Tratamiento conservador de la fractura diafisaria de húmero: presentación de un caso / Conservative treatment of the dyaphisial fracture of the humerus: Presentation of a case

Uno de los pilares fundamentales en el tratamiento conservador de las fracturas diafisarias del húmero ha sido el uso del yeso colgante como método de inmovilización, por lo que se decició aplicar dicho tratamiento en un paciente después de haber realizado el diagnóstico de dicha afección. Se evaluó la eficacia del método empleado a través del seguimiento periódico de la evolución clínica e imaginológica de la lesión, obteniéndose la consolidación de la fractura sin que se apreciara complicación alguna, resultado que concuerda con la literatura mundial, la cual refiere la importancia y resultados positivos del método empleado. Teniendo en cuenta lo práctico, económico y útil que resulta el mismo los autores consideraron oportuno presentar esta experiencia con el objetivo de promover la extensión práctica del tratamiento conservador de la fractura diafisaria del húmero(AU)

One of the main pillars of the humerus dyaphisial fracture conservative treatment has been the usage of the hanging plaster cast as an immobilization method, so we decided to use that treatment in a patient after diagnosing that condition. We evaluated the efficacy of the used method periodically following the clinical and imaging evolution of the lesion, obtaining the consolidation of the fracture without any complication, result agree with the international literature that refers the importance and positive outcomes of the used method. Taking into account its suitability, effectiveness, and usefulness we considered it opportune to present this experience with the objective of promoting the practical extension of the humerus dyaphisial fracture conservative treatment(AU)

Tratamiento conservador de la fractura diafisaria de húmero: presentación de un caso / Conservative treatment of the dyaphisial fracture of the humerus: presentation of a case

Uno de los pilares fundamentales en el tratamiento conservador de las fracturas diafisarias del húmero ha sido el uso del yeso colgante como método de inmovilización, por lo que se decició aplicar dicho tratamiento en un paciente después de haber realizado el diagnóstico de dicha afección. Se evaluó la eficacia del método empleado a través del seguimiento periódico de la evolución clínica e imaginológica de la lesión, obteniéndose la consolidación de la fractura sin que se apreciara complicación alguna, resultado que concuerda con la literatura mundial, la cual refiere la importancia y resultados positivos del método empleado. Teniendo en cuenta lo práctico, económico y útil que resulta el mismo los autores consideraron oportuno presentar esta experiencia con el objetivo de promover la extensión práctica del tratamiento conservador de la fractura diafisaria del húmero.

One of the main pillars of the humerus dyaphisial fracture conservative treatment has been the usage of the hanging plaster cast as an immobilization method, so we decided to use that treatment in a patient after diagnosing that condition. We evaluated the efficacy of the used method periodically following the clinical and imaging evolution of the lesion, obtaining the consolidation of the fracture without any complication, result agree with the international literature that refers the importance and positive outcomes of the used method. Taking into account its suitability, effectiveness, and usefulness we considered it opportune to present this experience with the objective of promoting the practical extension of the humerus dyaphisial fracture conservative treatment.

Traditional Chinese medicine speeds-up humerus fracture healing: two case reports.

OBJECTIVE: Two cases illustrate the potential benefit of traditional Chinese medicine (TCM) treatments on speeding-up proximal humeral fracture healing. CLINICAL FEATURES: The cases include two patients with traumatic right proximal humerus closed fracture, one who fell down while standing on a chair and the other hit by a moped. Alternative treatments had been applied to restore humerus fracture. They were treated with the same modality by acupuncture on LI4, LI10, LI1, LI15, LI16 and SI9, with occasional electroacupuncture at LI4 and LI16, as well as concomitant herbal formula powder prescription named "Zhèng Gu Zi Jin Dan". Within 2 months treatment, both patients seemed to have speed-up bone healing. The Constant Score increased from 9 to 42 and 36, before and after acupuncture therapy. CONCLUSIONS: To our experience, the old patients' fracture had speed-up healing while under TCM treatments. This might hint that TCM treatments not only play a role in pain control, but also accelerate bone healing for certain fracture cases. Long-term follow-up and future experimental studies are warranted to examine the efficacy of TCM treatments for healing bone fracture in the elderly.

