[Subcapital correcting humerus osteotomy in post-traumatic malposition of the humerus head].
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Bone Plates↗
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[Late results of surgically and conservatively treated humerus head and subcapital humerus fractures].
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Adolescent↗
Comparison of humerus length with femur length in fetuses with Down syndrome.
A recent report by FitzSimmons et al. demonstrated a greater frequency of upper- versus lower-extremity shortening in autopsies of second-trimester fetuses with trisomy 21. We undertook this study to determine whether this upper-limb shortening could be detected by prenatal ultrasonography in the second trimester and therefore identify fetuses at risk for trisomy 21. A retrospective review of all prenatal sonograms preceding genetic amniocentesis was conducted. Between 1987 and 1990 11 consecutive fetuses between 15 and 22 weeks' gestation with trisomy 21 were identified by genetic amniocentesis. Femur and humerus lengths were plotted on growth curves created from 1470 normal patients between 12 and 26 weeks. Gestational age was confirmed by last menstrual period and biparietal diameter. In fetuses with trisomy 21, seven of 11 humeri were less than 5th percentile, for a sensitivity of 64%, whereas only two of 11 femurs were less than 5th percentile, for a sensitivity of 18%. Biparietal diameter/femur length and biparietal diameter/humerus length ratios were also tested to predict Down syndrome. In only 2 of 11 cases was the biparietal diameter/femur length ratio greater than 95th percentile, whereas the biparietal diameter/humerus length ratio was greater than 95th percentile in 7 of 11. Since all seven were identified by shortened humerus alone, we conclude that humerus length versus gestational age is the simplest and most effective screen. The positive predictive value of an abnormally short humerus length in detecting Down syndrome was 6.8% in our population where the prevalence of Down syndrome was 1 of 173. The present study supports the observations of FitzSimmons et al. that shortened humerus length has a greater sensitivity than femur length in cases of trisomy 21. We conclude that in fetuses at risk for trisomy 21 humerus length should be determined, because it may, if shortened, aid in the prenatal diagnosis.
Anthropometry↗
Techniques for direct radiographic visualization during closed pinning of supracondylar humerus fractures in children.
After reduction of a displaced supracondylar humerus fracture, the distal humerus must be easy to visualize; radiographic techniques in which the forearm overlaps the distal humerus make interpretation of fracture reduction difficult. Eighteen patients with displaced supracondylar humerus fractures were treated with reduction that was maintained manually with a variant of Dunlop's extension traction. This allows direct fluoroscopic evaluation of Baumann's angle, the contour of the distal humerus, the pin insertion site, and the angle of pin insertion. In young patients with a thin distal humerus and swollen elbow, the easiest pin placement may be achieved by inserting the pin on the lateral view (after the anteroposterior view confirms a satisfactory reduction).
Child↗
Avascular necrosis after fracture-separation of the distal end of the humerus in children.
Fracture-separation of the distal end of the humerus in children has been reported infrequently, and may be misdiagnosed as a fracture of the condyle or a traumatic dislocation of the elbow. We discuss eight cases of a seldom reported complication following fracture-separation of the distal end of the humerus. This complication consists of dissolution of the trochlea within three to six weeks postinjury and a defect of the medial or central part of the condyle that develops later. The fractures were severely displaced fracture-separation of the distal end of the humerus with large medial or lateral metaphyseal fragment, but initially misdiagnosed as a fracture of the medial, lateral condyle or a traumatic dislocation of the elbow in six of eight cases. We performed open reduction in six cases because of initial misdiagnosis or because of difficulty in satisfactory closed reduction. We speculated that this complication is due to avascular necrosis of the distal end of the humerus, and that fracture-separation of the distal end of the humerus is more common than reported.
Child↗
[Early functional treatment of humerus shaft fractures by the Sarmiento method].
