Single-Slice Hounsfield Unit (HU) Value of the Chinese Proximal Humerus on Routine Chest CT: A Study on Opportunistically Screening for Low Bone Density / Valor de Unidad Hounsfield (HU) de Corte Único del Húmero Proximal Chino en una Tomografía Computarizada de Tórax de Rutina: Un Estudio sobre la Detección Oportunista de Baja Densidad Ósea

SUMMARY: A Study on Relationship between Single-Slice Hounsfield Unit(HU) value of the Chinese proximal humerus and Bone Mineral Density(BMD) Using Routine Chest CT and Dual-energy X-ray Absorptiometry(DEXA) was performed. Data were collected from 240 individuals who underwent DEXA and routine chest CT scans (including full images of the proximal humerus) on the same day at 967 Hospitals between January 2019 and December 2021. The method of measuring single-slice HU values of the proximal humerus on routine chest CT scans exhibited high reliability and repeatability (intraclass correlation coefficient > 0.961, P < 0.001). A strong positive correlation was observed between single-slice HU values of the proximal humerus and DEXA results, with the 20-mm HU value demonstrating the highest correlation. Across different BMI groups, the Area Under Curve (AUC) for the 20-mm HU value was consistently the largest (AUC=0.701- 0.813, P< 0.05). Therefore, the 20-mm HU value can be considered a reliable reference for the opportunistic screening of low BMD, with reference values of -4HU for underweight individuals, -13HU for normal weight individuals, -7HU for overweight individuals, and -16HU for obese individuals. Values below these thresholds indicate a risk of low BMD. This study enriches the Chinese BMD data and offers a swift and effective approach for opportunistically screening low BMD.

Se realizó un estudio sobre la relación entre el valor de la Unidad Hounsfield (HU) de corte único del húmero proximal chino y la densidad mineral ósea (DMO) mediante TC de tórax de rutina y absorciometría de rayos X de energía dual (DEXA). Se recopilaron datos de 240 personas que se sometieron a DEXA y tomografías computarizadas de rutina de tórax (incluidas imágenes completas del húmero proximal) el mismo día en 967 hospitales entre enero de 2019 y diciembre de 2021. El método para medir los valores de HU de un solo corte del húmero proximal en las tomografías computarizadas de tórax mostraron alta confiabilidad y repetibilidad (coeficiente de correlación intraclase > 0,961, P < 0,001). Se observó una fuerte correlación positiva entre los valores de HU de un solo corte del húmero proximal y los resultados de DEXA, demostrando el valor de HU de 20 mm la correlación más alta. En diferentes grupos de IMC, el área bajo la curva (AUC) para el valor HU de 20 mm fue consistentemente el más grande (AUC = 0,701-0,813, P <0,05). Por lo tanto, el valor de HU de 20 mm puede considerarse una referencia fiable para el cribado oportunista de DMO baja, con valores de referencia de -4 HU para personas con bajo peso, -13 HU para personas con peso normal, -7 HU para personas con sobrepeso y -16 HU para personas obesas. Los valores por debajo de estos umbrales indican un riesgo de DMO baja. Este estudio es un aporte para los datos chinos sobre la DMO y ofrece un enfoque rápido y eficaz para detectar de forma oportunista la DMO baja.

Distribution characteristics of humeral head screws in treatment of proximal humeral fractures with proximal humerus internal locking system plate / 中国组织工程研究

BACKGROUND:Proximal humerus internal locking system locking plate is the most commonly used fixation method for proximal humeral fractures,but its failure rate is still high in clinical practice.Reasonable screw placement is an important factor affecting the stability of internal fixation. OBJECTIVE:To investigate the distribution of humeral head screws in the treatment of proximal humeral fractures with proximal humerus internal locking system plate and its influence on internal fixation failure. METHODS:From January 2017 to December 2021,data from patients with proximal humeral fractures undergoing proximal humerus internal locking system plate in Third Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively analyzed.A total of 124 patients were enrolled,including 16 males and 108 females,at the age of≥60 years.According to whether there was internal fixation failure after operation,they were divided into normal group(n=101)and internal fixation failure group(n=23).The patient's age,gender,fracture type,the integrity of the medial column,plate height,neck-shaft angle,whether the talus screw was inserted,and the number of humeral head screws,were collected.The humeral head was divided into eight zones according to the postoperative digital radiography anteroposterior film,and the distribution characteristics of the screws in each zone were collected,and the heat map of the screw distribution was drawn. RESULTS AND CONCLUSION:(1)There were no significant differences between the two groups in age,gender,fracture type,the integrity of the medial column,plate height,neck-shaft angle,whether to insert talus screws,and the number of humeral head screws(P>0.05).(2)The heat map showed that the humeral head screws were evenly distributed in the normal group,mainly scattered in zones 4,6,and 7.However,the screw distribution in the internal fixation failure group was not uniform,mainly concentrated in zones 4 and 6.In addition,in the ideal area of talus screws(7/8 zone),there were significantly more screws in the normal group than in the internal fixation failure group.(3)It is indicated that in the treatment of proximal humeral fractures with proximal humerus internal locking system plate,the uniform distribution of humeral head screws is the key to ensuring the internal fixation effect.A reasonable distribution of humeral head screws helps to improve the treatment effect and the success rate of internal fixation.

