ABSTRACT
OBJECT: To explore the treatment effect of the anterior medial neurovascular interval approach to coronal shear fractures of the distal humerus. METHODS: This prospective study included two female patients who were 30-64 years old, with a mean age of 47 years. Fractures were caused by falling from a bicycle. The time between the injury and operation was 1-2 days, with a mean time interval of 1.5 days. Two patients with coronal shear fracture of the distal humerus were treated with open reduction and internal fixation using anterior neurovascular interval approach. RESULTS: There were no intraoperative and postoperative neurological and vascular complications or infections, and the fracture was united. At 12 months after the surgery, the patient returned to work without pain, and with a normal range of motion for elbow and forearm rotation. The X-rays revealed excellent fracture union, no signs of heterotopic ossification, and no traumatic arthritis. According to Mayo's evaluation standards for elbow function, a score of 100 is excellent. CONCLUSIONS: The application of the anterior neurovascular interval approach of the elbow in the treatment of shear fracture of the articular surface of the distal humerus, particularly the trochlea of the humerus, can reduce the stripping of the soft tissue.
Subject(s)
Elbow Joint/surgery , Fracture Fixation, Internal/methods , Humeral Fractures/surgery , Humerus/injuries , Neurosurgical Procedures/methods , Vascular Surgical Procedures/methods , Adult , Female , Follow-Up Studies , Humans , Humeral Fractures/physiopathology , Humerus/physiopathology , Medical Illustration , Middle Aged , Prospective Studies , Reproducibility of Results , Time Factors , Treatment OutcomeABSTRACT
SUMMARY OBJECT: To explore the treatment effect of the anterior medial neurovascular interval approach to coronal shear fractures of the distal humerus. METHODS: This prospective study included two female patients who were 30-64 years old, with a mean age of 47 years. Fractures were caused by falling from a bicycle. The time between the injury and operation was 1-2 days, with a mean time interval of 1.5 days. Two patients with coronal shear fracture of the distal humerus were treated with open reduction and internal fixation using anterior neurovascular interval approach. RESULTS: There were no intraoperative and postoperative neurological and vascular complications or infections, and the fracture was united. At 12 months after the surgery, the patient returned to work without pain, and with a normal range of motion for elbow and forearm rotation. The X-rays revealed excellent fracture union, no signs of heterotopic ossification, and no traumatic arthritis. According to Mayo's evaluation standards for elbow function, a score of 100 is excellent. CONCLUSIONS: The application of the anterior neurovascular interval approach of the elbow in the treatment of shear fracture of the articular surface of the distal humerus, particularly the trochlea of the humerus, can reduce the stripping of the soft tissue.
RESUMO OBJETIVO: Explorar o efeito do tratamento com uma abordagem anterior do intervalo neurovascular médio para fraturas de cisalhamento coronal da porção distal do úmero. METODOLOGIA: Este estudo prospectivo incluiu duas pacientes do sexo feminino de 30-64 anos de idade, com idade média de 47 anos. As fraturas foram causadas por quedas de bicicleta. O tempo entre a lesão e a operação foi de 1-2 dias, com um intervalo de tempo médio de 1,5 dias. Duas pacientes com cisalhamento coronal da porção distal do úmero foram tratadas com redução aberta e fixação interna utilizando a abordagem anterior do intervalo neurovascular. RESULTADOS: Não houve complicações neurológicas e vasculares intra e pós-operatórias, nem complicações ou infecções, e a fratura foi unida. Após 12 meses da cirurgia, as pacientes retornaram ao trabalho sem dor e com uma amplitude normal de movimento de rotação do antebraço e cotovelo. Os raios-X revelaram excelente união das fraturas, sem sinais de ossificação heterotópica e sem artrite traumática. De acordo com as diretrizes da clínica Mayo para avaliação da função do cotovelo, uma pontuação de 100 é considerada excelente. CONCLUSÃO: A aplicação da abordagem anterior do intervalo neurovascular do cotovelo no tratamento de uma fratura de cisalhamento da superfície articular da porção distal do úmero, especificamente da tróclea do úmero, pode reduzir o desgaste do tecido mole.
