Supracondylar humeral fractures and lateral elbow condyle fractures in children: association between body weight, clinical signs, and fracture severity.

BACKGROUND: The objective of our study was to investigate the association between body weight, clinical signs and surgical time, and the severity of elbow fractures sustained exclusively by a ground-level fall in children. METHODS: Patients aged 2-11 years with elbow fracture caused exclusively by a ground-level fall were included. BMI was plotted on the sex-specific BMI-for-age percentile growth chart to obtain the BMI percentile. The elbow fractures were classified according to Gartland Classification for supracondylar fractures and the Song Classification for lateral humeral condyle fracture. Our main outcome measurement was Body Mass Index and fracture severity according Gartland or Song classifications. RESULTS: A total of 175 patients with elbow fractures were included in this study. The mean age of total population was 5.4 years (±2.4). The majority of our patients were male (61.7%), nearly of 48% were overweight or obese patients. The ecchymosis and puckering were the clinical sign more frequent in more severe fractures. CONCLUSIONS: Our data presented did not observe a direct relation between obesity and the severity of elbow humeral fractures in the pediatric population with a ground-level fall.

Metástasis bilateral de húmero, en paciente con cáncer renal, tratado con inmunoterapia y cirugía: reporte de un caso / Bilateral Humeral metastases, in a patient with renal cancer, treated with immunotherapy and surgery: case report

El carcinoma de células renales es el 7mo cáncer en frecuencia a nivel mundial con más de 300.000 casos nuevos al año y es la 3era malignidad genitourinaria más frecuente. El sitio más común de metástasis es el pulmón mientras que el esqueleto ocupa el segundo lugar con una frecuencia que varía entre un 20% a un 35%. Se ha reportado una sobrevida de 12 meses en promedio luego de la aparición de metástasis óseas. Reporte del caso de un paciente con diagnóstico de cáncer renal de células claras y metástasis óseas (en columna, pelvis y ambos húmeros), que evoluciona con fractura de ambos brazos. El paciente es aceptado en un ensayo clínico de tratamiento con inmunoterapia y además se somete a una reducción y osteosíntesis bilateral de húmero con clavo endomedular, logrando la consolidación de ambas fracturas y, por ende, la regresión de la enfermedad.

Renal cell carcinoma is ranked 7th in frequent cancer worldwide with more than 3000.000 new cases per year, as well as it's ranked 3rd in frequent genitourinary malignancy. The most common area of metastases is lung followed by skeleton in second place. The frequency of skeleton metastases varies from 20% to 35%. A survival average time of 12 months is generally observed after the appearance of bone metastases. This case report is about a patient diagnosed with clear cell renal cancer and bone metastases (in the spine, pelvis and both humerus) that evolves with fracture of both arms. The patient undergoes a clinical trial with immunotherapy and also a reduction and osteosynthesis of both arms with intramedullary nail, achieving consolidation of both fractures and regression of the disease.

Humeral stress fracture in a female CrossFit athlete: a case report.

BACKGROUND: Humeral stress fractures are rare injuries usually related to sports practice and joint overload without a direct trauma. A proximal humeral stress fracture has never been reported in a CrossFit athlete. CASE PRESENTATION: We report a stress fracture in the humerus of a 22-year-old woman after intense CrossFit training. Patient's previous medical history included amenorrhea and reduced Vitamin D levels. The patient was treated conservatively and resumed CrossFit training after she was advised not to until follow up imaging. CONCLUSIONS: We present the MRI features of the case and emphasize the difficulties in diagnosis due to multiple possible causes of shoulder pain in a CrossFit athlete and by negative findings on early radiographs. Hormonal variations, Vitamin D insufficiency and the patient's attitude towards exercise were important factors that contributed for the stress injury after weight-lifting in CrossFit.

Continuous pain and swelling after humerus fracture in an 86-years-old woman.

