unstable humeral head was performed (a pin through the humeral head into the glenoid). The external fixator was removed at 3 weeks, and at a 3-year follow-up, the patient had acquired nearly full range of motion of her shoulder without pain and no significant limitations of her arm movements or activities. In conclusion, given a patient with a chronic anteriorly dislocated shoulder and a healing ipsilateral shaft fracture, an external fixation stabilization of both the fracture and the relocated repaired dislocation is a viable treatment option.

Adolescent↗
PubMed1993

Vascularity of the humeral head after proximal humeral fractures. An anatomical cadaver study.

We studied the arterial anatomy and the effect of four-part fractures on the vascularity of the humeral head, using barium sulphate perfusion of 16 cadaver shoulders. The main arterial supply to the humeral head was via the ascending branch of the anterior humeral circumflex artery and its intraosseous continuation, the arcuate artery. There were significant intraosseous anastomoses between the arcuate artery and: 1) the posterior humeral circumflex artery through vessels entering the posteromedial aspect of the proximal humerus; 2) metaphyseal vessels; and 3) the vessels of the greater and lesser tuberosities. Simulated four-part fractures prevented the perfusion of the humeral head in most cases. If, however, the head fragment extends distally below the articular surface medially, some perfusion of the head persists by the posteromedial vessels. These vessels are important in the management of comminuted fractures of the proximal humerus.

Aged↗
PubMed1981

Post-traumatic avascular necrosis of the humeral head in displaced proximal humeral fractures.

Nineteen patients with displaced four-part fracture or fracture-dislocation of the proximal humerus were retrospectively studied to investigate the incidence of avascular necrosis and its clinical importance. The average followup duration was 23.6 months. No incidence of avascular necrosis of the humeral head with subchondral collapse was found. Four patients were found to have coarse trabeculae suggesting a revascularized humeral head which probably had become necrotic after the trauma. The treatment of choice for displaced four-part fracture or fracture-dislocation of the proximal humeral is early adequate open reduction and internal fixation rather than primary prosthetic replacement. The authors believe that a majority of the humeral heads in this injury develop avascular necrosis, but most of the humeral heads are quickly revascularized with creeping substitution.

Aged↗
PubMed2000

[Treatment outcome after primary hemi-alloarthroplasty in dislocated humeral head fractures].

Humeral head fractures often lead to a high complication rate because of vulnerable vascularization of the humeral head, pretraumatical soft tissue lesions and osteoporotic bone. Compared with open reduction and internal fixation primary hemiarthroplasty seems to be an encouraging alternative treatment in case of dislocated and comminuted fractures. To evaluate our results following primary hemiarthroplasty we examined the outcome of 27 patients treated between November 1993 and May 1997 by primary hemiarthroplasty (15 Neer II, 12 Aequalis) in our institution within two weeks after trauma. The average patient follow-up was 3.5 years. Postoperatively more than 80% of the patients reported no pain. Excellent or good results with abduction over 90 degrees, low or moderate loss of power and low restraint in activities of all day living were achieved in about 50% of patients. The results according to the criteria of the Constant-Score depended on the intensity of the rehabilitation programme with an average outcome of 65 points. Maybe in the future functional results can be improved by a more aggressive rehabilitation and stronger rotator cuff refixation.

Aged↗
PubMedDate not supplied

The development of humeral head retroversion.

Humeral head retroversion is important in a variety of clinical situations, but it is not known when retroversion actually develops to adult values. In utero and at birth, the humeral head is known to be in marked retroversion. It derotates sometime thereafter to assume the more standard value with which orthopedic surgeons are familiar. By studying a unique collection of children's bones (180 humeri), I have been able to determine that the greater part of this process takes place, on average, by the age of 8 years (SD +/- 2.12 years); from then on, however, the development continues more slowly until the final adult dimensions are reached, as heralded by the appearance of the radial groove at approximately 16 years of age. This process, along with its timing, appears to be similar, but opposite in direction to, the derotation process that is known to take place in the hip. It has not previously been documented in the shoulder.

Adolescent↗
PubMedDate not supplied

Nontraumatic osteonecrosis of the humeral head.

The humeral head is the second most common site for nontraumatic osteonecrosis after the femoral head, yet it has attracted relatively little attention. Osteonecrosis is associated with many conditions, such as corticosteroid use, sickle-cell disease, alcoholism, dysbarism (or caisson disease), Gaucher's disease, and other systemic conditions. The diagnosis is a clinical and radiographic one, the latter forming the basis for its staging. Treatment depends on the chronicity and severity of symptoms, as well as the degree of clinical and radiographic progression. Surgical treatment includes arthroscopic debridement and core decompression for early osteonecrosis and hemiarthroplasty or total shoulder arthroplasty for more advanced disease. This report reviews osteonecrosis of the humeral head, with an emphasis on current treatment options.

Arthroplasty↗
PubMedDate not supplied

Comparison of humeral head retroversion with the humeral axis/biceps groove relationship: a study in live subjects and cadavers.

