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Sample records for complex proximal humerus

  1. Fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig

    2013-01-01

    . The bandages were further supported by splints made of wood or coarse grass. Healing was expected in forty days. Different fracture patterns have been discussed and classified since Ancient Greece. Current classification of proximal humeral fractures mainly relies on the classifications proposed by Charles......, classification of proximal humeral fractures remains a challenge for the conduct, reporting, and interpretation of clinical trials. The evidence for the benefits of surgery in complex fractures of the proximal humerus is weak. In three systematic reviews I studied the outcome after locking plate osteosynthesis......Fractures of the proximal humerus have been diagnosed and managed since the earliest known surgical texts. For more than four millennia the preferred treatment was forceful traction, closed reduction, and immobilization with linen soaked in combinations of oil, honey, alum, wine, or cerate...

  2. Second generation locked plating for complex proximal humerus fractures in very elderly patients.

    Science.gov (United States)

    Gavaskar, Ashok S; Karthik B, Bhupesh; Tummala, Naveen C; Srinivasan, Parthasarathy; Gopalan, Hitesh

    2016-11-01

    Humeral head sacrificing procedures are more favored in elderly patients with complex proximal humerus fractures because of high incidence of failures and complications with osteosynthesis. The purpose of this study is to assess the outcome of second generation locked plating techniques in 3 and 4 part fractures in active elderly patients >70years with an emphasis on function and complications. 29 patients with displaced 3 and 4 part proximal humerus fractures were treated using the principles of second-generation proximal humerus locked plating. Fixed angle locked plating (PHILOS) using the anterolateral deltoid spilt approach augmented with traction cuff sutures was performed. Minimum of 7 locking head screws including 2 calcar screws were used. In cases with a comminuted medial calcar, an endosteal fibular strut was used. Subchondral metaphyseal bone voids were filled with injectable calcium phosphate cement. Radiological outcome (union, head - shaft angle, tuberosity reduction), functional outcome assessment (Constant and ASES scores) and complications (loss of reduction, nonunion and osteonecrosis) were assessed. The fracture united in 24 of the 26 patients available for follow up at a mean of 27 months (12-40 months). 3 patients developed complications that required arthroplasty (fixation failure in 2 patients and osteonecrosis in 1 patient). Follow up age adjusted Constant (63.1±11.9) and ASES scores (62.58±7.5) showed the extent of functional improvement post surgery. Patients with fractures having a non-comminuted medial calcar and valgus displacement of the humeral head had better functional scores and fewer complications. Osteosynthesis with second generation locked plating techniques provide satisfactory outcome in very elderly patients with complex proximal humerus fractures with minimal complications. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Open reconstruction of complex proximal metadiaphyseal fragility fractures of the humerus.

    Science.gov (United States)

    James, Isaac B; Farrell, Dana J; Evans, Andrew R; Siska, Peter A; Tarkin, Ivan S

    2014-03-01

    A proactive surgical and rehabilitation protocol was implemented to manage humeral fractures involving both the proximal end and shaft in an older patient population. Primary treatment goals were early return to function and reliable fracture union with minimal complications. From 2008 to 2012, 21 such operations were performed; 18 were considered "fragility" fractures based on mechanism, patient age, and evidence of osteopenia or osteoporosis. Open reduction and internal fixation (ORIF) was employed using direct reduction and fixation with a long periarticular locking plate. Physiotherapy was commenced 2 weeks postoperatively. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was used to assess functional outcome at a time point greater than 1 year postoperative. The study group consisted primarily of elderly females (83% with a median age of 69 years) whom sustained complex metadiaphyseal proximal humeral fractures after simple mechanical fall (78%). Uneventful union occurred in all cases. Local complications included 1 case of partial radial nerve palsy, which had resolved completely by 1 year. No cases of infection were identified. Long-term return to functionality was evident with a median DASH score of 12 (mean = 21, standard deviation = 20, n = 13). Seventy five percent of patients reported minimal or no pain (question [Q] 24), and 75% achieved return of overhead function (Q6, 12, and 15). Treatment of complex metadiaphyseal fragility fractures with anatomic reduction, fixed angle plating, and early physiotherapy returns the older patient to optimized functionality with minimal risk of complication. The DASH outcomes are equivalent to ORIF of isolated proximal humerus fractures and clinically indistinguishable from the general population.

  4. Large metaphyseal volume hemiprostheses for complex fractures of the proximal humerus.

    Science.gov (United States)

    Fucentese, Sandro F; Sutter, Reto; Wolfensperger, Fabian; Jost, Bernhard; Gerber, Christian

    2014-03-01

    Results of hemiarthroplasty after acute complex proximal humerus fractures are controversial. The main problem is the fixation and healing of the greater tuberosity (GT). To address this problem a hemiarthroplasty with a large metaphyseal volume was designed and introduced. Thirty hemiarthroplasties were implanted for acute, complex, proximal humeral fractures in 30 consecutive patients (average age: 63.3 years; range, 41-78). One patient was lost; 2 patients could only be interviewed telefonically. Two patients had to be revised because of secondary displacement of the GT within the first 2 postoperative years. The remaining 25 patients were assessed clinically, radiographically, and with computer tomography (CT) imaging after a mean of 25 months (range, 24-29). Greater tuberosity healed in situ in 23 patients. In 12 cases, CT documented severe resorption of GT without displacement of a measurable bone fragment and an intact clinical cuff function with a radiographically preserved acromio-humeral distance. The mean Constant score was 59 points (range, 26-81), the mean relative Constant score 75% (range, 31-100). The mean anterior elevation was 117° (range, 45-160). The mean subjective shoulder value was 70% (range, 25-98). In 4 cases (14%), tuberosity dislocation occurred which was associated with an increase of fatty infiltration and poor result. The 2-year results with a large metaphyseal volume fracture-prosthesis showed good to excellent results, with a failure rate of 14%. Substantial resorption of the greater tuberosity was frequent, but was not associated with functional incompetence of the rotator cuff. The overall results obtained justify its continued use. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  5. Locking plate fixation for proximal humerus fractures.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2012-02-01

    Locking plates are increasingly used to surgically treat proximal humerus fractures. Knowledge of the bone quality of the proximal humerus is important. Studies have shown the medial and dorsal aspects of the proximal humeral head to have the highest bone strength, and this should be exploited by fixation techniques, particularly in elderly patients with osteoporosis. The goals of surgery for proximal humeral fractures should involve minimal soft tissue dissection and achieve anatomic reduction of the head complex with sufficient stability to allow for early shoulder mobilization. This article reviews various treatment options, in particular locking plate fixation. Locking plate fixation is associated with a high complication rate, such as avascular necrosis (7.9%), screw cutout (11.6%), and revision surgery (13.7%). These complications are frequently due to the varus deformation of the humeral head. Strategic screw placement in the humeral head would minimize the possibility of loss of fracture reduction and potential hardware complications. Locking plate fixation is a good surgical option for the management of proximal humerus fractures. Complications can be avoided by using better bone stock and by careful screw placement in the humeral head.

  6. Arthroplasty for the surgical management of complex proximal humerus fractures in the elderly: a cost-utility analysis.

    Science.gov (United States)

    Nwachukwu, Benedict U; Schairer, William W; McCormick, Frank; Dines, David M; Craig, Edward V; Gulotta, Lawrence V

    2016-05-01

    Shoulder hemiarthroplasty (HA) has been the standard treatment for complex proximal humerus fractures in the elderly requiring surgery but not amenable to fixation. Reverse total shoulder arthroplasty (RTSA) has also emerged as a costly albeit highly effective alternative. The purpose of this study was to compare the cost-effectiveness of nonoperative fracture care, HA, and RTSA for complex proximal humerus fractures from the perspective of both U.S. payors and hospitals. A Markov model was constructed for the treatment alternatives. Costs were expressed in 2013 U.S. dollars and effectiveness in quality-adjusted life-years (QALYs). The principal outcome measure was incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to evaluate model assumptions. In the base case, from the payor perspective, RTSA was associated with an ICER of $8100/QALY; HA was eliminated from payor analysis as a cost-ineffective strategy. From the hospital perspective, however, HA was not cost-ineffective and the ICER for HA was $36,700/QALY, with RTSA providing incremental effectiveness at $57,400/QALY. RTSA was the optimal strategy in 61% and 54% of payor and hospital probabilistic sensitivity analyses, respectively. The preferred strategy was dependent on associated QALY gains, primary RTSA cost, and failure rates for RTSA. RTSA can be a cost-effective intervention in the surgical treatment of complex proximal humerus fractures. HA can also be a cost-effective intervention, depending on the cost perspective (cost-ineffective for payor but cost-effective for the hospital). This analysis highlights the opportunities for increased cost-sharing strategies to alleviate the cost burden on hospitals. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  7. Open Reduction and Internal Fixation (ORIF) of Complex 3- and 4-Part Fractures of the Proximal Humerus

    Science.gov (United States)

    Grawe, Brian; Le, Toan; Lee, Thomas; Wyrick, John

    2012-01-01

    Introduction: Treatment of complex fracture patterns of the proximal humerus continues to be a challenging and controversial clinical scenario. The aim of this study was to report on the outcomes of complex displaced 3- and 4-part fractures of the proximal humerus treated with locked plating and compare the functional results of patients on the basis of age at time of injury. Methods: A retrospective review was completed to identify patients whom had sustained a 3- or 4-part fracture of the proximal humerus (Neer classification), treated surgically with locked compression plating. Patients were recruited for a final follow-up, with clinical (Constant and Disabilities of the Arm, Shoulder, Hand [DASH] scores) and radiographic outcome analysis. Results were compared (t test and Wilcoxon test) with fracture type (3- vs 4-part) and patient age at time of fracture (65years) as the primary outcome measure. The presence or absence of a complication and presence or absence of a concomitant osseous injury at the time of presentation were evaluated as secondary outcome measures, in regard to overall functional results of the treatment in question. Complications were defined as posttraumatic osteoarthritis, avascular necrosis of the humeral head, and screw cutout with chondrolysis. The null hypothesis being that age of the patient at the time of injury would not greatly affect functional outcome measurements. Results: Forty-five fractures were identified in 45 patients, with 31 three-part fractures and 14 four-part fractures, and 17 patients were available for final follow-up (9 three-part and 8 four-part). Twelve patients were identified as under the age of 65 years and were compared with 5 patients who were identified as older than 65 years of age. The relative Constant score, at final follow-up, for those under the age of 65 was 88.58, while the score for those above the age of 65 was 82.5. In a similar fashion, the DASH score for those younger than 65 was 11.67, while the

  8. Clinical evaluation of a new custom offset shoulder prosthesis for treatment of complex fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Mehlhorn, Alexander T; Schmal, Hagen; Sudkamp, Norbert P

    2006-01-01

    A and only 33% in Group B. The least satisfying partial function was shoulder mobility in both groups. Radiographic evaluation did not correlate with the Constant Score. Patients secondarily treated with arthroplasty seem to have less chance to achieve a satisfying functional outcome compared to those......Primary hemiarthroplasty of the shoulder is an accepted procedure to treat complex proximal humeral fractures. The goal of this study was to assess the functional outcome in patients treated with hemiarthroplasty using a custom offset shoulder prosthesis, either for an acute four-part fracture...... of the proximal humerus or following failed primary treatment of a complex humeral fracture. Thirty seven patients were followed up for a mean of 17 months after shoulder replacement (Group A: four-part-fractures; n = 26, Group B: posttraumatic necrosis/non-union after failed primary treatment; n = 11...

  9. Impacted valgus fractures of the proximal humerus

    Directory of Open Access Journals (Sweden)

    Fabiano Rebouças Ribeiro

    2016-04-01

    Full Text Available Impacted valgus fractures of the proximal humerus are considered to be a special type fracture, since impaction of the humeral head on the metaphysis with maintenance of the posteromedial periosteum improves the prognosis regarding occurrences of avascular necrosis. This characteristic can also facilitate the reduction maneuver and increase the consolidation rate of these fractures, even in more complex cases. The studies included were obtained by searching the Bireme, Medline, PubMed, Cochrane Library and Google Scholar databases for those published between 1991 and 2013. The objective of this study was to identify the most common definitions, classifications and treatment methods used for these fractures in the orthopedic medical literature.

  10. Open Reduction and Internal Fixation (ORIF) of Complex 3- and 4-Part Fractures of the Proximal Humerus: Does Age Really Matter?

    Science.gov (United States)

    Grawe, Brian; Le, Toan; Lee, Thomas; Wyrick, John

    2012-03-01

    Treatment of complex fracture patterns of the proximal humerus continues to be a challenging and controversial clinical scenario. The aim of this study was to report on the outcomes of complex displaced 3- and 4-part fractures of the proximal humerus treated with locked plating and compare the functional results of patients on the basis of age at time of injury. A retrospective review was completed to identify patients whom had sustained a 3- or 4-part fracture of the proximal humerus (Neer classification), treated surgically with locked compression plating. Patients were recruited for a final follow-up, with clinical (Constant and Disabilities of the Arm, Shoulder, Hand [DASH] scores) and radiographic outcome analysis. Results were compared (t test and Wilcoxon test) with fracture type (3- vs 4-part) and patient age at time of fracture (65years) as the primary outcome measure. The presence or absence of a complication and presence or absence of a concomitant osseous injury at the time of presentation were evaluated as secondary outcome measures, in regard to overall functional results of the treatment in question. Complications were defined as posttraumatic osteoarthritis, avascular necrosis of the humeral head, and screw cutout with chondrolysis. The null hypothesis being that age of the patient at the time of injury would not greatly affect functional outcome measurements. Forty-five fractures were identified in 45 patients, with 31 three-part fractures and 14 four-part fractures, and 17 patients were available for final follow-up (9 three-part and 8 four-part). Twelve patients were identified as under the age of 65 years and were compared with 5 patients who were identified as older than 65 years of age. The relative Constant score, at final follow-up, for those under the age of 65 was 88.58, while the score for those above the age of 65 was 82.5. In a similar fashion, the DASH score for those younger than 65 was 11.67, while the score for those older than 65

  11. Treatment of complex acute proximal humerus fractures using hemiarthroplasty Tratamento das fraturas complexas agudas da extremidade proximal do úmero com o uso de hemiartroplastia

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    Bruno Lobo Brandão

    2013-01-01

    Full Text Available OBJECTIVE: Evaluate the clinical and radiological results of hemiarthroplasty for treatment of complex proximal humerus fractures. METHODS: Sixty-seven patients were included, with follow-up of 12 to 62 months. Mean age was 65 years (44 to 88, and 47 patients were female (70%. Clinical assessment was performed using the University of California Los Angeles score (UCLA and measurement of range of motion (ROM according to the American Academy of Orthopaedic Surgeons criteria. A standardized radiological evaluation was conducted, with special attention to healing and position of tuberosities. Patients were divided into two groups: A (anatomical healing of tuberosities and B (without anatomical healing of tuberosities. Statistical analyses were performed using the t test. Level of significance was set at p OBJETIVO: Avaliar os resultados funcionais e radiográficos dos pacientes submetidos à hemiartroplastia para tratamento das fraturas complexas da extremidade proximal do úmero. MÉTODOS: Foram incluídos 67 pacientes, com seguimento que variou entre 12 e 62 meses. A média de idade foi de 65 anos (44 a 88 e 47 pacientes eram do sexo feminino (70%. Os pacientes foram avaliados clinicamente por meio da avaliação da amplitude de movimentos (ADM e do escore funcional da University of California Los Angeles (UCLA. A avaliação radiográfica foi feita de forma padronizada com divisão dos pacientes em dois grupos: A (consolidação do tubérculo maior em posição anatômica e B (ausência de consolidação anatômica do tubérculo maior. Na análise estatística consideramos significativos os achados com p < 0,05. RESULTADOS: A pontuação média do UCLA foi de 26 pontos, com média de oito pontos para dor e 64 pacientes satisfeitos subjetivamente (96%. Na avaliação da amplitude de movimento (ADM ativa encontramos uma média de 104º de flexão anterior e 36º de rotação lateral. No grupo A, com 33 pacientes, encontramos uma média de 122º de

  12. Locking plate osteosynthesis in displaced 4-part fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig; Frich, Lars H; Winther, Annika

    2011-01-01

    There is considerable uncertainty about the optimal treatment of displaced 4-part fractures of the proximal humerus. Within the last decade, locking plate technology has been considered a breakthrough in the treatment of these complex injuries.......There is considerable uncertainty about the optimal treatment of displaced 4-part fractures of the proximal humerus. Within the last decade, locking plate technology has been considered a breakthrough in the treatment of these complex injuries....

  13. Reverse shoulder arthroplasty in acute fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig; Rasmussen, Jeppe V; Olsen, Bo S

    2013-01-01

    The indications for surgical intervention in complex fractures of the proximal humerus are disputed. In elderly patients with poor bone stock it may be impossible to obtain satisfactory fixation of the tuberosities to a hemiarthroplasty (HA). In such cases primary insertion of a reverse shoulder...... control group of HA. The median constant score was 58 (range 44-68) which is comparable to previous reviews of HA in 4-part fractures. Complications included dislocation, infection, hematoma, instability, neurological injury, reflex sympathetic dystrophy, intraoperative fractures, periprosthetic fractures...

  14. Conservative Treatment for Bilateral Displaced Proximal Humerus Head Fracture

    OpenAIRE

    Rodriguez-Corlay, Ruy E; Velutini-Becker, Ricardo; Aguilar-Alcal?, Luis D

    2016-01-01

    Proximal humerus fracture represents five to eight percent of all fractures and is twice as common in women than in men. Most cases of displaced fracture of the proximal humerus are treated surgically; it is probable that more cases are preferred to be treated surgically greater than required. The optimal treatment for these fractures remains controversial, but physicians have a tendency to treat via open reduction and fixation with angular locking plates or glenohumeral arthroplasty.? We pre...

  15. Treatment of three- and four-part proximal humeral fractures with locking proximal humerus plate.

    Science.gov (United States)

    Sun, Jing-Cheng; Li, Yu-Lin; Ning, Guang-Zhi; Wu, Qiang; Feng, Shi-Qing

    2013-08-01

    The purpose of this study was to evaluate the effectiveness and complications of the locking proximal humerus plate to treat proximal humerus fractures. A retrospective clinical trial. Department of Orthopaedics, Tianjin Medical University General Hospital. Sixty-eight consecutive patients with three- or four-part fractures of the proximal humerus were treated with locking proximal humerus plates. The deltopectoral anterolateral acromial approach was used to the proximal humerus; open reduction and locking proximal humerus plate were applied. Constant Score was used to measure the shoulder functional recovery, and Visual Analog Scale (VAS) was used to measure subjective evaluation of pain. The radiology was observed. After average 26.7 months, the average Constant Score was 72.6 ± 13.2 points and the average VAS was 1.2 ± 0.8 points. All the complications such as screw perforation into the glenohumeral joint, screws loosening, soft tissue infections, avascular necrosis and delayed union occurred in eight cases (11.8 %). The effectiveness of the locking proximal humerus plate was similar to other published literatures on treating fractures of the proximal humerus; however, a lower complications rate in short follow-up time was observed in this study. It may potentially provide a favorable option for treating three- or four-part fractures of the proximal humerus. Dealing with each particular fracture pattern, surgeons should have a decision of appropriate way to internal fixation.

  16. Design and Clinical Application of Proximal Humerus Memory Connector

    Science.gov (United States)

    Xu, Shuo-Gui; Zhang, Chun-Cai

    2011-02-01

    Treatment for comminuted proximal humerus fractures and nonunions are a substantial challenge for orthopedic surgeons. Plate and screw fixation does not provide enough stability to allow patients to begin functional exercises early after surgery. Using shape memory material nickel titanium alloy, we designed a new device for treating severe comminuted proximal humerus fractures that accommodates for the anatomical features of the proximal humerus. Twenty-two cases of comminuted fracture, malunion, and nonunion of the proximal humerus were treated with the proximal humeral memory connector (PHMC). No external fixation was needed after the operation and patients began active shoulder exercises an average of 8 days after the operation. Follow-up evaluation (mean 18.5 months) revealed that bone healing with lamellar bone formation occurred an average of 3.6 months after surgery for the fracture cases and 4.5 months after surgery for the nonunion cases. Average shoulder function was 88.5 according to the criteria of Michael Reese. PHMC is an effective new device to treat comminuted proximal humerus fractures and nonunions. The use of this device may reduce the need for shoulder joint arthroplasty.

  17. Bizarre parosteal osteochondromatous proliferation of the proximal humerus: case report

    Energy Technology Data Exchange (ETDEWEB)

    Bush, J.B.; Meyer, Mark S. [Ochsner Clinic Foundation, Department of Orthopedics, New Orleans, LA (United States); Reith, John D. [University of Florida College of Medicine, Departments of Pathology, Immunology and Laboratory Medicine and Orthopaedics and Rehabilitation, Gainesville, Florida (United States)

    2007-06-15

    Bizarre parosteal osteochondromatous proliferation (BPOP), or Nora's lesion, is a rare lesion of bone occurring predominantly in the long bones of the hands and feet. It exists as a puzzling clinical entity of uncertain origins and high recurrence rates after surgical resection. To our knowledge, this clinical entity has not been reported in the proximal aspect of the humerus. An interesting report of a lesion occurring in the proximal humerus, which initially was misinterpreted as a parosteal osteosarcoma, is discussed outlining the clinical, radiographic and pathologic features of the BPOP lesion. (orig.)

  18. Results of the proximal humerus endoprosthetic reconstruction after tumour resection

    Directory of Open Access Journals (Sweden)

    I. M. Mikailov

    2014-01-01

    Full Text Available The purpose of the study was to evaluate the results of surgical reconstructions of the proximal humerus after transarticular tumour resection, compare the functional results with the results of shoulder arthroplasty in patients with extensive damage of the proximal humerus of non-neoplastic origin. Material and methods. Between 2001 and 2013 38 proximal humeral reconstructions were performed in our clinic: using monopolar endoprostheses - 26 (68% and modular systems with reversible head -12 (32%. The control group included 46 patients with extensive lesions of the proximal humerus of non-neoplastic origin, operated in our clinic in the period from 2006 to 2012. Term follow-up of patients ranged from 7 months to 9 years. Assessment of functional results was carried out in a period from six months to one year. Results. The seven-year survival according the Kaplan - Meier method for patients with primary malignant tumors of the proximal humerus (25 patients was 77%. In the study group the average value of functional outcome MSTS score was 77.7%. Unipolar prosthesis showed a bad result, both in the control (61,3% MSTS, 60,7 Neer and in the main (67,7% MSTS, 61,1 Neer study groups. Conclusion. Currently the method of choice which doesn’t impair the oncologic component of treatment patients with shoulder neoplastic lesions is its replacement with modular reversible systems in combination with additional soft tissue fixation.

  19. Missed posterior shoulder dislocation with malunited proximal humerus fracture

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    Kumar Sunil

    2013-12-01

    Full Text Available 【Abstract】Posterior dislocation of the shoulder may be missed or neglected at initial presentation especially in developing countries. We present a case of 40-year-old In- dian man who had 3-month missed posterior dislocation of the right shoulder along with malunited fracture of the ana- tomical neck of the humerus. Open reduction and stabiliza- tion with modified McLaughlin procedure was performed. Rotational osteotomy of proximal humerus had to be per- formed as supplementary procedure to keep the humeral head stable in glenoid cavity during functional range of movements. The patient had excellent result of the shoulder at 3 years follow-up. Key words: Shoulder dislocation; Humerus; Osteotomy

  20. Intramedullary Nailing for Pathological Fractures of the Proximal Humerus.

    Science.gov (United States)

    Choi, Eun-Seok; Han, Ilkyu; Cho, Hwan Seong; Park, In Woong; Park, Jong Woong; Kim, Han-Soo

    2016-12-01

    Endoprosthetic reconstruction is widely applied for pathological fractures of the proximal humerus; however, functional impairment is usually unsatisfactory. The aims of the current study are to evaluate the reliability of interlocking intramedullary (IM) nailing with cement augmentation as a fixation method in proximal humeral lesions and to assess functional outcomes. We reviewed 32 patients with pathological fractures of the proximal humerus who underwent interlocking IM nailing and cement augmentation. Functional scores and pain relief were assessed as outcomes. The mean follow-up period was 14.2 months. The mean Musculoskeletal Tumor Society functional score and Karnofsky performance status scale score were 27.7 and 75.6, respectively. Improvement of pain assessed using the visual analogue scale was 6.2 on average. Thirty-one patients (97%) experienced no pain after surgery. The mean ranges of forward flexion and abduction were 115° and 112.6°, respectively. All patients achieved stability and had no local recurrence without failure of fixation until the last follow-up. Proximal interlocking IM nailing with cement augmentation appears to be a reliable treatment option for pathological or impending fractures of the proximal humerus in selected patients with metastatic tumors, even with extensive bone destruction.

  1. Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates

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    Jaiswal Atin

    2013-12-01

    Full Text Available 【Abstract】Fractures of the proximal humerus are uncommon in young patients. Although bilateral fracture of proximal humerus itself is rare, association with epilepsy and electrocution is frequent. Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature. We report a rare case of bilateral traumatic dis- placed proximal humerus fractures in a 40 years old male patient, which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome. Key words: Humeral fractures; Shoulder fractures; Fracture fixation, internal

  2. FUNCTIONAL OUTCOME OF PHILOS PLATE FIXATION FOR PROXIMAL HUMERUS FRACTURES

    Directory of Open Access Journals (Sweden)

    Ch. Venkateswarlu

    2016-01-01

    Full Text Available INTRODUCTION Treating a proximal humerus fracture remained a challenging problem until proximal humeral internal locking system has been developed. Our study aims at evaluating the functional outcome of 30 consecutive patients with proximal humeral fracture treated by Philos plate fixation; 30 patients with proximal humeral fractures who attended our hospital between December 2013 and December 2015 were included in the study; 18 women and 12 men with a mean age of 47.5years (30-60 years are included. Data was collected prospectively and outcomes were assessed using constant shoulder score. The mean follow-up period was 12 months (6-18 months. Mean union time of all the fractures was 11.4 weeks (8-20 weeks. The mean constant shoulder score at final review was 70.5 (52-92. Philos plate provides stable fracture fixation for proximal humerus fracture in both young and elderly patients, which enables for early mobilisation and achieves acceptable functional results.

  3. Surgical treatment of proximal humerus fractures using PHILOS plate

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    Vijay Sharma

    2014-10-01

    Full Text Available 【Abstract】Objective: To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system (PHILOS plate for proximal humerus fractures. Methods: We reviewed 51 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2007 to 2012. There were 35 men and 16 women with a mean age of 38 years (range 24-68. There were 41 patients in the age group of <60 years and 10 patients in the age group of >60 years. According to Neer classification system, 8, 15 and 23 patients had 2-part, 3-part, and 4-part fractures, respectively and 5 patients had 4-part fracture dislocation. All surgeries were carried out at our tertiary care trauma centre. Functional evaluation of the shoulder at final follow-up was done using Constant-Murley score. Results: The mean follow-up period was 30 months (range 12-44 months. Two patients were lost to followup. Of the remaining 49 patients, all fractures were united clinically and radiologically. The mean time for radiological union was 12 weeks (range 8-20 weeks. At the final follow-up the mean Constant-Murley score was 79 (range 50-100. The results were excellent in 25 patients, good in 13 patients, fair in 6 atients and poor in 5 patients. During the follow-up, four cases of varus malunion, one case of subacromial impingement, one case of deep infection, one case of intraarticular screw penetration and one case of failure of fi xation were noted. No cases of avascular necrosis, hardware failure, locking screw loosening or nonunion were noted. Conclusion: PHILOS provides stable fixation in proximal humerus fractures. To prevent potential complications like avascular necrosis, meticulous surgical dissection to preserve vascularity of humeral head is necessary. Key words: Proximal humerus fracture; Fracture fixation, internal; Proximal humeral internal locking system

  4. [Angle-stable intramedullary nailing of proximal humerus fractures with the PHN (proximal humeral nail)].

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    Blum, Jochen; Hansen, Matthias; Rommens, Pol Maria

    2009-09-01

    Stable fixation of two- and three-part fractures of the proximal humerus through minimally invasive operative technique and rapid bone healing as well as restoration of original anatomy. Early functional training with the goal of restoration of former mobility and daily activities. Unstabile two- and three-part fractures of the proximal humerus (AO classification: 11-A2, 11-A3, 11-B1, 11-B2, 11-B3). Subcapital nonunion of the humerus. Pathologic fractures. Pediatric fractures of the proximal humerus. Fractures of the proximal humerus types 11-C2 und 11-C3 according to the AO classification. Active local infection, e.g., after former operation. Closed reduction. Anterior acromial incision, splitting of the deltoid muscle and the rotator cuff. Opening of the medullary canal with the awl. Nail introduction. Spiral blade introduction in cannulated technique through stab incision. Distal interlocking through aiming device, angle-stable blocking of nail and blade through end cap. Postoperative fixation in Gilchrist sling until 2nd postoperative day; then physiotherapy respecting fracture type and stability, local swelling, patient's age and compliance, and concomitant injuries. 151 proximal humeral fractures were treated with a proximal humeral nail (PHN). 108 patients could be followed up 1 year postoperatively. Significant complications were perforation of the articular surface through bolts or blades (n = 8), implant-related pain (n = 10), fragment dislocation (n = 2), nonunion (n = 2), humeral head necrosis (n = 3), and superficial infection (n = 1). 1 year after the operation, the Constant-Murley Score showed a median value of 75.3 in the injured shoulder and of 89.9 in the uninjured shoulder. The DASH (Disability of the Arm, Shoulder and Hand) Score was 5.9 preoperatively and 9.3 at 1 year postoperatively. The worst results regarding the Constant-Murley Score as well as the DASH Score were found in C-type fractures.