Modified calcaneal plate combined with suture anchors in treatment of comminuted fracture of split-type greater tuberosity of humerus(Liu-Gang type IV) / 中国组织工程研究

BACKGROUND:Numerous scholars have previously researched certain greater tuberosity fractures and the procedures used to treat them.Few researchers,however,have studied the comminuted split fracture of the greater tuberosity of the humerus(Liu-Gang type IV)with rotator cuff tear in great detail. OBJECTIVE:To compare the clinical therapeutic effect of open repair position modified calcaneal plate combined with suture anchors and proximal humeral internal locking system(PHILOS)plate in the treatment of comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears(Liu-Gang type IV). METHODS:Case data of 30 patients with comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears(Liu-Gang type IV)from May 2012 to May 2022 were retrospectively analyzed.They were divided into the modified calcaneal plate combined with suture anchor group(group A)and the PHILOS with#2 Johnson group(group B),with 15 cases in each group.Intraoperative blood loss,surgical time,and incision length of all patients were recorded.Pain visual analog scale score,Constant-Murley score,as well as shoulder joint abduction,forward flexion,external rotation,and dorsal expansion activities during the last follow-up(>1 year)were evaluated. RESULTS AND CONCLUSION:(1)The surgical incision length and operation time were shorter,and blood loss was less in group A than those in group B(P<0.05).(2)No significant difference in visual analog scale score and Constant-Murley score was detected between the two groups(P>0.05).(3)During the last follow-up,forward flexion in group A was better than that in group B(P<0.05).No significant difference in abduction,external rotation,and dorsal expansion was determined between group A and group B(P>0.05).(4)In terms of complications,there was 1 case of shoulder joint pain and discomfort in group A(7%),2 cases of subacromial impingement syndrome,2 cases of upward movement of nodules,and 2 cases of shoulder joint pain(40%)in group B.There were significant differences in complication rates between the two groups(P=0.031).(5)In summary,the modified calcaneal plate combined with suture anchors in the treatment of comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears(Liu-Gang type IV)could better restore the forward flexion function of the shoulder joint and has a small incision,less blood loss,shorter operation time and fewer complications.

Therapeutic efficacy of massage versus instrument-assisted soft tissue mobilization in patients with lateral epicondylitis of the humerus / 中国组织工程研究

BACKGROUND:Instrument-assisted soft tissue mobilization is often used as a noninvasive treatment for soft tissue(skeletal muscle,ligament,and fascia)injuries and postoperative recovery to improve pain and enhance strength in the range of joint motion. OBJECTIVE:To compare the clinical efficacy of instrument-assisted soft tissue mobilization and massage therapy in patients with lateral epicondylitis of the humerus. METHODS:A total of 25 athletes with lateral epicondylitis of the humerus were enrolled in this study and randomized into two groups:13 subjects receiving instrument-assisted soft tissue mobilization as the experimental group and 12 subjects receiving massage therapy as the control group.The treatment period was 4 weeks,with two sessions per week.Elbow joint visual analog scale,Mayo elbow performance index,elbow range of motion measurement,and forearm strength were measured and recorded in both groups before and after treatment. RESULTS AND CONCLUSION:Both treatments significantly reduced visual analog scale score of the elbow joint after the first and last treatments(P＜0.05),but the visual analog scale score showed no significant difference between the two groups(P＞0.05).The Mayo elbow performance index showed a significant increase in both groups after the first and last treatments(P＜0.05),but there was no significant difference between the two groups(P＞0.05).In the maximum grip strength test,the maximum grip strength of the experimental group in the vertical direction and during internal and external rotations after treatment was better than that before treatment(P＜0.05),while the control group only showed improved maximum grip strength during internal rotation(P＜0.05),with no significant improvement in maximum grip strength in other states.There was also no significant difference in the maximum grip strength in all the three states between the two groups(P＞0.05).After the last treatment,the range of motion of the elbow joint and the angle of forearm pronation and supination were significantly improved in both intervention groups(P＜0.05).The maximum angle of the elbow joint for flexion was smaller than that before treatment(P＜0.05),and there was no significant difference in each angle of motion between the two groups(P＞0.05).The range of motion of the forearm and elbow joint in both groups were significant improved after the first and last treatment(P＜0.05)and there was no significant difference in difference in the range of motion of the forearm and elbow joint between the two groups(P＞0.05).To conclude,both instrument-assisted soft tissue mobilization and massage therapy significantly reduce pain,improve elbow flexibility and increase joint range of motion in patients with lateral epicondylitis of the humerus.However,instrument-assisted soft tissue mobilization is better than massage therapy to improve the maximum grip strength.