Metastases to bone are the most frequent cause of destructive lesions to the skeleton in adults . The tumours that are most likely to metastasize to bone are prostate (32%), breast (22%), kidney (16%), lung and thyroid. The typical distribution of metastatic lesions are to the spine, ribs, pelvis, and proximal limb girdles. The humerus is the second most common site for long bone metastases, behind only the femur in its frequency of involvement . It represents the 20% of all bony metastases. We present a clinical case of an 86 yo woman with a previous diagnosis of myofibroblastic sarcoma of the maxillaris who suffers a pathological fracture of the humeral shaft secondary to metastasis and was misdiagnosed and treated for a typical humeral fracture using and intramedullary pinning (Hackethal technique), producing the progression of the disease within the humeral shaft. Due to the end state of the disease (multiple metastases), we decided to perform a palliative treatment with radiotherapy. This particular case report does confirm that is very important to rule out a malignancy in cases of osteolytic or poorly marginated lesions, particularly in patients older than 40 years of age. Therefore, it is imperative that the treating physician has a rational and effective approach to the diagnostic evaluation and treatment of these patients in order to avoid a malpractice.

Las metástasis del hueso son la causa más frecuente de lesiones destructivas del esqueleto en adultos. Los tumores que tienen más probabilidades de metastatizar a los huesos son próstata (32%), mama (22%), riñón (16%), pulmón y tiroides. La distribución típica de las lesiones metastásicas es a la columna vertebral, las costillas, la pelvis y las cinturas escapular y pélvica. El húmero es el segundo sitio más común para metástasis en huesos largos, sólo detrás del fémur en su frecuencia, representando el 20% de todas las metástasis óseas. Se presenta un caso clínico de una mujer de 86 años con diagnóstico previo de sarcoma miofibroblástico de mandíbula que sufre una fractura patológica de la diáfisis humeral secundaria a metástasis, se diagnosticó erróneamente y se trató como si fuera una fractura normal utilizando pinning intramedular (técnica de Hackethal), produciendo la progresión de la enfermedad dentro de la diáfisis humeral. Debido al estadio final de la enfermedad (metástasis múltiples), decidimos realizar un tratamiento paliativo con radioterapia. Este caso en particular confirma que es muy importante descartar una neoplasia maligna en casos de lesiones osteolíticas o mal delimitadas, particularmente en pacientes mayores de 40 años de edad. Por lo tanto, es imprescindible que el médico tratante tenga un enfoque racional y efectivo para la evaluación diagnóstica y el tratamiento de estos pacientes con el fin de evitar una mala práctica.

Continuous pain and swelling after humerus fracture in an 86-years-old woman / Dolor e inflamación continua posterior a fractura de húmero en una mujer de 86 años

Abstract: Metastases to bone are the most frequent cause of destructive lesions to the skeleton in adults. The tumours that are most likely to metastasize to bone are prostate (32%), breast (22%), kidney (16%), lung and thyroid. The typical distribution of metastatic lesions are to the spine, ribs, pelvis, and proximal limb girdles. The humerus is the second most common site for long bone metastases, behind only the femur in its frequency of involvement. It represents the 20% of all bony metastases. We present a clinical case of an 86 yo woman with a previous diagnosis of myofibroblastic sarcoma of the maxillaris who suffers a pathological fracture of the humeral shaft secondary to metastasis and was misdiagnosed and treated for a typical humeral fracture using and intramedullary pinning (Hackethal technique), producing the progression of the disease within the humeral shaft. Due to the end state of the disease (multiple metastases), we decided to perform a palliative treatment with radiotherapy. This particular case report does confirm that is very important to rule out a malignancy in cases of osteolytic or poorly marginated lesions, particularly in patients older than 40 years of age. Therefore, it is imperative that the treating physician has a rational and effective approach to the diagnostic evaluation and treatment of these patients in order to avoid a malpractice.