Subject(s)
Humans , Female , Adult , Vascular Surgical Procedures/methods , Neurosurgical Procedures/methods , Elbow Joint/surgery , Fracture Fixation, Internal/methods , Humeral Fractures/surgery , Humerus/injuries , Time Factors , Prospective Studies , Reproducibility of Results , Follow-Up Studies , Treatment Outcome , Humeral Fractures/physiopathology , Humerus/physiopathology , Medical Illustration , Middle AgedABSTRACT
PURPOSE: The aim of our study is to show the functional outcomes and complication rates of humeral complex fractures in adults, using osteosynthesis with two bridging orthogonal submuscular plates. METHODS: The study consists of a prospective case series of 13 patients with isolated humeral complex fractures treated with two bridging orthogonal submuscular plates. Functional assessment was performed using disabilities of the arm, shoulder, and hand (DASH) score with 30 items. The age ranged from 22 to 68 years, with a mean age of 39 years. Functional assessment with DASH score was performed at the twelfth postoperative week. RESULTS: All patients presented fracture healing in the fourth postoperative month. Of the 13 patients, five (38%) had a DASH score of zero (best function possible). One patient developed neuropraxis and presented with a score of 100 (worst possible). One case developed superficial infection, which was treated with oral antibiotics and local debridement. CONCLUSIONS: This study demonstrated satisfactory functional outcome in patients with distal-third diaphyseal humeral complex fractures treated with two locked submuscular plates. The authors consider it as a safe method and an efficient alternative, especially in younger patients who require early functional recovery.
Subject(s)
Fracture Fixation, Internal/methods , Humeral Fractures/surgery , Adult , Aged , Bone Plates , Diaphyses/injuries , Diaphyses/surgery , Fracture Fixation, Internal/adverse effects , Fracture Fixation, Internal/instrumentation , Fracture Healing , Humans , Humeral Fractures/physiopathology , Middle Aged , Prospective Studies , Young AdultABSTRACT
BACKGROUND: The AAOS guidelines suggest operative fixation of all type 2 supracondylar humerus fractures. Not all type 2 fractures are the same. Wilkins type 2a fractures have intrinsic stability. The purpose of this paper is to report closed reduction and single-pin fixations for Wilkins 2a fractures. METHODS: Fifteen consecutive type 2a fractures treated with single-pin fixation were prospectively evaluated. Procedure notes, age, sex, side involved, duration of immobilization, and complications were recorded. Radiographs were measured for the lateral humerocapitellar line and the humeral ulna angle. At final follow-up the carrying angle, range of motion, and the Flynn criteria were recorded. RESULTS: The average age of patients was 5 years (age range, 1 to 9 y). Three females and 12 males were studied. Eight right elbows and 7 left elbows were injured. A 0.0625 K-wire was used in 2 cases and a 2 mm K-wire was used in 13 cases. On preoperative lateral radiographs, the anterior humeral line did not intersect the capitellum. On postoperative radiographs, the anterior humeral line intersected the middle third of the capitellum. Following pinning, the elbow was immobilized in a long-arm cast in pronation with elbow at 75 degrees of flexion. The cast and pin were removed at an average of 27 days (range, 25 to 31 d). One patient was lost to follow-up. The remaining 14 patients were followed for at least 3 months. At final follow-up, the carrying angle was within 2 degrees of the opposite elbow and ROM was within 3 degrees of the opposite elbow in all cases. Final Flynn criteria were excellent in all 14 patients. There were no complications. CONCLUSIONS: Treatment of supracondylar fractures has evolved from selective pinning of type 2 fractures to pinning all type 2 fractures. The results of the current study demonstrate the efficacy of using a single lateral entry pin for stabilization of type 2a fractures in children. LEVEL OF EVIDENCE: Level III.
Subject(s)
Bone Wires , Elbow Joint/surgery , Fracture Fixation, Internal/methods , Humeral Fractures/surgery , Casts, Surgical , Child , Child, Preschool , Elbow Joint/physiopathology , Female , Follow-Up Studies , Fracture Fixation, Internal/instrumentation , Humans , Humeral Fractures/physiopathology , Humeral Fractures/therapy , Immobilization , Infant , Male , Range of Motion, Articular , Treatment Outcome , Elbow InjuriesABSTRACT
INTRODUÇÃO: As fraturas supracondilares de Gartland tipo III são as lesões comuns em crianças. Apresentamos um método de redução manipulativa, imobilização e fixação usando gesso-de-Paris, com o cotovelo em extensão total (braço reto). MÉTODO: Estudo retrospectivo analisando todos os pacientes com fraturas supracondilares de Gartland tipo III no Wellington Public Hospital, durante o período de fevereiro de 1999 a março de 2007. Os sete pacientes foram tratados pela técnica do braço reto, e os desfechos clínicos foram revisados neste estudo. RESULTADO: Todos os pais ficaram satisfeitos com os resultados. Usando os critérios de Flynn,6 seis pacientes atingiram excelentes resultados e um teve resultado bom quando se analisou o ângulo de alinhamento. Ao verificar a amplitude de movimento, quatro pacientes tiveram resultados bons, um moderado e dois, ruim. CONCLUSÃO: O tratamento com braço reto das fraturas supracondilares de Gartland tipo III parece ser uma alternativa não-invasiva e segura da fixação com fio K.