  5. [Clinical analysis of prosthesis replacement for proximal humerus tumors].

    Science.gov (United States)

    Weng, Xiaojun; Liao, Qiande; Li, Xiaosheng; Wang, Jing

    2016-01-01

    To explore surgical strategies, functions and prognosis of artificial prosthesis replacement and soft tissue reconstruction for patients with invasive benign or primary malignant proximal humerus tumor.
 A total of 17 patients with invasive benign or primary malignant proximal humerus tumor underwent prosthetic replacement after segment bone tumor resection and soft tissues reconstruction from April 2007 to April 2014 were enrolled. Based on histological types, tumor stages and surgical procedures, the effects of artificial prosthesis replacement and soft tissue reconstruction on prognosis and shoulder joint function were evaluated.
 All patients were followed up for 8 to 96 months (average time: 58.9 months). Among 11 patients with primary malignant tumor, 5 died of tumor recurrence or metastasis, and 6 showed tumor-free survival for 24 to 91 months (average time: 54.83 months). The 6 patients with aggressive benign tumors survived for 39 to 96 months, with an average of 72.33 months. The shoulder joint function of 17 patients recovered to 64.88% of normal. There were significant differences in the shoulder joint function between the patients who underwent half shoulder replacement and those who underwent total shoulder replacement (56.25% vs 72.56%, Pshoulder joint function between the patients who underwent Type I A excision (retention of abductor muscles and rotator cuff) and those who underwent Type I B excision (68.75% vs 61.44%, Pshoulder joint function is associated with the methods of prosthesis replacement and soft tissue resection.

  6. Pathological fractures of the proximal humerus treated with a proximal humeral locking plate and bone cement.

    Science.gov (United States)

    Siegel, H J; Lopez-Ben, R; Mann, J P; Ponce, B A

    2010-05-01

    Bone loss secondary to primary or metastatic lesions of the proximal humerus remains a challenging surgical problem. Options include preservation of the joint with stabilisation using internal fixation or resection of the tumour with prosthetic replacement. Resection of the proximal humerus often includes the greater tuberosity and adjacent diaphysis, which may result in poor function secondary to loss of the rotator cuff and/or deltoid function. Preservation of the joint with internal fixation may reduce the time in hospital and peri-operative morbidity compared with joint replacement, and result in a better functional outcome. We included 32 patients with pathological fractures of the proximal humerus in this study. Functional and radiological assessments were performed. At a mean follow-up of 17.6 months (8 to 61) there was no radiological evidence of failure of fixation. The mean revised musculoskeletal Tumour Society functional score was 94.6% (86% to 99%). There was recurrent tumour requiring further surgery in four patients (12.5%). Of the 22 patients who were employed prior to presentation all returned to work without restrictions. The use of a locking plate combined with augmentation with cement extends the indications for salvage of the proximal humerus with good function in patients with pathological and impending pathological fractures.

  7. Internal fixation of proximal humerus fractures using the T2-proximal humeral nail.

    Science.gov (United States)

    Popescu, Dragos; Fernandez-Valencia, Jenaro A; Rios, Moisés; Cuñé, Jordi; Domingo, Anna; Prat, Salvi

    2009-09-01

    Surgical management of proximal humerus fractures remains controversial and there is an increasing interest in intramedullary nailing. Created to improve previous designs, the T2-proximal humeral nail (PHN) (Stryker) has been recently released, and the English literature lacks a series evaluating its results. We present a clinical prospective study evaluating this implant for proximal humeral fractures. We evaluated the functional and radiological results and possible complications. Twenty-nine patients with displaced fractures of the proximal humerus were treated with this nail. One patient was lost right after surgery and excluded from the assessment. Eighteen patients were older than 70 years. There were 21 fractures of the proximal part of the humerus and 7 fractures that also involved the shaft; 15 of the fractures were two-part fractures (surgical neck), 5 were three-part fractures, and 1 was a four-part fracture. All fractures healed in a mean period of 2.7 months. There was one delayed union that healed in 4 months. One case of avascular necrosis of the humeral head was observed (a four-part fracture), but remained asymptomatic and did not require further treatment. In one case a back-out of one proximal screw was observed. A final evaluation with a minimum 1 year follow-up was performed by an independent observer; in 18 patients, the mean Constant score was 65.7 or 76.1% with the adjustment of age and gender; in 19 patients, the mean Oxford Shoulder Score was 21.7. The results obtained with the T2-PHN nail indicate that it represents a safe and reliable method in the treatment of two- and three-part fractures of the proximal humerus. The proximal fixation mechanism diminishes the rate of back-out of the screws, a frequent complication described in the literature. Better functional results were obtained from the patients younger than 70 years, but these were not statistically significant.

  8. Fractures of the proximal humerus in children and adolescents

    Directory of Open Access Journals (Sweden)

    Ruban Raj Joshi, Dr

    2013-12-01

    Full Text Available Background: In most children proximal humeral fractures are treated non-operatively with generally good results. The aim of the study was to evaluate the clinical outcome of closed/open reduction in children with severely displaced proximal humeral fractures. Materials and Methods: The charts of 15 patients (8 girls and 7 boys; mean age: 9.4 years with proximal humeral fractures who were managed at our institution were reviewed from October 2011 to December 2013. Results: There were 7 metaphyseal fractures and 8 physeal injuries which were angulated according to Neer-Horowitz score as grade II (n=2, grade III(n=4 and grade IV(n=9. Associated lesions comprised open fracture with head trauma in a 2 year old female child which was operated on primarily and the 14 others by secondary intention. All patients were treated surgically with either closed (n = 5 or open (n=10 reduction and internal fixation with Kirschner wire or titanium elastic nails (TENs. They were assessed for clinical and radiological healing at a mean follow up of 1.25 years ranging from 0.5 to 2.0 years. Conclusion: Surgical option is indicated for severely displaced and unstable fractures in older children and adolescents. In addition to the periosteum , long head of the biceps, deltoid muscle, and bone fragments in combination can prevent fracture reduction. Key words: Proximal humerus fracture, Children, Open reduction, Operative.

  9. Treatment of proximal humerus fractures in the elderly

    Science.gov (United States)

    Launonen, Antti P; Lepola, Vesa; Flinkkilä, Tapio; Laitinen, Minna; Paavola, Mika; Malmivaara, Antti

    2015-01-01

    Background and purpose There is no consensus on the treatment of proximal humerus fractures in the elderly. Patients and methods We conducted a systematic search of the medical literature for randomized controlled trials and controlled clinical trials from 1946 to Apr 30, 2014. Predefined PICOS criteria were used to search relevant publications. We included randomized controlled trials involving 2- to 4-part proximal humerus fractures in patients over 60 years of age that compared operative treatment to any operative or nonoperative treatment, with a minimum of 20 patients in each group and a minimum follow-up of 1 year. Outcomes had to be assessed with functional or disability measures, or a quality-of-life score. Results After 2 independent researchers had read 777 abstracts, 9 publications with 409 patients were accepted for the final analysis. No statistically significant differences were found between nonoperative treatment and operative treatment with a locking plate for any disability, for quality-of-life score, or for pain, in patients with 3- or 4-part fractures. In 4-part fractures, 2 trials found similar shoulder function between hemiarthroplasty and nonoperative treatment. 1 trial found slightly better health-related quality of life (higher EQ-5D scores) at 2-year follow-up after hemiarthroplasty. Complications were common in the operative treatment groups (10–29%). Interpretation Nonoperative treatment over locking plate systems and tension banding is weakly supported. 2 trials provided weak to moderate evidence that for 4-part fractures, shoulder function is not better with hemiarthroplasty than with nonoperative treatment. 1 of the trials provided limited evidence that health-related quality of life may be better at 2-year follow-up after hemiarthroplasty. There is a high risk of complications after operative treatment. PMID:25574643

  10. Surgical Management of 3 and 4-Part Proximal Humerus Fractures with Locking Plates in Elderly

    Directory of Open Access Journals (Sweden)

    Emrah Kovalak

    2017-05-01

    Full Text Available Aim: Proximal humeral fractures are approximately 5% of all fractures and, %15-20 is displaced and unstable. By the introduction of locking plates there used to be a substantial rise in the osteosynthesis of the 3 and 4-part proximal humeral fractures. But there is still a lack of consensus for the optimal treatment of these complex fractures. In this retrospective study, we aimed to evaluate the functional outcomes and prognostic factors of 3 and 4-part proximal humerus fractures treated with locking plate osteosynthesis in elderly. Material and Method: 53 patients with displaced 3 and 4-part proximal humeral fractures treated with locking plate osteosynthesis between 2010 and 2015 were included. The fractures were classified according to Neer classification system. Outcomes were assessed by Constant-Murley scoring system (CMS, visual analog pain scale and plain radiographs. In reference to range of motion, forward elevation and abduction of the arm were measured.Results: No statistically significant differences found between the 3- part and 4- part fractures in CMS, forward elevation and, abduction (p>0.05. Pain was significantly higher in 4-part fractures (p=0.035. CMS, forward elevation, and abduction were inversely correlated with age and delay in surgery. There was statistical significance between the patients had complications and those not in terms of CMS, forward elevation and, abduction (p=0.029, p=0.017 and p=0.024. Discussion: Functional outcomes of locking plate fixation of proximal humerus fractures are associated with patient related factors, fracture pattern, surgeon and, the implant. When indications are carefully selected, locking plate osteosynthesis yield good outcomes in surgical treatment of 3 or 4-part proximal humerus fractures.

  11. [Morbidity and mortality of surgically treated proximal humerus fractures].

    Science.gov (United States)

    Isart, A; Sánchez, J F; Santana, F; Puig, L; Cáceres, E; Torrens, C

    2014-01-01

    The aim of the present study is to analyse the factors associated with mortality and the capacity to perform daily life activities (DLA) in patients with surgically treated proximal humeral fractures. A retrospective study was conducted on 94 patients with a surgically treated proximal humeral fracture, with a mean follow-up of 8 years (2 - 12 years). A correlation analysis was performed to determine the relationship between the type of fracture, surgical technique, comorbidities and mortality and DLA. The Student t test was used for statistical analysis. A total of 72 patients were identified, 18.6% of them died during follow-up, all diagnosed with some comorbidity. There was no correlation between mortality, type of fracture or the technique used. Most of the patients (85.4%) had comorbidities, and 79.5% were completely independent for DLA. Although there was no relationship with the type of fracture, there was a significant reduction in the performing of DLA in patients treated with hemiarthroplasty, and in patients with neurological disorders. There was a mortality of 18.6% among patients with surgically treated proximal humerus fractures. The majority of surgically treated patients were fully independent for DLA at long-term follow-up. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  12. Axillary Artery Injury Associated with Proximal Humerus Fracture: A Report of 6 Cases

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    Rinne M. Peters

    2017-01-01

    Full Text Available Proximal humerus fractures are common, but associated injury of the axillary artery is uncommon. The majority of published blunt traumatic axillary artery injuries are associated with anterior glenohumeral dislocation; a few are associated with isolated proximal humerus fractures or fracture-dislocation. Experience within our institution demonstrates that axillary artery injury is often unrecognized on initial presentation owing to palpable peripheral pulses and the absence of ischemia and places the hand at risk of necrosis and amputation if there is prolonged ischemia and the forearm at risk of compartment syndrome after revascularization. Accurate physical examination in combination with a low threshold for Doppler examination or angiography can establish the diagnosis of axillary artery injury. We present 6 cases of axillary artery injury associated with proximal humerus fractures in order to highlight the potential for this vascular injury in the setting of a proximal humerus fracture.

  13. The mechanical benefit of medial support screws in locking plating of proximal humerus fractures.

    Science.gov (United States)

    Zhang, Wen; Zeng, Langqing; Liu, Yanjie; Pan, Yao; Zhang, Wei; Zhang, Changqing; Zeng, Bingfang; Chen, Yunfeng

    2014-01-01

    The purpose of this study was to evaluate the biomechanical advantages of medial support screws (MSSs) in the locking proximal humeral plate for treating proximal humerus fractures. Thirty synthetic left humeri were randomly divided into 3 subgroups to establish two-part surgical neck fracture models of proximal humerus. All fractures were fixed with a locking proximal humerus plate. Group A was fixed with medial cortical support and no MSSs; Group B was fixed with 3 MSSs but without medial cortical support; Group C was fixed with neither medial cortical support nor MSSs. Axial compression, torsional stiffness, shear stiffness, and failure tests were performed. Constructs with medial support from cortical bone showed statistically higher axial and shear stiffness than other subgroups examined (Pproximal humerus was not supported by medial cortical bone, locking plating with medial support screws exhibited higher axial and torsional stiffness than locking plating without medial support screws (P ≤ 0.0207). Specimens with medial cortical bone failed primarily by fracture of the humeral shaft or humeral head. Specimens without medial cortical bone support failed primarily by significant plate bending at the fracture site followed by humeral head collapse or humeral head fracture. Anatomic reduction with medial cortical support was the stiffest construct after a simulated two-part fracture. Significant biomechanical benefits of MSSs in locking plating of proximal humerus fractures were identified. The reconstruction of the medial column support for proximal humerus fractures helps to enhance mechanical stability of the humeral head and prevent implant failure.

  14. Age-related changes in proximal humerus bone health in healthy, white males

    Science.gov (United States)

    Mantila Roosa, Sara M.; Hurd, Andrea L.; Xu, Huiping; Fuchs, Robyn K.; Warden, Stuart J.

    2013-01-01

    Introduction The proximal humerus is relatively under investigated despite being the fourth most common site for osteoporotic fracture. Methods A cross-sectional study was performed to assess age-related changes in dual-energy x-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) properties of the proximal humerus in a cohort of 170 healthy, white males. Results Regression models estimated considerable age-related loss of DXA measured bone quantity at the proximal humerus, with areal bone mineral density modeled to decline by 29% (95%CI, 17.5–35.0%) in the 50 years between ages 30 and 80 years (pproximal humerus bone strength in the 50 years between ages 30 and 80 years (pproximal humeral bone health which, when coupled with a traumatic event such as a fall, may contribute to osteoporotic fracture at this site. PMID:22258805

  15. Double line sign: a helpful sonographic sign to detect occult fractures of the proximal humerus

    Energy Technology Data Exchange (ETDEWEB)

    Rutten, Matthieu J.C.M.; Jager, Gerrit J. [Jeroen Bosch Hospital, Department of Radiology, Hertogenbosch (Netherlands); Waal malefijt, Maarten C. de [University Medical Center Nijmegen, Department of Orthopedic Surgery, Nijmegen (Netherlands); Blickman, Johan G. [University Medical Center Nijmegen, Department of Radiology, Nijmegen (Netherlands)

    2007-03-15

    The aim of this study was to describe a new sonographic sign of bone fracture and to determine if it can be helpful in decreasing the number of missed fractures of the proximal humerus. Ultrasound (US) of the shoulder was performed in 57 consecutive patients with shoulder pain and/or disability following trauma. All cases were prospectively reviewed for the presence of a humeral fracture. Sonographic signs of fractures, with special emphasis on what was termed the 'double line sign' (DLS), were assessed. Plain radiography was considered the standard of reference and in equivocal cases magnetic resonance imaging (MRI). Twenty-eight patients had a tuberosity complex fracture, which were all detected at US examination. Sonographic features of a fracture were periosteal elevation, corticol bone discontinuity, step-off deformity or a combination of these findings. This study showed that in 26 (93%) patients an additional sonographic feature, a DLS, could be demonstrated. The DLS is a helpful and probably reliable sonographic sign to indicate a humeral fracture. High-spatial-resolution US substantially increases the detection of fractures of the proximal humerus and should be considered as an alternative diagnostic tool prior to computed tomography (CT), MRI and arthroscopy in patients with persisting shoulder pain and/or disability following trauma. (orig.)

  16. Philos Plate in Proximal Humerus Fracture–Its Functional Outcome and Complications

    Directory of Open Access Journals (Sweden)

    Vivek Bansal,

    2015-06-01

    Full Text Available AIM: Technique for the fixation of two, three, and four part proximal humerus fractures has rapidly shifted towards the use of locking plates. The objective of this prospective study was to evaluate functional outcome and complications of proximal humeral fractures managed with proximal humerus internal locking system (PHILOS. METHODS: 16 men and 9 women aged 19 to 82 (mean, 49.24 with an acute proximal humerus fracture were treated with PHILOS plate by using deltopectoral approach. Outcome measurements included Constant score, complications, and radiographic assessment. RESULTS: 11 patients had 2-part fractures, 11 patients had 3-part fractures, and 3 patients had 4-part fractures. After 6 month follow up, a mean Constant score 57.4 was achieved. Outcomes were excellent in 16%, good in 44%, fair in 16% while poor in 24%. The Constant score was poorer for Neer type IV fractures as compared to other types. The most frequently occurring complications in our patients were malreduction 20%, screw perforation 16%, infection 12%, avascular necrosis 8%, frozen shoulder 8%, impingement 4% and plate pull out 4%. CONCLUSION: Fixation of proximal humerus fractures with proximal humerus locking plates is associated with satisfactory functional outcomes in 2-part and 3-part fracture. The incidence of complications and subsequent re-operation is relatively high. Advanced surgical skills and surgeon’s experience are considered to be more critical for successful operative treatment.

  17. The mechanical benefit of medial support screws in locking plating of proximal humerus fractures.

    Directory of Open Access Journals (Sweden)

    Wen Zhang

    Full Text Available BACKGROUND: The purpose of this study was to evaluate the biomechanical advantages of medial support screws (MSSs in the locking proximal humeral plate for treating proximal humerus fractures. METHODS: Thirty synthetic left humeri were randomly divided into 3 subgroups to establish two-part surgical neck fracture models of proximal humerus. All fractures were fixed with a locking proximal humerus plate. Group A was fixed with medial cortical support and no MSSs; Group B was fixed with 3 MSSs but without medial cortical support; Group C was fixed with neither medial cortical support nor MSSs. Axial compression, torsional stiffness, shear stiffness, and failure tests were performed. RESULTS: Constructs with medial support from cortical bone showed statistically higher axial and shear stiffness than other subgroups examined (P<0.0001. When the proximal humerus was not supported by medial cortical bone, locking plating with medial support screws exhibited higher axial and torsional stiffness than locking plating without medial support screws (P ≤ 0.0207. Specimens with medial cortical bone failed primarily by fracture of the humeral shaft or humeral head. Specimens without medial cortical bone support failed primarily by significant plate bending at the fracture site followed by humeral head collapse or humeral head fracture. CONCLUSIONS: Anatomic reduction with medial cortical support was the stiffest construct after a simulated two-part fracture. Significant biomechanical benefits of MSSs in locking plating of proximal humerus fractures were identified. The reconstruction of the medial column support for proximal humerus fractures helps to enhance mechanical stability of the humeral head and prevent implant failure.

  18. Preoperative assessment of the cancellous bone mineral density of the proximal humerus using CT data

    Energy Technology Data Exchange (ETDEWEB)

    Krappinger, Dietmar; Roth, Tobias; Gschwentner, Martin; Suckert, Armin; Blauth, Michael; Hengg, Clemens; Kralinger, Franz [Innsbruck Medical University, Department of Trauma Surgery and Sports Medicine, Innsbruck (Austria)

    2012-03-15

    Osteoporotic fractures of the proximal humerus show an increasing incidence. Osteoporosis not only influences the fracture risk after low-energy trauma, but also affects the mechanical stability of internal fixation. Preoperative assessment of the local bone quality may be useful in the surgical treatment of patients sustaining these injuries. The aim of the present study was to present a method for the preoperative assessment of the local cancellous bone mineral density (BMD) of the proximal humerus using CT data. In the first part of the study, CT scans of 30 patients with unilateral fractures of the proximal humerus after low-energy trauma were used. The local BMD was assessed on the contralateral uninjured side. All 30 patients additionally underwent dual-emission X-ray absorptiometry (DXA) of the lumbar spine, proximal femur, and forearm of the side of the uninjured proximal humerus within 6 weeks after trauma. Three independent trauma surgeons performed measurements on the uninjured proximal humerus twice with a time interval of 4 weeks in order to assess the inter- and intraobserver reliability of the method. In the second part of the study, the local BMD of 507 patients with either proximal humerus fractures or chronic shoulder instability was assessed by a single trauma surgeon. In both parts, the average HU values in standardized ROIs of the humeral head were automatically calculated after correcting for HU values below the water equivalent. A linear calibration equation was computed for the calculation from HU to BMD using a calibration device (EFP). The intra- and interobserver reliability was high (ICC > 0.95). Correlation coefficients between the local BMD of the proximal humerus and other anatomical sites were between 0.35 (lumbar spine) and 0.64 (forearm). We found a high correlation between the local BMD and age. The BMD in the fracture group was significantly lower than in the instability group. These patients were significantly older and more

  19. Intrathoracic fracture-dislocation of the proximal humerus treated with rib fixation and shoulder arthroplasty.

    Science.gov (United States)

    Hawkes, Timothy; Parra, Michael; Shrock, Kevin

    2014-04-01

    Proximal fractures of the humerus resulting in intrathoracic displacement of the humeral head are rare, but cause serious pain and can lead to pulmonary and glenohumeral complications. Many treatment options exist, but there is still no literature regarding mortality and morbidity associated with rib fixation in concordance with treatment of the proximal humerus. This case describes a patient who was treated using a multi-team approach that involved shoulder arthroplasty with rib fixation, and which resulted in decreased pain and decreased narcotic use while improving the patient's pulmonary function.

  20. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus

    NARCIS (Netherlands)

    Wijgman, A. J.; Roolker, W.; Patt, T. W.; Raaymakers, E. L. F. B.; Marti, R. K.

    2002-01-01

    BACKGROUND: Controversy persists concerning the preferred treatment of displaced fractures of the proximal part of the humerus. The present study was undertaken to evaluate the results of open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus and

  1. "Floating arm" injury in a child with fractures of the proximal and distal parts of the humerus: a case report

    Directory of Open Access Journals (Sweden)

    Güven Melih

    2009-09-01

    Full Text Available Abstract Introduction Simultaneous supracondylar humerus fracture and ipsilateral fracture of the proximal humerus in children is rare. Case presentation A 10-year-old Turkish boy with an extension type supracondylar humerus fracture and ipsilateral fracture at the proximal metaphyseal-diaphyseal junction of the humerus was treated by closed reduction and percutaneous Kirschner wire fixation. Closed reduction was performed using a Kirschner wire as a "joystick" to manipulate the humeral shaft after some swelling occurred around the elbow and shoulder. Conclusion The combination of fractures at the proximal and distal parts of the humerus can be termed as "floating arm" injury. Initial treatment of this unusual injury should be focused on the supracondylar humerus fracture. However, closed reduction can be difficult to perform with the swelling around the elbow and shoulder. A temporary Kirschner wire can be used as a "joystick" to fix and reduce the fracture.

  2. Double line sign: a helpful sonographic sign to detect occult fractures of the proximal humerus.

    NARCIS (Netherlands)

    Rutten, M.J.C.M.; Jager, G.J.; Waal Malefijt, M.C. de; Blickman, J.G.

    2007-01-01

    The aim of this study was to describe a new sonographic sign of bone fracture and to determine if it can be helpful in decreasing the number of missed fractures of the proximal humerus. Ultrasound (US) of the shoulder was performed in 57 consecutive patients with shoulder pain and/or disability

  3. Diagnosing displaced four-part fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig; Bagger, Jens; Sylvest, Annette

    2009-01-01

    Displaced four-part fractures comprise 2-10 % of all proximal humeral fractures. The optimal treatment is unclear and randomised trials are needed. The conduct and interpretation of such trials is facilitated by a reproducible fracture classification. We aimed at quantifying observer agreement...... on the classification of displaced four-part fractures according to the Neer system. Published and unpublished data from five observer studies were reviewed. Observers agreed less on displaced four-part fractures than on the overall Neer classification. Mean kappa values for interobserver agreement ranged from 0.......16 to 0.48. Specialists agreed slightly more than fellows and residents. Advanced imaging modalities (CT and 3D CT) seemed to contribute more to classification of displaced four-part patterns than in less complex fracture patterns. Low observer agreement may challenge the clinical approach to displaced...

  4. [Clinical efficacies of different internal fixation materials in the treatment of senile proximal humerus fractures].

    Science.gov (United States)

    Liu, Junchuan; Di, Jun; Zhao, Changping; Yao, Shuangquan; Zhu, Lian; Wang, Bo; Ren, Dong

    2014-12-23

    To explore the clinical efficacies of different internal fixation materials in the treatment of senile proximal humerus fractures. A total of 284 hospitalized patients of proximal humerus fractures over 60 years of age cases from October 2009 to February 2012 were randomly divided into two groups of locking proximal humeral plate (LPHP) and PHILOS (n = 142 each). And the clinical efficacies of two groups were compared. For PHILOS and LPHP groups, the fracture healing periods were (11.64 ± 3.81) and (14.95 ± 3.95) weeks. And there was statistical significance (P 0.05). Both PHILOS and LPHP are effective in the treatment of senile proximal humeral fractures.However, the former is conducive to fracture healing and has shorter healing time and lowered postoperative pain.

  5. Deltoid Tuberosity Index: A Simple Radiographic Tool to Assess Local Bone Quality in Proximal Humerus Fractures.

    Science.gov (United States)

    Spross, Christian; Kaestle, Nicola; Benninger, Emanuel; Fornaro, Jürgen; Erhardt, Johannes; Zdravkovic, Vilijam; Jost, Bernhard

    2015-09-01

    Osteoporosis may complicate surgical fixation and healing of proximal humerus fractures and should be assessed preoperatively. Peripheral quantitative CT (pQCT) and the Tingart measurement are helpful methods, but both have limitations in clinical use because of limited availability (pQCT) or fracture lines crossing the area of interest (Tingart measurement). The aim of our study was to introduce and validate a simple cortical index to assess the quality of bone in proximal humerus fractures using AP radiographs. We asked: (1) How do the deltoid tuberosity index and Tingart measurement correlate with each other, with patient age, and local bone mineral density (BMD) of the humeral head, measured by pQCT? (2) Which threshold values for the deltoid tuberosity index and Tingart measurement optimally discriminate poor local bone quality of the proximal humerus? (3) Are the deltoid tuberosity index and Tingart measurement clinically applicable and reproducible in patients with proximal humerus fractures? The deltoid tuberosity index was measured immediately above the upper end of the deltoid tuberosity. At this position, where the outer cortical borders become parallel, the deltoid tuberosity index equals the ratio between the outer cortical and inner endosteal diameter. In the first part of our study, we retrospectively measured the deltoid tuberosity index on 31 patients (16 women, 15 men; mean age, 65 years; range, 22-83 years) who were scheduled for elective surgery other than fracture repair. Inclusion criteria were available native pQCT scans, AP shoulder radiographs taken in internal rotation, and no previous shoulder surgery. The deltoid tuberosity index and the Tingart measurement were measured on the preoperative internal rotation AP radiograph. The second part of our study was performed by reviewing 40 radiographs of patients with proximal humerus fractures (31 women, nine men; median age, 65 years; range, 22-88 years). Interrater (two surgeons) and

  6. Fractures in the proximal humerus: functional outcome and evaluation of 70 patients treated in hospital.

    Science.gov (United States)

    Fjalestad, Tore; Strømsøe, Knut; Blücher, Judith; Tennøe, Bjørn

    2005-06-01

    Patients with proximal humeral fractures are mostly elderly. In addition to the proximal humeral fracture, they often have other injuries related to poor bone quality. The surgical treatment of proximal humeral fractures in elderly patients with comminuted fractures is associated with several problems and a high frequency of complications. The aims of this study were to evaluate patients with a proximal humeral fracture treated in a hospital, assess the outcome of the fracture treatment, and decide whether surgical treatment of displaced proximal humeral fractures is superior to conservative treatment or not. Patients with fractures of the proximal part of the humerus treated in our hospital were followed during two different periods (14 and 10 months). The study in the first time period was retrospective in design, while in the second period the patients were followed prospectively. Seventy patients, (71% women) with a mean age of 71 years, were included in the study. A functional test was performed within 12-14 months after the injury using a modified Rowe shoulder score. Surgical treatment was performed in 15 patients (21%). Neither the surgical approach nor the implants used for osteosynthesis were standardized. Fifty-five patients (79%) were treated conservatively with a modified Velpeau bandage or a sling. The fractures were classified according to AO into type A (27%), type B (58%) and type C (14%). Osteoporotic risk factors were present in many of the patients, mainly characterized by other skeletal injuries than the proximal humeral fracture (43%). In the group of complex, displaced, non-impacted fractures B2, B3, C2, C3 included (20 fractures), the group treated conservatively had a mean Rowe score of 48/75 (64% of maximum score) and SD 16.8, while in the surgically treated group the mean score was 28/75 (38% of maximum score) and SD 8.1. The difference between the two treatments was significant, with a p-value of 0.01 in favour of the conservatively

  7. Tuberosity healing after reverse shoulder arthroplasty for acute proximal humerus fractures: the "black and tan" technique.