The functional treatment of humerus shaft fractures with a brace according to Sarmiento is described. Reported are the results of the functional treatment of 47 humerus shaft fractures. Every humerus shaft fracture normally treated conservatively, including the humerus shaft fractures in polytraumatised patients and those patients with a primary radial nerve injury, can be treated in this way. The functional treatment of humerus shaft fractures results in a quick and uneventful healing of the fracture with a good function and cosmetic aspect.
Adolescent↗
[Surgical therapy of dislocation fractures of the head of the humerus in adults. Personal procedure and results].
Surgical intervention is indicated in the vast majority of humerus head fracture dislocations. In the present paper, we report on the results of 24 such interventions performed between 1975 and 1984. Implantation of a T-plate is considered the standard procedure to obtain osteosynthetic stability during exercise. However, in elderly patients or in cases of multiple fragment fracture, this procedure is inadequate to achieve the required stability. In such cases, development of a humerus head necrosis would rather be promoted. If a sufficiently stable osteosynthesis without the risk of necrosis cannot be achieved, we prefer replacement of the humerus head by a shoulder prosthesis to humerus head resection, resection-interposition-arthroplasty or shoulder arthrodesis. However, not only optimal surgical management of humerus head fracture dislocations has a decisive influence on the later function of the most flexible human joint with the important rotator cuff, but also properly performed active and systematic postoperative physiotherapy.
Adult↗
Morphological effects of mechanical forces on the human humerus.
Various mechanical forces produce a variable stimulus intensity on bone and have different effects on its growth and development. The aim of this project was to study the effects of a variety of mechanical forces on human humerus morphology. This was investigated by measuring the cortical thickness (cm) and diameter (cm) of the humerus at its proximal, middle and distal thirds from radiographs. The humerus of each of 46 men (five controls, six swimmers, eight gymnasts, seven javelin throwers, nine discus throwers and 11 weightlifters) was radiographed on both right and left sides. The humerus size variation among the participants, in order of increasing size, was found to be as follows: gymnasts, controls, swimmers, javelin throwers, weightlifters and discus throwers respectively. The humeral cortex was largest in the weightlifters, being significantly (P less than 0.05) thicker at distal, medial and proximal sites. The proximal and distal humeral sites in javelin and discus throwers were significantly thicker than those of the control subjects. From the results, static load would seem to provide a higher stimulus to bone than dynamic loading.
Biomechanical Phenomena↗
Risk factors for fractures of the distal forearm and proximal humerus. The Study of Osteoporotic Fractures Research Group.
The Study of Osteoporotic Fractures is a prospective cohort study begun in 1986 that includes 9,704 women aged 65 years and older from Maryland, Minnesota, Oregon, and Pennsylvania. A total of 171 women suffered fractures of the distal forearm, and 79 women had fractures of the proximal humerus during the first 2.2 years of follow-up. Most fractures at both sites occurred as a result of a fall. Low bone mineral density was a strong predictor of these fractures; comparing those in the lowest quintile of bone mineral density in the distal radius with those in the highest quintile, the rate ratio was 4.1 for fractures of the distal forearm and 7.5 for fractures of the proximal humerus. Other factors associated with an increased rate of distal forearm fracture independently of low bone mineral density included poor visual acuity, number of falls in the year before baseline, and frequent walking. Factors that appeared to be independently associated with an increased rate of fracture of the proximal humerus included a recent decline in health status, insulin-dependent diabetes mellitus, infrequent walking, and several indicators of neuromuscular weakness such as inability to stand with feet in a tandem position for more than a few seconds. These data support the hypothesis that distal forearm fractures often occur as a result of a fall in women with low bone mineral density who are relatively healthy and active and have good neuromuscular function, while fractures of the proximal humerus tend to occur as a result of a fall in women with low bone mineral density who are less healthy and less active than average and who have poor neuromuscular function.
Age Factors↗
[Therapy of humerus fractures of the collum chirurgicum].