OBJECTIVE: Gartland type III supracondylar fractures are a common injury in children. We present a method of manipulative reduction, immobilization and fixation using Plaster of Paris with the elbow in full extension (straight-arm). METHOD: Retrospective study analyzing all patients with Gartland type III supracondylar fractures at the Wellington Public Hospital during the period from February 1999 to March 2007. The seven patients had been treated with the straight-arm technique, and the clinical outcomes are reviewed in this study. RESULT: All the parents were satisfied with the results. Using the Flynn criteria6, six patients achieved excellent results and one good, in relation to the carrying angle. With regard to the range of motion, four patients had good results, one fair, and two poor. CONCLUSION: Straight-arm treatment of Gartland type III supracondylar fractures appears to be a non-invasive and safe alternative to K-wire fixation.
Subject(s)
Humans , Child, Preschool , Child , Fracture Fixation, Internal , Humeral Fractures/physiopathology , Humeral Fractures/rehabilitation , Immobilization/methods , Arm , Brazil , Elbow/injuries , Humeral Fractures , Retrospective StudiesABSTRACT
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.
Subject(s)
Fracture Fixation, Internal/methods , Fractures, Ununited/surgery , Humeral Fractures/surgery , Humerus/injuries , Wounds and Injuries/surgery , Adult , Aged , Disability Evaluation , Elbow Joint/physiopathology , Elbow Joint/surgery , Female , Fracture Healing , Fractures, Ununited/etiology , Fractures, Ununited/physiopathology , Humans , Humeral Fractures/etiology , Humeral Fractures/physiopathology , Intra-Articular Fractures/etiology , Intra-Articular Fractures/physiopathology , Intra-Articular Fractures/surgery , Male , Middle Aged , Pain/physiopathology , Postoperative Complications , Range of Motion, Articular , Recovery of Function , Reoperation , Retrospective Studies , Wounds and Injuries/complications , Young AdultABSTRACT
Presentamos un estudio prospectivo longitudinal y observacional, realizado en el Hospital de Traumatología "Magdalena de las Salinas" del IMSS, durante el periodo comprendido de diciembre de 1991 a diciembre de 1993, seleccionando a 22 pacientes con el diagnóstico de fracturas diafisarias de el húmero, complejas (figuras 1 y 2) y/o complicadas (figura 3), tratados con el sistema de fijación externa tubular modular no transfictivo (figuras 4, 5 y 6). Durante el seguimiento de los pacientes, obtuvimos buenos resultados en un 72.7 por ciento, regulares en un 18.1 por ciento y malos resultados en un 9 por ciento. Observamos las siguientes complicaciones: Clínicas: cuatro casos con lesión del nervio radial postquirúrgico con recuperación del mismo sin secuelas, cuatro casos con alteraciones funcionales en codo y hombro que no limitaban para la realización de sus actividades y que mejoraron con rehabilitación y un caso con anquilosis severa de codo y muñeca (reportados como resultados regulares). Mecánicas: Dos pacientes que evolucionaron a pseudoartrosis (resultados malos). Multifactoriales: en todos los casos se presentó exudado a través de los tornillos Shanz como dato de aflojamiento de los mismos. Con lo referido previamente podemos establecer que el sistema de fijación externa propuesto, es de utilidad en el tratamiento de las fracturas complejas y complicadas de la diáfisis humeral en adultos, proporcionando resultados funcionales y radiológicos satisfactorios y que las complicaciones van estrechamente relacionadas a la magnitud y severidad de la lesión pero que la mayoría puede resolverse satisfactoriamente sin secuelas