Evaluation of curative effects of arthroscopic external tension band fixation in the treatment of greater tubercle fracture of the humerus / 中华创伤杂志

Objective:To compare the clinical outcomes of arthroscopic external tension band fixation versus open reduction and internal fixation in the treatment of greater tubercle fracture of the humerus.Methods:A retrospective cohort study was conducted on 55 patients with greater tubercle fracture of the humerus admitted to Taizhou Hospital of Zhejiang Province from September 2019 to June 2022, including 24 males and 31 females, aged 26-80 years [(61.7±10.5)years]. Out of them, 35 patients treated with open reduction and internal fixation (open reduction group), and 20 patients were treated with external anchor tension band under arthroscopy (arthroscopy group). The operation time, and the Visual Analogue Scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score and shoulder active range of motion (anterior flexion, abduction and posterior extension) before operation, at 1 month after operation and at the last follow-up were compared between the two groups. Bone healing was observed in both groups at the last follow-up. Postoperative complications were compared between the two groups.Results:All the patients were followed up for 12-29 months [(16.9±4.0)months]. There was no significant difference in operation time between the two groups ( P>0.05). There were no significant differences in the VAS score, ASES score, Constant-Murley score and shoulder active range of motion between the two groups before operation ( P>0.05). The VAS score of the arthroscopy group was 3(2, 3)points at 1 month after operation, which was significantly lower than that of the open reduction group [4(3, 4) points] ( P<0.01). No significant difference was found in the VAS score at the last follow-up between the two groups ( P>0.05).The ASES scores of the arthroscopy group were (70.6±4.2)points and (90.2±3.7)points at 1 month after operation and at the last follow-up respectively, which were significantly higher than those of the open reduction group [(64.7±6.4)points and (87.5±4.9)points respectively] ( P<0.05 or 0.01). There was no significant difference in the Constant-Murley score between the arthroscopy group [(71.8±4.3)points] and the open reduction group [(70.9±5.3)points] at 1 month after operation ( P>0.05), while the Constant-Murley score of the arthroscopy group was (94.1±3.1)points at the last follow-up, which was significantly higher than that of the open reduction group [(89.2±4.7)points] ( P<0.01). At 1 month after operation and at the last follow-up, ranges of motion of the anterior flexion, abduction and posterior extension were (52.7±12.3)° and (140.0±16.9)°, (57.4±8.6)° and (125.0±14.3)°, and 16(15, 19)° and 25(20, 30)° in the arthroscopy group respectively, which were significantly higher than those in the open reduction group [(42.2±5.2)° and (110.9±14.0)°, (52.8±6.0)° and (103.7±11.7)°, and 10(10, 20)° and 16(15, 25)° respectively] ( P<0.05 or 0.01). At the last follow-up, it was found that bony union was achieved in both groups. There were no obvious complications such as incision infection or joint stiffnessin both groups. In the open reduction group, 2 patients had internal fixation failure within 1-3 months after operation but was treated with revision operation; 6 patients developed shoulder stiffness at 3-6 months after operation but had outpatient rehabilitation. The incidence rate of postoperative complications in the arthroscopy group [0%(0/20)] was significantly lower than that in the open reduction group [23%(8/35)] ( P<0.05). Conclusion:Compared with open reduction and internal fixation with plates and screws, arthroscopic external anchor tension band fixation in the treatment of greater tuberosity fracture of the humerus has the advantages of earlier pain relief, better shoulder functional improvement, better recovery of shoulder mobility, and fewer complications.

Research progress on valgus impacted proximal humeral fractures / 中国修复重建外科杂志

OBJECTIVE@#To review the advancement made in the understanding of valgus impacted proximal humeral fracture (PHF).@*METHODS@#The domestic and foreign literature about the valgus impacted PHF was extensively reviewed and the definition, classification, pathological features, and treatment of valgus impacted PHFs were summarized.@*RESULTS@#PHF with a neck shaft angle ≥160° is recognized as a valgus impacted PHF characterized by the preservation of the medial epiphyseal region of the humeral head, which contributes to maintenance of the medial periosteum's integrity after fracture and reduces the occurrence of avascular necrosis. Therefore, the valgus impacted PHF has a better prognosis when compared to other complex PHFs. The Neer classification designates it as a three- or four-part fracture, while the AO/Association for the Study of Internal Fixation (AO/ASIF) categorizes it as type C (C1.1). In the management of the valgus impacted PHF, the selection between conservative and surgical approaches is contingent upon the patient's age and the extent of fracture displacement. While conservative treatment offers the advantage of being non-invasive, it is accompanied by limitations such as the inability to achieve anatomical reduction and the potential for multiple complications. Surgical treatment includes open reduction combined with steel wire or locking plate and/or non-absorbable suture, transosseous suture technology, and shoulder replacement. Surgeons must adopt personalized treatment strategies for each patient with a valgus impacted PHF. Minimally invasive surgery helps to preserve blood supply to the humeral head, mitigate the likelihood of avascular necrosis, and reduce postoperative complications of bone and soft tissue. For elderly patients with severe comminuted and displaced fractures, osteoporosis, and unsuitable internal fixation, shoulder joint replacement is the best treatment option.@*CONCLUSION@#Currently, there has been some advancement in the classification, vascular supply, and management of valgus impacted PHF. Nevertheless, further research is imperative to assess the clinical safety, biomechanical stability, and indication of minimally invasive technology.