Resumen: Las metástasis del hueso son la causa más frecuente de lesiones destructivas del esqueleto en adultos. Los tumores que tienen más probabilidades de metastatizar a los huesos son próstata (32%), mama (22%), riñón (16%), pulmón y tiroides. La distribución típica de las lesiones metastásicas es a la columna vertebral, las costillas, la pelvis y las cinturas escapular y pélvica. El húmero es el segundo sitio más común para metástasis en huesos largos, sólo detrás del fémur en su frecuencia, representando el 20% de todas las metástasis óseas. Se presenta un caso clínico de una mujer de 86 años con diagnóstico previo de sarcoma miofibroblástico de mandíbula que sufre una fractura patológica de la diáfisis humeral secundaria a metástasis, se diagnosticó erróneamente y se trató como si fuera una fractura normal utilizando pinning intramedular (técnica de Hackethal), produciendo la progresión de la enfermedad dentro de la diáfisis humeral. Debido al estadio final de la enfermedad (metástasis múltiples), decidimos realizar un tratamiento paliativo con radioterapia. Este caso en particular confirma que es muy importante descartar una neoplasia maligna en casos de lesiones osteolíticas o mal delimitadas, particularmente en pacientes mayores de 40 años de edad. Por lo tanto, es imprescindible que el médico tratante tenga un enfoque racional y efectivo para la evaluación diagnóstica y el tratamiento de estos pacientes con el fin de evitar una mala práctica.

Increased risk of humerus and lower leg fractures in postmenopausal women with self-reported premenopausal hirsutism and/or oligomenorrhea.

OBJECTIVE: The aim of this study was to investigate the prevalence of fracture in women aged >55 years with self-reported premenopausal hirsutism and/or oligomenorrhea. STUDY DESIGN: A cross-sectional study including 1057 post-menopausal women aged >55 years who were treated in a primary care facility in Santa Maria, South Brazil, from March 2013 through August 2013. Data were collected using a standardized questionnaire for characteristics including fracture history, medication use, and reproductive history (oligomenorrhea, hirsutism, miscarriage, the diagnosis or treatment of hypothyroidism, hyperprolactinemia, or infertility). RESULTS: A non-significant trend towards an increased prevalence of all fragility fractures was observed in women with premenopausal hirsutism and/or oligomenorrhea when compared to those without (20.4% vs. 15.7%). After correction for age, falls, and comorbidities, fracture prevalence was significantly higher in the lower leg (OR 3.1 [CI 1.1-8.6]; P=0.029), and humerus (OR 2.6 [CI 1.2-5.4]; P=0.015) in the women with hirsutism and/or oligomenorrhea. CONCLUSION: This is a hypothesis-generating study which evaluated the association between hirsutism and/or oligomenorrhea and fractures in postmenopausal women. Our results suggest that premenopausal hirsutism and/or oligomenorrhea may be associated with an increased risk of fracture postmenopause, particularly in the humerus and lower leg.

[Increased stability in osteosynthesis of osteoporotic distal humerus with standard implants]. / Aumento de la estabilidad en la osteosíntesis de húmero distal osteoporótico con implantes convencionales.

UNLABELLED: Surgery has proven to be the treatment of choice for distal humerus fractures if one wants to obtain the best results. However, this involves a high degree of complexity and therefore there are poor results. OBJECTIVE: Is it possible to improve the stability of osteosynthesis for osteoporotic distal humerus fractures using standard plates placed together using a screw 4.5 mm in diameter? MATERIAL AND METHODS: In an eight-month period a total of six female patients with distal humerus fractures underwent surgery at IMSS Trauma Emergencies Hospital. TECHNIQUE: A 1/3 tubular lateral plate was fixed to a reconstruction plate 3.5 mm medially using a 4.5 mm cortical screw going from lateral to medial. ASSESSMENT: The Mayo Scale was used to assess the elbow. RESULTS: Mean follow-up was 23.3 months; three right and three left elbows were operated; mean age of females was 78.83 years; three excellent, one good and two fair results were reported, and no poor results. CONCLUSIONS: It is possible to achieve adequate stability with standard implants; good results are obtained.