Risk factors for failed closed reduction of pediatric supracondylar humerus fractures.

The purpose of this retrospective study was to examine pediatric supracondylar humerus fractures at a Level I trauma center. Data were analyzed to identify risk factors associated with closed reduction failure. Closed pediatric supracondylar humerus fractures that were treated at the authors' trauma center between October 1997 and January 2009 were reviewed. The main outcome variable was necessity of open reduction. To determine which factors were independently associated with a failed closed reduction, a multivariate logistic model was fit predicting open reduction status.A total of 174 patients required operative treatment. Of these, 23 underwent open reduction and 151 underwent with closed reduction and percutaneous pinning. For patients who required open reduction, 39.1% had an associated injury compared with 14.6% of patients treated with closed reduction (P=.008). Average time from presentation to surgery was 4.1 hours in the open reduction and 6.3 hours in the closed reduction group (P=.049). Risk factors that significantly predicted failure of closed reduction were the presence of an associated injury, initial fracture displacement, and Gartland type III fracture (P=.008, .03, and .023, respectively).Associated injury, large initial fracture displacement, and Gartland type III factures were statistically significant independent risk factors for closed reduction failure. Increased time from injury to presentation demonstrated a trend toward open reduction. Consideration should be given to the expedient transfer of patients with type III supracondylar humerus fractures with associated injuries when definitive care will be provided at another institution.

Upper extremity stress fractures and spondylolysis in an adolescent baseball pitcher with an associated endocrine abnormality: a case report.

Lower extremity stress fractures are relatively common among competitive athletes. Stress fractures of the upper extremity, however, are rare and most have been reported in the literature as case reports. We present a case of an adolescent baseball pitcher who had both proximal humeral and ulnar shaft stress fractures, as well as spondylolysis of the lumbar spine. This particular patient also had an underlying endocrine abnormality of secondary hyperparathyroidism with a deficiency in vitamin D. A bone mineral density panel demonstrated a high T score (+2.79 SD above the mean) and the patient's biologic bone age was noted to be 2 years ahead of his chronologic age. The patient was treated with a course of vitamin D and calcium supplementation. After treatment, both the vitamin D and parathyroid hormone returned to normal levels. The upper extremity stress fractures and spondylolysis were managed conservatively and he was able to return to full activity and baseball. For patients who present with multiple stress fractures not associated with consistent high levels of repeated stress, a bone mineral density panel should be considered. If vitamin D deficiency is present, a course of oral supplementation may be considered in the management. An endocrinology consult should also be considered in patients who present with multiple stress fractures. Conservative management of upper extremity stress fractures and spondylolysis was successful in returning this patient back to his previous activity level.

Tratamiento del quiste óseo solitario con energía piramidal / Treatment of the solitary bone cyst with pyramidal energy

Se describe el caso clínico de una niña con fractura patológica recurrente a causa de un quiste óseo solitario en el tercio superior del húmero izquierdo. La aplicación de la energía piramidal constituyó una técnica terapéutica eficaz para eliminar el mencionado quiste(AU)

The clinical case of a girl with recurrent pathological fracture due to a solitary bone cyst in the upper third of the left humerus is described. Application of pyramidal energy was an effective therapeutic technique to remove this cyst(AU)

Tratamiento del quiste óseo solitario con energía piramidal / Treatment of the solitary bone cyst with pyramidal energy

Se describe el caso clínico de una niña con fractura patológica recurrente a causa de un quiste óseo solitario en el tercio superior del húmero izquierdo. La aplicación de la energía piramidal constituyó una técnica terapéutica eficaz para eliminar el mencionado quiste.

The clinical case of a girl with recurrent pathological fracture due to a solitary bone cyst in the upper third of the left humerus is described. Application of pyramidal energy was an effective therapeutic technique to remove this cyst.

[Manual reduction of 90 degree bending elbow and external fixation with paper splint for treatment of type I capitellum fractures].

