An anterior neurovascular interval approach to coronal shear fractures of the distal humerus: a prospective clinical study with short- to mid-term follow-up

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.

Reconstructive surgery in primary malignant and aggressive benign bone tumor of the proximal humerus

Primary malignant bone tumors of the proximal humerus have traditionally been treated by forequarter amputation. However, with the increased interest in limb salvage operations, efforts have been made to improve reconstructive surgery and some methods have become available for tumor control and preservation of a useful distal limb. This report describes three reconstructive techniques used for reconstruction of the humerus following primary tumor excision. We followed 11 patients treated by reconstructive surgery following tumor excision for primary malignant and aggressive benign bone tumors in the proximal humerus. The average follow-up period was 35.6 months. The histologic diagnosis included osteosarcoma (9), chondrosarcoma (1) and giant cell tumor (1). The options for reconstructive surgery following tumor excision were six prosthetic arthroplasties with low heat treated autobone, four arthroplasties with Ender nail and bone cement, and one arthroplasty with custom-made tumor prosthesis. We performed a retrospective analysis regarding functional status, as well as local recurrence, distant metastasis and complication. The functional status at final follow-up averaged 16 points (53.3%) overall: 17 points (56.7%) in the six prosthetic arthroplasties with low heat treated autobone; 15 points (50.0%) in two of four arthroplasties with Ender nail and bone cement (the two others died); and 16 points (53.3%) in the one arthroplasty with custom-made tumor prosthesis. Local recurrence was not observed in any of the cases. The complications noted were one nonunion between reimplanted, low heat treated autobone and the normal distal humerus and two metal failures. Each of these techniques for reconstructive surgery resulted in a relatively good outcome, although somewhat better results were found in the case of prosthetic arthroplasty with low heat treated autobone.

Tratamiento quirúrgico de la inestabilidad glenohumeral multidireccional / Surgical treatment for multidirectional instability of the shoulder

Ensayo clínico realizado entre 1987 y 1992; la muestra estuvo conformada por 22 pacientes que reunieron los criterios de inclusión (inestabilidad glenohumeral multidireccional), las variables de estudios fueron: signos de hiperelasticidad, de inestabilidad glenohumeral, y de alamiento escapular. En todos se realizó tratamiento quirúrgico, y posteriormente llevaron a cabo tratamiento de rehabilitación. Se estudiaron 22 pacientes, 14 de sexo masculino y 8 de sexo femenino; rango de edad de 16 a 35 años; todos mostraron signos de alamiento escapular y en 20 se identificaron signos de alamiento escapular y en 20 se identificaron signos positivos de hiperelasticidad e inestabilidad anterior e inferior. Se mostró negativización de los signos clínicos a las 12 semanas del postoperatorio y hubo reintegración a las actividades deportivas al 5º mes de la cirugía. La técnica quirúrgica utilizada es un procedimiento sencillo, que no limita la movilidad articular y permite una rápida reintegración a las actividades ocupacionales y deportivas. No se registraron complicaciones

Primary lymphoma of the bone involving epiphyseal humerus: report of a case

Lymphoma is considered to be primary in bone when it arises in the medullary cavity without concurrent regional lymph node or visceral involvement. Some of these tumors present with a large extraosseous soft tissue mass with little cortical destruction and periostial reaction on plain radiographs. This may result in a delay in the diagnosis and improper therapy

Luxación recurrente escápulo-humeral anterior variedad subcoracoidea, tratamiento quirúrgico con técnica de De la Fuente: informe de una serie y descripción de la técnica / Scapulo-humeral anterior relapsing dislocation, sub-coracoid variety: treatment by the De la Fuente's technique. report of a series and description of the technique