From 1978 to 1989 178 patients were treated for humerus fractures of the surgical neck. An examination after an average of 9 months showed in 119 cases of dislocation of the humerus of less than one shaft width no significant differences between conservative and operative treatment. In case of major dislocation of more than one shaft width (n = 59) operative treatment resulted in significantly better functional results in all age groups. A wider indication for operation after 1986 lead to better results even in the elder patients. Younger patients profited by an operative treatment even in case of minor dislocation, especially as regards maximum mobility of the shoulder joint. In most cases percutaneous or open drill-wire osteosynthesis was preferred. It is concluded that in elder patients only humerus fractures of the surgical neck with major dislocations should be operated upon. With younger patients an indication for operative treatment can also be seen in cases with minor dislocation. Nevertheless, the fractures of the proximal humerus, even in case of an increased operative treatment, remain a field of conservative therapy.
Adult↗
Nonunion of the proximal humerus. A review of 25 cases.
Records of 25 patients with nonunion of the proximal humerus were reviewed retrospectively. The initial fractures included 19 two-part surgical neck fractures and six three-part fractures. Fourteen fractures were treated nonoperatively and 11 surgically. Nine of 11 of the initial internal fixations were unsatisfactory. At the time of fracture 16 patients had one or more significant medical illnesses. Nonunion of the proximal humerus was associated with considerable morbidity. Patients complained of pain, stiffness, and disability in association with shoulder dysfunction. Four treatment groups were evaluated. Patients who declined treatment and patients treated with nonreamed intramedullary nails had limited shoulder motion and pain without union. Patients treated with proximal humeral hemiarthroplasty had relief of pain but limited motion despite rotator cuff reconstruction. The best results of treatment occurred after open reduction with internal fixation and bone grafting. A tension band construction that fixed the rotator cuff and proximal humerus to a plate/shaft composite was used successfully in seven patients. Although satisfactory reconstruction of nonunion of the proximal humerus can be obtained, the results of treatment in this series were only fair. Only 48% (12 of 25 patients) had good results.
Adolescent↗
Structural adaptations of the femur and humerus to arboreal and terrestrial environments in three species of macaque.
One reason to measure cross-sectional structural properties of primate long bones is to define mechanically relevant complexes of traits that describe the adaptation of bone to different biomechanical environments. This can be effectively accomplished when congeneric species having different postural and locomotor behaviors are compared. This paper compares the cross-sectional geometry of the femur and humerus in three behaviorally different macaque species as a basis for defining such patterns. Cross-sectional moments of inertia in the standard anatomical planes were calculated at five locations along the diaphyses of the femur and humerus in Macaca fascicularis, M. nemestrina, and M. mulatta. The data suggest that the "barrel-shaped" femur is associated with behaviors for which long limbs and small body size are an asset. This may be associated with, but is not restricted to, leaping behaviors. The data also suggest that structural rigidity of the femur and humerus is greater per unit body weight in primates that spend significant amounts of time in terrestrial environments than in those that are more restricted to climbing in arboreal environments.
Analysis of Variance↗
[Clavicula pro humero--a new surgical method for malignant tumors of the proximal humerus].
In the majority of cases with malignant tumors in the proximal part of the humerus a limb saving tumor resection is possible. Reconstruction of the defect is necessary to maintain the length of the arm and to create a fulcrum for elbow flexion and extension. Several methods of reconstruction have been described in the literature including the fixation of distal humerus to the second rib or to the clavicle by means of Küntscher-nails, the implantation of a proximal humerus prosthesis without or with accompanying bone transplantation, a bridging of the defect using an allograft or an arthrodesis of the shoulder joint using free or vascularized bone transplants. The following paper describes a new surgical procedure whereby the vascularization of the clavicle is preserved and the clavicle used to bridge the defect. Although the follow-up period of the patients operated on so far in this way is relatively short, the functional advantages of this operation over the other forms of reconstruction can already be observed.
Adult↗
Lesions of the mid-shaft of the humerus presenting as shoulder capsulitis.