OBJECTIVE: To study the operation points of manual reduction for treatment of capitellum fractures of type I and analyze the characteristics of fixation with paper splint. METHODS: From April 2000 to February 2008, 27 cases with capitellum fractures of type I were treated by manual reduction of 90 degrees bending elbow and external fixation with paper splint, included 23 males and 4 females aged from 5 to 14 years old (means 8.9 years) with the course from 1 to 23 hours (averaged 5.4 hours). Before treatment all the wounded elbows were swollen and malfunctioned, the X-ray film showed that the fracture fragments of capitellum were separated and upside down displaced in varying degrees. During reduction, the correct restoration point was found and the reduction was correct, continuous and steady, and coordinated the passive movement of forearm and elbow joint, and the 90 degrees bending elbow was fixed by paper splint. All the patients were assessed according to JOA elbow joint function assessment method. RESULTS: All 27 patients were followed-up for from 6 months to 2 years (averaged 17 months). All the elbow joints were painless, the movement and functions were normal, the elbow joints were stable. After reduction, no complication was found. There were 25 cases with the fracture site reaches or nearly reaches healing of anatomical counterparts, only 2 cases with slight cubitus valgus deformity. According to JOA score 25 cases gained 100 scores and 2 cases gained 97 scores. CONCLUSION: This method has advantage of strong stability, high success rate, firm and easy fixation, without pressure sore and necrosis.

Outcome of treatment of the mismanaged pediatric elbow trauma: a series of 73 cases.

PURPOSE: To analyze the outcome of the management of pediatric elbow trauma referred to our hospital after initial intervention by traditional bone setters. METHOD: Retrospective study of 73 patients, presenting to the hospital with a complication attributable to the initial mismanagement of their injuries. RESULTS: The mode of presentation was directly related to the type of initial intervention on the basis of which we were able to quantify bone setters into two groups. The first group using a rather rough method of trauma treatment involving the application of tight local bandages, massage and manipulation and a second group having a relatively less rough approach, applying splints to the injured extremity without tight bandages and manipulation. The result of treatment of these injuries was determined by the delay in presentation and the type of injury. CONCLUSION: This study highlights the importance of dealing with the unchecked and unsupervised practice of bone setting in the developing world. We believe that training these people on the pattern of traditional birth attendants can at the very least lower the occurrence, if not entirely eliminate the problem of mismanaged trauma in this part of the world.

Management of fractures of the humerus in Ancient Egypt, Greece, and Rome: an historical review.

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, reduction, and bandaging of humeral fracture in Ancient Egypt, Greece, and Rome.

The role of electromagnetic stimulation in the management of established non-union of long bone fractures: what is the evidence?

BACKGROUND: Non-union following long bone fractures is a cause of significant morbidity to the patient. The management of this condition has proved difficult for the orthopaedic surgeon. Much research has been carried out on the use of electromagnetic stimulation in the healing of non-union. OBJECTIVES: The objective of this review is to determine what evidence exists to support electromagnetic stimulation in the management of established non-union of long bone fractures. METHODS: A systematic search was carried out of the peer-reviewed English language literature to identify all studies investigating electromagnetic stimulation in the treatment of non-union of fractures of long bones. RESULTS: Three of the articles reviewed were randomised clinical trials. Forty-six other studies were also included in the review. CONCLUSIONS: There is a consensus that electromagnetic stimulation is an effective adjunct to conventional therapy when used in the management of non-union of long bone fractures.

Fractura de húmero en el recién nacido: presentación de un caso / Humerus fracture in newborn: a case report

La fractura de húmero en el recién nacido es infrecuente, siendo raramente mencionada en la literatura. En este informe se trata de un recién nacido normal, que nació por parto eutócico y que producto de una maniobra intempestiva realizada por el personal que asistió el trabajo de parto en el Hospital Provincial Docente Manuel de Céspedes, Bayamo, Granma, presentó al nacimiento deformidad a nivel del miembro superior derecho, además de irritabilidad y llanto a la movilización; por lo que es interconsultado con el Especialista en Ortopedia y Traumatología, se solicita radiografía de brazo derecho, constatándose fractura de húmero desplazada, la cual es inmovilizada con férula posterior de yeso por dos semanas teniendo una evaluación satisfactoria(AU)