[Type I Salter-Harris lesion of the distal humeral epiphysis in children under one year of age. Case report and literature review]. / Lesión fisiaria tipo I de Salter y Harris de la epífisis humeral distal en niños menores de 1 año. Reporte de un caso y revisión de la literatura.

The pure physeal lesion of the distal humeral epiphysis is an uncommon and difficult-to-diagnose condition due to the absence of calcified ossification centers during the first three months of life, which usually leads to delaying the diagnosis or to misdiagnosis. However, the prognosis is good and complications are few. We report the case of a 3-month-old female patient who was admitted for open reduction and fixation with Kirschner nails.

Post-traumatic distal humerus non-union : Open reduction and internal fixation: long-term results.

The objective of this paper is to evaluate the long-term functional results achieved after open reduction and internal fixation of 24 distal humerus non-unions. Non-unions were extra-articular-extracapsular (11 cases), extra-articular-intracapsular (8 cases) and intra-articular (5 cases). Preoperative elbow range of motion averaged 45 degrees. Time between original trauma and revision surgery averaged 14 months. Stabilisation methods varied according to type and location of the non-union. Follow-up averaged 46 months (range: 18-108). Elbow range of motion at last examination averaged 98 degrees . Flexion averaged 110 degrees and extension loss averaged 17 degrees . The disabilities of the arm, shoulder and hand (DASH) score averaged 16 points. Secondary transposition of the ulnar nerve was necessary in three cases. Sixteen patients reported no pain at last examination, seven had mild pain and one had moderate pain. Distal humerus non-unions present different characteristics; consequently, surgical treatment must be individualised for each patient. Even though they are demanding procedures, bony union and good long-term functional results were achieved.

Fractura de húmero por medición de fuerzas o gallitos: reporte de casos / Humeral fracture during arm wrestling: case reports

Humeral fracture during arm wrestling is unusual. There are not many cases described. Demographical characteristics and mechanism seems to be a common factor. Frequently, correspond to a distal third humeral shaft spiral fracture. Some cases can be associated to a radial nerve injury. We present 2 cases which shown similar fractures, one of them with radial nerve palsy. Both cases underwent to open reduction and internal fixation.

La fractura de húmero por medición de fuerzas o “gallitos”, es un evento inusual. Los reportes bibliográficos son escasos. Las características demográficas y el mecanismo parecieran ser un factor común en todos los casos. Generalmente, corresponde a una fractura de tercio distal de diáfisis humeral de rasgo espiroideo. En algunas ocasiones se puede asociar a compromiso del nervio radial. Mostramos2 casos, los cuales presentan fracturas de similares características y uno de ellos compromiso del nervio radial. La resolución de ambos casos fue quirúrgica.

[Primary hyperparathyroidism with severe skeletal involvement in one patient with parathyroid carcinoma]. / Hiperparatiroidismo primario con compromiso esquelético grave. Un caso de carcinoma paratiroideo.

Parathyroid carcinoma is an uncommon cause of primary hyperparathyroidism; however, when this condition is severe, cancer must be suspected. We report on a 28-year-old male with severe hypercalcemia, cachexia, acute pancreatitis, urolithiasis, anemia and a severe skeletal involvement with multiple fractures. The patient had a 4-cm parathyroid tumor, that was surgically excised, along with the ipsilateral thyroid lobe. During the postoperative period, he had a severe and prolonged hungry bone syndrome, with a slow recovery of fractures, with functional and anatomical sequelae in the extremities. PTH levels were adequate for the serum calcium during the 16 months of follow-up.