Morphometric study of the diaphysial nutrient foramen of the humerus in the Indore population

Background: The nutrient arteries may be affected to a consequence of fracture/surgical intervention of fracture of the humeral shaft, which may result in nonunion or delayed union of fracture. Number and position of nutrient arteries must be determined. In order to preserve them during any surgical procedure of the humeral shaft, it is therefore essential to be aware of the existence of the nutrient foramen. The primary objective of this research is to identify the number, location, and orientation of nutrient foramina (NF) of humerus. Methods: The study was conducted on 100 dried humeri of unknown gender obtained from department of anatomy, Index Medical College, Indore (M.P), India. The number, location, and direction of NF were observed. Results: One nutrient foramen was present in 77% of humeri, followed by double foramen in 20% of cases and triple foramen in 3% of cases. The anteromedial surface hosted the majority (80.16%) of the NF, followed by the anterolateral (4.76%) and posterior surfaces (15.08%). The middle third of the shaft (96.03%) included the greatest number of NF, followed by the distal third (3.97%). On the distal end of the humerus, there was no nutrient foramen to be observed. All NF were directed downward. Conclusions: The location of the nutrient foramen of the humerus was not constant; it may present on anteromedial, anterolateral, or posterior surfaces. Similarly, it may present on the middle or distal third of the shaft of the humerus. This study will help surgeons planning the surgical intervention of the shaft of the humerus, which will possibly reduce the chances of nonunion or delayed union.

Nutrient foramen of humerus

Background: Humerus is a typical long bone of arm in human body extending from shoulders to elbow. Nutrient foramen is the small opening present in most of the bone of human body to transmit the nutrient artery which supplies nutrition to different parts of bone. The aim of the present study is to identify the number of nutrient foramen in dry humerus and to observe direction and allocation of the nutrient foramina. Methods: The present study was carried out in 60 dry humeri (23 rights and 37 lefts) collected from Department of Anatomy, Government Medical College Srinagar. Bones were examined with respect to the number, direction and anatomical location of nutrient foramen. Results: Out of 60 dry humeri, 36 (60%) had a single nutrient foramen, 14 (23.3%) had double, 7 (11.6%) had triple and 3 (5%) had no nutrient foramen. About 52% of the bones had nutrient foramen on the medial border, 40% on the Anteromedial surface, 3% on lateral border, 3% on posterior surface and 2% on the anterior border. Majority of the bones i.e., 81% have the nutrient foramen in the middle 1/3rd zone, 17% at the junction between middle 1/3rd zone and lower 1/3rd zone and 2% in the lower 1/3rd zone. Conclusions: By knowing the number and location of the nutrient foramina in humerus it is useful in preventing intra-operative injury of nutrient artery during orthopedic, plastic and reconstructive surgery.

Fractura desplazada de húmero proximal

Introducción: Las fracturas de húmero proximal representan entre un 4-6 % de todas las fracturas y en algunos grupos poblacionales inciden en un 10 %. El manejo quirúrgico permite la cicatrización anatómica de los huesos y tejidos blandos; favorece la función de la extremidad y minimiza el riesgo. Objetivo: Evaluar los diferentes tipos de tratamiento para las fracturas de húmero proximal a partir de la presentación de cuatro casos. Presentación de casos: Los cuatros pacientes se evaluaron por la escala de Constant, independientemente de los procederse quirúrgicos. Tres de ellos tuvieron un seguimiento mínimo de seis meses y sobrepasaron los 80 puntos. El otro paciente se mantuvo en consulta durante tres meses y logró una puntuación por encima de 50. Conclusiones: El método quirúrgico debe permitir una fijación estable para la movilización temprana de la articulación. Al elegirlo debe tenerse en cuenta la edad, la geometría de la fractura, la calidad ósea y los criterios de Hertel.

Introduction: Fractures of the proximal humerus represent 4 to 6% of all fractures and 10% in some population groups. Surgical management allows anatomical healing of bones and soft tissues; promotes limb function and minimizes risk. Objective: To evaluate the different types of treatment for proximal humerus fractures from the presentation of four cases. Case report: Four patients were evaluated by the Constant scale, regardless of the surgical procedure. Three of them had a minimum follow-up of six months and exceeded 80 points. The other patient was kept in consultation for three months and achieved a score above 50. Conclusions: The surgical method should allow stable fixation for early joint mobilization. When choosing it, age, fracture geometry, bone quality and Hertel criteria must be taken into account.

Fractura de capitellum en el adulto

Introducción: La fractura del extremo distal del húmero afecta la superficie articular y puede provocar incapacidad biomecánica de la articulación si no se trata adecuadamente. Objetivo: Presentar una paciente con fractura del capitellum, tratada mediante osteosíntesis. Presentación del caso: Paciente femenina de 49 años que se cayó sobre su mano en extensión. Presentó dolor intenso en el codo izquierdo y se le diagnosticó una fractura del capitellum desplazada. Se trató con osteosíntesis. Conclusiones: El tratamiento mediante osteosíntesis de la fractura del capitellum constituye la mejor opción para la rápida rehabilitación del paciente.

