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Do computed tomography and its 3D reconstruction increase the reproducibility of classifications of fractures of the proximal extremity of the humerus?

Matsushigue,Thaís; Franco,Valmir Pagliaro; Pierami,Rafael; Tamaoki,Marcel Jun Sugawara; Netto,Nicola Archetti; Matsumoto,Marcelo Hide
Fonte: Sociedade Brasileira de Ortopedia e Traumatologia Publicador: Sociedade Brasileira de Ortopedia e Traumatologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2014 Português
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95.81%
OBJECTIVE: to determine whether 3D reconstruction images from computed tomography (CT) increase the inter and intraobserver agreement of the Neer and Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification systems. METHODS: radiographic images and tomographic images with 3D reconstruction were obtained in three shoulder positions and were analyzed on two occasions by four independent observers. RESULTS: the radiographic evaluation demonstrated that using CT improved the inter and intraobserver agreement of the Neer classification. This was not seen with the AO classification, in which CT was only shown to increase the interobserver agreement. CONCLUSION: use of 3D CT allows better evaluation of fractures with regard to their component parts and their displacements, but nevertheless the intraobserver agreement presented is less than ideal.

Axillary artery lesion secondary to fracturing of the proximal third of the humerus: case report

Miyazaki,Alberto Naoki; Fregoneze,Marcelo; Santos,Pedro Doneux dos; Silva,Luciana Andrade da; Sella,Guilherme do Val; Checchia,Sergio Luiz; Santos,Sílvia Helena Cavadinha Cândido dos; Fernandes,Fábio Araujo
Fonte: Sociedade Brasileira de Ortopedia e Traumatologia Publicador: Sociedade Brasileira de Ortopedia e Traumatologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2015 Português
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75.74%
Lesions of the axillary artery are rare in patients with fracturing of the proximal third of the humerus and may have greatly varying clinical manifestations. They are responsible for 15% and 20% of upper-limb artery injuries and the commonest mechanism is a fall to the ground, which accounts for 79% of such injuries. In some cases, the signs only appear later on. It is important to bear this association in mind, so as to make an early diagnosis and avoid serious complications. We report on a case of traumatic injury of the axillary artery secondary to fracturing of the proximal third of the humerus in an 84-year-old patient, with late evolution of clinical signs of ischemia in the limb affected. The aim here was to discuss the diagnostic difficulties and treatment.

Outcome of supracondylar fractures of the humerus in children.

Thomas, A P; Alpar, E K
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/1987 Português
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85.68%
Seventy patients who had sustained supracondylar fractures of the humerus as children were examined. Loss of carrying angle of the elbow occurred if the fracture was immobilized in a varus position during healing. Varus malalignment could have been obviated if comparative radiographs of the other elbow had been taken and the Baumann angles compared. Rotation and posterior displacement at the fracture had little bearing on the outcome. Immobilization of the fracture in a collar and cuff sling was as effective as more elaborate methods.

Management of grade III supracondylar fracture of the humerus by straight-arm lateral traction

Sadiq, M. Z.; Syed, T.; Travlos, J.
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
75.83%
Supracondylar fracture of the humerus is a common upper limb fracture in children for which treatment is controversial and often technically difficult, and complications are common. Cubitus varus is the most prevalent complication encountered in such fractures, with a mean incidence rate of 30%. A variety of methods for treating displaced fractures have been recommended. We reviewed 20 cases of severely displaced grade III supracondylar fractures of the humerus in children. There was marked swelling and distorted local anatomy in all these fractures, which were managed conservatively with straight-arm lateral traction. The patients were treated in skin traction for 2 weeks, following which they commenced physiotherapy. The traction was applied with the arm at 90° of abduction and the forearm in supination. None of the patients developed any complication, and all had the full range of movements. None had cubitus varus deformity, and none of these patients required further surgical treatment. There was a complete patient and parent satisfaction. Open or closed reduction with internal fixation is the most common method of treating these injuries, however in some cases this can be very difficult and dangerous. If the local anatomy and swelling do not allow this treatment then non-operative measures have to be adopted. We conclude that straight-arm lateral traction is a safe and effective method of treating these fractures...

Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study

Changulani, M.; Jain, U. K.; Keswani, Tulsi
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
85.96%
The aim of this study was to compare the results of the humerus intramedullary nail (IMN) and dynamic compression plate (DCP) for the management of diaphyseal fractures of the humerus. Forty-seven patients with diaphyseal fracture of the shaft of the humerus were randomised prospectively and treated by open reduction and internal fixation with IMN or DCP. The criteria for inclusion were grade 1 or 2a compound fractures, polytrauma, early failure of conservative treatment and unstable fractures. The patients with pathological fractures, grade 3 open fractures, refractures and old neglected fractures of the humerus were excluded from the study. Twenty-three patients underwent internal fixation by IMN and 24 by DCP. Reamed antegrade nailing was done in all cases. DCP was done through an anterolateral or posterior approach. The outcome was assessed in terms of the union time, union rate, functional outcome and the incidence of complications. Functional outcome was assessed using the American Shoulder and Elbow Surgeons’ Score (ASES). On comparing the results by independent samples t test, there was no significant difference in ASES scores between the two groups (P>0.05). The average union time was found to be significantly lower for IMN as compared to DCP (P<0.05). The union rate was found to be similar in both groups. Complications such as infection were found to be higher with DCP as compared to IMN...

Treatment of difficult fractures and nonunions of the humerus and elbow with a modified Küntscher nail.

Burdeaux, B. D.; York, B. P.
Fonte: University of Iowa Publicador: University of Iowa
Tipo: Artigo de Revista Científica
Publicado em //1993 Português
Relevância na Pesquisa
75.82%
A series of fourteen difficult fractures and nonunions of the humerus and elbow have been treated over a period of twenty-eight years with a modified Kuntscher Nail. A total of twenty-six operative attempts had been previously made in this group of fourteen patients. One patient had eight failed surgeries prior to treatment. Slots were placed along the spine of the nail for transfixion with screws. In two instances additional modification of the Kuntscher nail was made by attaching a plate to the end of the nail for fixation to the ulna after retrograde insertion into the humerus. One such device was used to fuse the elbow. The other was used to stabilize a low nonunion in which the elbow was already fused. Union was obtained in nine cases with failure in five. Four of the failures united with one additional surgery. The one failed case had a surgical neck fracture which was eventually treated with a Neer prosthesis. The method described may not be superior to other methods; however, it can be successful in obtaining union in difficult elbow and humerus fractures or nonunions resulting from multiple failed prior procedures.

Pediatric supracondylar fractures of the distal humerus

Brubacher, Jacob W.; Dodds, Seth D.
Fonte: Humana Press Inc Publicador: Humana Press Inc
Tipo: Artigo de Revista Científica
Publicado em 10/05/2008 Português
Relevância na Pesquisa
75.76%
Supracondylar fractures of the humerus are a common pediatric elbow injury that are historically associated with morbidity due to malunion, neurovascular complications, and compartment syndrome. True anteroposterior and lateral radiographs are essential not only for an accurate diagnosis, but also for creating a treatment plan for these injuries. A staging system (based on the lateral radiograph) for classifying the severity of the fracture helps guide definitive management. Nondisplaced fractures are treated initially with a posterior splint, followed by a long-arm casting. Closed reduction and percutaneous pinning is the preferred treatment for displaced or unstable fractures. If there is any question about fracture stability, patients should be seen within 5 days postoperatively for repeat radiographs to ensure that the reduction and pin fixation has been maintained. Understanding the anatomy, radiographic findings, management options, and complications associated with this fracture allow physicians to limit the morbidity associated with this relatively common pediatric injury.

Management of Fractures of the Humerus in Ancient Egypt, Greece, and Rome: An Historical Review

Brorson, Stig
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Português
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85.86%
Fractures of the humerus have challenged medical practitioners since the beginning of recorded medical history. In the earliest known surgical text, The Edwin Smith Papyrus (copied circa 1600 BC), three cases of humeral fractures were described. Reduction by traction followed by bandaging with linen was recommended. In Corpus Hippocraticum (circa 440–340 BC), the maneuver of reduction was fully described: bandages of linen soaked in cerate and oil were applied followed by splinting after a week. In The Alexandrian School of Medicine (third century BC), shoulder dislocations complicated with fractures of the humerus were mentioned and the author discussed whether the dislocation should be reduced before or after the fracture. Celsus (25 BC–AD 50) distinguished shaft fractures from proximal and distal humeral fractures. He described different fracture patterns, including transverse, oblique, and multifragmented fractures. In Late Antiquity, complications from powerful traction or tight bandaging were described by Paul of Aegina (circa AD 625–690). Illustrations from sixteenth and seventeenth century surgical texts are included to show the ancient methods of reduction and bandaging. The richness of written sources points toward a multifaceted approach to the diagnosis...