    Science.gov (United States)

    Formaini, Nathan T; Everding, Nathan G; Levy, Jonathan C; Rosas, Sam

    2015-11-01

    Reverse shoulder arthroplasty has seen increased use for management of complex proximal humeral fractures in the elderly. Recent evidence has shown that tuberosity healing leads to improved active range of motion and functional outcomes. The purpose of this study was to report on the radiographic and clinical outcomes of a consecutive series of patients having undergone reverse shoulder arthroplasty for fracture utilizing the "black and tan" method--a hybrid cementation-impaction grafting technique that uses autogenous cancellous bone graft to create an interface between the proximal cement mantle and the area of tuberosity repair. Twenty-five patients (average age, 77 years; range, 63-88 years) were included in the analysis with a mean follow-up of 17 months. All patients underwent reverse shoulder arthroplasty for a complex proximal humerus fracture using the black and tan technique. The tuberosity healing rate was 88%. At final follow-up, mean active elevation was 117° ± 23°, mean abduction was 86° ± 16°, and mean external rotation was 29° ± 18°. External rotation strength averaged 4.9 ± 0.2. The Simple Shoulder Test and Single Assessment Numeric Evaluation scores averaged 7 and 76, respectively. The mean American Shoulder and Elbow Surgeons total score was 71; visual analog scale score for pain, 2; and visual analog scale score for function, 7. Of the 25 patients, 21 (84%) rated their satisfaction with the surgery as excellent or good. The black and tan technique together with standard suture repair and an implant with features that support tuberosity repair results in a high tuberosity healing rate with restoration of external rotation after reverse shoulder arthroplasty for fracture. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  8. A new technique of closed intramedullary nailing in fractures of the proximal humerus with varus deformity

    Directory of Open Access Journals (Sweden)

    A. N. Chelnokov

    2015-01-01

    Full Text Available Introduction. Varus displacement is common in fractures of the proximal humerus. Development of new low invasive surgical modalities providing anatomy restoration and non-traumatic fracture fixation is actual. Purpose of the study was development of the low invasive technique of closed interlocking nailing providing reduction of the typical varus displacement in fractures and posttraumatic deformities of the proximal humerus. Material and methods. A new technique of correction of the proximal humerus in fractures and posttraumatic deformities was applied in 12 patients - 7 with two-part fractures and 5 with posttraumatic varus deformities. The surgical technique includes application of a small wire circular external frame. Its proximal part is secured to the humeral head to reduce varus displacement along with connection to the distal part of the frame, and the reached alignment is fixed by an intramedullary nail. Results. In all 12 cases we succeeded to reduce the varus deformity. At 1 year follow-up healing was reached in 11 patients, and in one patient exchange compression nailing was performed. Constant score in 1 year was 76±17 after fracture treament, and 70±16 in posttraumatic deformities, which corresponeded to good results. Conclusion. The presented technique allows to reach 40-50° angular correction without open approach and significant soft tissue damage. The obtained results confirm efficacy of the new technique and pertinence of its use in patients with fractures and posttraumatic deformities of this localization. The introduced technique of closed nailing appears to be a promising approach in reconstructive surgery of the proximal humerus.

  9. Evolution of treatment of of the proximal humerus fractures (review

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    P. G. Kogan

    2013-01-01

    Full Text Available The article in generalized form acquaints with the publications devoted to the bases of proximal humeral fractures treatment. A brief digression on anatomy and biomechanics of the humeral joint allows to consider the main morphological features of it. The most commonly used classification of proximal humeral fractures concisely classify many types of damage. According to the clinical and anatomical characteristics of fractures tracked the historical aspect, the development and the current state of the most common methods of treatment. In his review collected works authors share their experience in the application of methods. It allows to further the perspective directions.

  10. Screw depth sounding in proximal humerus fractures to avoid iatrogenic intra-articular penetration.

    Science.gov (United States)

    Bengard, Matthew J; Gardner, Michael J

    2011-10-01

    Unstable and displaced proximal humerus fractures remain a treatment challenge. The use of locked plates has improved construct stability, but complication rates remain high. Biomechanical studies have emphasized the importance of anchoring screws in the subchondral bone of the humeral head to improve implant stability. However, the spherical shape of the proximal humerus and the limited tactile sensation of its soft cancellous bone make determining accurate screw length difficult, and reported rates of intraoperative screw penetration are high. Iatrogenic screw penetration, even if recognized and corrected before leaving the operating room, may lead to late failure. We present a simple technique of quickly and safely determining screw length using a blunt-tipped Kirschner wire and instruments found in basic orthopaedic sets.

  11. Axillary artery lesion secondary to fracturing of the proximal third of the humerus: case report

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    Alberto Naoki Miyazaki

    2015-02-01

    Full Text Available Lesions of the axillary artery are rare in patients with fracturing of the proximal third of the humerus and may have greatly varying clinical manifestations. They are responsible for 15% and 20% of upper-limb artery injuries and the commonest mechanism is a fall to the ground, which accounts for 79% of such injuries. In some cases, the signs only appear later on. It is important to bear this association in mind, so as to make an early diagnosis and avoid serious complications. We report on a case of traumatic injury of the axillary artery secondary to fracturing of the proximal third of the humerus in an 84-year-old patient, with late evolution of clinical signs of ischemia in the limb affected. The aim here was to discuss the diagnostic difficulties and treatment.

  12. Revision after shoulder replacement for acute fracture of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig; Salomonsson, Björn; Jensen, Steen L

    2017-01-01

    Background and purpose - For more than half a century, stemmed hemiarthroplasty (SHA) has been used in the treatment of comminuted and displaced fractures of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been increasingly popular in cases where it is difficult to obtain satisfactory...... fixation of the tuberosities. We report revision rates and reasons for revision after shoulder arthroplasty for acute fractures of the proximal humerus. Patients and methods - This study was based on a common dataset from the Nordic Arthroplasty Register Association (NARA), which includes data reported...... to the national shoulder arthroplasty registries in Denmark, Sweden, and Norway. We included 6,756 shoulder arthroplasties performed for acute fractures between 2004 and 2013. Results - There were 6,112 SHAs (90%) and 565 RSAs (8.4%). The cumulative arthroplasty survival rate after 5 years was 0.96 for both SHA...

  13. Influence of Early Bisphosphonate Administration for Fracture Healing in Patients with Osteoporotic Proximal Humerus Fractures.

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    Seo, Joong-Bae; Yoo, Jae-Sung; Ryu, Jee-Won; Yu, Kun-Woong

    2016-12-01

    Bisphosphonates are generally known to adversely affect fracture healing because they inhibit osteoclastic bone resorption. However, some authors argue that bisphosphonates have no adverse effect on the restoration of the mechanical integrity of long bones after fractures. It is unclear whether bisphosphonates can be initiated safely in patients with acute proximal humerus fractures. The aim of this study was to determine whether the early use of a bisphosphonate affects healing and outcomes of osteoporotic proximal humerus fractures treated with a locking compression plate. Between August 2004 and June 2013, a total of 82 osteoporotic patients who underwent locking plate fixation of proximal humerus fractures were enrolled retrospectively. The patients were divided into two groups according to the timing of the commencement of treatment with alendronate after surgery: group A (n = 34, initiation of the bisphosphonate treatment within two weeks after surgery) and group B (n = 48, control group, initiation of the treatment three months after surgery). Patients were assessed for radiographic union at 2, 6, 10, and 16 weeks, 6 months, and 1 year after surgery. Clinical assessments were performed using the Constant score and American Shoulder and Elbow Surgeons (ASES) score at 1 year after surgery. No significant differences were observed between the two groups with respect to radiographic and clinical outcomes after locking plate fixation. All patients obtained fracture union, and the mean time to radiographic union was similar in group A and group B (6.3 and 6.6 weeks, respectively; p = 0.67). This study shows that the early initiation of bisphosphonate treatment does not affect bone union or clinical outcomes in patients with an osteoporotic proximal humerus fracture treated by locking compression plate fixation.

  14. Simple bone cyst involving proximal epiphysis of the humerus : a case report

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    Yi, Bum Ha; Ryu, Kyung Nam; Park, Yong Koo; Han, Chung Soo [Kyughee Univ. Hospital, Seoul (Korea, Republic of)

    1998-08-01

    Simple or unicameral bone cysts are metaphyseal lesions of long bones. They usually move away from the physis with growth to become diaphyseal in location. Involvement of the physis and epiphysis by these cystic lesions is very rare. This paper reports a case of simple bone cyst of the proximal humerus in a 11- year -old girl which was shown by MR imaging to extend through the physis into the epiphysis.

  15. Reducing resource utilization during non-operative treatment of pediatric proximal humerus fractures.

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    Gladstein, A Z; Schade, A T; Howard, A W; Camp, M W

    2017-02-01

    The majority of proximal humeral fractures in the skeletally immature are treated non-operatively. Operative indications vary but are largely based on degree of displacement. Non-union is rare. Non-operatively treated fractures are typically monitored radiographically to assess healing. We hypothesize that the decision to treat fractures operatively is made at the time of first imaging and that follow-up X-rays do not lead to a change in management. We retrospectively reviewed the records of 239 patients treated for proximal humerus fractures over a 5-year period. There were 225 who were treated non-operatively. Records were reviewed for the number of clinic visits and radiographs, as well as any change to operative management based on follow-up X-rays. The primary outcome of the study was the proportion of proximal humerus fractures, initially treated non-operatively, for which displacement or angulation on follow-up radiographs led to a change to operative treatment. Secondary outcomes were the number of follow-up radiographs obtained after the initial diagnosis and initiation of non-operative treatment. Of the 225 patients that were initially managed non-operatively, only 1 patient required subsequent surgical management. This patient underwent a proximal humerus epiphysiodesis 365 days from injury after development of a partial growth arrest. The mean number of fracture clinic visits for patients managed non-operatively was 2.67 (±1.24). The mean number of radiology department visits and radiographs obtained was 3.57 (±1.44) and 8.36 (±3.89) respectively. No clinical or radiographic non-unions were identified in these patients. No patients suffered a refracture during the review period. This study shows that of the 239 uncomplicated pediatric proximal humerus fractures treated at our hospital over a 5-year period, only 1 had a change in treatment plan, from non-operative to operative, based on follow-up radiographs. These data suggest that non

  16. A PROSPECTIVE STUDY ON TREATMENT OF PROXIMAL HUMERUS FRACTURES IN ADULTS

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    Bhavani Prasad

    2015-10-01

    Full Text Available BACKGROUND: Treatment of proximal humerus has been subject of much controversy and confusion with diversity of opinion regarding the care of fractures of proximal end of humerus. The aim of this study was to review the outcome, results and complications of the operat ive procedure in a series of thirty patients. INTRODUCTION: Proximal humerus fractures are one of the commonest fractures occurring in the skeleton. They account for approximately 4 - 5% of the fracture attendance at the hospital . 1,2 They occur more commonly in elderly patients, after cancellous bone of the humeral neck has weakened by senility but these fracture are seen in patients of all ages & merge with epiphyseal separations. The most serious fractures and fracture dislocations are often seen in active, middle aged patients. These fractures can be extremely disabling and their management often demands experienced surgical skills and judgment . 2 Because of increasing incidence of high velocity trauma, complicated fracture pattern in proximal humerus are be coming increasingly common. It has been always engima of management because of numerous muscles attachment and paucity of space for fixing implant in fracture of proximal humerus. Voluminous literature is available on this topic and treatment pattern diffe rs very much. The preferred treatment varies depend on the patient’s age and bone quality, the expertise , surgical team and the patients expectations. Although a number of reports have described the outcome of treatment of proximal humeral fractures, compa rison of these fractures is hampered by inconsistence in fracture classification, treatment and evaluation method. The surgery should be carried out as soon as the patient’s general condition permits. A delay of several days makes reduction more difficult and a significant delay results in absorption of bone, making secure internal fixation impossible . 3 The object of the osteosynthesisis is to reduce the

  17. Early results for treatment of two- and three-part fractures of the proximal humerus using Contours PHP (proximal humeral plate).

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    Biazzo, Alessio; Cardile, Carlo; Brunelli, Luca; Ragni, Paolo; Clementi, Daniele

    2017-04-28

    The management of displaced 2- and 3-part fractures of the proximal humerus is controversial, both in younger and in elderly patients. The purpose of this paper is to evaluate the functional results of the Contours Proximal Humerus Plate (OrthofixR, Bussolengo,Verona, Italy), for the treatment of displaced 2- and 3-part fractures of the proximal humerus. We retrospectively reviewed 55 patients with proximal humerus fractures, who underwent osteosynthesis with Contours Proximal Humerus Plate from December 2011 to March 2015. We had 21 patients with 2-part fractures and with an average age of 67.1 years and 34 patients with 3-part fractures, with average age of 63.6 years. The average union time was 3 months. The mean Constant score was 67 for 2-part fracture group and 64.9 for 3-part fracture group. The difference was not statistically significant (p = 0.18). The overall complication rate was 14.5 %. Six patients underwent additional surgery (10.9%). The most frequent major complication was secondary loss of reduction following varus collapse of the fracture (2 cases). In these patients, there was loss of medial hinge integrity due to impaction and osteoporosis. The placement of the main locking screw in the calcar area to provide inferomedial support is the rational of the Contours Proximal Humerus Plate. Osteosynthesis with Contours Proximal Humerus Plate is a safe system for treating displaced 2- and 3-part fractures of the proximal humerus, with good functional results and complication rates comparable to those reported in the literature.

  18. The Hounsfield value for cortical bone geometry in the proximal humerus - an in vitro study

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    Lim Fat, Daren; Kennedy, Jim; Galvin, Rose; O' Brien, Fergal; Mc Grath, Frank; Mullett, Hannan [Royal College of Surgeons in Ireland, Investigations Carried Out at Anatomy Lab, Dublin (Ireland)

    2012-05-15

    Fractures of the proximal humerus represent a major osteoporotic burden. Recent developments in CT imaging have emphasized the importance of cortical bone thickness distribution in the prevention and management of fragility fractures. We aimed to experimentally define the CT density of cortical bone in the proximal humerus for building cortical geometry maps. With ethical approval, we used ten fresh-frozen human proximal humeri. These were stripped of all soft tissue and high-resolution CT images were then taken. The humeral heads were then subsequently resected to allow access to the metaphyseal area. Using curettes, cancellous bone was removed down to hard cortical bone. Another set of CT images of the reamed specimen was then taken. Using CT imaging software and a CAD interface, we then compared cortical contours at different CT density thresholds to the reference inner cortical contour of our reamed specimens. Working with 3D model representations of these cortical maps, we were able to accurately make distance comparison analyses based on different CT thresholds. We could compute a single closest value at 700 HU. No difference was found in the HU-based contours generated along the 500-900 HU pixels (p = 1.000). The contours were significantly different from those generated at 300, 400, 1,000, and 1,100 HU. A Hounsfield range of 500-900 HU can accurately depict cortical bone geometry in the proximal humerus. Thresholding outside this range leads to statistically significant inaccuracies. Our results concur with a similar range reported in the literature for the proximal femur. Knowledge of regional variations in cortical bone thickness has direct implications for basic science studies on osteoporosis and its treatment, but is also important for the orthopedic surgeon since our decision for treatment options is often guided by local bone quality. (orig.)

  19. [Biomechanical investigation of fixed-angle plate osteosynthesis of the proximal humerus].

    Science.gov (United States)

    Röderer, G; AbouElsoud, M; Gebhard, F; Claes, L; Aschoff, A J; Kinzl, L

    2010-02-01

    Proximal humeral fractures are common in the elderly population and are often associated with osteoporosis. Fixation of unstable proximal humeral fractures is problematic due to loss of fixation in osteoporotic bone. Fixed-angle devices are intended to provide superior mechanical stability due to the principle of an internal fixator. The NCB(R)-PH (non-contact-bridging proximal humerus) plate is a new fixed-angle device that locks the screws to the plate by secondary insertion of a locking cap. The aim of this study was to investigate if and to what extent NCB-PH plates applied in the locked mode provide higher mechanical stability in a proximal humerus fracture model. For this investigation 16 (8 pairs) fresh frozen cadaveric humeri were used. An AO/ASIF 11-B 1 fracture of the proximal humerus was created in each bone and fixed with the NCB-PH plate. In a paired setting one bone was fixed with the plate in the locked mode and the other with the plate in the non-locked mode. The bones were then subjected to 100 cycles of axial loading and interfragmentary motion was measured. Bones surviving this test were subjected to load-to-failure testing and the force at which failure occurred was recorded. Bones fixed with the plate in the locked mode showed a statistically significant lower (51%) interfragmentary rotation compared to bones fixed with the plate in the non-locked mode. There was also a tendency for the bones fixed with the plate in the locked mode to fail first under higher forces (16%) during load-to-failure testing. The NCB-PH plate provides superior interfragmentary stability when used in the locked mode in a human cadaveric proximal humerus fracture model. Therefore, we recommend that all screws should be inserted in the locked mode. The results suggest that the NCB-PH plate in the locked mode provides higher primary postoperative stability thus permitting early functional treatment of the patient.

  20. Outcome analysis following removal of locking plate fixation of the proximal humerus

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    Fischer Florian

    2008-10-01

    Full Text Available Abstract Background Concerning surgical management experience with locking plates for proximal humeral fractures has been described with promising results. Though, distinct hardware related complaints after fracture union are reported. Information concerning the outcome after removal of hardware from the proximal humerus is lacking and most studies on hardware removal are focused on the lower extremity. Therefore the aim of this study was to analyze the functional short-term outcome following removal of locking plate fixation of the proximal humerus. Methods Patients undergoing removal of a locking plate of the proximal humerus were prospectively followed. Patients were subdivided into the following groups: Group HI: symptoms of hardware related subacromial impingement, Group RD: persisting rotation deficit, Group RQ: patients with request for a hardware removal. The clinical (Constant-Murley score and radiologic (AP and axial view follow-up took place three and six months after the operation. To evaluate subjective results, the Medical Outcomes Study Short Form-36 (SF-36, was completed. Results 59 patients were included. The mean length of time with the hardware in place was 15.2 ± 3.81 months. The mean of the adjusted overall Constant score before hardware removal was 66.2 ± 25.2% and increased significantly to 73.1 ± 22.5% after 3 months; and to 84.3 ± 20.6% after 6 months (p Conclusion A significant improvement of clinical outcome following removal was found. However, a general recommendation for hardware removal is not justified, as the risk of an anew surgical and anesthetic procedure with all possible complications has to be carefully taken into account. However, for patients with distinct symptoms it might be justified.

  1. Benefits and harms of locking plate osteosynthesis in intraarticular (OTA Type C) fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig; Rasmussen, Jeppe Vejlgaard; Frich, Lars Henrik

    2012-01-01

    INTRODUCTION: Locking plate osteosynthesis of proximal humeral fractures are widely recommended and used, even in complex intraarticular fracture patterns such as AO/OTA Type C fractures. We systematically reviewed clinical studies assessing the benefits and harms of osteosynthesis with angle...... stable plates in AO/OTA Type C fractures of the proximal humerus. METHODS: We conducted an iterative search in PubMed, Embase, Cochrane Library, Web of Science, Cinahl, and PEDro in all languages from 1999 to November 2010. Eligible studies should study the outcome for Type C fractures after primary...... osteosynthesis with locking plate within two weeks of injury, and a follow-up period of six months or more. Patients should be evaluated with the Constant-Murley Score (CS). Two observers extracted data independently. RESULTS: Twelve studies and 282 Type C fractures were included. Results were categorised...

  2. The prediction of cyclic proximal humerus fracture fixation failure by various bone density measures.

    Science.gov (United States)

    Varga, Peter; Grünwald, Leonard; Windolf, Markus

    2018-02-22

    Fixation of osteoporotic proximal humerus fractures has remained challenging, but may be improved by careful pre-operative planning. The aim of this study was to investigate how well the failure of locking plate fixation of osteoporotic proximal humerus fractures can be predicted by bone density measures assessed with currently available clinical imaging (realistic case) and a higher resolution and quality modality (theoretical best-case). Various density measures were correlated to experimentally assessed number of cycles to construct failure of plated unstable low-density proximal humerus fractures (N = 18). The influence of density evaluation technique was investigated by comparing local (peri-implant) versus global evaluation regions; HR-pQCT-based versus clinical QCT-based image data; ipsilateral versus contralateral side; and bone mineral content (BMC) versus bone mineral density (BMD). All investigated density measures were significantly correlated with the experimental cycles to failure. The best performing clinically feasible parameter was the QCT-based BMC of the contralateral articular cap region, providing significantly better correlation (R 2  = 0.53) compared to a previously proposed clinical density measure (R 2  = 0.30). BMC had consistently, but not significantly stronger correlations with failure than BMD. The overall best results were obtained with the ipsilateral HR-pQCT-based local BMC (R 2  = 0.74) that may be used for implant optimization. Strong correlations were found between the corresponding density measures of the two CT image sources, as well as between the two sides. Future studies should investigate if BMC of the contralateral articular cap region could provide improved prediction of clinical fixation failure compared to previously proposed measures. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  3. The influence of local bone quality on fracture pattern in proximal humerus fractures.

    Science.gov (United States)

    Mazzucchelli, Ruben A; Jenny, Katharina; Zdravkovic, Vilijam; Erhardt, Johannes B; Jost, Bernhard; Spross, Christian

    2017-12-26

    Bone mineral density and fracture morphology are widely discussed and relevant factors when considering the different treatment options for proximal humerus fractures. It was the aim of this study to investigate the influence of local bone quality on fracture patterns of the Neer classification as well as on fracture impaction angle in these injuries. All acute, isolated and non-pathological proximal humerus fractures admitted to our emergency department were included. The fractures were classified according to Neer and the humeral head impaction angle was measured. Local bone quality was assessed using the Deltoid Tuberosity Index (DTI). The distribution between DTI and fracture pattern was analysed. 191 proximal humerus fractures were included (61 men, mean age 59 years; 130 women, mean age 69.5). 77 fractures (40%) were classified as one-part, 72 (38%) were two-part, 24 (13%) were three- and four-part and 18 (9%) were fracture dislocations. 30 fractures (16%) were varus impacted, whereas 45 fractures (24%) were classified as valgus impacted. The mean DTI was 1.48. Valgus impaction significantly correlated with good bone quality (DTI ≥ 1.4; p = 0.047) whereas no such statistical significance was found for the Neer fracture types. We found that valgus impaction significantly depended on good bone quality. However, neither varus impaction nor any of the Neer fracture types correlated with bone quality. We conclude that the better bone quality of valgus impacted fractures may be a reason for their historically benign amenability to ORIF. On the other hand, good local bone quality does not prevent fracture comminution. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Outcomes evaluation of locking plate osteosynthesis in displaced fractures of the proximal humerus

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    Mauro Emilio Conforto Gracitell

    2013-12-01

    Full Text Available Objective: To evaluate functional outcomes, radiographic findings and complications of proximal humeral fractures treated with locking plates and to determine prognostic factors for successful clinical outcomes. Methods: Forty patients undergoing internal fixation of fractures of the proximal humerus with the Philos(r plate were included in the study. The surgeries were performed between 2004 and 2011 and the patients underwent radiographic and clinical evaluation, by Constant -Murley and Dash score. Outcomes were analyzed by use of multivariate regression with several different variables. Results: Patients were on average of 61.8 ± 16.28 years, and most were female (70%. The Constant -Murley score was 72.03 ± 14.01 and Dash score was 24.96 ± 19.99. The postoperative radiographs showed a head-shaft angle of 135.43º± 11.82. Regression analysis showed that the patient's age and the Hertel classification influenced the Constant -Murley scale (p = 0.0049 and 0.012, respectively. Other prognostic criteria such as Neer and AO classification, head-shaft angle, the presence of metaphyseal comminution and extension of the humeral metaphyseal fragment showed no effect on prognosis. Complications occurred in four patients (10%. Conclusion: The fixation with the Philos(r plate provided good clinical and radiographic results in fractures of the proximal humerus, with a low complication rate. Patient's age and Hertel classification were defined as prognostic factors that led to worse functional outcomes.

  5. Locking screw-plate interface stability in carbon-fibre reinforced polyetheretherketone proximal humerus plates.

    Science.gov (United States)

    Hak, David J; Fader, Ryan; Baldini, Todd; Chadayammuri, Vivek B S

    2017-07-13

    Carbon-fibre reinforced polyetheretherketone (CFR-PEEK) plates have recently been introduced for proximal humerus fracture treatment. The purpose of this study was to compare the locking screw-plate interface stability in CFR-PEEK versus stainless steel (SS) proximal humerus plates. Locking screw mechanical stability was evaluated independently in proximal and shaft plate holes. Stiffness and load to failure were tested for three conditions: (1) on-axis locking screw insertion in CFR-PEEK versus SS plates, (2) on-axis locking screw insertion, removal, and reinsertion in CFR-PEEK plates, and (3) 10-degree off-axis locking screw insertion in CFR-PEEK plates. Cantilever bending at a rate of 1 mm/minute was produced by an Instron machine and load-displacement data recorded. Shaft locking screw load to failure was significantly greater in CFR-PEEK plates compared to SS plates (746.4 ± 89.7 N versus 596.5 ± 32.6 N, p PEEK plates (p PEEK plates. The mechanical stability of locking screws in CFR-PEEK plates is comparable or superior to locking screws in SS plates.

  6. Periprosthetic soft tissue recurrence of chondroblastoma after attempted en bloc excision from the proximal humerus

    Energy Technology Data Exchange (ETDEWEB)

    Hammond, G.W.; Tehranzadeh, J.; Hoang, B.H. [University of California, Irvine, Department of Orthopaedic Surgery, Orange (United States); Gu, M. [University of California, Irvine, Department of Pathology, Orange (United States)

    2006-01-01

    A case of soft tissue recurrence of chondroblastoma after attempted en bloc excision and endoprosthetic replacement is described. This tumor in the proximal humerus recurred after initial curettage and was subsequently treated by attempted en bloc excision with positive microscopic margins. The patient then presented with a large soft tissue recurrence surrounding the endoprosthesis. This periprosthetic recurrence necessitated re-excision and revision of the endoprosthesis. Recurrence is not uncommon following curettage of chondroblastoma. However, less is known about soft tissue recurrence after en bloc resection of this tumor with positive margins. A subset of chondroblastoma may exist with more locally aggressive behavior. (orig.)

  7. [Humerus varus: correction by proximal valgus osteotomy with precontourned plate fixation in children].

    Science.gov (United States)

    Tallón-López, J; Domínguez-Amador, J J; Andrés-García, J A

    2014-01-01

    Varus deformity of the proximal humerus in children is a little known pathology due to its low incidence of presentation. Progress has been made in recent years in understanding the possible etiology and pathophysiological causes. Radiological criteria for diagnosis and functional impairment that occurs have also been defined. However, there are few reports in the literature about the surgical treatment of this deformity in children. In this paper we present a case of surgical treatment of this deformity by corrective osteotomy fixed with precontoured external maleolar plate osteosynthesis. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  8. Reverse shoulder arthroplasty with glenoid bone grafting for anterior glenoid rim fracture associated with glenohumeral dislocation and proximal humerus fracture.