Introduction: The fracture of the distal end of the humerus affects the articular surface and it can cause biomechanical disability of the joint if it is not treated properly. Objective: To report the case of a patient with capitellum fracture, treated by osteosynthesis. Case report: This is the case of a 49-year-old female patient who fell on her outstretched hand. She complained of severe pain in her left elbow and she was diagnosed with a displaced capitellum fracture. The pateinmet was treated with osteosynthesis. Conclusions: The treatment by osteosynthesis of the capitellum fracture is the best option for the rapid rehabilitation of the patient.

EVALUATION OF OUTCOME OF PROXIMAL HUMERUS FRACTURES MANAGED WITH PHILOS PLATE

INTRODUCTION: Proximal humeral fractures account for 4 to 5 percentage of all fractures.minimally displaced can be managed non-operatively in adults. Displaced and unstable fractures should be treated surgically to achieve painless shoulder and good range of movement. AIM AND OBJECTIVES: Our study Is to evaluate the clinical, functional and radiological result of operative proximal humerus fractures managed PHILOS Plating. MATERIAL AND METHODS: 26 patients with displaced proximal humeral fractures that were treated by PHILOS plating between June 2018 to December 2019 were included in this study. The Constant-Murley score (CMS) was used to evaluate the outcome. RESULT: Out of 26 patients 9 were male and 17 were female. The mean age was 52 years. The mean surgical time was 88 min. The mean fracture union time was 11.5 weeks. Outcome was excellent in 17 cases, Good in 6 and Fair in 3 cases. CONCLUSION: Fixation with PHILOS is associated with good to excellent outcomes. It gives high rate of union, good range of movement and has minimal complications.

No-consolidación diafisaria de húmero en pacientes adultos con osteoporosis. Tratamiento quirúrgico y resultados a largo plazo / Diaphyseal osteoporotic nonunion of the humerus in elderly patients. Surgical treatment and long-term results

Resumen: Introducción: evaluar los resultados radiográficos y funcionales obtenidos a largo plazo en pacientes adultos que presentaron no-consolidaciones atróficas diafisarias de húmero asociadas a osteoporosis; tratadas quirúrgicamente mediante reducción abierta y fijación interna con placas e injerto óseo. Material y métodos: evaluamos retrospectivamente 22 pacientes, con edad promedio de 72 años, el tiempo desde el trauma inicial hasta la cirugía definitiva promedió, 18 meses. Once pacientes eran fumadores y cuatro presentaban infección activa. El score de Constant y el DASH preoperatorios promediaron 23.13 y 81.04, respectivamente. El valor de la escala analógica del dolor preoperatorio promedió 7.45 puntos. Resultados: el seguimiento promedió 69 meses. Se obtuvo la consolidación en todos los casos, luego de un promedio de 4.68 meses. Al último seguimiento, los valores del DASH promediaron 20.27 puntos y el score de Constant promedió 79.31 puntos. La escala analógica del dolor promedió 0.77 puntos. La estabilización se realizó utilizando clavos placa bloqueados en 12 no-consolidaciones, placas bloqueadas de compresión en seis y doble placa en cuatro. Los pacientes con infección activa fueron tratados en dos etapas utilizando la técnica descripta por Masquelet. Se asoció injerto óseo en todas las reconstrucciones (autoinjerto esponjoso de cresta ilíaca en 17, aloinjerto en tres y se combinó aloinjerto estructural con autoinjerto esponjoso en dos). Dos gramos de vancomicina en polvo fueron asociados localmente al injerto óseo. Conclusión: la combinación de reducción abierta y fijación interna con placas e injerto óseo permitió obtener la consolidación y resultados funcionales objetivos y subjetivos buenos y predecibles a largo plazo en todos los casos, sin complicaciones mayores ni la necesidad de intervenciones quirúrgicas sucesivas.

Abstract: Introduction: to evaluate the long term radiographic and functional results achieved in adult patients with osteoporotic, atrophic, non-unions of the diaphyseal humerus, treated surgically by open reduction and internal fixation with plates and bone graft. Material and methods: we retrospectively evaluated 22 patients. Patient's age averaged 72 years. Time from initial trauma to definitive surgery averaged 18 months. Eleven patients were smokers, and four had active infection. Pre-operative Constant score and DASH score averaged 23.13 and 81.04, respectively. Pre-operative pain scale averaged 7.45 points. Results: follow-up averaged 69 months. Union was achieved in all cases after an average of 4.68 months. DASH score at last follow-up averaged 20.27 points and Constant score 79.31 points. Analog pain scale averaged 0.77 points. Stabilization was performed using locking blade plates in 12 non-unions, locking compression plates in six cases, and double plating in four non-unions. Patients with active infection were treated in two stages using Masquelet's technique. Bone graft was associated in all cases (cancellous iliac crest autograft in 17, allograft in three, and combined structural allograft and cancellous autograft in two). Two grams of vancomycin powder were associated to the bone graft in all cases. Conclusion: the use of open reduction and internal fixation with plates associated to bone graft with local antibiotics, aloud achieving bony union and good predictable long-term objective and subjective functional results in all cases, without major complications or the need of further surgical intervention.