The purpose of this study was to investigate whether the axis of the humeral articular surface bears a more constant relationship to the bicipital groove than to the distal humerus. This finding could help intraoperative placement of a shoulder prosthesis in the most anatomic position. Magnetic resonance imaging was used in 41 live volunteers and 9 cadavers to measure the distance from the biceps groove to a line drawn perpendicular to the midpoint of the humeral articular surface. A cadaver model with a plastic humeral prosthesis was used to convert this biceps distance into an angular measurement. The relationship between the biceps distance and the retroversion angle of the humeral head with respect to the humeral epicondyles was analyzed. The biceps distance averaged 11.8 mm+/-3.5 mm (equivalent to 26.8 degrees+/-8.3 degrees), whereas retroversion averaged 26.8 degrees +/-12.2 degrees. This difference in variability is significant (P=.008). Placing the fin of a humeral head implant 12 mm posterior to the biceps groove reproduces normal anatomy better than the use of an arbitrary standard of 30 degrees to 40 degrees of retroversion.

Adult↗
PubMedDate not supplied

The effect of glenoid inclination on superior humeral head migration.

Superior humeral head migration may contribute to the development of rotator cuff disease. The purpose of this study was to test the hypothesis that superior inclination of the glenoid facilitates superior humeral head migration. Eight cadaveric shoulders were tested by use of a custom test fixture, and rotator cuff forces were applied. Glenoid inclination was varied (intact, +5 degrees, +10 degrees, and +15 degrees ), and the force required to produce superior humeral head migration was measured. Each increase in glenoid inclination (more superiorly facing glenoid) produced significant reduction in the force required for superior humeral head migration (5 degrees, 14.2% reduction; 10 degrees, 29.9% reduction; and 15 degrees, 37.5% reduction; P <.001). These findings demonstrate that glenoid inclination is an important factor in determining the force required for superior humeral head migration. This suggests that a more upward-facing glenoid increases the risk for superior humeral translation and, in turn, may play a role in the development of rotator cuff disease.

Aged↗
PubMed2003

[Humeral head fractures].

Humeral head fractures generally may be treated in a non-operative concept with early physiotherapy when fragment dislocation is minor. Dislocated 2-part fractures (head and shaft fragment) may be treated with closed reduction. If the fracture persists unstable, K-wire, cerclage, intramedullary nailing or plate osteosynthesis are the eligible methods. Particularly isolated K-wire osteosynthesis is associated with a high risk of implant or fragment dislocation. Dislocated 3- or 4-part fractures need additional reduction and fixation of the tubercles. In osteoporotic fractures, intraosseous fixation may lead to complications. Especially cerclage and/or isolated screws (eventually additional K-wires) osteosynthesis allows good reduction for functional treatment in the older patient. Sufficient results in long-term outcome are achieved by minimal invasive techniques even in partial avascular head necrosis. In 4-part fractures prosthetic replacement should be considered. Especially when old patients have severe destruction or luxation of the humeral calotte prosthetic treatment may be indicated. Early functional physiotherapy is important after all types of osteosynthesis or prosthesis.

Adult↗
PubMed2000

Complications with humeral head replacement.

Humeral head replacement has been shown to be an excellent surgical option for a variety of debilitating shoulder conditions. New techniques and advances in prosthetic design have furthered the success of this procedure. When performed without appropriate indications, exacting technique, and a tailored rehabilitation program, however, complications often result. Early recognition and appropriate management of these complications aid in achieving a satisfactory result.

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↗
PubMed1997

Complications of humeral head replacement for proximal humeral fractures.

The indications for humeral head replacement in acute fractures and in chronic fracture problems have been studied over many decades and are reasonably well defined. Complications have probably been understudied. Many different complications occur, and their frequency and the need for reoperation is quite high. Because of the variety of complications that occur, familiarity with preventive measures and treatment options is important, not only to deal with complications arising from endoprostheses, but also to treat musculoskeletal infections, nerve injuries, fractures, instability, nonunion of tuberosities, malunion, and rotator cuff or capsule contracture or tearing. Physicians also must be able to integrate reparative/reconstructive surgery with a program of postoperative rehabilitation. The challenges are many. Treatment often provides considerable improvement for the patient, but often the extent of the improvement is somewhat less than optimal.

Adult↗
PubMed1997

[Dislocated multiple fragment fractures of the head of the humerus. Does dislocation of the humeral head fragment signify a worse prognosis?].