    Science.gov (United States)

    Garofalo, R; Brody, F; Castagna, A; Ceccarelli, E; Krishnan, S G

    2016-12-01

    Large fractures of the anterior glenoid rim can result in persisting instability and osteoarthritis of the glenohumeral joint When this fracture is associated with a glenohumeral dislocation and proximal humerus fracture could be a concern. The goal of this paper was to evaluate the clinical and radiological outcomes and complications of reverse shoulder arthroplasty (RSA) and glenoid bone graft in cases with a significant anterior glenoid fracture associated with a proximal humerus fracture. RSA and step bone graft harvested from proximal humeral head could be a viable option in the treatment of this complex injury. Retrospective case series. Twenty-six patients underwent RSA and glenoid bone graft in a single stage procedure were evaluated at an average 32 months postoperatively. There were 18 women and 8 men with a mean age of 68.5 years (range 63-75 years). Reverse shoulder arthroplasty with a contoured glenoid bone graft placed underneath the baseplate using humeral head autograft was utilized in all cases. Clinical outcomes were evaluated with range of motion, Constant score and self-reported subjective outcome rated as excellent, good, fair or poor. Radiographic evaluation was performed to evaluate for baseplate displacement or loosening, bone graft union, resorption or collapse. At final follow-up, average active elevation was 135° (range 110°-145°), abduction 122° (range 60°-160°), and external rotation 30° (range 0 to 45°). The mean Constant score was 68.2 (range 54-83). The clinical results were rated as excellent by 15 patients, good by 9, and fair by 2. Radiographic evaluation showed the disc of cancellous bone graft healed without any signs of graft resorption or migration in all 26 cases. No reoperation was performed on any patient in this series. RSA with glenoid bone grafting produces satisfactory short-term outcomes with acceptable complication rates for treatment of patients greater than 60 years old with proximal humerus fractures

  9. Humeral surface replacement for the sequelae of fractures of the proximal humerus.

    Science.gov (United States)

    Pape, G; Zeifang, F; Bruckner, T; Raiss, P; Rickert, M; Loew, M

    2010-10-01

    Fractures of the proximal humerus can lead to malalignment of the humeral head, necrosis and post-traumatic osteoarthritis. In such cases surface replacement might be a promising option. A total of 28 shoulders with glenohumeral arthritis subsequent to a fracture underwent surface replacement arthroplasty of the humeral head in patients with a mean age of 60 years (35 to 83). On the basis of the inclination of the impacted head, post-traumatic arthritis was divided into three types: type 1, an impacted fracture of the head in an anatomical position (seven cases); type 2, a valgus impacted fracture (13 cases); type 3, a varus impacted fracture (eight cases). The outcome was measured by means of the Constant score. According to the Boileau classification of the sequelae of fractures of the proximal humerus, all 28 patients had a final result of intra-capsular category 1. The mean Constant score for the 28 shoulders increased from 23.2 points (2 to 45) pre-operatively to 55.1 points (20 to 89) at a mean of 31 months (24 to 66) post-operatively. Valgus impacted fractures had significantly better results (p humeral shaft, such as peri-prosthetic fractures. Further surgery can be undertaken more easily as the bone stock is preserved.

  10. Functional outcome of closed fractures of proximal humerus managed by Joshi′s external stabilizing system

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    Anil Kumar Gupta

    2012-01-01

    Full Text Available Background: Proximal humeral fractures account for 4-5% of all fractures; most of them involving elderly and osteoporotic people. 1 51% of such fractures are displaced. Two Fractures with minimal displacement, regardless of the number of fracture lines, can be treated with closed reduction and early mobilization, but anatomical reduction in displaced fractures is difficult to obtain and the incidence of pseudarthrosis is high 3-5. We evaluated the functional results of closed Neer′s 2- and 3-part proximal humerus fractures treated by Joshi′s external stabilizing system. Materials and Methods: Sixteen patients with proximal humeral fractures were managed from 2008 to 2010 by Joshi′s stabilizing external fixation. They were 10 males and 6 females, with a mean age of 57.5 years. Based on Neer′s classification, there were eleven 3-part fractures and five 2-part fractures. The mechanism of injuries included seven road traffic accidents and nine fall. Shoulder mobilization exercises were started within 1 week after stabilization with JESS. External fixation was removed after the evidence of union (6-8 weeks. Pain was evaluated by visual analogue scale (VAS and shoulder range of motion was evaluated by Constant Scoring System. Followup was done at 4 weeks, 8 weeks, 12 weeks, and then at every 4 weeks. Results: Mean followup was of 20.5 months (range 9-30 months. Postoperative mean VAS score and Constant Score of patients was 2.1 (±0.73 and 78.1 (±9.61 at an average followup of 6 months. Mean duration for union was 6.5 (±1.18 weeks. One case of K-wire loosening and one case of pin tract infection were the complications noted. Conclusion: External fixation by JESS is an alternative option to treat Neer′s 2 and 3 part proximal humerus fractures with good results.

  11. A severely displaced metaphyseal fracture of the proximal humerus with dislocation of the shoulder in a child

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    JI Jonghun

    2014-02-01

    Full Text Available 【Abstract】Fracture of the proximal humerus metaphysis with coexistent dislocation of the shoulder in chil- dren is a rare injury. The injury often occurs as a consequence of high velocity trauma. Most fractures of the proximal humerus commonly associated with the epiphysis in children can be treated with closed reduction. We presented a case of 5-year-old girl who sustained this type of fracture- dislocation of the shoulder. Open reduction and internal fixation with multiple smooth K-wires was performed. At two years follow-up, the patient was pain free and regained full range of motion.

  12. Primary hemiarthroplasty versus conservative treatment for comminuted fractures of the proximal humerus in the elderly (ProCon): a multicenter randomized controlled trial

    NARCIS (Netherlands)

    den Hartog, Dennis; van Lieshout, Esther M. M.; Tuinebreijer, Wim E.; Polinder, Suzanne; van Beeck, Ed F.; Breederveld, Roelf S.; Bronkhorst, Maarten W. G. A.; Eerenberg, Jan Peter; Rhemrev, Steven; Roerdink, W. Herbert; Schraa, Gerrit; van der Vis, Harm M.; van Thiel, Thom P. H.; Patka, Peter; Nijs, Stefaan; Schep, Niels W. L.

    2010-01-01

    Fractures of the proximal humerus are associated with a profound temporary and sometimes permanent, impairment of function and quality of life. The treatment of comminuted fractures of the proximal humerus like selected three-or four-part fractures and split fractures of the humeral head is a

  13. Primary hemiarthroplasty versus conservative treatment for comminuted fractures of the proximal humerus in the elderly (ProCon): A Multicenter Randomized Controlled trial

    NARCIS (Netherlands)

    D. den Hartog (Dennis); W.E. Tuinebreijer (Wim); S. Polinder (Suzanne); E.F. van Beeck (Ed); R.S. Breederveld (Roelf S.); M.W.G.A. Bronkhorst (Maarten); J.P. Eerenberg (Jan Peter); S. Rhemrev (Steven); W.H. Roerdink (Herbert); G. Schraa (Gerrit); H.M. van der Vis (Harm); T.P.H. Thiel (Tom); P. Patka (Peter); S. Nijs (Stefaan); N.W.L. Schep (Niels)

    2010-01-01

    textabstractBackground. Fractures of the proximal humerus are associated with a profound temporary and sometimes permanent, impairment of function and quality of life. The treatment of comminuted fractures of the proximal humerus like selected three-or four-part fractures and split fractures of the

  14. External fixation by Joshi′s external stabilizing system in cases of proximal humerus fractures in elderly subjects

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    Soumya Ghosh

    2013-01-01

    Full Text Available Fracture of the proximal humerus is a common and debilitating injury occurring mainly in elderly females and accounts for 4-5% of all adult fractures. Patients with displaced, unstable proximal humeral fractures may have improved outcomes if managed operatively. Objectives: To study the effect of using Joshi′s external stabilizing system (JESS for the management of fractures of proximal humerus in elderly. Materials and Methods: This prospective study was conducted in a tertiary care hospital in West Bengal on 28 subjects with proximal humerus fractures. As per Neer′s classification, 3- and 4-part fractures were included and prepared for JESS fixation. The results of the treatment were evaluated as per Neer′s criteria. Patients were followed up for 10 − 12 months. Results: Among 18 females and 10 males, 22 had 3-part fracture and 6 had 4-part fracture. Mean duration of JESS application was 10 weeks. Among patients with 3-part fractures 4 cases had excellent result, 12 had satisfactory result, 4 had unsatisfactory result and treatment failed in 2 cases. With 4-part fractures, 2 cases had unsatisfactory result and 4 cases were failures. Conclusion: JESS is an alternative option for the treatment of proximal humerus fractures, especially in elderly patients with osteoporosis, showing excellent to good results in cases of Neer′s type 3-part fracture.

  15. Low-grade central osteosarcoma in proximal humerus: a rare entity

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    Tang F

    2017-10-01

    Full Text Available Fan Tang,1,2 Li Min,1,2 Yong Zhou,1 Yi Luo,1 Chongqi Tu1 1Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2Sarcoma Biology Laboratory, Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, MA, USA Abstract: Low-grade central osteosarcoma is a rare subtype of tumor with low-grade malignancy. Currently, wide resection with negative resection margin is the standard treatment for this disease. The role of neoadjuvant chemotherapy in low-grade central osteosarcoma was controversial and was mostly considered for tumors containing high-grade focal areas. Local tumor recurrences often exhibited a tumor with higher histologic grade or differentiation with the potential for metastases. In low-grade central osteosarcoma, timely wide resection after definite diagnosis can result in 5-year survival for almost 90%. However, the relatively nonspecific radiological and pathological findings make diagnosis very difficult. MDM2 and CDK4 are specific and provide sensitive markers for the diagnosis of low-grade central osteosarcoma, helping to differentiate low-grade central osteosarcoma from some benign lesions, including fibrous dysplasia, bone giant cell tumor, and chondrosarcoma. Here, we report the case of a 19-year-old woman with low-grade central osteosarcoma located at the proximal humerus. The affected site was rare, but the sensitive biomarkers CDK4 and MDM2 were positive. The patient recovered well after wide tumor resection following a proximal humerus endoprosthesis replacement. Our case highlighted the management strategies in low-grade central osteosarcoma. Being familiar with radiographic features, understanding the biological characteristics, and mastering diagnostic biomarkers can help oncologists avoid embarrassing situations in treatment when this rare tumor is highly suspected, even when located at an uncommon site. The discussion in this report

  16. Primary total elbow arthroplasty in complex fractures of the distal humerus

    DEFF Research Database (Denmark)

    Sørensen, Brian Weng; Brorson, Stig; Olsen, Bo Sanderhoff

    2014-01-01

    AIM: To evaluate short- to medium term outcome of total elbow arthroplasty (TEA) in complex fractures of the distal humerus. METHODS: A consecutive series of 24 complex distal humerus fractures operated with TEA in the period 2006-2012 was evaluated with the Mayo Elbow Performance score (MEPS), p...

  17. Modular prostheses in the treatment of proximal humerus metastases: review of 40 cases

    Science.gov (United States)

    Scotti, C.; Peretti, G. M.; Fontana, F.; Fraschini, G.

    2008-01-01

    Background The humerus is the second most common site of metastatic bone disease involving long bones. Tumors which have a predilection for dissemination to bone are those of breast, prostate, thyroid, lung and kidney. The rationale for surgical treatment of these lesions is to prevent or treat pathological fractures in order to relieve pain and improve function. Materials and methods Forty patients who had resection of the proximal humerus for metastatic bone disease and reconstruction with a modular prosthesis were retrospectively reviewed. Results Mean functional outcome was 73.1% (Enneking score) and better results were achieved when a reverse prosthesis was implanted. Overall survival was 70% at 1 year, 42.5% at 2 years and 20% at 5 years. Local recurrence occurred in 4 patients, each of whom had initially been treated for a pathological fracture. Conclusions It is important to follow rational guidelines, like those of Capanna and Mirels, in order to prevent pathological fractures and to give the patient a definitive treatment, as the advances in the management of cancer prolong the survival of these patients. In this series, satisfactory results were obtained, giving the patients an acceptable quality of life. PMID:19384474

  18. The role of reverse shoulder arthroplasty in management of proximal humerus fractures with fracture sequelae: a systematic review of the literature

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    James Holton

    2017-02-01

    Full Text Available Fracture sequelae of the proximal humerus poses a complex management decision due to the frequent deformity and its consequences on the peri-articular soft tissues. These patients are frequently elderly with significant medical comorbidities. Due to the age of the patient there is frequently rotator cuff deficiency and therefore the reverse shoulder arthroplasty (RSA becomes the arthroplasty of choice. We have performed a systematic review of the literature and report nine studies presenting RSA for the treatment of fracture sequelae of the proximal humerus. It is clear that RSA can improve the range of movement and function following proximal humerus fracture sequelae. However, there is a risk of significant complications including dislocation (16.7%, infection (6.7%, intra-operative fracture (3% and neurological injury (2.6%. There is a need to invest in future prospective comparative studies and randomised trials to further test RSA in fracture sequelae patients. This will provide us with information regarding the longevity of different prosthesis, outcomes and costeffectiveness of treatment.

  19. Prediction of the pre-morbid 3D anatomy of the proximal humerus based on statistical shape modelling.

    Science.gov (United States)

    Poltaretskyi, S; Chaoui, J; Mayya, M; Hamitouche, C; Bercik, M J; Boileau, P; Walch, G

    2017-07-01

    Restoring the pre-morbid anatomy of the proximal humerus is a goal of anatomical shoulder arthroplasty, but reliance is placed on the surgeon's experience and on anatomical estimations. The purpose of this study was to present a novel method, 'Statistical Shape Modelling', which accurately predicts the pre-morbid proximal humeral anatomy and calculates the 3D geometric parameters needed to restore normal anatomy in patients with severe degenerative osteoarthritis or a fracture of the proximal humerus. From a database of 57 humeral CT scans 3D humeral reconstructions were manually created. The reconstructions were used to construct a statistical shape model (SSM), which was then tested on a second set of 52 scans. For each humerus in the second set, 3D reconstructions of four diaphyseal segments of varying lengths were created. These reconstructions were chosen to mimic severe osteoarthritis, a fracture of the surgical neck of the humerus and a proximal humeral fracture with diaphyseal extension. The SSM was then applied to the diaphyseal segments to see how well it predicted proximal morphology, using the actual proximal humeral morphology for comparison. With the metaphysis included, mimicking osteoarthritis, the errors of prediction for retroversion, inclination, height, radius of curvature and posterior and medial offset of the head of the humerus were 2.9° (± 2.3°), 4.0° (± 3.3°), 1.0 mm (± 0.8 mm), 0.8 mm (± 0.6 mm), 0.7 mm (± 0.5 mm) and 1.0 mm (± 0.7 mm), respectively. With the metaphysis excluded, mimicking a fracture of the surgical neck, the errors of prediction for retroversion, inclination, height, radius of curvature and posterior and medial offset of the head of the humerus were 3.8° (± 2.9°), 3.9° (± 3.4°), 2.4 mm (± 1.9 mm), 1.3 mm (± 0.9 mm), 0.8 mm (± 0.5 mm) and 0.9 mm (± 0.6 mm), respectively. This study reports a novel, computerised method that accurately predicts the pre-morbid proximal humeral anatomy even in challenging

  20. Open reduction and Internal Fixation of Displaced Proximal Humerus Fractures with AO Stainless Steel T-Plate

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    Hussain S

    2014-03-01

    Full Text Available Background: Proximal humeral fractures are considered the last unsolved fractures in orthopaedics. The treatment is controversial and various operative modalities have been reported in the literature. The aim of the present study was to evaluate functional outcome and complication rate after open reduction and internal fixation of displaced proximal humerus fractures by proximal humerus AO stainless steel Tplate. Twenty-five (25 patients with displaced proximal humerus fractures treated with proximal humerus T-plate between May 2005 and June 2008 were included in the study. Fractures were classified according to the Neer classification into displaced 2-part, 3-part, and 4-part fractures. Patients were followed-up for a minimum period of two years. Functional evaluation was done according to the Neer scoring system. Scores were compared with other studies in the literature using similar implant. Twenty patients had 2-part fracture, four had 3-part fracture, and one had 4-part fracture. Eighty-eight [88% (n = 22] patients had good to excellent result, eight [8% (n = 2] had fair, and four [4% (n = 1] had poor result. Difference in Neer’s score between 2-part and 3-part fractures was not significant. Complications encountered in this series were screw backout in 8% (n = 2, superficial infection in 12% (n= 3, and avascular necrosis in 4% (n = 1 of cases. We conclude that proximal humerus AO T- plate is a cheap and easily available implant, aspects which are particularly relevant in third world countries like India. It gives reliable fixation for 2-part and 3-part fractures. Its use in more complicated fracture patterns of 4-part fractures is not recommended.

  1. External fixation for the treatment of open fractures of the proximal humerus caused by firearms

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    Mirić Dragan

    2004-01-01

    Full Text Available Nine patients with open fractures of the proximal humerus were treated using an external fixation device. All of them had grade III open fractures resulting from high-velocity missile and explosive injuries with massive foreign body contamination. Radial nerve injury was present in five and two multiply injuried patients with thoracic wall and abdominal viscera were present. There were no major arterial injuries. Chronic osteitis with fistula and sequestra developed in one. There were no nonunions and no refractures. Minor painless limitation of shoulder and elbow motion presented in all patient. Upper-third humeral open fractures due to firearms are a unique type of open fractures. They are usually highly comminuted therefore, stable fixation is difficult or impossible to achieve. On the other hand, the risk of infection is high following plate fixation. External fixation allows adequate management of the soft tissue wounds, provides stable bone fixation and allows early mobilization of the shoulder and elbow.

  2. The overlooked side of convulsion: bilateral posterior fracture and dislocation of proximal humerus.

    Science.gov (United States)

    Yigit, Mehmet; Yaman, Asli; Yigit, Eda; Turkdogan, Kenan Ahmet

    2016-05-01

    Injuries after an epileptic convulsion have been seen commonly such as burns, head injury and dislocation of the extremities. But fractures of the extremities due to convulsion are rare. External trauma mechanism is not necessary for extremity fractures. Muscle contractions can cause increased load on the skeleton and it can be complicated by dislocation andor fracture of extremities. Almost 1-4% of all the shoulder dislocations are posterior. In this case report we present a 32 year old male patient who had bilateral posterior fracture and dislocation of proximal humerus after convulsion. We would like to emphasize that it is so important to make systemic examination and evaluation of the patients who were admitted to emergency department after epileptic convulsion.

  3. Minimally invasive percutaneous plating of proximal humeral shaft fractures with the Proximal Humerus Internal Locking System (PHILOS).

    Science.gov (United States)

    Brunner, Alexander; Thormann, Sebastian; Babst, Reto

    2012-08-01

    This study evaluated our results after minimally invasive percutaneous plating of proximal humeral shaft fractures with the Proximal Humerus Internal Locking System (PHILOS, Synthes, Switzerland). Between 2005 and 2008, 15 patients with unilateral displaced proximal humeral shaft fractures were treated and followed up over a median period of 27 months (range, 12-38 months). The final follow-up included anteroposterior and lateral x-rays, range of shoulder motion, pain by visual analog scale (VAS), the Constant-Murley shoulder score, the Disabilities of Arm, Shoulder and Elbow (DASH) score, and the Short Form 36 (SF36) assessment. No intraoperative or postoperative complications occurred. No secondary fracture displacement or radial neuropathy was observed postoperatively. One patient had open reduction and internal fixation for pseudoarthrosis 16 months after the initial surgery. At the final follow-up, the median range of motion of the operated shoulder was flexion, 145°; extension, 45°; internal rotation, 40°; external rotation, 70°; and abduction, 135°. Median results on outcome assessments were VAS pain score, 0 points; Constant-Murley score, 74 points, representing 87.5% of the median Constant-Murley score of the unaffected shoulder; DASH score, 34 points, and the SF36, 83 points. Minimally invasive percutaneous plating with the PHILOS offers a valid option in the treatment of proximal humeral shaft fractures with comparable rates of nonunion and lower rates of radial neuropathy compared with open procedures. Furthermore, the results indicate that this method is associated with lower rates of wound infection and a shorter stay in the hospital for the patient. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  4. Review of fixation techniques for the four-part fractured proximal humerus in hemiarthroplasty

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    Lorenzetti Silvio

    2011-07-01

    Full Text Available Abstract Introduction The clinical outcome of hemiarthroplasty for proximal humeral fractures is not satisfactory. Secondary fragment dislocation may prevent bone integration; the primary stability by a fixation technique is therefore needed to accomplish tuberosity healing. Present technical comparison of surgical fixation techniques reveals the state-of-the-art approach and highlights promising techniques for enhanced stability. Method A classification of available fixation techniques for three- and four part fractures was done. The placement of sutures and cables was described on the basis of anatomical landmarks such as the rotator cuff tendon insertions, the bicipital groove and the surgical neck. Groups with similar properties were categorized. Results Materials used for fragment fixation include heavy braided sutures and/or metallic cables, which are passed through drilling holes in the bone fragments. The classification resulted in four distinct groups: A: both tuberosities and shaft are fixed together by one suture, B: single tuberosities are independently connected to the shaft and among each other, C: metallic cables are used in addition to the sutures and D: the fragments are connected by short stitches, close to the fragment borderlines. Conclusions A plurality of techniques for the reconstruction of a fractured proximal humerus is found. The categorisation into similar strategies provides a broad overview of present techniques and supports a further development of optimized techniques. Prospective studies are necessary to correlate the technique with the clinical outcome.

  5. Intramedullary Pinning with Tension-Band Wiring for Surgical Neck Fractures Of the Proximal Humerus in Elderly Patients

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    Cheng-Chang Lu

    2004-11-01

    Full Text Available Most proximal humeral fractures in the elderly population are related to osteoporosis. Several methods have been proposed to treat surgical neck fractures of the proximal humerus in elderly people. This study investigates a new method of intramedullary pinning with tension-band wiring. From June 1998 to March 2001, 10 female patients with a mean age of 73.0 years and displaced two- or three-part surgical neck fractures of the proximal humerus were studied. Two intramedullary pins were used with tension-band wiring via a deltopectoral approach with minimum dissection. The mean follow-up was 20.6 months. Final outcome was evaluated using the constant score, visual analog scale (VAS score, questionnaire, and an outcome assessment form. The outcome was excellent in four patients, good in five, and fair in one. The mean Constant score was 80.8 and the VAS score was 83.0. There was no nonunion, avascular necrosis, deep infection, or pin migration. No patient needed further revision open reduction with internal fixation or prosthesis replacement. We therefore concluded that intramedullary pinning with tension-band wiring is a safe, reliable method, with few complications, for treating surgical neck fractures of the proximal humerus in elderly patients.

  6. Asymptomatic Migration of a Kirschner Wire from the Proximal Aspect of the Humerus to the Thoracic Cavity: A Case Report.

    Science.gov (United States)

    Pientka, William F; Bates, Christopher M; Webb, Brian G

    2016-01-01

    A 78-year-old man presented with an open fracture of the proximal aspect of the humerus and an axillary artery laceration; the fracture was treated provisionally with Kirschner wires (K-wires). Forty-five days postoperatively, he presented with pin prominence at the lateral aspect of the arm, and was incidentally noted to have migration of a separate K-wire to the left lung. He underwent successful thoracotomy and lung wedge resection for wire removal. K-wires used in the fixation of fractures of the proximal aspect of the humerus may migrate into the thoracic cavity. No modification of this technique, including the use of threaded, terminally bent, or external pins that are visibly secured, eliminates the potential for devastating complications.

  7. Secondary Subacromial Impingement after Valgus Closing-Wedge Osteotomy for Proximal Humerus Varus

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    Hirotaka Sano

    2015-01-01

    Full Text Available A 31-year-old construction worker had been suffering from both the motion pain and the restriction of elevation in his right shoulder due to severe varus deformity of humeral neck, which occurred after proximal humeral fracture. The angle for shoulder flexion and abduction was restricted to 50 and 80 degrees, respectively. Valgus closing-wedge osteotomy followed by the internal fixation using a locking plate was carried out at 12 months after injury. Postoperatively, the head-shaft angle of the humerus improved from 65 to 138 degrees. Active flexion and abduction angles improved from 80 to 135 degrees and from 50 to 135 degrees, respectively. However, the patient complained from a sharp pain with a clicking sound during shoulder abduction even after removal of the locking plate. Since subacromial steroid injection temporarily relieved his shoulder pain, we assumed that the secondary subacromial impingement was provoked after osteotomy. Thus, arthroscopic subacromial decompression was carried out at 27 months after the initial operation, which finally relieved his symptoms. In the valgus closing-wedge osteotomy, surgeons should pay attention to the condition of subacromial space to avoid causing the secondary subacromial impingement.

  8. Revision after shoulder replacement for acute fracture of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig; Salomonsson, Björn; Jensen, Steen L

    2017-01-01

    Background and purpose - For more than half a century, stemmed hemiarthroplasty (SHA) has been used in the treatment of comminuted and displaced fractures of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been increasingly popular in cases where it is difficult to obtain satisfactory...... to the national shoulder arthroplasty registries in Denmark, Sweden, and Norway. We included 6,756 shoulder arthroplasties performed for acute fractures between 2004 and 2013. Results - There were 6,112 SHAs (90%) and 565 RSAs (8.4%). The cumulative arthroplasty survival rate after 5 years was 0.96 for both SHA...... and RSA. The relative risk of revision of RSA was 1.4 (95% CI: 0.9-2.2) with SHA as reference. For both types of arthroplasty, the most common reason for revision was infection (SHA 0.8%, RSA 2.1%). The relative risk of revision due to infection was 3.1 (95% CI: 1.6-5.9) for RSA with SHA as reference...

  9. [Biomechanical study of percutaneous pinning as the treatment of proximal humerus fractures].

    Science.gov (United States)

    Jiang, Chun-yan; Wang, Man-yi; Rong, Guo-wei

    2004-03-22

    To investigate the influence on fracture stability by different pin construct during percutaneous pinning for the treatment of proximal humerus fractures. Eighteen pairs (36) adult fresh-frozen humeri were match-paired and divided into 4 groups. Dual-energy bone density scan had been used in order to rule out the influence by different degrees of osteoporosis of the cadaver. Two-part surgical neck fracture model was carried out unanimously in all 36 humeri. Four terminal threaded pins (2.5 mm in diameter) were used in fixation for all specimen. Parallel type pinning (box type) were carried out in 2 groups and convergent type pinning (fan shape) in the other 2 groups. Instron5566 biomechanical tester was applied in determining both anti-shear and anti-torsion ultimate load of each specimen. There was no statistical difference between parallel pin construct and convergent construct in regard of anti-shear resistance (P = 0.73). But by mean of anti-torsion resistance, the parallel construct had significant advantage over the convergent construct (P = 0.04). According to our biomechanical data, parallel pin construct seems to have better torsional stability. We suggest that parallel pin fixation should be applied whenever possible. Convergent pin construct should be considered when parallel construct is not possible or the distance between pins are too small (< 1 cm).

  10. [Retrograde intramedullary nailing in proximal fracture of the humerus in the elderly patient. Results of a minimally invasive management concept].

    Science.gov (United States)

    Hoffmann, R; Khodadadyan, C; Raschke, M; Melcher, I; Maitino, P D; Haas, N P

    1998-01-01

    Retrograde intramedullary fixation of proximal humerus fractures with flexible wires was evaluated in a prospectively documented study. Seventy-four fractures in 73 patients with unstable proximal humerus shaft or neck fractures were fixed with 3-11 flexible intramedullary wires. The age of the patients averaged 72 years (42 females, 31 males). In nine fractures additional implants (screws, cerclages) were used to fix dislocated fragments through an anterior approach to the shoulder. Complications associated with the procedure especially in osteoporotic bone were secondary loss of reduction (16%) and wire migration (21%) which lead to revision surgery in 14% of patients within 6 weeks. A minimum follow-up of 12 months (average 16.5 months) could be obtained in 61 patients (84%). According to the Neer- and Constant-scores 60% showed good or excellent results, 30% had a satisfactory and 10% had an unsatisfactory or poor result.--Retrograde intramedullary, flexible wire fixation can provide an overall satisfactory outcome in unstable proximal humerus fractures of the elderly. However, the high incidence of secondary wire dislocations especially in marked osteoporosis appears to be an unsolved problem of this treatment modality.

  11. Lessons learned from treating patients with unstable multifragmentary fractures of the proximal humerus by minimal invasive plate osteosynthesis.

    Science.gov (United States)

    Oh, Hyoung Keun; Cho, Dae Yeon; Choo, Suk Kyu; Park, Jong Woong; Park, Ki Chul; Lee, Jung Il

    2015-02-01

    The authors present clinical and radiographic results of minimal invasive plate osteosynthesis (MIPO) for three- or four-part fractures of the proximal humerus. Twenty-six patients with three- or four-part proximal humeral fractures treated with the MIPO technique through the deltoid splitting approach were clinically and radiographically evaluated at a minimum of 12 months with an average of 20.1 months. The valgus-impacted type of three-part fracture was excluded to verify the results of the MIPO with unstable multifragmentary fractures of the proximal humerus. Twenty female patients and six male patients were included (mean age 67 years; range 18-90 years). No cases of nonunion were seen. The mean forward flexion, abduction, and external rotation were 145°, 119°, and 48°, respectively. The mean visual analog scale (VAS) for pain was 1.47 points. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 14.5 points, and the mean UCLA score was 29.6 points. The mean neck-shaft angle was 134°. Twenty-three patients had adequate medial support, and three patients did not have adequate medial support on initial postoperative radiographs. Five shoulders (19 %) developed complicated results. Two cases of proximal malposition of the plate (7.7 %) and two intra-articular screw penetrations (7.7 %) were observed. One case of osteonecrosis of the humeral head was identified at the final follow-up (3.8 %). The MIPO technique provides reliable radiologic and functional outcomes for three- and four-part proximal humeral fractures. Our results might support the use of MIPO for treating unstable multi fragmentary fractures of proximal humerus such as three- or four-part fractures to decrease osteonecrosis of humeral head.