A morphometric study of supratrochlear foramen of humerus in a medical institute in North-East India

Background: The clinical importance of the supratrochlear foramen (STF) of the humerus, an anatomical variation, has been recognised because of its association with low-impact fractures of the distal end and narrow medullary canal of the humerus. According to the literature, STF prevalence varies between ethnic groups and even between individuals of the same ethnic group. Many studies in India also reflect variations in the prevalence of STF in different regions. However, the study of STF is still a rarity in northeast India, where different indigenous peoples are living. Methods: A descriptive cross-sectional study of dry humerus bones was conducted a medical institute in Manipur. The presence of STF, its shape, maximum dimensions (transverse and vertical), and distances from the medial and lateral epicondyles were observed. Results: STF was present in 28.57% of bones, of which 53.85% were observed in the left humerus and 46.15% in the right humerus. STF was found in different shapes, including oval (46.15%), round (19.23%), irregular (19.23%), and triangular (15.38%). The 66.67% of the STF were situated more medially in the right humerus, while 78.57% of the STF were also located more medially in the left humerus. Conclusions: The study of STF showed a prevalence of 28.57%. The oval-shaped foramen was the most common. The majority of the STF was placed more medially in both the right and left humeri.

Tratamiento de la fractura diafisaria de húmero con clavo intramedular "Telegraph®"

Introducción: El enclavado intramedular acerrojado por vía anterógrada es uno de los métodos quirúrgicos para el tratamiento de la fractura diafisaria de húmero y tiene como ventaja ser una técnica por mínimo acceso. Objetivo: Evaluar los resultados del tratamiento de la fractura diafisaria de húmero con el clavo intramedular acerrojado anterógrado "Telegraph®". Métodos: Se realizó un estudio prospectivo, longitudinal y descriptivo en 16 pacientes con fractura diafisaria de húmero; intervenidos quirúrgicamente con el sistema intramedular "Telegraph®" en el Hospital Ortopédico Docente "Fructuoso Rodríguez". Se evaluaron los resultados según la escala QuickDASH. Resultados: Predominaron los pacientes entre 40 y 60 años y del sexo femenino. El tiempo medio de seguimiento estuvo entre 27,25 ± 4,5 meses. El tipo de fractura A2a (trazo simple, oblicuo, del tercio medio) fue la más frecuente. Hubo pocas complicaciones y no afectaron el resultado final. A los 6 meses de la operación, el 75 % de los pacientes presentó un grado de dificultad nulo o incipiente. Conclusiones: Con el uso del clavo intramedular acerrojado "Telegraph®" se obtienen resultados funcionales satisfactorios por lo que constituye una opción válida de tratamiento.

Introduction: Locked intramedullary nailing by antegrade approach is one of the surgical methods for the treatment of humeral diaphyseal fracture and has the advantage of being a minimal access technique. Objective: To evaluate the results of the treatment of the diaphyseal fracture of the humerus with the Telegraph® antegrade locked intramedullary nail. Methods: A prospective, longitudinal, descriptive study was carried out in 16 patients with diaphyseal fracture of the humerus; underwent surgery with the Telegraph® intramedullary system at Fructuoso Rodríguez Orthopedic Hospital. The results were evaluated according to the QuickDASH scale. Results: There was a predominance of patients between 40 and 60 years of age and of the female sex. The mean follow-up time was 27.25 ± 4.5 months. The type of A2a fracture (simple, oblique line, of the middle third) was the most frequent. There were few complications and they did not affect the final result. Six months after the operation, 75% of the patients had no or incipient degree of difficulty. Conclusions: The use of Telegraph® locked intramedullary nail, satisfactory functional results are obtained, establishing a valid treatment option.

FUNCTIONAL OUTCOME FOLLOWING BI-COLUMNAR PLATING OF AO-TYPE 13C DISTAL HUMERUS FRACTURES.

Background: Intra articular fractures of the distal humerus are uncommon injuries and present the most difficult challenge among fractures of the distal end of the humerus. Objective of this study is to evaluate the functional outcome following bicolumnar plating of AO-Type 13C distal humerus fractures. A total of 20 int Materials and Methods: ra articular (AO TYPE C) distal humerus fractures were operated within a period of 2 years in KVG medical college and hospital Sullia were included in the study in which there were 12 males and 8 females.16 cases were due to RTA, 4 were due to self-fall, Out of 20 cases,1 (5%) was of AO C1 type of fracture, 16(80%) were of C2 and 3 (15%) were of C3 type of fractures. All the patients were operated with pre-countered distal humerus locking plates in orthogonal fashion and functional outcome was measured by Mayo's Elbow Performance Score (MEPS). In our series of 20 cases, the Results: average duration of the radiological union was 16±02 weeks. Excellent results were seen in 10, good in 6 and fair in 3, and poor in 1 According to Mayo's Elbow Performance Score (MEPS) at the end of 12 months follow up. Open reduct Conclusion: ion and internal fixation with bicolumnar plating is the ideal fixation for AO 13 type C distal humerus fractures. Use of locking plates, stable fixation, along with early elbow mobilization influence the final functional outcome. Bicolumnar plating provides better stability, allows early elbow range of motion and prevents elbow stiffness.