PROBLEM: The vascularity of the articular fragment is of key importance for the final outcome in three- and four-part fractures of the humeral head. Displacement of the articular segment may compromise the arterial blood supply to the humeral head and result in avascular necrosis. There is still controversy as to whether three-and four-part fracture dislocations (articular fragment outside the glenoid) have an even worse prognosis than displaced three- and four-part fractures. PATIENTS AND METHODS: Between January 1985 and May 1993, 102 patients with three- and four-part fractures of the humeral head were treated by ORIF (mostly tension band wiring) at our institution. In a retrospective study we analysed the functional (Constant 100 point score) and radiological outcome of 67 (66%) of these patients. There were 21 patients with fracture dislocations (FD), n = 5 type B2X, n = 5 type B3X, n = 3 type C2X, n = 8 type C3X, according to the classification of Habermeyer [7]. The "X" represents the dislocation of the articular fragment, whereas the classification to each type is done after reduction of the head. The remaining 46 patients presented with displaced, but not dislocated, three- and four-part fractures (DF), n = 24 type B2, n = 7 type B3, n = 3 type C2, n = 12 type C3. Average follow-up was 25 months (7-72 months). Patients with FD were significantly younger (average age 50 years) than patients with DF (average age 63 years, P < 0.05) and showed a significantly higher incidence of traumatic nerve or plexus lesions (FD 19%, DF 2%, P < 0.05). RESULTS: Concerning the functional results, there was no statistically significant difference between the two groups. The FD patients even showed a slight tendency to better results than patients with DF. This was true for the three-part fractures (average Constant score 78 versus 67 points), as well as for the four-part fractures (average Constant score 62 versus 55 points). The significantly younger age of the FD patients may explain their better results. The entire group of patients with three-part fractures showed a significantly better functional outcome (average Constant score 68 points) than patients with four-part fractures (average Constant score 55 points, P < 0.05). The rate of partial and total avascular necrosis of the humeral head was strongly correlated to the fracture type (number of fragments, fracture of the anatomical or surgical neck, according to the classification of Habermeyer),but again there was no difference between the FD and DF group (B2X: 20%, B3X: 20%, C2X: 33%, C3X: 63%; B2: 25%, B3: 29%, C2: 33%, C3: 67%). Astonishingly, the FD were not associated with an increased rate of avascular necrosis of the humeral head. Three (axillary nerve) out of the five observed primary nerve and plexus lesions had a full neurological recovery after 6-12 months; the two patients with alterations of the brachial plexus showed a slow tendency of improvement at follow-up (12 and 18 months), but still had gross muscular atrophy and impaired sensory function. CONCLUSION: In displaced three-and four-part fractures of the humeral head the dislocation of the articular segment does not seem to increase the risk of avascular necrosis, if treated by timely and careful ORIF with respect to the vascularity. Even with the increased risk of primary nerve and plexus lesions in fracture dislocations, good functional results can be achieved by early operative nerve decompression and fracture stabilization in this middle-aged patient group. However, older patients with displaced or dislocated four-fragment fractures through the anatomical neck (type C3) have a poor chance of a favourable outcome, and therefore primary prosthetic replacement should be considered.

Adult↗
PubMed2003

[Fractures of the humeral head].

Fractures of the humeral head are very common in elderly people, with 70% of all such fractures being seen at an age of more than 60 years. For the radiological examination of the fracture, x-rays from two levels are mandatory. The number and position of the fragments, assessment of intact or ruptured periosteum between the fragments and muscle forces acting on the fragments have to be determined from the x-rays. A 3-D CT scan can be very useful for better understanding of the character of the fracture. The remaining displacement between fragments after reduction have to be evaluated according to their location. Even small incongruities between fragments in the subacromial space will impair the gliding mechanism, whereas remaining displacements between the head and shaft can be accepted to a much larger extent. According to the fracture mechanism, we can basically differentiate between avulsion fractures and depression fractures. The avulsion fractures are characterised by a varus tendency of the humeral head,whereas the depression fractures are characterised by a valgus position of the head fragment. This has to be taken into consideration when choosing the implant for fixation. The indication for reconstructive surgery or prosthetic replacement depends on the type of fracture, on the quality of bone and on the familiarity of the surgeon with the treatment of humeral head fractures. The implants currently used for fixation can basically be differentiated between rigid and semi-rigid. The indication for the one or the other depends on the fracture type and the bone quality. In general, for simple fractures and in case of poor bone quality semi-rigid implants are indicated. Despite the fact that an understanding of the character of the fractures and implants has improved over the last few years, there are still types of fractures which need primary prosthetic replacement.

Age Factors↗
PubMed2001

Fractures involving splitting of the humeral head.

Splitting fractures of the humeral head are rare; part of the humeral head dislocates and the unfractured part remains attached to the shaft. We report eight cases in young patients. In five the diagnosis was made at presentation: three had minimal internal fixation using a superior subacromial approach, one had a closed reduction and one a primary prosthetic replacement. All five patients regained excellent function with no avascular necrosis at two years. In three the injury was initially unrecognised; two developed a painless bony ankylosis and one is awaiting hemiarthroplasty. It is important to obtain the three trauma radiographic views to diagnose these unusual fractures reliably. CT delineates the configuration of the fracture. In young patients open reduction and internal fixation seems preferable to replacement of the humeral head, since we have shown that the head is potentially viable.

Adult↗