  12. A comprehensive update on current fixation options for two-part proximal humerus fractures: a biomechanical investigation.

    Science.gov (United States)

    Yoon, Richard S; Dziadosz, Daniel; Porter, David A; Frank, Matthew A; Smith, Wade R; Liporace, Frank A

    2014-03-01

    Recent advancements in implant technology offer updated options for surgical management that have been rapidly adopted into clinical practice. The objective of this study is to biomechanically test and compare the current fixation options available for surgical fixation of two-part proximal humerus fractures and establish load to failure and stiffness values. Sixteen match-paired (32 total) fresh-frozen, cadaveric specimens were randomized to receive 1 of 4 fixation constructs following creation of an AO/OTA Type 11A3 (two-part) proximal humerus fractures. Fixation constructs tested consisted of 3.5 mm fixed angle plate (3.5-FAP), 4.5 mm fixed angle plate (4.5-FAP), humeral intramedullary nail (IMN), and a humeral intramedullary nail with a fixed angle blade (IMN-FAB). Specimen bone density was measured to ensure no adequate, non-osteoporotic bone. Constructs were tested for stiffness and ultimate load to failure and compared via one-way ANOVA analysis with subsequent post hoc Tukey HSD multiple group comparison statistical analysis. The IMN-FAB construct was significantly stiffer than the 3.5-FAP construct (123.8 vs. 23.9, pproximal humerus fracture exhibited that the stiffest and highest load to failure construct was the IMN-FAB followed by the IMN, 3.5-FAP and then the 4.5-FAP constructs. However, prospective clinical trials with longer-term follow-up are required for definitive assessment of the ideal fixation construct for surgical management of two-part proximal humerus fractures. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Anatomical and biomechanical evaluation of an intramedullary nail for fractures of proximal humerus fractures based on tuberosity fixation.

    Science.gov (United States)

    Clavert, Ph; Hatzidakis, A; Boileau, P

    2016-02-01

    For unstable proximal humerus fractures, both plates and nails may be recommended. We introduce an anterograde nail designed for the treatment of 3- and 4-parts proximal humerus fractures. The aim of this study is to compare the biomechanics of this nail versus a plate and then to analyze the relationships of the screws with the axillary nerve. Our working hypotheses are as follows: (1) this nail is biomechanically equal or better to the reference plate and (2) it does not endanger the axillary nerve. Biomechanical study: using 40 sawbones, a reproducible 4-part fracture was created and fixed first with an angle-stable plate for proximal humeral fracture, then fixed with the nail using 2 posterior screws. All specimens were mounted in a custom testing apparatus. Two trails were performed needing each time 5 "normal" and 5 "osteoporotic" bones. On 20 unpaired shoulders, a nail was inserted with all screws through a superior approach (deltoid split approach). Dissection of all shoulders was done to identify the axillary nerve. The distance between each screw and the axillary nerve or its branches was measured. The proximal humerus nail demonstrated higher values than locking plate for both stiffness and load to failure. The failure mode differs in function of the type of osteosynthesis. The lowest distance between a screw and the axillary nerve was 20.13 mm. We introduce a biomechanically efficient nail without increased neurological risks to improve the pullout strength of the screws to provide more secure fixation of proximal humeral fractures. Basic Science Study, Anatomic Cadaver Study. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. New endoprosthesis suspension method with polypropylene monofilament knitted mesh after resection of bone tumors in proximal humerus.

    Science.gov (United States)

    Fujibuchi, Taketsugu; Matsumoto, Seiichi; Shimoji, Takashi; Ae, Keisuke; Tanizawa, Taisuke; Gokita, Tabu; Hayakawa, Keiko

    2015-06-01

    Endoprosthetic reconstruction of the proximal humerus is one of the standard procedures after resection of tumors of the proximal humerus and has been considered a reliable method to reconstruct the proximal humerus in recent reports. However, instability of the shoulder joint caused by loss of the rotator cuff and deltoid muscle function is often observed after such an endoprosthetic reconstruction. We performed the endoprosthesis suspension method with polypropylene monofilament knitted mesh. This suspension method, by which the endoprosthesis is suspended from the bone structure, was used after resection of tumors in 9 patients. We assessed postoperative stability of the shoulder joint by comparing these patients with 12 patients who underwent the conventional surgical technique, by which the mesh-wrapped endoprosthesis is attached only to soft tissue. In radiographic and physical evaluation, 4 of the 12 patients in the soft tissue reconstruction group showed shoulder joint instability. No patient in the suspension method group showed subluxation of the humeral prosthesis. The mean shoulder flexion was 35° and 65° and the mean shoulder abduction was 40° and 40° for the soft tissue reconstruction group and the suspension method group, respectively. Shoulder joint subluxation sometimes occurs because of elongation of the attached soft tissue in the conventional reconstruction with mesh, whereas no shoulder joint subluxation occurs after endoprosthetic reconstruction in the suspension method because the bone structure has no leeway for elongation. Excellent stability of our new method enables exercise of the surgical shoulder at an early stage, leading to improved range of shoulder joint motion. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  15. Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis.

    Science.gov (United States)

    Klein, Michael; Juschka, Miriam; Hinkenjann, Bernd; Scherger, Bernhard; Ostermann, Peter A W

    2008-01-01

    To evaluate clinical and radiologic results after implantation of the Delta III reverse shoulder prosthesis in elderly patients with comminuted fractures of the proximal humerus. Prospective, single-center-based cohort study. Level II Trauma Center. Patients undergoing insertion of Delta III reverse shoulder prosthesis for the treatment of comminuted fractures of the proximal humerus between July 2002 and December 2004. Surgery with the Delta III reverse shoulder prosthesis through a juxta-acromial approach. Duration of surgery, x-ray evaluation by Nerot's Score, complications, and functional outcome based on the Constant Score, the modified American Shoulder and Elbow Surgeons Score, the Disabilities of the Arm, Shoulder and Hand Score, and the 36-item short-form health survey (SF-36) Score. Twenty patients (14 females, 6 males) with a mean age of 74.85 +/- 5.73 years were included into the study followed up for 33.29 +/- 9.6 months. The average range of motion was for abduction 112.5 +/- 38.19 degrees and for anterior elevation 122.67 +/- 32.84 degrees. The mean Constant Score was 67.85 +/- 13.56. The mean Disabilities of the Arm, Shoulder and Hand Score was 46.85 +/- 15.68, and the mean modified American Shoulder and Elbow Surgeons Score was 68 +/- 11.83. The Physical Component Scale of the SF-36 was 38 +/- 11.94. The Mental Component Scale of the SF-36 score was 52.59 +/- 10.92. Operations were performed 10.05 +/- 8.78 days (3-41) after trauma, and the average operation time was 75.7 +/- 18.11 minutes. The good functional outcome and the short intervention time in our present study and not needing a sufficient rotator cuff for implementation purposes suggest the use of the Delta III reverse shoulder prosthesis as a treatment option for elderly patients with comminuted fractures of the proximal humerus.

  16. Long Term Results of PHILOS Plating and Percutaneous K-Wire Fixation in Proximal Humerus Fractures in The Elderly

    Directory of Open Access Journals (Sweden)

    GS Jaura

    2014-03-01

    Full Text Available This is a report of a study on the long term results of PHILOS plating and percutaneous K-wire fixation in a prospective series of proximal humerus fractures in elderly patients. We reviewed a total of 60 patients with proximal humerus fractures in 30 patients (Group 1, who were treated by open reduction and internal fixation with Proximal Humeral Internal Locking System (PHILOS plate and 30 patients (Group 2 who were treated with percutaneous K-wire fixation. Functional outcome was assessed using Visual Analogue Scale(VAS and Constant-Murley Score. Mean Constant-Murley score was 84.6 points (range: 61-100 in Group 1 and - 76.4 points(range:56-100 in Group 2 at final follow up. Values varied depending upon the fracture type with worst in 4-part fractures. Mean VAS Score was 2.6(range:0-10 in Group 1 and 3.8(range:0-10 in Group 2. We obtained satisfactory results in both the groups, with each procedure having its advantages and shortcomings. We found that PHILOS plate fixation provided stable fixation with minimal implant problems and enabled early range-of motion exercises to achieve acceptable functional results. Fixation with percutaneous K-wires presented an efficient treatment option with the advantages of minimal invasiveness and soft tissue dissection.

  17. A prospective study to assess the surgical outcome in three- and four-part proximal humerus fracture with PHILOS plate

    Directory of Open Access Journals (Sweden)

    Mahantesh Y Patil

    2012-01-01

    Full Text Available Background: Optimal surgical management of three- and four-part proximal humeral fractures in osteoporotic patients is controversial, with many advocating prosthetic replacement of the humeral head. Proximal humerus interlocking osteosyntheses that maintain angular stability under load have been proposed as an alternative to hemiarthroplasty for the treatment of three- and four-part proximal humeral fractures. Materials and Methods: The records showed 50 patients, with a mean age of 57.5 years. The Neer three-part proximal humeral fractures were 18 in number, and the four-part proximal humeral fractures were 32. All the patients were treated surgically between January 2008 and December 2010. All patients had a radiographic and clinical follow-up performed at one, three, and six months and at one year. The clinical outcomes were measured with the use of the Constant-Murley system. This study was based on level 1 of the evidence. Results: The mean Constant score (and standard deviation at the time of the final follow-up was better in the locked-plate group. The mean Constant score was 80 (range, 40 - 100. Complications with this fixation included osteonecrosis in one patient, malunion in one patient, Axillary nerve palsy in one patient, and impingement syndrome in one patient. Conclusions: The most important factor for a favorable outcome in three- and four-part fractures in the proximal end humerus gives an accurate anatomical reduction, which is achieved by locking plate osteosynthesis, with multiplanar screws. It is a safe and effective method, with minimal tissue damage, higher primary stability, and load transfer through the implant, which are important to avoid complications. The PHILOS Plate produces promising functional outcomes.

  18. [High bone consolidation rates after humeral head-preserving revision surgery in non-unions of the proximal humerus].

    Science.gov (United States)

    Aytac, S D; Schnetzke, M; Hudel, I; Studier-Fischer, S; Grützner, P A; Gühring, T

    2014-12-01

    Fractures of the subcapital and proximal humerus shaft region are common fractures of the human skeleton. Their treatment should provide an early functional after-care of the shoulder joint, that is prone to arthrofibrosis. Although the upper extremity is not weight-bearing the occurrence of proximal humerus non-unions leads to severe impairment with inability to work and restrictions of activity of daily life. The aim of this study was to investigate whether an operative revision of proximal humerus non-unions with reosteosynthesis and application of distant autologous bone grafts can lead to sufficient bone healing. The second aim was to find out whether patients achieved an acceptable functional outcome, as alternatively patients could be treated by reconstruction with a shoulder prosthesis. 27 patients (female = 15, male = 12) with reosteosynthesis of the proximal humerus and proximal humeral shaft due to non-union after initially operative fracture treatment were included between 2008 and 2014. Average age of patients was 56 years (23-87), 48% had no comorbidities, while 52% of the patients had at least 1 comorbidity such as diabetes, hypertension or nicotine abusus. The mean number of prior surgical intervention was 1.2 (1-3). The mean time between initial surgery and re-osteosynthesis was 12.3 months. Patients with signs of infection pseudarthrosis were excluded. The initial type of osteosynthesis was with plates (n = 16; thereof PHILOS Plate n = 14), and intramedullary nails (T2, Targon Nail, PHN, Seidel Nail; n = 11). Revision surgery was done with plate osteosynthesis (n = 26; thereof PHILOS Plate n = 4; LC Plate n = 10; angle plate n = 12). In 23 patients (89%) a distant bone transplantation was done from the iliac crest, and 1 patient received allogenous bone. Three patients (11%) received bone morphogenetic protein 7 (BMP 7) in combination with distant bone graft. Intraoperative swabs from the pseudarthrosis area

  19. A scale-space curvature matching algorithm for the reconstruction of complex proximal humeral fractures.

    Science.gov (United States)

    Vlachopoulos, Lazaros; Székely, Gábor; Gerber, Christian; Fürnstahl, Philipp

    2018-01-01

    The optimal surgical treatment of complex fractures of the proximal humerus is controversial. It is proven that best results are obtained if an anatomical reduction of the fragments is achieved and, therefore, computer-assisted methods have been proposed for the reconstruction of the fractures. However, complex fractures of the proximal humerus are commonly accompanied with a relevant displacement of the fragments and, therefore, algorithms relying on the initial position of the fragments might fail. The state-of-the-art algorithm for complex fractures of the proximal humerus requires the acquisition of a CT scan of the (healthy) contralateral anatomy as a reconstruction template to address the displacement of the fragments. Pose-invariant fracture line based reconstruction algorithms have been applied successful for reassembling broken vessels in archaeology. Nevertheless, the extraction of the fracture lines and the necessary computation of their curvature are susceptible to noise and make the application of previous approaches difficult or even impossible for bone fractures close to the joints, where the cortical layer is thin. We present a novel scale-space representation of the curvature, permitting to calculate the correct alignment between bone fragments solely based on corresponding regions of the fracture lines. The fractures of the proximal humerus are automatically reconstructed based on iterative pairwise reduction of the fragments. The validation of the presented method was performed on twelve clinical cases, surgically treated after complex proximal humeral fracture, and by cadaver experiments. The accuracy of our approach was compared to the state-of-the-art algorithm for complex fractures of the proximal humerus. All reconstructions of the clinical cases resulted in an accurate approximation of the pre-traumatic anatomy. The accuracy of the reconstructed cadaver cases outperformed the current state-of-the-art algorithm. Copyright © 2017 Elsevier B

  20. Technique of Open Reduction and Internal Fixation of Comminuted Proximal Humerus Fractures With Allograft Femoral Head Metaphyseal Reconstruction.

    Science.gov (United States)

    Parada, Stephen A; Makani, Amun; Stadecker, Monica J; Warner, Jon J P

    2015-10-01

    Proximal humerus fractures are common injuries that can require operative treatment. Different operative techniques are available, but the hallmark of fixation for 3- and 4-part fractures is a locking-plate-and-screw construct. Despite advances in this technology, obtaining anatomical reduction and fracture union can be difficult, and complications (eg, need for revision) are not uncommon. These issues can be addressed by augmenting the fixation with an endosteally placed fibular allograft. Although biomechanical and clinical results have been good, the technique can lead to difficulties in future revision to arthroplasty, a common consequence of failed open reduction and internal fixation. The technique described, an alternative to placing a long endosteal bone graft, uses a trapezoidal, individually sized pedestal of allograft femoral head to facilitate the reduction and healing of the humeral head and tuberosity fragments in a displaced 3- or 4-part fracture of the proximal humerus. It can be easily incorporated with any plate-and-screw construct and does not necessitate placing more than 1 cm of bone into the humeral intramedullary canal, limiting the negative effects on any future revision to arthroplasty.

  1. Operative treatment of 2-part surgical neck fractures of the proximal humerus (AO 11-A3) in the elderly: Cement augmented locking plate Philos™ vs. proximal humerus nail MultiLoc®.

    Science.gov (United States)

    Helfen, Tobias; Siebenbürger, Georg; Mayer, Marcel; Böcker, Wolfgang; Ockert, Ben; Haasters, Florian

    2016-10-28

    Proximal humeral fractures are with an incidence of 4-5 % the third most common fractures in the elderly. In 20 % of humeral fractures there is an indication for surgical treatment according to the modified Neer-Criteria. A secondary varus dislocation of the head fragment and cutting-out are the most common complications of angle stable locking plates in AO11-A3 fractures of the elderly. One possibility to increase the stability of the screw-bone-interface is the cement augmentation of the screw tips. A second is the use of a multiplanar angle stablentramedullary nail that might provide better biomechanical properties after fixation of 2-part-fractures. A comparison of these two treatment options augmented locking plate versus multiplanar angle stable locking nail in 2-part surgical neck fractures of the proximal humerus has not been carried out up to now. Forty patients (female/male, ≥60 years or female postmenopausal) with a 2-part-fracture of the proximal humerus (AO type 11-A3) will be randomized to either to augmented plate fixation group (PhilosAugment) or to multiplanar intramedullary nail group (MultiLoc). Outcome parameters are Disabilities of the Shoulder, Arm and Hand-Score (DASH) Constant Score (CS), American Shoulder and Elbow Score (ASES), Oxford Shoulder Score (OSS), Range of motion (ROM) and Short Form 36 (SF-36) after 3 weeks, 6 weeks, 3 months, 6 months, 12 and 24 months. Because of the lack of clinical studies that compare cement augmented locking plates with multiplanar humeral nail systems after 2-part surgical neck fractures of the proximal humerus, the decision of surgical method currently depends only on surgeons preference. Because only a randomized clinical trial (RCT) can sufficiently answer the question if one treatment option provides advantages compared to the other method we are planning to perform a RCT. Clinical Trial ( NCT02609906 ), November 18, 2015, registered retrospectively.

  2. [Case-control studies on therapeutic effects of combined methods of minimally invasive percutaneous proximal humerus locked osteosynthesis plate with injectable bone for the treatment of proximal humerus fractures in elderly patients].

    Science.gov (United States)

    Wang, Zhao-Hui; Deng, Dun; Chen, Li-Qiu; Zhang, Wei-Kang; Yan, Hai-Bo; Chen, Xiao-Yu; Liang, Zhong; Jiang, Zheng-Hui

    2013-05-01

    To evaluate the clinical effects of combined methods of minimally invasive percutaneous proximal humeral internal locking system (PHILOS) and injectable bone for the treatment of proximal humerus fractures in elderly patients. From January 2006 to January 2012, 80 patients with proximal humerus fractures were randomly divided into two groups (n = 40). The patients in the research group were treated with minimally invasive PHILOS fixation combined with injectable bone, including 20 males and 20 females, with an average age of (68.4 +/- 11.9) years; according to AO classification, 2 cases of type A1, 3 cases of type A2, 6 cases of type B1, 7 cases of type B2, 9 cases of type B3, 6 cases of type C1, 7 cases of type C2. The patients in the control group were treated with PHILOS fixation, including 18 males and 22 females, with an average age of (65.4 +/- 10.7) years; according to AO classification, 3 cases of type A1, 4 cases of type A2, 5 cases of type B1, 8 cases of type B2, 10 cases of type B3, 5 cases of type C, and 5 cases of type C2. The BMD, satisfactory rate, postoperative complications,bone healing time, Constant-Murley score in the two groups were reviewed and compared. In the research group, no patients had necrosis of femoral head, 1 patient had shoulder varus, 1 patient had internal fixation loosening, 36 patients were satisfactory with the treatment results, BMD was (1.013 +/- 0.109) g/cm2, bone healing time averaged (12.00 +/- 3.79) weeks, and the Constant-Murley score was 97.2 +/- 4.6. In the control group, 3 patients had necrosis of femoral head, 5 patients had shoulder varus, 6 patients had internal fixation loosening, 32 patients were satisfactory with the treatment results, BMD was (0.812 +/- 0.089) g/cm2, bone healing time averaged (20.00 +/- 8.67) weeks,and the Constant-Murley score was 78.5 +/- 3.2. The results of BMD, satisfactory rate, postoperative complications, bone healing time, and Constant-Murley score in the research group were better

  3. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial.

    Science.gov (United States)

    Rangan, Amar; Handoll, Helen; Brealey, Stephen; Jefferson, Laura; Keding, Ada; Martin, Belen Corbacho; Goodchild, Lorna; Chuang, Ling-Hsiang; Hewitt, Catherine; Torgerson, David

    2015-03-10

    The need for surgery for the majority of patients with displaced proximal humeral fractures is unclear, but its use is increasing. To evaluate the clinical effectiveness of surgical vs nonsurgical treatment for adults with displaced fractures of the proximal humerus involving the surgical neck. A pragmatic, multicenter, parallel-group, randomized clinical trial, the Proximal Fracture of the Humerus Evaluation by Randomization (PROFHER) trial, recruited 250 patients aged 16 years or older (mean age, 66 years [range, 24-92 years]; 192 [77%] were female; and 249 [99.6%] were white) who presented at the orthopedic departments of 32 acute UK National Health Service hospitals between September 2008 and April 2011 within 3 weeks after sustaining a displaced fracture of the proximal humerus involving the surgical neck. Patients were followed up for 2 years (up to April 2013) and 215 had complete follow-up data. The data for 231 patients (114 in surgical group and 117 in nonsurgical group) were included in the primary analysis. Fracture fixation or humeral head replacement were performed by surgeons experienced in these techniques. Nonsurgical treatment was sling immobilization. Standardized outpatient and community-based rehabilitation was provided to both groups. Primary outcome was the Oxford Shoulder Score (range, 0-48; higher scores indicate better outcomes) assessed during a 2-year period, with assessment and data collection at 6, 12, and 24 months. Sample size was based on a minimal clinically important difference of 5 points for the Oxford Shoulder Score. Secondary outcomes were the Short-Form 12 (SF-12), complications, subsequent therapy, and mortality. There was no significant mean treatment group difference in the Oxford Shoulder Score averaged over 2 years (39.07 points for the surgical group vs 38.32 points for the nonsurgical group; difference of 0.75 points [95% CI, -1.33 to 2.84 points]; P = .48) or at individual time points. There were also no

  4. Reverse shoulder endoprosthesis for pathologic lesions of the proximal humerus: a minimum 3-year follow-up.

    Science.gov (United States)

    Maclean, Simon; Malik, Shahbaz S; Evans, Scott; Gregory, Jonathan; Jeys, Lee

    2017-11-01

    The Bayley Walker (Stanmore Implants, Elstree, UK) reversed polarity, linked shoulder replacement is designed to provide stable function in the treatment of a painful shoulder with poor soft tissue coverage. We reviewed the results of the prosthesis in destructive pathologic lesions of the proximal humerus at a United Kingdom tumor center. We identified 8 patients (2 men, 6 women) in our database. Clinical information and functional outcome scores were collected, including range of movement, Toronto Extremity Salvage Score, the Musculoskeletal Tumor Score. Radiographs from the last clinic follow-up were analyzed. Of the 8 patients, 2 were revisions for aseptic loosening around proximal humeral endoprosthetic replacements. Indications for surgery included chondrosarcoma in 4, metastatic disease in 2, Ewing sarcoma in 1, and osteomyelitis in 1. Patients were a mean age at diagnosis of 49 years (range, 16-78 years). One patient died of metastatic disease during follow-up. Mean follow-up was 49 months (range, 36-90 months). At the latest follow-up, there was 100% survivorship using revision as the end point. There were no local recurrences. Three of 5 patients returned to their previous occupation. Neuropathic pain developed in 1 patient postoperatively, but no other postoperative complications were noted. Radiographs showed no progressive lucencies or scapula notching. Mean range of movement at final follow-up was abduction, 62°; forward flexion, 71°; and external and internal rotation, 50°. The Bayley Walker prosthesis gives excellent medium-term survivorship and pain relief in patients with pathologic lesions of the proximal humerus requiring wide local excision. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  5. Radius neck-to-humerus trochlea transposition elbow reconstruction after proximal ulnar metastatic tumor resection: case and literature review

    Directory of Open Access Journals (Sweden)

    Chen FeiYan

    2012-07-01

    Full Text Available Abstract Wide en bloc excision of proximal ulna sections is used to treat traumatic and pathological fractures of the ulna, though poor standardization of clinical treatment often results in long-term failure of such reconstructed biomechanical structures. In order to provide insight into effective ulnar reconstructive treatments, the case of an 80-year-old Chinese Han male presenting with pathological fracture caused by a proximal ulnar metastatic tumor concurrent with metastatic renal cancer complicated by occurrence in the brain and lungs is reported and contrasted with alternative treatment techniques. Wide resectioning of the proximal ulna and reconstruction with local radius neck-to-humerus trochlea transposition resulted in preservation of functionality, sensitivity, and biomechanical integrity after postsurgical immobilization, 6 weeks of passive- and active-assisted flexion, and extension with a hinged brace. The resultant Musculoskeletal Tumor Society rating score was 25 of 30 (83 %. Full sensitivity and mobility of the left hand and elbow (10° to 90° with minimally impaired supination and pronation was restored with minimal discomfort. No evidence of local recurrence or other pathological complications were observed within a 1-year follow-up period. Efficient reconstruction of osseous and capsuloligamentous structures in the elbow is often accomplished by allografts, prosthesis, and soft tissue reconstruction, though wide variations in risk and prognosis associated with these techniques has resulted in disagreements regarding the most effective standards for clinical treatment. Current findings suggest that radius neck-to-humerus trochlea transposition offers a superior range of elbow movement and fewer complications than similar allograft and prosthetic techniques for patients with multiple metastatic cancers.

  6. Least Possible Fixation Techniques of 4-Part Valgus Impacted Fractures of the Proximal Humerus: A Systematic Review

    Science.gov (United States)

    Panagopoulos, Andreas; Tatani, Irini; Ntourantonis, Dimitrios; Seferlis, Ioannis; Kouzelis, Antonis; Tyllianakis, Minos

    2016-01-01

    The valgus-impacted (VI) 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. We systematically reviewed clinical studies assessing the benefits and harms of least possible fixation techniques (LPFT) for this unique fracture type. Such information would be potentially helpful in developing an evidence-based approach in the management of these complex injuries. We performed analytic searches of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library, restricting it to the years 1991-2014. Included studies had to describe outcomes and complications after primary osteosynthesis with any type of LPFT apart from plate-screws and intramedullary nailing. Eligibility criteria were also included English language, more than 5 cases, minimum follow up of one year and report of clinical outcome using at least one relevant score (Constant, Neer or ASES). Based on 292 database hits we identified 12 eligible studies including 190 four-part valgus impacted fractures in 188 patients. All eligible studies were case series composed of min 8 to max 45 patients per study. The gender distribution was 60% (112) female and 40% (76) male. The average age of the patients at the time of injury was 54.5 years. In 8/12 studies an open reduction was used for fracture fixation using different surgical techniques including KW, cerclage wires, cannulated screws and osteosutures. Closed reduction and percutaneous fixation was used in 4 studies. Mean follow-up time ranged from 24 to 69 months. A good functional outcome (constant score >80) was reported in 9/12 studies. The most common complication was avascular necrosis of the humeral head with an overall incidence of 11% (range, 0-26.3%). Total avascular necrosis (AVN) was found in 15/188 patients (7.9%) and was more common in percutaneous techniques and partial AVN in 6/188 (3

  7. Least possible fixation techniques of 4-part valgus impacted fractures of the proximal humerus: a systematic review

    Directory of Open Access Journals (Sweden)

    Andreas Panagopoulos

    2016-03-01

    Full Text Available The valgus-impacted (VI 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. We systematically reviewed clinical studies assessing the benefits and harms of least possible fixation techniques (LPFT for this unique fracture type. Such information would be potentially helpful in developing an evidence-based approach in the management of these complex injuries. We performed analytic searches of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library, restricting it to the years 1991-2014. Included studies had to describe outcomes and complications after primary osteosynthesis with any type of LPFT apart from plate-screws and intramedullary nailing. Eligibility criteria were also included English language, more than 5 cases, minimum follow up of one year and report of clinical outcome using at least one relevant score (Constant, Neer or ASES. Based on 292 database hits we identified 12 eligible studies including 190 four-part valgus impacted fractures in 188 patients. All eligible studies were case series composed of min 8 to max 45 patients per study. The gender distribution was 60% (112 female and 40% (76 male. The average age of the patients at the time of injury was 54.5 years. In 8/12 studies an open reduction was used for fracture fixation using different surgical techniques including KW, cerclage wires, cannulated screws and osteosutures. Closed reduction and percutaneous fixation was used in 4 studies. Mean follow-up time ranged from 24 to 69 months. A good functional outcome (constant score >80 was reported in 9/12 studies. The most common complication was avascular necrosis of the humeral head with an overall incidence of 11% (range, 0-26.3%. Total avascular necrosis (AVN was found in 15/188 patients (7.9% and was more common in percutaneous techniques and partial AVN in 6

  8. Diagnosing displaced four-part fractures of the proximal humerus: a review of observer studies

    DEFF Research Database (Denmark)

    Brorson, S.; Bagger, J.; Sylvest, A.

    2008-01-01

    Displaced four-part fractures comprise 2-10 % of all proximal humeral fractures. The optimal treatment is unclear and randomised trials are needed. The conduct and interpretation of such trials is facilitated by a reproducible fracture classification. We aimed at quantifying observer agreement...... on the classification of displaced four-part fractures according to the Neer system. Published and unpublished data from five observer studies were reviewed. Observers agreed less on displaced four-part fractures than on the overall Neer classification. Mean kappa values for interobserver agreement ranged from 0.......16 to 0.48. Specialists agreed slightly more than fellows and residents. Advanced imaging modalities (CT and 3D CT) seemed to contribute more to classification of displaced four-part patterns than in less complex fracture patterns. Low observer agreement may challenge the clinical approach to displaced...

  9. Influence of age, gender, and radiographic features on the deltoid splitting approach for surgical osteosynthesis in displaced proximal humerus fractures: a comparison study.