Se trataron 40 pacientes quirúrgicamente por luxación recurrente escápulo-humeral en su variedad anterior, en el Módulo de Extremidad Torácica del H.T.O.L.V. del IMSS y en la consulta privada del Dr. Víctor De la Fuente Narváez con técnica de artroplastia de "De la Fuente" en el periodo comprendido de agosto de 1974 a noviembre de 1992. Se realizó diagnóstico clínico, radiográfico, artrográfico y tomográfico en todos los pacientes. De los 40 pacientes, 34 (85 por ciento) correspondieron al sexo masculino y seis (15 por ciento) al sexo femenino. Las edades fluctuaron entre los 17 y 59 años de edad con una media de 38 años. El tiempo de evolución postquirúrgica de 15 pacientes fue de 2-19 años y el resto de 2-8 meses. Se intervinieron 22 (55 por ciento) obreros, 10 (25 por ciento) profesionistas, cuatro (10 por ciento) estudiantes, tres (7.5 por ciento) amas de casa y un (1.5 por ciento) deportistas. Se obtuvieron 31 (77.5 por ciento con resultados excelentes, ocho (20 por ciento) pacientes con buenos resultados y un (2.5 por ciento) pacientes con regular resultado. No hemos encontrado malos resultados

Rotational deformity of the distal humerus in cubitus varus.

The medial rotation deformity of the distal humerus usually exists in the cubitus varus deformity but has received little attention. Study of this deformity in 29 cases of cubitus varus was carried out using the osteotomized bony specimens that were removed during closed wedge osteotomy in order to determine the actual bone deformity. The average duration of the varus deformity was 5.6 yrs (range 1 to 11). The medial rotation deformity of the distal humerus averaged 27 degrees (range 15 to 45). There was no correlation between the degree of rotation and that of the varus deformity (correlation coefficient r = 0.15). The affected-side shoulder compensated well in both internal and external rotation, and had a greater arc of rotation than that of the normal side. The affected-side shoulder exhibited an internal rotation deformity with an average of 16 degrees (range 5 to 25), with restriction of external rotation of only 13 degrees (range 0 to 20) in comparison to normal side shoulder.

Síndrome de hombro doloroso secundario a tenonitis bicipital: resultados del tratamiento quirúrgico / Painful shoulder syndrome secondary to bicipital tendinitis: results of surgical treatment

En el Hospital de Traumatología y Ortopedia "Lomas Verdes" del Instituto Mexicano del Seguro Social, en el Módulo de extremidad Torácica, se trataron quirúrgicamente 42 pacientes de síndrome de hombro doloroso, por tenonitis del bicipital. Seis de ellos presentaron capsulitis adhesiva. El periodo se estudio compresndió de marzo de 1987 a marzo de 1991, el diagnóstico se realizó con base en estudios clínicos-radiográficos, los cuales se complementaron con ultrasonografía en 10 pacientes. En todos fracasó el tratamiento conservador y se excluyó del estudio a aquellos en quienes existía patología metabólica de fondo. Se utilizaron tres procedimientos de acuerdo con los hallazgos transoperatorios; revisión, tenodesis en la corredera bicipital y transposición tendinosa de la porción larga del bíceps a la apófisis coracoides. En todos los casos se realizó liberación quirúrgica subacromial y en seis se agregó capsulotomía ántero-inferior. La evaluación postoperatoria final se realizó a los cinco años como máximo y seis meses como mínimo; se obtuvieron 13 (30 por ciento) de casos excelentes; 24 (57 por ciento) de buenos resultados; cuatro (10 por ciento) regulares y uno (2 por ciento) malo.

Treatment of radial neuropathy associated with fracture humerus

Twelve humeral shaft fractures with associated radial nerve injuries in twelve patients, with adequate follow-up were seen over a period of three years. Initial treatment was closed reduction and plaster fixation in eleven patients. Two of the twelve patients were treated by delayed exploration at ten and twelve weeks. All patients had complete recovery of radial nerve functions. We recommend careful observation for return of radial nerve functions, and exploration at twelve weeks after injury if there is still no clinical or electromyographic evidence of recovery at that time

Displaced fractures of the proximal end of the humerus

Thirty five proximal humeral fractures were reviewed in relation to the Neer classification and the treatment given. Twenty-two cases were - treated conservatively and thirteen cases were treated surgically by open reduction and internal fixation by AO buttress plate in 7 cases and by K-wire and screws in 5 cases and by arthrodesis in one neglected case. In the displaced two-part fractures and fracture dislocation there was no significant difference in the results between the surgical and the conservative groups. Closed treatment gave satisfactory results in the three part fractures [5 cases] but not in the four part fractures [6 cases]. Dislocated-fractures of the humeral head should be treated by means of osteosynthesis. In younger patients osteosynthesis by T-shaped buttress plate has been used as the method of choice. In older patients open reduction and K wires fixation could be used