We describe three patients who presented with pain and restriction of movement at the shoulder suggestive of capsulitis, but proved to have lesions of the mid-shaft of the humerus. It is important to be aware of the possibility of this cause of a 'frozen shoulder', since radiographs of the shoulder are usually cropped at the mid-humerus and lesions at this level may easily be missed. A radiograph of the entire humerus, or an isotope bone scan, may be more useful than repeated shoulder radiographs in patients whose shoulder symptoms do not respond to standard treatment.
Adult↗
Use of polypropylene mesh to stabilize the "floating humerus" after total scapulectomy.
Total scapulectomy for malignant disease is a rarely performed procedure that presents a significant challenge for shoulder reconstruction. Failure to stabilize the resulting "floating humerus" may result in significant esthetic and functional problems. Current techniques of reconstruction and stabilization may yield suboptimal results and significant morbidity. We report a case of Ewing's sarcoma of the scapula, which required total scapulectomy. Polypropylene mesh was used in an attempt to prevent migration of the head of the humerus. The result was a stable shoulder with satisfactory motion and no additional morbidity. We believe that polypropylene mesh offers an advantage in shoulder reconstruction after total scapulectomy and should be considered as an option for stabilization of the humerus.
Adult↗
[Centro-medullary nailing in fractures of the upper end of the humerus in children and adolescents].
The authors report a series of 55 fractures of the upper extremity of the humerus in children and adolescents surgically treated by elastic intramedullary nailing. The place of this surgical technique is evaluated in the general treatment of these fractures, which have the prognostic always favorable. The results, with a 1 year follow-up, are all excellent or good on the functional and anatomical plan. The cases of mal union have been rare and the correction is obtained with growth. This way be explained by the capacity of remodeling of the upper humerus. The treatment of fractures of the upper extremity of the humerus is first orthopaedic in children and adolescents, but the osteosynthesis by elastic intramedullary nailing can represent a surgical method of choice in the fractures which are displaced, unstable or which need a thoraco-branchial plaster.
Adolescent↗
Distal humerus in hominoid evolution.
Multivariate analysis of 16 measurements of the distal humerus in samples of hominoids, cercopithecoids, Tertiary hominoid fossils, and early hominids shows the following results: (1) there is a substantial and functionally interpretable difference between the distal humerus of cercopithecoids and hominoids (excluding Hylobates); (2) the Tertiary hominoid fossils resemble the cercopithecoids more than the hominoids although they are in some ways intermediate; (3) the hominid fossil from Kanapoi resembles Homo sapiens very closely; (4) the Kromdraai humerus is intermediate in shape between Pan and other hominoids; and (5) the large fossil hominid from East Rudolf (KNM-ER 739) is unique among the hominoids.
Animals↗
Comparison of closed reduction and percutaneous pinning versus open reduction and percutaneous pinning in displaced supracondylar fractures of the humerus in children.
A retrospective review of 29 children with displaced supracondylar humerus fractures was performed. Fifteen patients treated with closed reduction and percutaneous pinning and 14 patients treated with open reduction and percutaneous pinning were evaluated at a minimum of 18 months (range 18-80 months). Results were graded according to the criteria of Flynn et al. (Flynn JC, Matthews JG, Benoit RL: Blind pinning of displaced supracondylar fractures of the humerus in children. J Bone Joint Surg [Am] 56:263-272, 1974) using both cosmetic and functional evaluations. Excellent or good results were obtained in 14 of the 15 fractures treated with closed reduction and percutaneous pinning and in 12 of the 14 fractures treated with open reduction and percutaneous pinning. The three fair cosmetic results were associated with inadequate reduction and residual medial angulation. Ten to 15 degrees of motion loss occurred in three older patients. One patient in each group had a minor pintract infection. There were no cases of iatrogenic nerve injury or myositis ossificans. The treatment goal in displaced supracondylar humerus fractures in children is anatomic reduction. If an anatomic reduction cannot be achieved with closed reduction, open reduction is indicated. This can be done without an increased risk of complications.
Bone Nails↗