    Science.gov (United States)

    Chen, Alvin Chao-Yu; Chiu, Chih-Hao; Hsu, Kuo-Yau; Chan, Yi-Sheng

    2017-11-28

    The deltoid splitting approach has recently been widely adopted to facilitate less invasive procedures for proximal humerus fractures. However, there are still concerns regarding its effectiveness in aging people and in cases involving complex fractures. This study was conducted to evaluate the efficacy of a proximal humeral locking plate using the anterolateral deltoid splitting approach and to specifically examine the effect of patient age, gender, and fracture pattern on surgical outcomes. Forty-two cases of proximal humeral fractures treated using the deltoid splitting approach and locking plate fixation were reviewed. Outcome differences were evaluated in terms of age, gender distribution, and radiographic analysis based on the Neer Classification. The influence of the surgical approach was further investigated by age-matched paired analysis after subdividing patients into two age groups (younger than 60 years vs. older than 60 years; N = 21, in each group). In total, 41 patients (98%) demonstrated fracture union. The average Constant score was 80.4. No significant differences were found between patients younger than 60 years, and the older patients. Higher mean scores were found in men than in women (p = 0.448) and in simple fractures than in complex fractures (p = 0.454), without any significant differences. Better postoperative functional outcomes were observed when the humeral head-neck angle was greater than 105°, with a significant difference (p = 0.000). Surgical complications were found in 16 patients (38%) without significant difference between two age groups (p = 0.268). The most common complication was screw penetration. Anterolateral deltoid splitting using locking plate fixation provided a feasible alternative for surgery of proximal humerus fractures in different age groups and yielded comparable outcomes when the neck-shaft angle was properly restored. Surgeons must be cautious regarding potential complications

  10. Relationship between the functional outcomes and radiological results of conservatively treated displaced proximal humerus fractures in the elderly: A prospective study

    OpenAIRE

    Mehmet Kerem Canbora; Ozkan Kose; Atilla Polat; Levent Konukoglu; Mucahit Gorgec

    2013-01-01

    Purpose: The purpose of this prospective study is to investigate the relationship between the functional outcome and the radiographic results of conservatively treated two-, three- and four-part proximal humeral fractures in patients aged over 65 years. Materials and Methods: The study comprised 29 prospectively followed cases aged over 65 years who presented with displaced proximal humerus fracture between 2009 and 2011. The fractures were classified according to the Neer classification ...

  11. Avaliação funcional retrospectiva de pacientes com fratura proximal de úmero fixada com placa com parafusos de ângulo fixo para região proximal no úmero Retrospective functional assessment of patients with humerus proximal fractures internally fixed with a fixed-angle plate for proximal humerus area

    Directory of Open Access Journals (Sweden)

    Rafael Inácio Barbosa

    2008-01-01

    Full Text Available As fraturas do úmero proximal são lesões comuns, levando seus pacientes a importantes limitações funcionais além de algumas complicações. Atualmente existem algumas opções de tratamentos cirúrgicos visando à melhor estabilização da lesão através de técnicas de ostessíntese, dependendo do grau de gravidade da lesão. Dentre eles, tem-se utilizado a placa com parafusos de ângulo fixo para região proximal do úmero, a qual possui o intuito de preservar a integridade biológica da cabeça umeral associada à redução anatômica segura utilizando múltiplos parafusos de fixação com estabilidade angular, permitindo assim a mobilização precoce do membro fraturado. Foram estudados retrospectivamente 11 pacientes com fratura proximal do úmero, tratados com esse modelo de placa entre os anos de 2004 e 2005. Na avaliação funcional foram utilizados o questionário de Constant e o índice DASH. Os resultados sugerem o aparecimento de perda funcional residual no membro superior após esse tipo de trauma, apesar da fixação estável e o tratamento fisioterapêutico.Proximal humeral fractures are common injuries leading to severe functional restrictions and complications for patients. Today, there are several surgical alternatives aimed at achieving better injury stabilization by means of osteosynthesis techniques, depending on injury severity. One of these is the fixed-angle plate fixation of the proximal humerus. This bone fixation system is intended to preserve the biologic integrity of the humeral head associated with a safe anatomical reduction, employing several fixating screws with angle stability, thereby allowing an early mobilization of the fractured limb. Eleven patients with proximal humeral fractures treated with the method of fixed-angle plate fixation of the proximal humerus in the period of 2004 to 2005 were retrospectively studied. The patients were subjected to the Constant questionnaire and the DASH index for

  12. Plate fixation of the proximal humerus: an international multicentre comparative study of postoperative complications

    NARCIS (Netherlands)

    Beeres, Frank J. P.; Hallensleben, N. D. L.; Rhemrev, S. J.; Goslings, J. C.; Oehme, F.; Meylaerts, S. A. G.; Babst, R.; Schep, N. W. L.

    2017-01-01

    The primary aim was to evaluate the number of complications following locking plate fixation of proximal humeral fractures in country X and in country Y. The secondary aim was to identify risk factors for complications. Multicentre retrospective case series of 282 consecutive patients with proximal

  13. Predictive factors for functional outcome and failure in angular stable osteosynthesis of the proximal humerus.

    LENUS (Irish Health Repository)

    Hardeman, Francois

    2012-02-01

    Angular stable osteosynthesis has become the gold standard in the operative treatment of proximal humeral fractures. The aim of this article is to determine the indications for osteosynthesis versus primary arthroplasty based on clinical and radiological parameters.

  14. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique.

    Science.gov (United States)

    Konrad, G; Bayer, J; Hepp, P; Voigt, C; Oestern, H; Kääb, M; Luo, C; Plecko, M; Wendt, K; Köstler, W; Südkamp, N

    2010-03-01

    The treatment of unstable displaced proximal humeral fractures, especially in the elderly, remains controversial. The objective of the present prospective, multicenter, observational study was to evaluate the functional outcome and the complication rate after open reduction and internal fixation of proximal humeral fractures with use of a locking proximal humeral plate. One hundred and eighty-seven patients (mean age, 62.9 +/- 15.7 years) with an acute proximal humeral fracture were managed with open reduction and internal fixation with a locking proximal humeral plate. At the three-month, six month,and one-year follow-up examinations, 165 (88%), 158 (84%), and 155 (83%) of the 187 patients were assessed with regard to pain, shoulder mobility, and strength. The Constant score was determined at each interval, and the Disabilities of the Arm, Shoulder and Hand (DASH) score was determined for the injured and contralateral extremities at the time of the one-year follow-up. Between three months and one year, the mean range of motion and the mean Constant score for the injured shoulders improved substantially. Twelve months after surgery, the mean Constant score for the injured side was 70.6 +/- 13.7 points, corresponding to 85.1% +/- 14.0% of the score for the contralateral side. The mean DASH score at the time of the one-year follow-up was 15.2 +/- 16.8 points. Sixty-two complications were encountered in fifty-two (34%) of 155 patients at the time of the one-year follow-up. Twenty-five complications (40%) were related to incorrect surgical technique and were present at the end of the operative procedure. The most common complication, noted in twenty-one (14%) of 155 patients, was intraoperative screw perforation of the humeral head. Twenty-nine patients (19%) had an unplanned second operation within twelve months after the fracture. Surgical treatment of displaced proximal humeral fractures with use of the locking proximal humeral plate that was evaluated in the

  15. Advantage of minimally invasive lateral approach relative to conventional deltopectoral approach for treatment of proximal humerus fractures.

    Science.gov (United States)

    Liu, Kuan; Liu, Peng-cheng; Liu, Run; Wu, Xing

    2015-02-15

    Despite the wide application of open reduction and internal fixation with locking plates for the treatment of proximal humeral fractures, the surgical invasive approach remains controversial. This study aimed to evaluate the pros and cons of the minimally invasive lateral approach for the treatment of proximal humeral fracture (PHF) in comparison with the deltopectoral approach. All patients who sustained a PHF and received open reduction and internal fixation (ORIF) surgery with locking plate through either minimally invasive subacromial approach or conventional deltopectoral approach between January 2008 and February 2012 were retrospectively analyzed. Patients were divided into the conventional group and min-group according to the surgical incision. Surgery-related information, postoperative radiography, complications, and shoulder functional measurement scores in a 2-year follow-up were collected and evaluated. Ninety-one patients meeting the inclusion criteria were included in this study. We observed a significant difference in both surgery time (81.8±18.3 vs. 91.0±18.4) (p=0.021) and blood loss (172±54.2 vs. 205±73.6) (p=0.016) between the min-group and conventional group. Compared to the conventional group, the min-group had significantly better Constant-Murley score and DASH score at early follow-up (pfractures, was observed in the min-group, the conventional group obtained better movement in the 4-part fractures. The minimally invasive lateral approach is the optimal alternative for the treatment of Neer's type 2 and 3 proximal humerus fractures.

  16. Unicameral Bone Cyst in the Proximal Humerus with Secondary Infection in an 18-Month-Old Foal

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    Maria C. Fugazzola

    2014-01-01

    Full Text Available An 18-month-old warmblood filly was 4/5 lame on the front right limb at referral and showed severe swelling of the right shoulder region and pain during manipulation of the shoulder region. Radiography revealed a roundish 5 × 7 cm radiolucent area with defined borders within the greater tubercle and the presence of a fracture of the lateral tubercle associated with the cyst. Cellular blood count was 27,500 WBC/μL and serum biochemical analyses revealed fibrinogen of 855 mg/dL. The fractured bone was removed surgically; the cyst debrided and filled with autologous cancellous bone graft. Three and five weeks after surgery the filly was reoperated on because of an osseous sequestrum and a periostal defect on the distal dorsolateral aspect of the pastern of the right hind limb and a septic synovitis of the DFTS of the left hind limb. Fifteen month after surgery the filly was not lame and was introduced to training. Unicameral bone cysts (UBC are well described lesions, often associated to pathologic fracture in the proximal humerus of children but, until present, no scientific report exists of UBC in the foal. The prompt surgical management had a favorable outcome.

  17. Trends in incidence of proximal humerus fractures, surgical procedures and outcomes among elderly hospitalized patients with and without type 2 diabetes in Spain (2001-2013).

    Science.gov (United States)

    Martinez-Huedo, Maria Angeles; Jiménez-García, Rodrigo; Mora-Zamorano, Eduardo; Hernández-Barrera, Valentín; Villanueva-Martinez, Manuel; Lopez-de-Andres, Ana

    2017-12-11

    Several studies have reported that diabetic persons have an increased risk for fractures than non-diabetes patients. The association between proximal humerus fractures and type 2 diabetes (T2DM) is unclear and some studies point to insulin treatment, hypoglycaemic episodes consequently to inadequate control of diabetes or, more recently, to an alteration of trabecular bone. We examined trends in the incidence of proximal humerus fractures, surgical procedures and outcomes among hospitalized patients aged ≥65 years, with and without T2DM in Spain, 2001-2013. This retrospective, observational study was conducted using the Spanish National Hospital Discharge Database to select all hospital admissions with proximal humerus fracture. We calculated incidences overall and stratified by diabetes status, year and sex. We analyzed surgical procedures, comorbidities, length of stay, in-hospital complications and in-hospital mortality. We identified 43,872 patients with proximal humerus fracture (18.3% had a T2DM diagnosis). Age-adjusted incidence rates elevated steadily over the study period for men and women with and without T2DM, independently of diabetes status, although we found a stable trend in the later years. Patients with T2DM had lower relative risk of proximal humeral fracture incidence: 0.87 (95%IC 0.82-0.93) for men and 0.97 (95%IC 0.95-1.00) for women. In-hospital complications were 4.0% of diabetic men vs. 2.6% in non-diabetic (p fracture with internal fixation and arthroplasty is increasing overtime and closed reduction with internal fixation is decreasing. Presence of T2DM in women was associated with higher in-hospital mortality (OR 1.67; 95%CI 1.29-2.15). Comorbidities, in-hospital complications and older age were predictors of higher in-hospital mortality in both sexes. The incidence of proximal humerus fractures seems to be increasing in Spain. The incidence is lower among men with than without T2DM. T2DM is associated to higher in

  18. Minimally invasive application of the non-contact-bridging (NCB) plate to the proximal humerus: an anatomical study.

    Science.gov (United States)

    Röderer, Götz; Abouelsoud, Maged; Gebhard, Florian; Böckers, Tobias M; Kinzl, Lothar

    2007-10-01

    To describe a minimal anterolateral acromial approach for minimally invasive (MI) treatment of fractures of the proximal humerus (PH) with the Non-Contact-Bridging (NCB) plate. 1) Cadaver study and 2) clinical case series. 1) University Institute of Anatomy and the 2) University Level I trauma center. SPECIMENS/PATIENTS: 1) Ten fresh frozen human humeri and 2) 22 patients with 22 isolated proximal humeral fractures. 1) Minimal anterolateral acromial approach with MI application of the NCB-PH plate followed by dissection of the axillary nerve and 2) MI fracture fixation using this approach and technique of plate insertion. 1) Integrity of the axillary nerve and evaluation of its relationship to the implant, and 2) early postoperative functional results. In the cadaver study, the nerve directly crossed over the percutaneously inserted plate in all the arms. The nerve then divided into two branches anterior to the plate in eight arms and divided into two branches directly over the plate in two arms. One branch of the axillary nerve in one arm was injured. In the clinical case series, no intraoperative complications relating to the approach or the implant occurred. No symptoms of axillary nerve lesion have been detected so far in the early follow-up. The minimal anterolateral acromial approach is suitable for MI technique to apply the NCB-PH. The relationship of the axillary nerve to the plate is anatomically close. We recommend that strict bone contact be maintained during plate insertion and that screw insertion complies with the guidelines provided for this technique. In a small clinical cases series, the plate and screws were inserted in accordance with these guidelines and no axillary nerve lesions have yet been detected.

  19. Protocol for the ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation trial: a pragmatic multi-centre randomised controlled trial of surgical versus non-surgical treatment for proximal fracture of the humerus in adults

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    Maffulli Nicola

    2009-11-01

    Full Text Available Abstract Background Proximal humeral fractures, which occur mainly in older adults, account for approximately 4 to 5% of all fractures. Approximately 40% of these fractures are displaced fractures involving the surgical neck. Management of this group of fractures is often challenging and the outcome is frequently unsatisfactory. In particular it is not clear whether surgery gives better outcomes than non-surgical management. Currently there is much variation in the use of surgery and a lack of good quality evidence to inform this decision. Methods/Design We aim to undertake a pragmatic UK-based multi-centre randomised controlled trial evaluating the effectiveness and cost-effectiveness of surgical versus standard non-surgical treatment for adults with an acute closed displaced fracture of the proximal humerus with involvement of the surgical neck. The choice of surgical intervention is left to the surgeon, who must use techniques that they are fully experienced with. This will avoid 'learning curve' problems. We will promote good standards of non-surgical care, similarly insisting on care-provider competence, and emphasize the need for comparable provision of rehabilitation for both groups of patients. We aim to recruit 250 patients from a minimum of 18 NHS trauma centres throughout the UK. These patients will be followed-up for 2 years. The primary outcome is the Oxford Shoulder Score, which will be collected via questionnaires completed by the trial participants at 6, 12 and 24 months. This is a 12-item condition-specific questionnaire providing a total score based on the person's subjective assessment of pain and activities of daily living impairment. We will also collect data for other outcomes, including general health measures and complications, and for an economic evaluation. Additionally, we plan a systematic collection of reasons for non-inclusion of eligible patients who were not recruited into the trial, and their baseline

  20. Low Osteoporosis Treatment Initiation Rate in Women after Distal Forearm or Proximal Humerus Fracture: A Healthcare Database Nested Cohort Study.

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    Marie Viprey

    Full Text Available Treatment initiation rates following fragility fractures have often been reported to be low and in recent years numerous programs have been implemented worldwide to increase them. This study aimed at describing osteoporosis (OP treatment initiation in a representative sample of women who were hospitalized for a distal forearm fracture (DFF or proximal humerus fracture (PHF in 2009-2011 in France. The data source was a nationwide sample of 600,000 individuals, extracted from the French National Insurance Healthcare System database. All women aged 50 years and older who were hospitalized for a DFF or PHF between 2009 and 2011 and who had not received any OP treatment in the preceding 12 months were included in a retrospective cohort study. OP treatments initiated during the year following the fracture were analyzed. From 2009 to 2011, 729 women were hospitalized for a DFF or a PHF and 284 were on OP treatment at the time of the fracture occurrence. Among the 445 women who had no prevalent OP treatment, 131 (29.4% received supplementation treatment only (vitamin D and/or calcium and 42 (9.4% received a pharmacologic OP treatment in the year following their fracture. Pharmacological OP treatments included bisphosphonates (n = 21, strontium ranelate (n = 14, hormone replacement therapy (n = 4, or raloxifene (n = 3. General practitioners prescribed 75% of initial OP treatments. Despite the guidelines published in 2006 and the numerous initiatives to promote post-fracture OP treatment, OP treatment initiation rate in women who were hospitalized for a fragility fracture remained low in 2009-2011 in France.

  1. [Treatment of unstable fractures of the proximal end of the humerus using elastic curved intramedullary wires].

    Science.gov (United States)

    Zifko, B; Zifko, B; Poigenfürst, J

    1987-04-01

    At the Accident Hospital Lorenz Böhler and the Accident Hospital Meidling in Vienna, 48 patients with proximal humeral fractures were treated by closed reduction, intramedullary fixation with elastic pins and immobilization for two weeks in a Velpeau type stockinette (Gilchrist) between February 1985 and February 1986. The pins have a diameter of 2 mm. At there lower end there is a 20 mm long elastic curve which is ment to anker the pin in the entry hole to the intramedullary cavity, preventing sliding out of the implant. At the upper end the last 20 mm of the wire are angulated for 15 degrees. AO-classification was used. 39 patients had surgical neck-fractures. There were 34 displaced fractures (AO-type A 2/2), six dislocation- and more segment fractures and three epiphyseal separations of the adductiontype. The functional results of 36 patients were evaluated according to Neer's table. 29 patients had more than 80 points, four patients had more than 70 points and three had poor results. Reason for poor results was in one case a fracture with dislocation of the greater tuberosity which should have been treated by open reduction and the age in a 82 year old patient, who had a poor functional result after twelve weeks of treatment despite good fracture healing. There were no problems with wound healing, infections, myositis ossificans or Sudeck disease. Closed reductions of unstable surgical neck fractures and intramedullary fixation causes least damage to the soft tissues of the shoulder, leading to early good functional results.

  2. RESULTS OF PROXIMAL HUMERUS FRACTURE TREATED WITH LOCK PLATE THROUGH A DELTOPECTORAL VERSUS AN ANTEROLATERAL DELTOID-SPLITTING APPROACH

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    Gautam Choudhury

    2016-07-01

    Full Text Available BACKGROUND Proximal humerus fractures account for 4-5% of all fractures with a prevalence of 70 per 100,000, raising to 405 per 100,000 in population aged over 70 years. Current study was performed to evaluate the results of displaced proximal humeral fractures after locking plate osteosynthesis through deltopectoral and Deltoid-splitting approach, and to find out whether the type of surgical approach has any influence on functional outcome and complication. MATERIAL & METHODS The study was done from July 2014 to June 2016 and 46 skeletally mature patients were selected and randomised into group A (Deltopectoral and group B (Deltoid splitting after taking informed consent, Fracture-dislocation. Out of 23 patients in Group A, 1 patient did not turn for followup. Whereas, out of 23 patients in Group B, 2 did not turn for followup. The functional outcome analysis was done using CMS Scores and Pain (VAS Score along with other variables such as amount of blood loss, operation time, union time were measured and compared between the study Groups. Statistical Analysis was done with the help of Paired 't' test for intra-group analysis and Unpaired 't' test for analysis between the two groups. The categorical data were analysed with the help of Fisher Exact Test. RESULTS The average duration of Hospital stay, injury treatment interval, mean operating time were similar for both the Groups. Blood loss with Deltopectoral approach was more (192.18 mL in Group A and 174.29 mL in Group B. All patients achieved successful union in average 11.49 weeks. Mean CMS Scores and Pain (VAS Scores difference between the Groups, were found to be statistically significant at 6 weeks and 12 weeks, but statistically insignificant at 6 months. CONCLUSION From the study, we found that the functional results in terms of improvement in pain and mean Constant Murley Scores, were significantly better at 6 weeks and 12 weeks with Deltoid Splitting approach when compared with

  3. [Treatment of the complex intraarticular fracture of the distal humerus with the latitude elbow prosthesis].

    Science.gov (United States)

    Burkhart, Klaus Josef; Müller, Lars Peter; Schwarz, Christina; Mattyasovszky, Stefan Georg; Rommens, Pol Maria

    2010-07-01

    Therapy of comminuted intraarticular distal humerus fractures in elderly patients with primary total elbow arthroplasty to achieve stable and painless function. Use of "third-generation" elbow prosthesis with the following options:--linked total elbow arthroplasty,--unlinked total elbow arthroplasty,--either with or without radial head replacement,--hemiarthroplasty. Comminuted intraarticular distal humerus fractures with poor bone quality, in which stable osteosynthesis is impossible. Failure of internal fixation without the technical possibility of revision osteosynthesis. Posttraumatic osteoarthritis or rheumatoid arthritis. Open fractures (Gustilo-Anderson type II or III) or contaminated wounds should not initially be treated with total elbow arthroplasty. Prosthetic replacement may be considered after consolidation of the soft tissue. Low compliance, high functional demands. Paralysis of the biceps muscle. Supine positioning of the patient. Surgical approach after Bryan-Morrey. Anterior transposition of the ulnar nerve. Preparation of the insertion of the triceps at the distal humerus, capsule and proximal ulna. Reflection of the triceps in continuity with the ulnar periosteum and the forearm fascia. Attempt at reconstruction of the epicondyles to achieve ligamentary stability and to implant an unlinked prosthesis. If this is technically not possible, the prosthesis is linked at the end of the operation. Removal of the distal humerus fragments. Determination of the prosthesis size. Detection of the extension-flexion axis. Opening of the humeral intramedullary canal. Determination of the offset. Preparation of the humeral prosthesis repository. Placement of the trial prosthesis. Potential implantation of a hemiprosthesis, if radial head, proximal ulna and ligaments are unaffected. Otherwise preparation of the ulnar prosthesis repository. If the radial head is unaffected, it can be preserved. Otherwise it has to be resected and preferably replaced. Placement of

  4. Treatment of proximal humerus fractures with a CFR-PEEK plate: 2-year results of a prospective study and comparison to fixation with a conventional locking plate.

    Science.gov (United States)

    Schliemann, Benedikt; Hartensuer, Rene; Koch, Thorben; Theisen, Christina; Raschke, Michael J; Kösters, Clemens; Weimann, Andre

    2015-08-01

    A radiolucent carbon fiber-reinforced polyetheretherketone (CFR-PEEK) plate was recently introduced for fixation of proximal humerus fractures. Prospective clinical and radiographic results of patients treated with a CFR-PEEK plate are compared with those of patients treated with a conventional locking plate. Twenty-nine patients (mean age, 66 years) were treated with a CFR-PEEK plate for a 3- or 4-part proximal humerus fracture. Patients were clinically and radiographically re-examined at 6 weeks, 6 months, 12 months, and 24 months with the Simple Shoulder Test, Constant-Murley score (CMS), and Oxford Shoulder Score (OSS) as well as with simple radiographs. In addition, results were compared with a matched group of patients treated with a conventional locking plate. At the final follow-up examination at 24 months, patients achieved a mean Simple Shoulder Test score of 58%, a mean CMS of 71.3 points (range, 44-97), and a mean OSS of 27.4 points (range, 8-45). Bone union was confirmed in all patients. Compared with patients treated with the conventional locking plate, patients treated with the CFR-PEEK plate achieved significantly better results with regard to the CMS and the OSS (P = .038 and .029, respectively). Furthermore, loss of reduction with subsequent varus deformity was less frequently observed in the CFR-PEEK plate group. Fixation of proximal humerus fractures with a CFR-PEEK plate provides satisfying clinical and radiographic results after 2 years of follow-up. The results are comparable to those achieved with conventional locking plates. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  5. Fractures and fracture-dislocations of the proximal humerus: A retrospective analysis of 82 cases treated with the Philos(®) locking plate.

    Science.gov (United States)

    Erasmo, Rocco; Guerra, Giovanni; Guerra, Luigi

    2014-12-01

    To present the experience in a single institution of the management of 82 consecutive fractures and fracture-dislocations of the proximal humerus treated with the Proximal Humeral Internal Locking System (Philos(®)) plate. A total of 81 patients with 82 proximal humerus fractures (one patient had bilateral fracture) were treated at our institution with open reduction and internal fixation with Philos(®) plate from January 2008 to December 2012 and the clinico-radiological outcome was analysed. Twelve of these patients also had a dislocation of the proximal humerus. According to the Neer classification, there were seven two-part fractures, 40 three-part fractures and 35 four-part fractures. All patients received a similar physical therapy programme following internal fixation. Mean final follow-up was 32 months. Functional outcome was evaluated for each patient using the Constant-Murley score; radiographic evaluation was also conducted and complications were recorded. At the end of the follow-up period, the mean Constant-Murley score for the injured side was 75 points (range 42-92); results were graded as excellent for eight patients, good for 52, moderate for 17 and poor for five. Twenty-three patients (28%) had complications during the follow-up period. Reoperation was required in 12 patients. Complications included avascular necrosis of the humeral head in 10 patients (12%), varus positioning of the head in four patients (4.8%), impingement syndrome in three patients (3.6%), secondary screw perforation in three patients (3.6%), non-union of the fracture in two patients (2.4%) and infection in one patient (1.2%). Open reduction and internal fixation of proximal humeral fractures with the Philos(®) plate was associated with good clinical outcomes provided the correct surgical technique was used. To better evaluate the real incidence of complications, it is important to follow patients for more than one year after surgery as some complications may arise after

  6. Effect of osteosynthesis, primary hemiarthroplasty, and non-surgical management for displaced four-part fractures of the proximal humerus in elderly

    DEFF Research Database (Denmark)

    Brorson, Stig; Olsen, Bo Sanderhoff; Frich, Lars Henrik

    2009-01-01

    BACKGROUND: Fractures of the proximal humerus are common injuries and account for 4-5 percent of all fractures, second only to hip and wrist fractures. The incidence is positively correlated with age and osteoporosis, and is likely to increase. Displaced four-part fractures are among the most...... severe injuries, accounting for 2-10 percent of proximal humeral fractures. The optimal intervention is disputed. Two previous randomised trials were very small and involved a noticeable risk of bias, and systematic reviews consequently conclude that there is inadequate basis for evidence-based treatment...... will be followed at least one year. The primary outcomes will be the overall score on the Constant Disability Scale, and its pain subscale, measured at 12 months. A blinded physiotherapist will carry out the assessments. Other secondary outcomes are Oxford Shoulder Score, and general health status (Short Form-36)....

  7. The effect of calcium and vitamin D3 supplementation on the healing of the proximal humerus fracture: a randomized placebo-controlled study

    DEFF Research Database (Denmark)

    Doetsch, A M; Faber, J; Lynnerup, N

    2004-01-01

    The purpose of this study was to (1) quantify the healing process of the human osteoporotic proximal humerus fracture (PHF) expressed in terms of callus formation over the fracture region using BMD scanning, and (2) quantify the impact of medical intervention with vitamin D3 and calcium...... demonstrated that it is possible to quantify callus formation of the PHF with sufficiently high precision to demonstrate the positive influence of vitamin D3 and calcium over the first 6 weeks after fracture. Whether this results in more stable fractures, extends to other fracture types, or applies to other...... scan, WHO criteria), and not taking any drugs related to bone formation, including calcium or vitamin D supplementation, were randomly assigned to either oral 800 IU vitamin D3 plus 1 g calcium or placebo, in a double-blind prospective study. We measured biochemical, radiographic, and bone mineral...

  8. Biomechanical effects of malposition of tuberosity fragments on the humeral prosthetic reconstruction for four-part proximal humerus fractures.

    Science.gov (United States)

    Frankle, M A; Greenwald, D P; Markee, B A; Ondrovic, L E; Lee, W E

    2001-01-01

    Variable outcomes in the prosthetic reconstruction of 4-part humerus fractures often can be attributed to inconsistent and nonanatomic tuberosity placement. To compare the effects of anatomic (anterior fin) versus nonanatomic (lateral fin) tuberosity placement, we developed a dynamic cadaver model for shoulder motion. With the use of a robotically driven, computer-controlled articulator, we tested external rotation torque in 5 fresh human shoulders. After evaluation of the intact shoulders, we experimentally induced 4-part humerus fractures in the specimens. These were then repaired by hemiarthroplasty, with the use of standard techniques to secure the greater and lesser tuberosities in either anatomic or nonanatomic positions; order was randomized. Nonanatomic tuberosity reconstruction led to significant impairment in external rotation kinematics and an 8-fold increase in torque requirements (P =.001). In contrast, anatomic reconstruction produced results indistinguishable from normal shoulder controls. This study underscores the importance of rotational alignment of tuberosities during reconstruction. Failure to properly position tuberosity fragments in the horizontal plane may result in insurmountable postoperative motion restriction.