Fractura de diáfisis humeral en adultos, experiencia con enclavado intramedular con clavo elástico de titanium: Hospital Central de Maracay estado Aragua enero-noviembre 2006 / Fracture of diáfisis humeral in adults, experience with located intramedular with elastic nail of titanium: Hospital Central de Maracay state Aragua january-november 2006

Se valoraron y trataron 7 pacientes adultos con fractura diasfisiaria de húmero, 4 del tipo 12 A2, y un caso con tipos 12 A3, 12 C1, 12 C2, según clasificación AO; se realizó enclavado intramedular elástico de titanio con clavos TENs, fueron valorados según escala de Rockwood y col., modificada por Pérez y Núñez, además de los criterios radiológicos de Balmaceda, observándose 89.71 por ciento de excelencia y 14.28 por ciento bueno, 71 por ciento sexo masculino afectado entre 15-25 años; 42.85 por ciento corresponde a accidentes de tránsito. El tiempo promedio de la técnica quirúrgica 90 minutos, abordaje retrógrado 85.72 por ciento, el promedio de hospitalización 3 días, la movilización de las articulaciones del codo y hombro a las 24 horas postoperatorio, promedio de consolidación de la fractura de 8 semanas, un caso presentó como complicación retardo de consolidación, los arcos de movilidad se consideran buenos a excelentes recuperados para las actividades cotidianas en un promedio de 4 semanas. Podemos concluir que el sistema de enclavado endomedular elástico TENs representa una alternativa de tratamiento para las fracturas diasfisiarias de húmero con trazo simple tipo A2, en pacientes jóvenes, por ser un método cerrado, no amerita inmovilización, y permite realizar rehabilitación precoz de la articulación del codo y hombro inmediata.

Traditional bonesetters in south western Nigeria--friends or foes?

OBJECTIVE: To highlight the dangers inherent in the practice of traditional bone setting in south western Nigeria as evidenced by the preventable complications that accompany treatment of fractures, joint dislocations and limb deformities by traditional bonesetters (TBS). METHOD: Twenty-five consecutive patients with fractures, dislocations and limb deformities who had been previously managed by TBS and who subsequently presented to the University College Hospital, Ibadan (on account of complications from treatment at the TBS) between 15 October 1999 and 31st March 2000 were evaluated. RESULT: Fourteen patients had fracture non-union or malunion necessitating open reduction and internal fixation. Two patients with wet gangrene of the extremities had amputations. CONCLUSION: Traditional bone setting is an ancient trade practiced in Nigeria and most developing countries without government regulations and they lack guidance. The complications that accompany these practices are unacceptable and it is imperative that there should be legislation to curb their activities and save the unsuspecting public from further harm or even death.

Fijación externa, alternativa terapéutica en fracturas del húmero y del fémur en niños / External fixator, alternative therapeutics in humeral and femoral fractures in children

Las fracturas de los niños son tratadas mediante métodos conservadores gracias, entre otras cosas, al ritmo de consolidación y al potencial de remodelación que caracteriza a esa etapa de la vida. Sin embargo, algunos métodos de inmovilización externa tiene el inconveniente de ser aparatosos y poco confortables para el niño que debe mantenerlos de 10 a 14 semanas en el fémur o 6 a 8 semanas en el húmero. La búsqueda de mayor comodidad para el paciente, sin descuidar el objetivo primario que es la recuperación funcional, ha llevado al desarrollo de nuevos materiales o sistemas de inmovilización externa. Se presenta una serie de 9 pacientes pediátricos con fracturas del fémur y 6 del húmero que fueron tratados mediante fijación externa en nuestro servicio y en la consulta privada del autor, en el periodo comprendido entre enero de 1994 y diciembre de 1995. En todos los pacientes se logró la consolidación sin necesidad de tratamiento complementario. En los niños, el sobrecrecimiento a los 2 años de la fractura fue en promedio de 7 mm en el fémur y 3 en el húmero. Los problemas durante el tratamiento fueron mínimos, pudiendo reintegrarse los niños a sus actividades escolares en un máximo de 3 semanas