Treatment of supracondylar fractures of the humerus in children through an anterior approach is a safe and effective method

Ersan, Onder; Gonen, Emel; Arik, Ahmet; Dasar, Uygar; Ates, Yalim
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
75.82%
In this prospective case series we evaluated the effectiveness and safety of using an anterior approach to paediatric supracondylar humerus fractures. We gathered data on 46 children that had a displaced supracondylar fracture of the humerus. All the patients had sustained a Gartland type III extension fracture that could not be reduced by closed means. Open reduction through an anterior approach was performed and two Kirschner wires were used to fix the fracture to the medial and lateral sides. Patients were recalled for follow-up and were evaluated using Flynn’s radiological and clinical criteria. Loss of extension and flexion was noted by clinical assessment and carrying angle measured on radiograms. A follow-up examination performed in the 24th postoperative week showed that all fractures had healed; the patients’ outcomes were rated as excellent or good according to Flynn’s criteria. As a result the anterior approach for open reduction of paediatric supracondylar humeral fractures is a safe and reliable method with very good results.

Treatment of pink pulseless hand following supracondylar fractures of the humerus in children

Korompilias, A. V.; Lykissas, M. G.; Mitsionis, G. I.; Kontogeorgakos, V. A.; Manoudis, G.; Beris, A. E.
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
85.73%
Although acute vascular injury is a common complication in children with severely displaced supracondylar humeral fractures, the management of patients with a pink pulseless hand still remains controversial. Between 1994 and 2006, 66 children with displaced supracondylar fractures of the humerus were treated. Five patients had an absence of the radial pulse with an otherwise well perfused hand. In one patient, radial pulse returned after closed reduction of the fracture. In four patients, open reduction and vascular exploration was required. Three patients had brachial artery occlusion because of thrombus formation. Thrombectomy was performed, which led to the restoration of a palpable radial pulse. In one patient with open fracture, brachial artery contusion and spasm were found, and treated by removal of adventitia. Surgical exploration for the restoration of brachial artery patency should be performed, even in the presence of viable pink hand after an attempt at closed reduction.

Minimally invasive treatment of pathological fractures of the humeral shaft

Ofluoglu, Onder; Erol, Bulent; Ozgen, Zerrin; Yildiz, Muzaffer
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
75.65%
Most patients with pathological fractures due to cancer metastasis have a limited life expectancy. Orthopaedic procedures, therefore, should be minimally invasive in order to avoid additional surgical morbidity. The purpose of this study was to analyse the results of minimally invasive approaches, including locked intramedullary nailing, followed by early postoperative radiation for pathological humeral shaft fractures. Twenty-four pathological fractures of the humerus diaphysis in 23 patients were treated with the prospective protocol, including antegrade unreamed intramedullary nailing and postoperative radiotherapy (20 Gy and five fractions). The patients and results of the surgery were evaluated by the Musculoskeletal Tumor Society upper extremity scoring system. All patients had a stable extremity, and the average function of 20 patients was 64% of the normal upper extremity function. Only one patient required revision surgery. The minimally invasive treatment of patients with pathological fractures of the humeral shaft with closed unreamed intramedullary nailing combined with adjuvant radiotherapy is an effective and safe procedure, even in seriously ill patients.

The treatment of displaced supracondylar fractures of the humerus in children : A comparison of three methods

Ababneh, M.; Shannak, A.; Agabi, S.; Hadidi, S.
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Publicado em /09/1998 Português
Relevância na Pesquisa
85.73%
This retrospective study compares the long-term results of the treatment of 135 children with displaced extension-type supracondylar fractures of the humerus using 3 different methods. Closed reduction and percutaneous fixation was superior with excellent and good results in 87% and had the lowest incidence of poor results (8%). Open reduction and wire fixation, and closed reduction with a plaster cast gave excellent and good results in 74% and 60% respectively. Closed reduction and wire fixation is recommended as the treatment for grades II and III supracondylar fractures.

Closed Reductions and Percutaneus ‘K’ Wire Fixation for Adolescent Intercondylar Fractures of the Distal Humerus

Julfiqar, ; Pant, Ajay; Huda, N.; Ahmed, Wasim
Fonte: JCDR Research and Publications (P) Limited Publicador: JCDR Research and Publications (P) Limited
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
75.79%
Introduction: Intercondylar (T-Condylar) fractures of the humerus are very rare in children. The usual mechanism of the injury which is involved is a fall on a flexed elbow. The treatment options vary, depending upon the degree of the displacement and the amount of comminution and; they may range from a simple application of traction to open reduction and internal fixation with plates and screws. Open reduction is associated with significant post–operative stiffness of the elbow and subsequent less than satisfactory functional results. In this publication, we are presenting our experience of treating seven adolescent T–Condylar fractures of the distal humerus with closed reductions and internal fixations with the percutaneus Kirchner (‘K’) wire.