Age-Related Changes of Biomechanical Properties for Limb Bones in Male Rats / 医用生物力学

Objective To investigate the age-related changes of biomechanical properties for humerus, femur and tibia in male rats and their application values in age estimation. Methods According to different weeks of age, 90 healthy male SD rats were divided into 2, 4, 6, 8, 17, 26, 52, 78 and 104-week groups with 10 rats in eachgroup. After the rats were executed by excessive anesthesia, humerus, femur, and tibia were separated and the attached soft tissues were removed. The length of the above-mentioned bones and the diameter of the middle section (compression site) were measured with vernier caliper, and the three-point bending test was conducted with electronic universal material testing machine to detect the ultimate load and displacement under ultimate load. Results There were significant differences in the ultimate load of humerus, femur and tibia among male rats in different age groups (P<0. 05). With the increase of week age, the ultimate loads of the humerus, femur and tibia increased first and then decreased, and reached the peak value in 52-week age group, showing a strong positive correlation with week age before 52 weeks ( r = 0. 884,0. 933,0. 929, P<0. 05). There was no significant difference in humerus and tibia. The displacement of femur under ultimate load was weakly positively correlated with week age (R= 0. 406,P<0. 05). The age prediction accuracy for automatic linear modeling of ultimate load for humerus, femur, tibia and three above-mentioned bones in rats before 52-week age was 78. 2% , 86. 8% , 84. 1% and 88. 3% , respectively. There was a strong positive correlation between the length of humerus, femur and tibia and the ultimate load (R= 0. 904, 0. 897, 0. 814, P<0. 05). The diameters of humerus, femur and tibia were strongly positively correlated with the ultimate load (R = 0. 759, 0. 814 and 0. 745, P<0. 05). Conclusions The ultimate loads of humerus, femur and tibia in male rats increased first and then decreased with age, and were positively correlated with age before 52 weeks, which could be used for age inference. The highest accuracy of age estimation was ultimate loads of three bones, followed by femur. The length/ middle diameter of humerus, femur and tibia were strongly positively correlated with the ultimate load.

Olecranon osteotomy approach for Dubberley type Ⅲ coronal fractures of the distal humerus / 中国骨伤

OBJECTIVE@#To retrospectively analyze the clinical efficacy of olecranon osteotomy approach in the treatment of Dubberley type Ⅲ coronal fractures of the distal humerus and summarize the treatment experience.@*METHODS@#From January 2016 to June 2020, 17 patients (5 males and 12 females) with Dubberley type Ⅲ coronal fractures of the distal humerus were treated by olecranon osteotomy approach. The age ranged from 37 to78 years old with an average of (58.5±12.9) years old. According to Dubberley classification, there were 5 cases of type Ⅲ A and 12 cases of type Ⅲ B. The curative effect was evaluated using the Borberg-Morrey elbow function score. The flexion, extension and rotation range of motion of the elbow joint, complications and postoperative imaging evaluation were recorded.@*RESULTS@#All the 17 patients got bony union. The follow-up time ranged from 12 to 33 months with an average of (15.6±5.6) months. There was 1 case of ischemic necrosis of capitulum humeri, 2 cases of traumatic arthritis and 1 case of heterotopic ossification, 1 case of malunion of fracture. The range of motion was (114.80±19.50) °. The Broberg-Morrey score was 85.3±8.2, excellent in 5 cases, good in 9 cases, fair in 3 cases and poor in 0 case.@*CONCLUSION@#Through olecranon osteotomy approach, the articular surface of distal humerus could be fully exposed, and the operation is convenient. Anatomical reduction and rigid fixation of the articular surface of distal humerus are the key factors for the succesful outcome.

Short-term effectiveness of transverse antecubital incision for failed closed reduction of Gartland type Ⅲ supracondylar humerus fractures in children / 中国修复重建外科杂志