  9. Primary hemiarthroplasty versus conservative treatment for comminuted fractures of the proximal humerus in the elderly (ProCon: A Multicenter Randomized Controlled trial

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    Van der Vis Harm M

    2010-05-01

    Full Text Available Abstract Background Fractures of the proximal humerus are associated with a profound temporary and sometimes permanent, impairment of function and quality of life. The treatment of comminuted fractures of the proximal humerus like selected three-or four-part fractures and split fractures of the humeral head is a demanding and unresolved problem, especially in the elderly. Locking plates appear to offer improved fixation; however, screw cut-out rates ranges due to fracture collapse are high. As this may lead to higher rates of revision surgery, it may be preferable to treat comminuted fractures in the elderly primarily with a prosthesis or non-operatively. Results from case series and a small-sample randomized controlled trial (RCT suggest improved function and less pain after primary hemiarthroplasty (HA; however these studies had some limitations and a RCT is needed. The primary aim of this study is to compare the Constant scores (reflecting functional outcome and pain at one year after primary HA versus non-operative treatment in elderly patients who sustained a comminuted proximal humeral fracture. Secondary aims include effects on functional outcome, pain, complications, quality of life, and cost-effectiveness. Methods/Design A prospective, multi-center RCT will be conducted in nine centers in the Netherlands and Belgium. Eighty patients over 65 years of age, who have sustained a three-or four part, or split head proximal humeral fracture will be randomized between primary hemiarthroplasty and conservative treatment. The primary outcome is the Constant score, which indicates pain and function. Secondary outcomes include the Disability of the Arm and Shoulder (DASH score, Visual Analogue Scale (VAS for pain, radiographic healing, health-related quality of life (Short-form-36, EuroQol-5D and healthcare consumption. Cost-effectiveness ratios will be determined for both trial arms. Outcome will be monitored at regular intervals over the

  10. Functional Outcome after Simultaneous Bilateral Four-Part Proximal Humerus Fracture: A Comparison of ORIF and Hemiarthroplasty in an Individual Patient

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    Prasad Ellanti

    2012-01-01

    Full Text Available Simultaneous bilateral four-part proximal humeral fractures are rare. Four-part fractures of the proximal humerus are difficult for the patient and technically demanding for the surgeon. Our surgical tactic is to attempt open reduction and internal fixation where possible. We report the functional outcome in a 56-year-old female who sustained simultaneous bilateral four-part proximal humeral fractures after falling down a flight of stairs. Open reduction and internal fixation using threaded pins and tension band suture was performed on one side, and shoulder replacement hemiarthroplasty was required on the other. Functional assessment was undertaken at two years after surgery, using the Oxford Shoulder Score. Although the objective outcomes assessment revealed little difference, the patient herself expressed a preference for the side treated by internal fixation. We conclude that an attempt to retain the native humeral head and the surgical tactic that favours internal fixation where possible is appropriate in these injuries. Excellent function can be achieved following hemiarthroplasty for trauma in a fit patient.

  11. Fratura epifisiolise da extremidade proximal do úmero com luxação intratorácica: relato de caso Epiphysiolysis fracture of the proximal end of the humerus with intrathoracic dislocation: a case report

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    Jaime Guiotti Filho

    2008-02-01

    Full Text Available A fratura da extremidade proximal do úmero com luxação intratorácica foi relatada em 1949 por West, em que a fratura era, somente, do tubérculo maior. Desde então, poucos casos foram relatados na literatura, a maioria constituída por pessoas idosas, prevalecendo como indicação terapêutica artroplastia parcial. Os autores relatam o caso de um adolescente de 14 anos de idade, sexo masculino, que apresentou fratura epifisiolise da extremidade proximal do úmero com luxação intratorácica em decorrência de acidente ciclístico e que foi submetido a tratamento cirúrgico com redução, osteossíntese e reinserção do manguito rotador. A recuperação da cabeça do úmero totalmente desvitalizada e o acompanhamento do processo de necrose e revas cularização durante seis anos, em paciente adolescente, parece não terem sido previamente relatados.Fracture of the proximal end of the humerus with intrathoracic dislocation was reported in 1949 by West, and the fracture was only a fracture of the greater tubercle. Few cases have since been published, and most of them in elderly individuals, partial arthroplasty prevailing as the therapy indication. The authors report the case of a 14 year old boy who presented with an epiphysiolysis fracture of the proximal end of the humerus with intrathoracic dislocation resulting from a bicycle accident. The boy was submitted to surgical treatment with reduction, osteosynthesis, and reinsertion of the rotator cuff. The totally devitalized humeral head recovery and the monitoring of the necrosis and revascularization process for a period of six years in a teenager patient seems to have never been reported before.

  12. Radius neck-to-humerus trochlea transposition elbow reconstruction after proximal ulnar metastatic tumor resection: case and literature review

    OpenAIRE

    Chen FeiYan; Xia Jun; Wei YiBing; Wang SiQun; Wu JianGuo; Huang GangYong; Chen Jie; Shi JingSheng

    2012-01-01

    Abstract Wide en bloc excision of proximal ulna sections is used to treat traumatic and pathological fractures of the ulna, though poor standardization of clinical treatment often results in long-term failure of such reconstructed biomechanical structures. In order to provide insight into effective ulnar reconstructive treatments, the case of an 80-year-old Chinese Han male presenting with pathological fracture caused by a proximal ulnar metastatic tumor concurrent with metastatic renal cance...

  13. Fixation of 4-part fractures of the proximal humerus: Can we identify radiological criteria that support locking plates or IM nailing? Comparative, retrospective study of 107 cases.

    Science.gov (United States)

    Gadea, F; Favard, L; Boileau, P; Cuny, C; d'Ollone, T; Saragaglia, D; Sirveaux, F

    2016-12-01

    No objective criteria exist to help surgeons choose between IM nailing and plate fixation for 4-part fractures of the proximal humerus. The goal of this study was to identify radiological criteria that would make one technique a better choice than the other. This was a comparative, multicentre, retrospective study of 54 cases of antegrade nailing and 53 cases of plating performed between 1st January 2009 and 31 December 2011 for 4-part fractures of the proximal humerus. All patients had a minimum radiological and clinical follow-up of 18 months. The functional outcomes were evaluated using the weighted Constant score; a poor result was defined as a weighted Constant scorehumeral head and tuberosities; morphology of the medial column (i.e. calcar comminution, posteromedial hinge, size of metaphyseal head extension); occurrence of avascular necrosis (AVN). After an average follow-up of 42 months, the weighted Constant scores and rate of poor outcomes were 77% and 48% in the nail group and 81% and 38% in the plate group, respectively (ns). The humeral head was reduced into an anatomical position, valgus or varus in 57%, 30% and 13% of cases in the nail group, and 58%, 29% and 13% in the plate group, respectively. The tuberosities healed in an anatomical position in 72% of nail cases and 70% of plate cases (ns). Only the presence of a medial hinge preoperatively had an effect on the functional outcomes in the nail and plate groups: the weighted Constant scores (P=0.05) and rate of poor outcomes (P=0.02) were 82% and 52% in the nail group and 97% and 9% in the plate group, respectively. The complication rates were comparable: the rates of AVN and articular screw penetration were 17% and 11% in the nail group, and 15% and 11% in the plate group, respectively. The surgical revision rate was 18.5% in the nail group and 30% in the plate group. If the medial hinge is preserved, we recommend locking plate fixation. In other cases, either technique can be used as long as the

  14. Functional results following fractures of the proximal humerus. A controlled clinical study comparing two periods of immobilization

    DEFF Research Database (Denmark)

    Kristiansen, B; Angermann, P; Larsen, T K

    1989-01-01

    In order to compare 1 and 3 weeks of immobilization following proximal humeral fractures a prospective controlled trial was performed in 85 patients. Clinical follow-up according to the Neer assessment system was done after 1, 3, 6, 12, and 24 months. One week of immobilization resulted in a better...

  15. Humeral head circle-fit method greatly increases reliability and accuracy when measuring anterior-posterior radiographs of the proximal humerus.

    Science.gov (United States)

    Mears, Chad S; Langston, Tanner D; Phippen, Colton M; Burkhead, Wayne Z; Skedros, John G

    2017-10-01

    Measurements made on routine A-P radiographs can predict strength/quality of the proximal humerus, as shown in terms of two easy-to-measure parameters: Cortical index (CI) and mean-combined cortical thickness (MCCT). Because of high variability inherent when using established methods to measure these parameters, we describe a new orientation system. Using digitized radiographs of 33 adult proximal humeri, five observers measured anatomical reference locations in accordance with: (i) Tingart et al. (2003) method, (ii) Mather et al. (2013) method, and (iii) our new humeral head Circle-Fit method (CFM). The Tingart and Mather methods measure CI and MCCT with respect to upper and lower edges of 20 mm tall rectangles fit to a proximal diaphyseal location where endosteal (Tingart) or periosteal (Mather) cortical margins become parallel. But high intra- and inter-observer variability occurs when placing the rectangles because of uncertainty in identifying cortical parallelism. With the CFM an adjustable circle is fit to the humeral head articular surface, which reliably and easily establishes a proximal metaphyseal landmark (M1) at the surgical neck. Distal locations are then designated at successive 10 mm increments below M1, including a second metaphyseal landmark (M2) followed by diaphyseal (D) locations (D1, D2 ⋯D6). D1 corresponds most closely to the proximal edges of the rectangles used in the other methods. Results showed minimal inter-observer variations (mean error, 1.5 ± 1.1 mm) when the CFM is used to establish diaphyseal locations for making CI and MCCT measurements when compared to each of the other methods (mean error range, 10.7 ± 5.9 to 13.3 ± 6.7 mm) (p < 0.001). © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2313-2322, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  16. PEEK versus titanium locking plates for proximal humerus fracture fixation: a comparative biomechanical study in two- and three-part fractures.

    Science.gov (United States)

    Schliemann, Benedikt; Seifert, Robert; Theisen, Christina; Gehweiler, Dominic; Wähnert, Dirk; Schulze, Martin; Raschke, Michael J; Weimann, Andre

    2017-01-01

    The high rigidity of metal implants may be a cause of failure after fixation of proximal humerus fractures. Carbon fiber-reinforced polyetheretherketone (PEEK) plates with a modulus similar to human cortical bone may help to overcome this problem. The present study assesses the biomechanical behavior of a PEEK plate compared with a titanium locking plate. Unstable two- and three-part fractures were simulated in 12 pairs of cadaveric humeri and were fixed with either a PEEK or a titanium locking plate using a pairwise comparison. With an optical motion capture system, the stiffness, failure load, plate bending, and the relative motion at the bone-implant interface and at the fracture site were evaluated. The mean load to failure for two- and three-part fracture fixations was, respectively, 191 N (range 102-356 N) and 142 N (range 102-169 N) in the PEEK plate group compared with 286 N (range 191-395 N) and 258 N (range 155-366 N) in the titanium locking plate group. The PEEK plate showed significantly more bending in both the two- and three-part fractures (p PEEK plate showed lower fixation strength and increased motion at the bone-implant interface compared with a titanium locking plate.

  17. The bicipital groove as a landmark for reconstruction of complex proximal humeral fractures with hybrid double plate osteosynthesis.

    Science.gov (United States)

    Theopold, Jan; Marquaß, Bastian; Fakler, Johannes; Steinke, Hanno; Josten, Christoph; Hepp, Pierre

    2016-03-12

    Complex proximal humerus fractures with metaphyseal comminution remain challenging regarding reduction and stability. In most fracture patterns the hard bone of the bicipital groove remains intact. In this case series, we describe a novel technique of hybrid double plate osteosynthesis of complex proximal humerus fractures with metaphyseal comminution. In randomly chosen shoulder specimens and synthetic bones, pilot studies for evaluation of the feasibility of the technique were performed. Between 4/2010 and 1/2012 10 patients underwent hybrid double plate osteosynthesis. Seven patients (4 male, 3 female, mean age was 50 years (range 27-73)) were available for retrospective analysis. Based on plain radiographs (anterior-posterior and axial view), the fractures were classified according to the Orthopaedic Trauma Association classification (OTA) and by descriptive means (head-split variant (HS), diaphyseal extension or comminution (DE)). Follow-up radiographs demonstrated complete fracture healing in six patients and one incomplete avascular necrosis. None of the patients sustained loss of reduction. Three patients where reoperated. The medium, not adapted, Constant score was 80 Points (58-94). Patients subjective satisfaction was graded mean 3 (range: 0-6) in the visual analog scoring system (VAS). The technique of hybrid double plate osteosynthesis using the bicipital groove as anatomic landmark may re-establish shoulder function after complex proximal humerus fractures in two dimensions. Firstly the anatomy is restored due to a proper reduction based on intraoperative landmarks. Secondly additional support by the second plate may provide a higher stability in complex fractures with metaphyseal comminution.

  18. The treatment of complex proximal humeral fractures: analysis of the results of 55 cases treated with PHILOS plate.

    Science.gov (United States)

    Fattoretto, D; Borgo, A; Iacobellis, C

    2016-08-01

    Complex proximal humerus fractures are often difficult to treat. Their frequency is high, especially in the elderly, and their treatment is still controversial. The aim of this study was to analyze the clinical and radiological results achieved by patients with complex proximal humerus fractures, treated with PHILOS plate only. A cohort of 55 patients was selected. The mean age was 63.4 (range 33-89), while the mean follow-up time was 21.5 months (range 6-75). Clinical outcome was evaluated with the "Constant-Murley shoulder score." All the informations about the presence of complications were gathered, and radiological images were used to calculate the head-shaft angle. The overall mean Constant score was 61.93 ± 18.59, the Individual CS was 70 ± 20 % and the Relative CS was 83 ± 23 %. No significant differences were found between fractures Neer 3 and Neer 4 and between the surgical approaches (delta-split vs. delto-pectoral). Six patients had a fracture with dislocation, seven patients (12.7 %) had complications while in four patients a head-shaft angle beyond the normal range was found. Osteosynthesis with PHILOS plate is stable in the greater part of the cases, and it allows an earlier rehabilitation and so a good functional result, which could be compromised by a prolonged immobilization. Therefore, PHILOS plate is a good option for the treatment of complex proximal humerus fractures.

  19. Composite reverse shoulder arthroplasty can provide good function and quality of life in cases of malignant tumour of the proximal humerus.

    Science.gov (United States)

    Lazerges, Cyril; Dagneaux, Louis; Degeorge, Benjamin; Tardy, Nicolas; Coulet, Bertrand; Chammas, Michel

    2017-12-01

    Management of proximal humeral tumours remains a surgical challenge. No study to date has assessed the quality of life scores following the composite reverse shoulder arthroplasty for this indication. We, therefore, evaluated function and quality of life following reconstruction with allograft for malignant tumour of the humerus. A series of six cases of humeral tumour treated by a single surgeon in a single centre was reviewed after a mean follow-up of 5.9 years. The tumours included two chondrosarcomas, one plasmocytoma and three metastases. Resection involved bone epiphysis, metaphysis and diaphysis in five cases (S3S4S5A) and epiphysis and metaphysis in one case (S3S4A). For reconstruction, an allograft composite reverse shoulder arthroplasty was used in all the cases. Outcomes were assessed with range of motion, the QuickDash score and the Short Form 12 (SF-12) Health Survey. Radiographs assessed osseointegration and complications. At the final follow-up, the mean shoulder range of motion were respectively 95°, 57° and 11° for forward flexion, abduction and external rotation. Mean QuickDASH score improved from 28 to 41 and VAS-pain scores improved from 5.1 to 2.3. The post-operative MSTS score was 73% and the Constant score was 46.1/100. The SF-12 PCS and MCS scores were also improved, respectively from 44.4 and 39.7 to 45.5 and 56.1. The mean satisfaction score was 8.1/10. Composite reverse shoulder arthroplasty is a viable alternative for reconstruction after resection of malignant humeral tumour. Although total tumour resection was the most important objective, the functional and quality of life scores were satisfactory.

  20. Fraturas da extremidade proximal do úmero: estudo comparativo entre dois métodos de fixação Proximal humerus fractures: comparative study of two different fixation methods

    Directory of Open Access Journals (Sweden)

    Ricardo Souza e Silva Morelli

    2010-01-01

    Full Text Available OBJETIVO: Comparar o resultado do tratamento das fraturas da extremidade proximal do úmero. osteossíntese com a placa em t de pequenos fragmentos (grupo a, promovendo uma estabilização relativa, em contraposição à placa com parafusos bloqueados (grupo b. MÉTODOS: São alocados de forma aleatória 18 pacientes e avaliados prospectivamente, segundo critérios clínicos, escala funcional e parâmetros radiográficos da redução obtida. RESULTADOS: Pela escala analógica de dor a média aos seis meses de evolução foi 2,1 para o grupo a e 2,2 para o grupo b, a amplitude de elevação no grupo a foi de 140ºe de 143ºno grupo b e a pontuação na escala funcional da ucla foi respectivamente 30 e 31. Nas radiografias avaliadas; no grupo a, três pacientes obtiveram ângulos medidos após a estabilização entre 0º e 10º de desvio em relação à anatomia normal e seis entre 11º e 40º, no grupo b sete pacientes com ângulos entre 0º e 10º e dois entre 11º e 20º. CONCLUSÕES: Nos resultados precoces e tardios não ocorreram diferenças clínicas e funcionais nos dois grupos, prevalecendo uma alta incidência de bons resultados. as medidas radiográficas das reduções obtidas ficaram mais próximas do anatômico no grupo tratado com placas bloqueadas.OBJECTIVES: The present study compares results of the treatment of patients with proximal humerus fractures using two different fixation methods: the t plate (group a for small segments that provides a relative stabilization is compared to the locking screw plate that promotes a rigid fixation. METHODS: eighteen patients were randomly divided into two groups and evaluated prospectively according to clinical aspect, functional score and radiographic parameters of displacement after fixation. RESULTS: using the visual analogue scale - vas, the mean pain at six months of follow-up was 2.1 for group a and 2.2 for group b. the mean range of forward elevation was 140º in group a and 143º in

  1. Hemiarthroplasty versus angle-stable locking compression plate osteosynthesis in the treatment of three- and four-part fractures of the proximal humerus in the elderly: design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Verbeek Paul A

    2012-02-01

    Full Text Available Abstract Background The optimal surgical management of dislocated three- and four-part fractures of the proximal humerus in elderly patients remains unclear. Most used techniques are hemiarthroplasty and angle-stable locking compression plate osteosynthesis. In the current literature there is no evidence available presenting superior results between hemiarthroplasty and angle-stable locking compression plate osteosynthesis in terms of speed of recovery, pain, patient satisfaction, functional outcome, quality of life or complications. Methods/Design A randomized controlled multicenter trial will be conducted. Patients older than 60 years of age with a dislocated three- or four-part fracture of the proximal humerus as diagnosed by X-rays and CT-scans will be included. Exclusion criteria are a fracture older than 14 days, multiple comorbidity, multitrauma, a pathological fracture, previous surgery on the injured shoulder, severely deranged function caused by a previous disease, "head-split" proximal humerus fracture and unwillingness or inability to follow instructions. Participants will be randomized between surgical treatment with hemiarthroplasty and angle-stable locking compression plate osteosynthesis. Measurements will take place preoperatively and 3 months, 6 months, 9 months, 12 months and 24 months postoperatively. Primary outcome measure is speed of recovery of functional capacity of the affected upper limb using the Disabilities of Arm, Shoulder and Hand score (DASH. Secondary outcome measures are pain, patient satisfaction, shoulder function, quality of life, radiological evaluation and complications. Data will be analyzed on an intention-to-treat basis, using univariate and multivariate analyses. Discussion Both hemiarthroplasty and angle-stable locking compression plate osteosynthesis are used in the current treatment of dislocated three-and four-part fractures of the proximal humerus. There is a lack of level-1 studies comparing

  2. Influence of trabecular microstructure and cortical index on the complexity of proximal humeral fractures.

    Science.gov (United States)

    Osterhoff, Georg; Diederichs, Gerd; Tami, Andrea; Theopold, Jan; Josten, Christoph; Hepp, Pierre

    2012-04-01

    Poor bone quality increases the susceptibility to fractures of the proximal humerus. It is unclear whether local trabecular and cortical measures influence the severity of fracture patterns. The goal of this study was to assess parameters of trabecular and cortical bone properties and to compare these parameters with the severity of fractures and biomechanical testing. Twenty patients with displaced proximal humeral fractures planned for osteosynthesis were included. Fractures were classified as either 2-part fractures or complex fractures. Bone after core drilling was harvested during surgery from the humeral head in each patient. Twenty bone cores obtained from nonpaired cadaver humeral heads served as nonfractured controls. Micro-CT (μCT) was performed and bone volume/total volume (BV/TV), connectivity density (CD), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular spacing (Tb.Sp), and bone mineral density (BMD) were assessed. The cortical index (CI) was determined from AP plain films. Biomechanical testing was done after μCT scanning by axially loading until failure, and ultimate strength and E modulus were recorded. BV/TV, BMD and CD showed moderate to strong correlations with biomechanical testing (r = 0.45-0.76, all p fracture groups and controls regarding μCT and biomechanical parameters. CI was not significantly different between the 2-part and complex fracture groups. In our study population local trabecular bone structure and cortical index could not predict the severity of proximal humeral fractures in the elderly. Complex fractures do not necessarily imply lower bone quality compared to simple fractures.

  3. Avaliação funcional retrospectiva de pacientes com fratura proximal de úmero fixada com placa com parafusos de ângulo fixo para região proximal no úmero Retrospective functional assessment of patients with humerus proximal fractures internally fixed with a fixed-angle plate for proximal humerus area

    OpenAIRE

    Rafael Inácio Barbosa; Alexandre Márcio Marcolino; Marisa de Cássia Registro Fonseca; Nilton Mazzer; Salomão Chade Zatiti

    2008-01-01

    As fraturas do úmero proximal são lesões comuns, levando seus pacientes a importantes limitações funcionais além de algumas complicações. Atualmente existem algumas opções de tratamentos cirúrgicos visando à melhor estabilização da lesão através de técnicas de ostessíntese, dependendo do grau de gravidade da lesão. Dentre eles, tem-se utilizado a placa com parafusos de ângulo fixo para região proximal do úmero, a qual possui o intuito de preservar a integridade biológica da cabeça umeral asso...

  4. Fraturas em duas e três partes do úmero proximal tratadas com sutura não absorvível Two- and three-part fractures of the proximal humerus treated with non-absorbable suture

    Directory of Open Access Journals (Sweden)

    Marco Antônio de Castro Veado

    2007-10-01

    150° (106°-210° nas fraturas em três partes, sendo verificada consolidação em valgo em nove pacientes (59% e, em varo, em dois pacientes. De acordo com o escore da UCLA, verificaram-se 88,8% de bons e excelentes resultados e 11,2% de maus resultados, para ambos os tipos de fratura. Os últimos, representados por um caso de pseudartrose e outro, por uma capsulite adesiva no pós-operatório. CONCLUSÃO: As fraturas em duas e três partes do úmero proximal podem ser satisfatoriamente tratadas com sutura não absorvível com incorporação do manguito rotador, particularmente nos idosos. Complicações relacionadas aos metais estão afastadas. Pacientes com fraturas do tubérculo maior tratados com suturas podem ter resultados similares aos daqueles com fraturas do colo cirúrgico. Embora o objetivo da cirurgia seja a reconstrução anatômica, alguma deformidade residual não impede resultado satisfatório. O método é pouco invasivo, permite estabilidade razoável dos fragmentos, com altos índices de consolidação óssea e satisfação do paciente. A cooperação do paciente é crucial para o sucesso terapêutico.OBJECTIVE: To evaluate the clinical and radiographic results of patients with two- and three-part fractures of the proximal end of the humerus treated with non-absorbable sutures and with incorporation of the rotator cuff, which allows for increased stability of the fixation, mainly in patients with low bone quality. METHODS: 19 patients were operated on, fifteen female and four male, with a mean age of 57.4 years (23-79 years and a mean follow-up of 53.4 months (seven to 144 months. Based on Neer classification, the authors found ten three-part fractures (surgical neck and larger tuberosity, and nine two-part fractures (two of the larger tuberosity and seven of the surgical neck. All of them were operated in the beach chair position with endotracheal anesthesia and brachial plexus blockade. Deltopectoral approach was used for two-part fractures of

  5. Effect of osteosynthesis, primary hemiarthroplasty, and non-surgical management for displaced four-part fractures of the proximal humerus in elderly: a multi-centre, randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Johannsen Hans

    2009-07-01

    Full Text Available Abstract Background Fractures of the proximal humerus are common injuries and account for 4–5 percent of all fractures, second only to hip and wrist fractures. The incidence is positively correlated with age and osteoporosis, and is likely to increase. Displaced four-part fractures are among the most severe injuries, accounting for 2–10 percent of proximal humeral fractures. The optimal intervention is disputed. Two previous randomised trials were very small and involved a noticeable risk of bias, and systematic reviews consequently conclude that there is inadequate basis for evidence-based treatment decisions. We aim to compare the effect of osteosynthesis with angle-stable plate with non-surgical management, and the effect of primary hemiarthroplasty with both osteosynthesis and non-surgical management. Methods/Design We will conduct a randomised, multi-centre, clinical trial including patients from ten national shoulder units within a two-year period. We plan to include 162 patients. A central randomisation unit will allocate patients. All patients will receive a standardised three-month rehabilitation program of supervised physiotherapy regardless of treatment allocation. Patients will be followed at least one year. The primary outcomes will be the overall score on the Constant Disability Scale, and its pain subscale, measured at 12 months. A blinded physiotherapist will carry out the assessments. Other secondary outcomes are Oxford Shoulder Score, and general health status (Short Form-36.

  6. FRACTURE SHAFT HUMERUS: INTERLOCKING

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    Deepak Kaladagi

    2014-12-01

    Full Text Available BACKGROUND: The incidence of humeral fracture has significantly increased during the present years due to the population growth and road traffic, domestic, industrial, automobile accidents & disasters like tsunami, earthquakes, head-on collisions, polytrauma etc. In order to achieve a stable fixation followed by early mobilization, numerous surgical implants have been devised. PURPOSE: The purpose of this study is to analyze the results of intramedullary fixation of proximal 2/3rd humeral shaft fractures using an unreamed interlocking intramedullary nail. INTRODUCTION: In 40 skeletally matured patients with fracture shaft of humerus admitted in our hospital, we used unreamed antegrade interlocking nails. MATERIAL: We carried out a prospective analysis of 40 patients randomly selected between 2001 to 2014 who were operated at JNMC Belgaum, MMC Mysore & Navodaya Medical College, Raichur. All cases were either RTAs, Domestic, Industrial, automobile accidents & also other modes of injury. METHOD: Routine investigations with pre-anaesthetic check-up & good quality X-rays of both sides of humerus was taken. Time of surgery ranged from 5-10 days from the time of admission. Only upper 1/3rd & middle 1/3rd humeral shaft fractures were included in the study. In all the cases antegrade locked unreamed humeral nails were inserted under C-arm. Patient was placed in supine position & the shoulder was kept elevated by placing a sandbag under the scapula. In all patients incision taken from tip of acromion to 3cm over deltoid longitudinally. Postoperatively sling applied with wrist & shoulder movements started after 24 hours. All the patients ranged between the age of 21-50 years. RESULTS: Total 40 patients were operated. Maximum fracture site were in the middle third- 76%, 14% upper 1/3rd. All 40 patients achieved union. The average time of union was 8-10 weeks. All patients regained full range of movements except in few cases, where there was shoulder

  7. Biomechanical evaluation of a new fixation technique for internal fixation of three-part proximal humerus fractures in a novel cadaveric model.

    Science.gov (United States)

    Brianza, Stefano; Plecko, Michael; Gueorguiev, Boyko; Windolf, Markus; Schwieger, Karsten

    2010-11-01

    The optimal surgical treatment for displaced proximal humeral fractures is still controversial. A new implant for the treatment of three-part fractures has been recently designed. It supplements the existing Expert Humeral Nail with a locking plate. We developed a novel humeral cadaveric model and the existing implant and the prototype were biomechanically compared to determine their ability in maintaining interfragmentary stability. The bone mineral density of eight pairs of cadaveric humeri was assessed and a three-part proximal humeral fracture was simulated with a Greater Tuberosity osteotomy and a surgical neck wedge ostectomy. The specimens were randomly assigned to either treatment. A bone anchor simulated part of a rotator cuff tendon pulling on the Greater Tuberosity. Specimens were initially tested in axial compression and afterward with a compound cyclic load to failure. An optical 3D motion tracking system continuously monitored the relative interfragmentary movements. The specimen stabilized with the prototype demonstrated higher stiffness (P=0.036) and better interfragmentary stability (P valuesplate assembly must be confirmed in vivo but the current study provides a biomechanical rationale for its use in the treatment of three-part proximal humeral fractures. The improved stability could be advantageous in particular when medial buttress is missing, even in osteoporotic bone. Copyright © 2010 Elsevier Ltd. All rights reserved.