Evaluation and management of pulseless pink/pale hand syndrome coexisting with supracondylar fractures of the humerus in children

Matuszewski, Łukasz
Fonte: Springer Paris Publicador: Springer Paris
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
85.84%
Elbow region fractures are the most common injuries in children. Among them, supracondylar fractures of the humerus are the most frequent. Massive displacement of the fractured bone causes severe injury to the soft tissue of that particular region. As a result, various types of injuries to the brachial artery such as entrapment, laceration, spasm of the vessel, and the presence of an intimal tear or thrombus formation are usually observed. The main goal of this study was to present our approach to children with supracondylar humerus fractures associated with brachial artery injuries. We would especially like to emphasize the necessity for other conservative or operative treatment concerning pulseless hand symptoms coexisting with supracondylar fractures of the humeral bone in children population. Data from 67 children were evaluated in our study. Supracondylar fractures were classified according to the Gartland’s scale. All patients had displaced extension type III injuries. During our follow-up study, we used Flynn’s grading system to evaluate functions of the elbow joint, forearm and wrist. Mean follow-up was 18 months; range, 13 months to 4 years. In the follow-up study, very good or good results were achieved in all 32 patients treated conservatively together with 6 patients with pulseless pink hand symptom. Very good or good results were achieved in 88 % of 35 patients operated on. Children who...

Pesamosca osteoplasty: surgical procedure for the spatial correction of cubitus varus or valgus post malunited supracondylar fractures of the humerus

Burnei, G; Gavriliu, Ş; Nepaliuc, I; Vlad, C; Drăgoescu, M; Georgescu, I; Ghita, RA; Muntean, L; Pârvan, AA; Dughilă, C; Ţiripa, I; Hamei, Ş; Klinaku, I
Fonte: Carol Davila University Press Publicador: Carol Davila University Press
Tipo: Artigo de Revista Científica
Publicado em //2014 Português
Relevância na Pesquisa
85.76%
Introduction. Supracondylar fractures of the humerus represent a current concern in the child’s and adolescent’s osteo-articular pathology. Even though orthopedic reductions are made correctly, fractures can become displaced when managed only by cast immobilization and complications may arise. The most frequent complications encountered in “Prof. Dr. Alexandru Pesamosca” Clinique, Bucharest, Romania, due to supracondylar humeral fractures, are valgus or varus deviations with angles that can sometimes exceed 40 degrees as a result of malunion.

Bryan and Morrey type IV intra-articular fracture of the distal extremity of the humerus treated surgically with anterior access: case report☆

Dressler, Hugo Bertani; de Paula, Ricardo Nunes Borges
Fonte: Brazilian Society of Orthopedics and Traumatology Publicador: Brazilian Society of Orthopedics and Traumatology
Tipo: Artigo de Revista Científica
Publicado em 27/04/2015 Português
Relevância na Pesquisa
75.74%
Within the context of elbow-level trauma, fractures with a coronal line at the distal extremity of the humerus are rare and result from indirect axial trauma with the arm extended. These are difficult-to-treat intra-articular fractures, since they require stable anatomical reduction in order to maintain joint congruence and diminish complications such as stiffness. This paper reports a case that occurred in a young man who suffered a fall from a ladder that resulted in a Bryan and Morrey type IV intra-articular fracture of the humerus. The injury was treated surgically by means of an anterior access, using osteosynthesis with two Herbert screws that were inserted from anterior to posterior.

Isolated greater tuberosity fractures of the proximal humerus : validation and clinical implications for a new radiologic measurement method and classification

Mutch, Jennifer
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
Português
Relevância na Pesquisa
75.95%
Les fractures isolées de la Grosse Tubérosité (GT) de l’humerus proximal sont rares et peu étudiées. Trois problèmes importants existent: 1: Même si 5mm + de déplacement supérieur du GT est cité comme indication chirurgicale, les mesures basées sur radiographie peuvent errer de plus que 10mm. 2: Les classifications de Neer et l’AO décrivent seulement un type de fracture de GT (gros fragment, ligne de fracture verticale). Deux autres types de fracture existent: type fracture-avulsion avec petit fragment osseux et type Hill-Sachs très latéral. 3: On manque d’études de pronostic ou de traitement des fractures de GT selon la morphologie. Article 1 montre et évalue une méthode simple de mesurer le déplacement supérieur de la GT (le GT ratio) sur les radiographies standard; ceci corrèle très bien avec tomographie (CT). Article 2 introduit une méthode de classification Morphologique des fractures de GT (Avulsion, Split, Dépression) qui a une fiabilité de bonne à excellente. Les données échographiques, radiologiques, et cliniques de 54 patients porteurs de fracture de GT (suivie moyenne 2.5 années) sont aussi incluses. Les patients <50 ans ont eu plus de déchirures de la coiffe et ceux avec fractures déplacées (≥ 5mm) avaient plus d’atrophie du susépineux. Les déchirures complètes de la coiffe et l’atrophie du susépineux augmentaient l’atteinte permanente. La morphologie des fractures de GT n’a pas eu un impact significatif sur le pronostic. Cependant...