OBJECTIVE@#To investigate the short-term effectiveness of transverse antecubital incision in the treatment of failed closed reduction of Gartland type Ⅲ supracondylar humeral fractures (SHFs) in children.@*METHODS@#Between July 2020 and April 2022, 20 children with Gartland type Ⅲ SHFs who failed in closed reduction were treated with internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision. There were 9 boys and 11 girls with an average age of 3.1 years (range, 1.1-6.0 years). The causes of injuries were fall in 12 cases and fall from height in 8 cases. The time from admission to operation ranged from 7 to 18 hours, with an average of 12.4 hours. The healing of the incision and the occurrence of complications such as nerve injury and cubitus varus were observed after operation; the elbow flexion and extension range of motion after removing the gypsum, after removing the Kirschner wire, and at last follow-up were recorded and compared, as well as the elbow flexion and extension and forearm rotation range of motion at last follow-up between healthy and affected sides; the Baumann angle was measured on the X-ray film, and the fracture healing was observed. At last follow-up, the effectiveness was evaluated according to the Flynn elbow function evaluation criteria.@*RESULTS@#All incisions healed by first intention, and there was no skin necrosis, scar contracture, ulnar nerve injury, and cubitus varus. Postoperative pain occurred in the radial-dorsal thumb in 2 cases. The gypsum was removed and elbow flexion and extension exercises were started at 2-4 weeks (mean, 2.7 weeks) after operation, and the Kirschner wire was removed at 4-5 weeks (mean, 4.3 weeks). All the 20 patients were followed up 6-16 months, with an average of 12.4 months. The fracture healing time was 4-5 weeks, with an average of 4.5 weeks, and there was no complication such as delayed healing and myositis ossificans. The flexion and extension range of motion of the elbow joint gradually improved after operation, and there were significant differences between the time after removing the gypsum, after removing the Kirschner wire, and at last follow-up ( P<0.017). There was no significant difference in the flexion and extension of the elbow joint and the forearm rotation range of motion between the healthy and affected sides at last follow-up ( P>0.05). There was no significant difference in Baumann angle between the time of immediate after operation, after removing the Kirschner wire, and at last follow-up ( P>0.05). According to Flynn elbow function evaluation standard, 16 cases were excellent and 4 cases were good, the excellent and good rate was 100%.@*CONCLUSION@#The treatment of Gartland type Ⅲ SHFs in children with failed closed reduction by internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision has the advantages of complete soft tissue hinge behind the fracture for easy reduction and wire fixation, small incision, less complications, fast fracture healing, early functional recovery, reliable reduction and fixation, and can obtain satisfactory results.

Effect of tuberosity repair on functional outcome of reverse shoulder arthroplasty in proximal humerus fractures / 中华创伤杂志(英文版)

PURPOSE@#Unsatisfactory results of hemiarthroplasty in Neer's 3- and 4-part proximal humerus fractures in elderly, have led to the shift towards reverse shoulder arthroplasty (RSA). The objective of our study was to repair the tuberosities that are generally overlooked during RSA and observe its impact on the functional outcome and shoulder scores.@*METHODS@#We include elderly patients with acutely displaced or dislocated 3- or 4-part proximal humerus fractures from July 2013 to November 2019 who were treated with RSA along with tuberosity repair by non-absorbable sutures and bone grafting harvested from the humeral head. Open injuries and cases with neuro-muscular involvement of the deltoid muscle were excluded. According to the tuberosity healing on radiographs of the shoulder at 9th postoperative month, the patients were divided into 2 groups, as the group with successful tuberosity repair and the other with failed tuberosity repair. Statistical analysis of the functional outcome and shoulder scores between the 2 groups were done by independent t-test for normally distributed parameters and Mann-Whitney test for the parameters, where data was not normally distributed.@*RESULTS@#Of 41 patients, tuberosity healing was achieved in 28 (68.3%) and failed in 13 (31.7%) cases. Lysis of the tuberosity occurred in 5 patients, tuberosity displacement in 2, and nonunion in 2. Mean age was 70.4 years (range 65 - 79 years) and mean follow-up was 58.7 months (range 18 - 93 months). There were no major complications. Group with successful tuberosity repair showed improvement in mean active range of movements, like anterior elevation (165.1° ± 4.9° vs. 144.6° ± 9.4°, p < 0.000), lateral elevation (158.9° ± 7.2° vs. 138.4° ± 9.6°, p < 0.000), external rotation (30.5° ± 6.9° vs. 35.0° ± 6.3°, p = 0.367), internal rotation (33.7° ± 7.5° vs. 32.6° ± 6.9°, p = 0.671) and in mean shoulder scores including Constant score (70.7 ± 4.1 vs. 55.5 ± 5.7, p < 0.000), American shoulder and elbow surgeons score (90.3 ± 2.4 vs. 69.0 ± 5.7, p < 0.000), disability of arm shoulder and hand score (22.1 ± 2.3 vs. 37.6 ± 2.6, p < 0.000).@*CONCLUSION@#Successful repair and tuberosity healing around the RSA prosthesis is associated with statistically significant improvement in postoperative range of motion, strength and shoulder scores. Standardized repair technique and interposition of cancellous bone grafts, harvested from the humeral head can improve the rate of tuberosity healing.

An unusual case of symmetric quadruple limb fractures / 中华创伤杂志(英文版)

A 19-year-old man had an accidental fall from the 2nd floor and sustained multiple injuries. On radiological evaluation, the patient had symmetrical quadruple limb involvement with bilateral humerus shaft, bilateral olecranon, bilateral femur shaft, and bilateral patella fractures. The patient was actively managed using damage control orthopaedics, and a sequence of skeletal fixation was planned based on the hemodynamic stability and periodical serum lactate assessment. Symmetrical quadruple limb fractures are very rare, which could be associated with higher mortality. A meticulous clinical evaluation, periodical blood parameter assessment and strict adherence to the principles of damage control orthopaedics can be conducive to prevent life-endangering complications.