Hiperparatiroidismo primario con compromiso esquelético grave: Un caso de carcinoma paratiroideo / Primary hyperparathyroidism with severe skeletal involvement in one patient with parathyroid carcinoma

Parathyroid carcinoma is an uncommon cause of primary hyperparathyroidism; however, when this condition is severe, cancer must be suspected. We report on a 28-year-old male with severe hypercalcemia, cachexia, acute pancreatitis, urolithiasis, anemia and a severe skelletal involvement with multiple fractures. The patient had a 4-cm parathyroid tumor, that was surgically excised, along with the ipsilateral thyroid lobe. During the postoperative period, he had a severe and prolonged hungry bone syndrome, with a slow recovery of fractures, with functional and anatomical sequelae in the extremities. PTH levels were adequate for the serum calcium during the 16 months of follow-up.

Fractura del húmero en una atleta de judo. Presentación de un caso / Humerus fracture in a judo athlete. A case report

Se presenta un caso de fractura espiroidea con fragmentos libres del húmero y lesión neurológica, en un atleta de 14 años de edad y 72 kg de peso, que se produce durante su enfrentamiento en el deporte de judo. Se discute la frecuencia de la fractura, la causa y el mecanismo de producción

Fractura helicoidal no patológica de húmero en pitcher. Reporte de un caso / Helicoid fracture of the humerus in a baseball pitcher. Case report

Se reporta un caso de fractura helicoidal en deportista joven de 18 años durante el lanzamiento de pitcheo en un juego de béisbol. El interes del informe radica en su infrecuencia

Hidatidosis del húmero complicada con fractura, infección bacteriana, fístula y localización extraósea / Humeral hydatidosis complicated with fracture, bacterial infection, fistula and extrabone location

The clinical case of an apparently healthy 63-year-old man from a rural area, with previous contact with dogs, who had a pathological fracture of the right humerus in presented. Initially he presented slight local pain, and functional discapacity. Eigh months later, after a radiological study and surgery (curettage), diagnosis of hydatid disease was made. Later on, after receiving two courses with albendazole, the parient continued in similar conditions for seven years, when his situation became complicated with bacterial, fistula and extraoseous hydatidosis. The humeral was resected and a segmentary prothesis was successfully set

Fractures of the humerus in arm wrestling.

Two cases of spiral fracture of the humerus, which occurred during arm wrestling, are reported. The possible mechanism is discussed.

Fraturas supracondileanas de úmero em crianças / Supracondylar fractures of the humerus in children

Os autores analisam os conceitos atuais em relaçäo ao diagnóstico e tratamento das fraturas supracondileanas de Umero nas crianças, e fazem consideraçöes sobre como evitar graver complicaçöes. Apresentam estatísticas própria de mais de 70 casos deste tipo de fratura ocorridos no período de apenas 12 meses em pronto socorro traumatológico da cidade de Santa Maria

Fracturas diafisiarias de humero: metodo Sarmiento / Diaphyseal fractures of the humerus: Sarmiento's method

Se realizo una pelicula (Cine Super 8mm) y un informe escrito sobre la experiencia con 54 fracturas diafisiarias de humero en el Hospital General Universitario de la Samaritan, de julio de 1978 a julio de 1981. Las lesiones fueron tratadas con la tecnica tratada por el Dr. Agusto Sarmiento. Esta difiere con la literatura en cuanto al tipo de inmovilizacion, ya que no implica restriccion de las articulaciones vecinas a la fractura. Se aduce un principio hidrostatico para mantener la alineacion y estabilidad del hueso; por otro lado, la funcion precoz del miembro favorece la osteogenesis y evita complicaciones. Los resultados obtenidos son en base a 48 pacientes, ya que los 12 restantes no acudieron a los controles. Por edades el grupo mas afectado es el de la tercera decada de la vida. La etiologia mas frecuente, son los accidentes de transito. Solo una complicacion con retardo de consolidacion en un paciente con una fractura segmentaria. El tiempo promedio de consolidacion fue de 12 semanas y la restauracion de los movimientos en codo y hombro fue excelente. Se ofrecio una rapida reincorcopracion a las labores cotidianas de los pacientes mediante la aplicacion de este metodo funcional