Bryan and Morrey type IV intra-articular fracture of the distal extremity of the humerus treated surgically with anterior access: case report

Dressler,Hugo Bertani; Paula,Ricardo Nunes Borges de
Fonte: Sociedade Brasileira de Ortopedia e Traumatologia Publicador: Sociedade Brasileira de Ortopedia e Traumatologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2015 Português
Relevância na Pesquisa
75.79%
Within the context of elbow-level trauma, fractures with a coronal line at the distal extremity of the humerus are rare and result from indirect axial trauma with the arm extended. These are difficult-to-treat intra-articular fractures, since they require stable anatomical reduction in order to maintain joint congruence and diminish complications such as stiffness. This paper reports a case that occurred in a young man who suffered a fall from a ladder that resulted in a Bryan and Morrey type IV intra-articular fracture of the humerus. The injury was treated surgically by means of an anterior access, using osteosynthesis with two Herbert screws that were inserted from anterior to posterior.

Reproducibility of the AO/ASIF and Gartland classifications for supracondylar fractures of the humerus in children

Rocha,Igor Tadeu Silveira; Faria,André de Siqueira; Fontoura Filho,Carlos; Rocha,Murilo Antônio
Fonte: Sociedade Brasileira de Ortopedia e Traumatologia Publicador: Sociedade Brasileira de Ortopedia e Traumatologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2015 Português
Relevância na Pesquisa
125.78%
OBJECTIVE: To evaluate the reproducibility of the radiographic classifications of Gartland and the Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) for supracondylar fractures of the humerus in children.METHODS: On two occasions, 50 radiographs in anteroposterior and lateral views were evaluated by three pediatric orthopedists in accordance with the Gartland and AO/ASIF pediatric classifications. Their responses were subjected to statistical analysis consisting of calculation of the κ coefficient to assess the intra- and interobserver concordance, in both classifications.RESULTS: The strength of the intraobserver concordance was high or near perfect for the three examiners in the two classification systems. The strength of the interobserver concordance was high in the two systems, with κcoefficients of 0.756 for the Gartland classification and 0.766 for the AO/ASIF classification.CONCLUSION: The Gartland and AO/ASIF classification systems showed similar reproducibility and performance. High strength of concordance was seen in the intra- and interobserver analyses.

Outcomes evaluation of locking plate osteosynthesis in displaced fractures of the proximal humerus

Gracitell,Mauro Emilio Conforto; Lobo,Frederico Lafraia; Ferreira,Gustavo Maximiano Aliperti; Palma,Marcos Vianna da; Malavolta,Eduardo Angeli; Benegas,Eduardo; Kojima,Kodi Edson; Ferreira Neto,Arnaldo Amado; Silva,Jorge dos Santos
Fonte: Sociedade Brasileira de Ortopedia e Traumatologia Publicador: Sociedade Brasileira de Ortopedia e Traumatologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2013 Português
Relevância na Pesquisa
75.83%
Objective: To evaluate functional outcomes, radiographic findings and complications of proximal humeral fractures treated with locking plates and to determine prognostic factors for successful clinical outcomes. Methods: Forty patients undergoing internal fixation of fractures of the proximal humerus with the Philos(r) plate were included in the study. The surgeries were performed between 2004 and 2011 and the patients underwent radiographic and clinical evaluation, by Constant -Murley and Dash score. Outcomes were analyzed by use of multivariate regression with several different variables. Results: Patients were on average of 61.8 ± 16.28 years, and most were female (70%). The Constant -Murley score was 72.03 ± 14.01 and Dash score was 24.96 ± 19.99. The postoperative radiographs showed a head-shaft angle of 135.43º± 11.82. Regression analysis showed that the patient's age and the Hertel classification influenced the Constant -Murley scale (p = 0.0049 and 0.012, respectively). Other prognostic criteria such as Neer and AO classification, head-shaft angle, the presence of metaphyseal comminution and extension of the humeral metaphyseal fragment showed no effect on prognosis. Complications occurred in four patients (10%). Conclusion: The fixation with the Philos(r) plate provided good clinical and radiographic results in fractures of the proximal humerus...