  8. [Centro-medullary nailing in the complex fractures of the upper end of the humerus: preliminary results in 6 cases].

    Science.gov (United States)

    Jamal, Louaste; Cherrad, Taoufik; Bousbaa, Hicham; Wahidi, Mohammed; Amhajji, Larbi; Rachid, Khalid

    2016-01-01

    Antegrade intramedullary nailing has become the gold standard to treat two-, three-, and four-part cephalo-tuberosity fractures. We report a retrospective study of 6 patients who have undergone centro-medullary nailing since January 2012. Mean follow-up was 12 months; the average age was 57 years. Clinical evaluation was based on gross and weighted Constant and Murley score, based on the age and sex, compared to the "normal" body surface area. Radiological assessment allowed us to evaluate bone healing, the occurrence of osteonecrosis of femoral head or of post-traumatic arthrosis. Radiological examination focused even on the state of the tuberosities and on the existence or not of osteolysis of the greater tubercle of the humerus. It was also used to identify the criteria for good reduction, namely cephalic cap angle and diaphyseal axis (αF) in face views. All patients underwent the same surgical procedure. Constant and Murley score for all patients was 64.13 points. Weighted score based on age and sex was 73%. Joint mobility was estimated at an average of 116° for all patients in anterior elevation, 99.9° in lateral elevation, and 42° in external rotation. Average αF angle was 42°. All patients met criteria for good reduction, namely αF. Centro-medullary nailing allows simple and cost-effective bone synthesis with very promising functional results. Comminuted fractures and osteoporosis may limit these indications.

  9. Avaliação das complicações do tratamento cirúrgico das fraturas da extremidade proximal do úmero com "placa bloqueada" Evaluation of the complications of surgical treatment of fractures of the proximal extremity of the humerus using a locking plate

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2012-10-01

    Full Text Available OBJETIVO: Avaliar as complicações do tratamento cirúrgico dos pacientes com fratura da extremidade proximal do úmero com "placa bloqueada". MÉTODOS: Entre julho de 2004 e dezembro de 2009, foram tratados 56 pacientes com fratura da extremidade proximal do úmero com a placa Philos®. Dezenove pacientes eram do sexo masculino e 37 do feminino, com média de idade de 62 anos, variando de 30 a 92 anos. Todos os casos tinham tempo de seguimento mínimo, no período pós-operatório, de 12 meses. Treze fraturas foram classificadas como em duas partes, 28 em três, oito em quatro e sete como fraturas epifisárias. RESULTADOS: Dos pacientes operados, 26 foram considerados como tendo obtido resultado excelente, 12 como bom, 10 como regular e oito como ruim, conforme o escore de UCLA. Trinta complicações ocorreram em 20 pacientes (35,7%, sendo a mais frequente a redução inadequada da fratura que ocorreu em oito casos. O impacto subacromial causado pela placa ocorreu em sete casos, enquanto a fixação inadequada da fratura em seis. Outras complicações como pseudoartrose, capsulite adesiva, necrose avascular, perda da redução em varo e infecção também foram verificadas. CONCLUSÃO: Os resultados funcionais do tratamento das fraturas da extremidade proximal do úmero com a "placa bloqueada" dependem da correta redução anatômica da fratura e fixação estável do implante. Complicações ainda são frequentes, principalmente devido à dificuldade técnica intraoperatória, à gravidade da fratura e à eventual inexperiência do cirurgião.OBJECTIVE: To evaluate the complications from surgical treatment using a locking plate among patients with fractures of the proximal extremity of the humerus. METHODS: Between July 2004 and December 2009, 56 patients with fractures of the proximal extremity of the humerus were treated using the PHILOS® plate. There were 19 male patients and 37 female patients, with a mean age of 62 years (range: 30 to

  10. Hemiartroplastia da extremidade proximal do úmero para o tratamento da fratura-luxação em quatro partes: grau de mobilidade obtido em relação à idade Hemiarthroplasty for treatment of four part fracture -dislocation of the proximal humerus: grade of mobility related to age

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    Mauricio Wanderley Moral Sgarbi

    2008-01-01

    Full Text Available As fraturas mais graves da extremidade proximal do úmero, são as fraturas - luxações em quatro partes. O tratamento clássico é a artroplastia do úmero proximal. Realizamos estudo retrospectivo de 20 pacientes submetidos à artroplastia parcial do ombro para o tratamento da fratura - luxação em quatro partes da extremidade proximal do úmero. O tempo de segmento pós operatório médio foi de 14 meses. Os pacientes foram avaliados quanto à elevação, rotação externa e rotação interna. Constituímos dois grupos: aqueles com elevação maior do que a média (grupo 1 e elevação menor do que a média (grupo 2. A elevação média obitida pelos 20 pacientes foi de 107,5 graus. Os pacientes do grupo 1, tiveram média de idade de 48,5. Os pacientes do grupo 2, tiveram média de idade de 66,3 (p=0,004. Obtivemos resultados mais favoráveis no que diz respeito à mobilidade nos pacientes dentro da faixa etária dos 50 anos. A elevação média do grupo 1 , foi de 154,38° e do grupo 2, foi de 76,25 graus p=0,0002. A rotação externa dos pacientes do grupo 1 foi de 31º e do grupo 2 foi de 9,6 graus (p=0,002. A rotação interna nos pacientes do grupo 1 foi ao nível da décima vértebra torácica enquanto nos pacientes do grupo 2 foi ao nível da quarta vértebra lombar(P=0,003.The most serious fractures of the proximal portion of the humerus is the four-part fracture- dislocation. The traditional approach is the arthroplasty of the proximal humerus. We describe a retrospective study of 20 patients submitted to partial arthroplasty of the shoulder for treating four-part fracture-dislocations of the proximal humerus. The mean postoperative follow-up time was 14 months. Patients were assessed for elevation, lateral and medial rotation. We divided the subjects into two groups: patients with higher elevation than the average (group 1 and with lower elevation than the average (group 2. The elevation average obtained for all patients was 107

  11. Cementless anatomical prosthesis for the treatment of 3-part and 4-part proximal humerus fractures: cadaver study and prospective clinical study with minimum 2 years followup

    Directory of Open Access Journals (Sweden)

    Obert Laurent

    2016-01-01

    Full Text Available Introduction: The purpose of this study was to evaluate the functional and radiological outcomes of a cementless, trauma-specific locked stem for 3- and 4-part proximal humeral fractures. Materials and methods: This study consisted of two parts: a cadaver study with 22 shoulders and a multicenter prospective clinical study of 23 fracture patients evaluated at least 2 years after treatment. In the cadaver study, the locked stem (HumelockTM, FX Solutions and its instrumentation were evaluated. In the clinical study, five senior surgeons at four different hospitals performed the surgical procedures. An independent surgeon evaluated the patients using clinical (Constant score, QuickDASH and radiological (X-rays, CT scans outcome measures. Results: The cadaver study allowed us to validate the height landmarks relative to the pectoralis major tendon. In the clinical study, at the review, abduction was 95° (60–160, forward flexion was 108° (70–160, external rotation (elbow at body was 34° (0–55, the QuickDASH was 31 (4.5–59, the overall Constant score was 54 (27–75, and the weighted Constant score was 76 (31.5–109. Discussion: This preliminary study of hemiarthroplasty (HA with a locked stem found results that were at least equivalent to published series. As all patients had at least a 2-year follow-up, integration of the locked stem did not cause any specific complications. These results suggest that it is possible to avoid using cement when hemiarthroplasty is performed for the humeral stem. This implant makes height adjustment and transosseous suturing of the tuberosities more reproducible.

  12. Cortical desmoid of the humerus: radiographic and MRI correlation

    Energy Technology Data Exchange (ETDEWEB)

    Kay, Matthew; Counsel, Peter [Princess Margaret Hospital for Children, Department of Diagnostic Imaging, Perth (Australia); Perth Radiological Clinic, Perth (Australia); Wood, David [Princess Margaret Hospital for Children, Department of Orthopedic Surgery, Perth (Australia); Breidahl, William [Perth Radiological Clinic, Perth (Australia)

    2017-07-15

    Cortical desmoids are self-limiting fibro-osseous lesions commonly occurring at the medial supracondylar femur in active adolescents, at either the origin of the medial head of the gastrocnemius or at the insertion of the adductor magnus aponeurosis. Less commonly, in a similar demographic, cortical desmoids may occur in the proximal humerus medially at the insertion of the pectoralis major muscle or laterally at the insertion of the deltoid. The radiographic appearance of the proximal humerus cortical desmoid has been described previously, but not the MRI appearance. We present the radiographic and MRI appearances of a proximal humerus cortical desmoid in a young adolescent who presented for investigation of right shoulder pain. (orig.)

  13. TETRAPOLIS - an exercise in building the complexities of proximity space

    National Research Council Canada - National Science Library

    Cristian Blidariu; Diana Giurea

    2017-01-01

    ... student’s intuitive ways for understanding these vicinities, their physical and symbolic proximities, through participatory tactics and certain poetic/architectural tools required in the phenomenological build-up of space...

  14. Avaliação do tratamento cirúrgico das fraturas em duas ou três partes do úmero proximal com o "sistema paraquedas" Evaluation of surgical treatment of fractures in two or three parts of the proximal humerus with the "parachute technique"

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Tenor Junior

    2010-06-01

    Full Text Available OBJETIVO: Avaliar, através dos resultados clínicos, a eficácia e a segurança da técnica cirúrgica denominada "sistema paraquedas" aplicada em pacientes adultos que sofreram fraturas desviadas e instáveis em duas ou em três partes do úmero proximal. MÉTODOS: Durante o período de janeiro de 1995 a junho de 2006, 59 pacientes adultos com fraturas em duas ou em três partes desviadas e instáveis foram operados pelo Grupo de Ombro e Cotovelo do Serviço de Ortopedia e Traumatologia do Hospital do Servidor Público Estadual de São Paulo com a técnica do "sistema paraquedas". Este método consiste em uma banda de tensão intramedular e fixação extra medular em "8" unindo os fragmentos da fratura, utilizando um parafuso esponjoso de 6,5mm com rosca parcial, arruela e dois fios inabsorvíveis, produzindo uma síntese estável, com mínima agressão às partes moles vizinhas, não requerendo a posterior retirada do material. A forma final desta síntese lembra a figura de um paraquedas aberto. Os pacientes tiveram um seguimento pós-operatório mínimo de seis meses. Para o diagnóstico foram realizadas radiografias nas incidências da série trauma de ombro. As fraturas foram classificadas de acordo com o sistema proposto por Neer. Utilizamos a escala da Universidade da Califórnia em Los Angeles (UCLA na avaliação dos resultados. RESULTADOS: Obteve-se 47% de bons e 26% de excelentes resultados com a técnica do "sistema paraquedas" de acordo com o escore da UCLA. CONCLUSÃO: A técnica do "sistema paraquedas" é opção segura e eficaz de tratamento das fraturas desviadas e instáveis em duas ou três partes do úmero proximal.OBJECTIVE: To evaluate, through clinical outcomes, the efficacy and safety of the surgical technique called the "parachute technique" as applied to adult patients who suffered displaced and unstable fractures in two or three parts of the proximal humerus. METHODS: During the period from January 1995 to June 2006

  15. Observing Complex Systems Thinking in the Zone of Proximal Development

    Science.gov (United States)

    Danish, Joshua; Saleh, Asmalina; Andrade, Alejandro; Bryan, Branden

    2017-01-01

    Our paper builds on the construct of the zone of proximal development (ZPD) (Vygotsky in Mind in society: the development of higher psychological processes, Harvard University Press, Cambridge, 1978) to analyze the relationship between students' answers and the help they receive as they construct them. We report on a secondary analysis of…

  16. Fracture of the humerus after cancellous bone graft harvesting in a dog.

    Science.gov (United States)

    Ferguson, J F

    1996-05-01

    A five-year-old male Shetland sheepdog underwent calcaneoquartal arthrodesis for instability of the proximal intertarsal joint. A cancellous bone graft was harvested from the proximal humerus and packed around the arthrodesis site. Twenty-four hours postoperatively the dog developed a non-weightbearing forelimb lameness. Clinical and radiographic examination revealed a fracture of the humerus through the hole used to obtain the graft. Surgical repair of the fracture led to an uneventful recovery.

  17. A STUDY ON PROXIMAL HUMERAL FRACTURES STABILISED WITH PHILOS PLATE

    Directory of Open Access Journals (Sweden)

    Praveen Sivakumar K

    2017-02-01

    Full Text Available BACKGROUND Techniques for treating complex proximal humeral fractures vary and include fixations using tension bands, percutaneous pins, bone suture, T-plates, intramedullary nails, double tubular plates, hemiarthroplasty, plant tan humerus fixator plates, Polaris nails and blade plates. Complications of these techniques include cutout or back out of the screws and plates, avascular necrosis, nonunion, malunion, nail migration, rotator cuff impairment and impingement syndromes. Insufficient anchorage from conventional implants may lead to early loosening and failure, especially in osteoporotic bones. In general, nonoperative treatment of displaced three and four-part fractures of the proximal humerus leads to poor outcome due to intraarticular nature of injury and inherent instability of the fragments. Comminuted fractures of the proximal humerus are at risk of fixation failure, screw loosening and fracture displacement. Open reduction and internal fixation with conventional plate and screws has been associated with unacceptably high incidence of screw pull out. PHILOS (the proximal humeral internal locking system plate is an internal fixation system that enables angled stabilisation with multiple interlocking screws for fractures of the proximal humerus. MATERIALS AND METHODS 30 patients with proximal humerus fractures who were admitted in the Department of Orthopaedics, Government General Hospital, Kakinada, during the period November 2014 - November 2016 were taken up for study according to inclusion criteria. All patients were treated with PHILOS plate. These proximal humerus fractures were classified according to Neer’s classification. Patients were followed up at 6 weeks, 12 weeks and 6 months’ interval. Functional outcomes for pain, range of motion and muscle power and function were assessed using the Constant-Murley scoring system. Collected data analysed with independent t-test and ANNOVA test. RESULTS The outcome of the study was 1

  18. Surgical treatment of pathologic fractures of humerus.

    Science.gov (United States)

    Piccioli, Andrea; Maccauro, Giulio; Rossi, Barbara; Scaramuzzo, Laura; Frenos, Filippo; Capanna, Rodolfo

    2010-11-01

    This study evaluates different operative treatment options for patients with metastatic fractures of the humerus focusing on surgical procedures, complications, function, and survival rate. From January 2003 to January 2008, 87 pathological fractures of the humerus in 85 cancer patients were surgically treated in our institutions. Histotypes were breast (n=21), lung (n=14), prostate (n=5), bladder (n=4), kidney (n=13), thyroid (n=7), larynx (n=1), lymphoma (n=5), myeloma (n=8), colon-rectum (n=1), melanoma (n=1), testicle (n=1), hepatocellular carcinoma (n=1) and unknown tumours (n=3). Lesions of the proximal epiphysis were treated with resection and endoprosthetic replacement (n=30). The remaining 57 fractures were stabilized with antegrade unreamed intra-medullary locked nailing without (9 cases) or with resection and use of cement (48 cases). The function of the upper limb was assessed using the Musculo-Skeletal Tumor Society (MSTS) rating scale and survival rate was retrospectively analysed. The mean survival time of patients after surgery was 8.3 months. Complications of endoprosthetic replacement recorded included disease relapse (n=3), soft tissue infection (n=2) and palsy of musculocutaneous nerve (n=1) whereas, for intra-medullary locked nailing there were three cases of soft tissue infection and one case of radial nerve palsy. The mean MSTS score at follow-up was 73% for endoprosthesis and 79.2% for locked intra-medullary nailing. Endoprosthetic replacement of the proximal humerus provides a good function of the upper limb, a low risk of local relapse with a low complication rate at follow-up. Unreamed nailing provides immediate stability and pain relief, minimum morbidity and early return of function. Copyright © 2010 Elsevier Ltd. All rights reserved.

  19. Shoulder arthroplasty in complex acute and chronic proximal humeral fractures

    DEFF Research Database (Denmark)

    Frich, Lars Henrik; Søjbjerg, J.O.; Sneppen, O.

    1991-01-01

    From 1983 to 1988, 42 shoulder arthroplasties were performed on comminuted acute or chronic proximal humeral fractures. Patients were categorized according to the post-fracture operative delay; there were 15 four-part fractures, with median post-fracture delay of 13 days (range: 7 to 21), and 27...... chronic fractures, including 11 four-part fractures, 9 three-part fractures, and 7 two-part fractures, with median post-fracture delay of 14 months (range: 4 to 72). Follow up was approximately 2 years in both groups (range: 1 to 5). All patients were evaluated according to a modified Neer score......-system and classified into four groups. Pain relief was satisfactory in the acute group, but was unpredictable in the chronic group. The results in the acute group were significantly superior (P less than .05). In the acute group, 3 (20%) patients had an excellent result and 6 patients (40%) had a good result, compared...

  20. Best Proximity Point Results in Complex Valued Metric Spaces

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    Binayak S. Choudhury

    2014-01-01

    complex valued metric spaces. We treat the problem as that of finding the global optimal solution of a fixed point equation although the exact solution does not in general exist. We also define and use the concept of P-property in such spaces. Our results are illustrated with examples.

  1. A Segmental Fracture of Humerus with Ipsilateral Forearm Fracture

    Directory of Open Access Journals (Sweden)

    Ruban Raj Joshi

    2016-12-01

    Full Text Available Introduction: Simultaneous segmental humerus fracture with ipsilateral forearm is an uncommon injury and scarcely mentioned in the literature. Case report: We present a case report on such a complex injury in a 9-year old child after falling down from the first floor of his house while playing. The injury pattern consist of ipsilateral supracondylar fracture humerus with distal humerus  and ipsilateral distal forearm fracture. Open reduction and pinning of the both injuries was obtained. Conclusion: Ipsilateral multiple fractures in children often result from high energy trauma and are associated with complications. Immediate reduction and fixation is required. If satisfactory reduction cannot be achieved by closed technique, open reduction should be considered to avert additional soft tissue injury and forthcoming complications.

  2. Axillary Arterial Thrombosis Secondary to Re-Fracture of the Humerus

    Directory of Open Access Journals (Sweden)

    Nikola Fatic

    2014-12-01

    Full Text Available In the presented case report, we evaluated mechanism of axillary artery thrombosis in cases of repeated fracture of the shoulder. A 73-year-old female fell down on an outstretched hand. Radiographs demonstrated a Neer’s 2-part displaced fracture of the proximal humerus and open fracture of the acromion. Forty years ago, in a car accident, fractures of the same proximal humerus and clavicle occurred and were surgically treated. Two hours after fixation with Kirschner wires, thrombosis of the axillary artery was quickly diagnosed and rapid treatment allowed revascularisation of the arm without any consequences.

  3. The surgical manegement of metastases to humerus-clinical evaluation.

    Science.gov (United States)

    Chrobok, Adam; Spindel, Jerzy; Miszczyk, Leszek; Koczy, Bogdan; Pilecki, Bogdan; Jarosz, Adam; Mrozek, Tomasz

    2003-06-30

    Background. The humerus is a common localisation of cancer metastases. The restoration of anatomical order and tumor resection within humerus is important for patients quality of everyday life and for their pain relief. The surgical treatment is one of the most important part of the whole oncological ways of tratment. The study objective was a clinical assesment of tumor resection and reconstruction within humerus according to matastasis localisation and the choice of surgical technique. Material and methods. In the years 1999-2002 19 patients underwent surgery due to pathological fracture or/and cancer metastasis within humerus. The shaft localisation of the tumor was found in 8 cases and in 11 patients the metastatic foci were found in proximnal diaphysis. In patients with proximal diaphysis localisation of the tumor the partial resection with subsequent joint exchange procedure was made. The humeral shaft metastatic cancer changes were treated by the segmental resection with subsequent surgical cement filling or auto/allogenical bone grafting combined with intramedullary nail or AO/ASIF plate stabilisation. The average follow-up period was 8,5 months. Results. In patients after resection with shoulder joint alloplasty according to the Enneking test a very good result was found in 7 and very good in 4 cases. In patients with femoral shaft metastatic tumor locaslisation, 6 good and 2 fair results were found. In 1 patient after 2 months rehabilitation a reoperation was needed due to the mechanical destabilisation. The best results were found in patients after intramedullary nailing.An acute soft tissue inflamation requiering surgical treatment was found in 1 patient after shoulder joint replacement. Conclusions. After clinical analysis of the material we highly recomend the partial humeral bone resection with subsequent shoulder alloplasty in patients with proximal humeral diaphysis metastatic localisation. In cases with shaft localisation a better results were

  4. Social complexity as a proximate and ultimate factor in communicative complexity

    Science.gov (United States)

    Freeberg, Todd M.; Dunbar, Robin I. M.; Ord, Terry J.

    2012-01-01

    The ‘social complexity hypothesis’ for communication posits that groups with complex social systems require more complex communicative systems to regulate interactions and relations among group members. Complex social systems, compared with simple social systems, are those in which individuals frequently interact in many different contexts with many different individuals, and often repeatedly interact with many of the same individuals in networks over time. Complex communicative systems, compared with simple communicative systems, are those that contain a large number of structurally and functionally distinct elements or possess a high amount of bits of information. Here, we describe some of the historical arguments that led to the social complexity hypothesis, and review evidence in support of the hypothesis. We discuss social complexity as a driver of communication and possible causal factor in human language origins. Finally, we discuss some of the key current limitations to the social complexity hypothesis—the lack of tests against alternative hypotheses for communicative complexity and evidence corroborating the hypothesis from modalities other than the vocal signalling channel. PMID:22641818

  5. Effect of osteosynthesis, primary hemiarthroplasty, and non-surgical management for displaced four-part fractures of the proximal humerus in elderly: a multi-centre, randomised clinical trial

    DEFF Research Database (Denmark)

    Brorson, Stig; Olsen, Bo Sanderhoff; Frich, Lars Henrik

    2009-01-01

    severe injuries, accounting for 2-10 percent of proximal humeral fractures. The optimal intervention is disputed. Two previous randomised trials were very small and involved a noticeable risk of bias, and systematic reviews consequently conclude that there is inadequate basis for evidence-based treatment...... decisions. We aim to compare the effect of osteosynthesis with angle-stable plate with non-surgical management, and the effect of primary hemiarthroplasty with both osteosynthesis and non-surgical management. METHODS/DESIGN: We will conduct a randomised, multi-centre, clinical trial including patients from...... ten national shoulder units within a two-year period. We plan to include 162 patients. A central randomisation unit will allocate patients. All patients will receive a standardised three-month rehabilitation program of supervised physiotherapy regardless of treatment allocation. Patients...

  6. Midshaft humeral fracture following a proximal humeral fracture: a case report

    National Research Council Canada - National Science Library

    Jayaseelan, Dhinu J; Post, Andrew A; Ruggirello, Leah D; Sault, Josiah D

    2014-01-01

    ... of rehabilitation of a proximal humerus fracture. A 63-year-old female recreational tennis player presented to physical therapy, progressing well following a proximal humeral fracture, sustained 18 weeks prior...

  7. Bilateral Humerus Fracture Following Birth Trauma

    OpenAIRE

    Dias, Edwin

    2012-01-01

    Birth injuries especially to humerus are rare in Caesarean sections as compared to vaginal deliveries. But in some difficult extractions even with expert care, injury may be sustained by the newborn. This is a report of a case of birth trauma induced fractures of both humerus during Caesarean section.

  8. Biomechanical comparison of orthogonal versus parallel double plating systems in intraarticular distal humerus fractures.

    Science.gov (United States)

    Atalar, Ata C; Tunalı, Onur; Erşen, Ali; Kapıcıoğlu, Mehmet; Sağlam, Yavuz; Demirhan, Mehmet S

    2017-01-01

    In intraarticular distal humerus fractures, internal fixation with double plates is the gold standard treatment. However the optimal plate configuration is not clear in the literature. The aim of this study was to compare the biomechanical stability of the parallel and the orthogonal anatomical locking plating systems in intraarticular distal humerus fractures in artificial humerus models. Intraarticular distal humerus fracture (AO13-C2) with 5 mm metaphyseal defect was created in sixteen artificial humeral models. Models were fixed with either orthogonal or parallel plating systems with locking screws (Acumed elbow plating systems). Both systems were tested for their stiffness with loads in axial compression, varus, valgus, anterior and posterior bending. Then plastic deformation after cyclic loading in posterior bending and load to failure in posterior bending were tested. The failure mechanisms of all the samples were observed. Stiffness values in every direction were not significantly different among the orthogonal and the parallel plating groups. There was no statistical difference between the two groups in plastic deformation values (0.31 mm-0.29 mm) and load to failure tests in posterior bending (372.4 N-379.7 N). In the orthogonal plating system most of the failures occurred due to the proximal shaft fracture, whereas in the parallel plating system failure occurred due to the shift of the most distal screw in proximal fragment. Our study showed that both plating systems had similar biomechanical stabilities when anatomic plates with distal locking screws were used in intraarticular distal humerus fractures in artificial humerus models. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  9. Life in the Hive: Supporting Inquiry into Complexity Within the Zone of Proximal Development

    Science.gov (United States)

    Danish, Joshua A.; Peppler, Kylie; Phelps, David; Washington, Dianna

    2011-10-01

    Research into students' understanding of complex systems typically ignores young children because of misinterpretations of young children's competencies. Furthermore, studies that do recognize young children's competencies tend to focus on what children can do in isolation. As an alternative, we propose an approach to designing for young children that is grounded in the notion of the Zone of Proximal Development (Vygotsky 1978) and leverages Activity Theory to design learning environments. In order to highlight the benefits of this approach, we describe our process for using Activity Theory to inform the design of new software and curricula in a way that is productive for young children to learn concepts that we might have previously considered to be "developmentally inappropriate". As an illuminative example, we then present a discussion of the design of the BeeSign simulation software and accompanying curriculum which specifically designed from an Activity Theory perspective to engage young children in learning about complex systems (Danish 2009a, b). Furthermore, to illustrate the benefits of this approach, we will present findings from a new study where 40 first- and second-grade students participated in the BeeSign curriculum to learn about how honeybees collect nectar from a complex systems perspective. We conclude with some practical suggestions for how such an approach to using Activity Theory for research and design might be adopted by other science educators and designers.

  10. 锁定髓内针系统与锁定钢板治疗老年肱骨近端骨折的临床比较%The Clinical Comparison of Locking Intramedullary Needle System and Locking Plate in the Treatment of Elderly Proximal Humerus Fracture

    Institute of Scientific and Technical Information of China (English)

    王驰; 袁定坤

    2016-01-01

    目的:比较锁定髓内针系统与锁定钢板对老年肱骨近端骨折的临床疗效。方法:选择2012年1月-2014年12月在本院进行肱骨近端骨折手术的老年患者130例,按照治疗方案分为锁定髓内针组与锁定钢板组。锁定髓内针组患者76例,锁定钢板组患者54例,分别给予髓内针和钢板进行内固定,观察患者手术用时间、术中出血量、骨折愈合时间等手术情况。随访患者6个月,观察两组患者主钉或者钢板松动、断裂;肩关节活动障碍或者疼痛;骨折不愈合或者延迟愈合等并发症发生情况。6个月后使用Neer肩关节评分法对患者恢复状况进行评分,满分100分,分值越高则功能恢复越好。结果:锁定髓内针组患者的切口长度、术中出血量、手术时间及愈合时间均短于锁定钢板组,差异均有统计学意义(P0.05)。锁定髓内针组出现8例并发症,发生率为10.52%,锁定钢板组出现6例并发症,发生率为11.11%。两组患者并发症发生率比较差异无统计学意义(P>0.05)。结论:锁定髓内针技术对患者损伤更小,其创口小,术中出血量少,因此患者恢复更快,对于年纪较大,身体较弱的患者,以及二部分骨折的患者可以优先考虑这种术式。%Objective: To compare the clinical effects of locking intramedullary needle pin system and locking plate in the treatment of elderly proximal humerus fracture.Method: 130 cases of elderly proximal humerus fracture which admitted in our hospital from January 2012 to December 2014 were divided into locking intramedullary needle group and locking plate group, according to the treatment plan. The locking intramedullary needle group with 76 cases were given intramedullary needle internal fixation and locking plate group with 54 cases were given locking plate internal fixation. The surgical operation time, intraoperative blood loss, fracture healing time of the

  11. Late Prosthetic Shoulder Hemiarthroplasty after Failed Management of Complex Proximal Humeral Fractures

    Directory of Open Access Journals (Sweden)

    A. Panagopoulos

    2013-01-01

    Full Text Available Background. The purpose of this study was to report our experience with shoulder hemiarthroplasty in the context of old trauma. Methods. 33 patients with failed treatment for a complex proximal humeral fracture underwent prosthetic hemiarthroplasty. There were 15 men and 18 women with a mean age of 58.1 years. The average period from initial treatment was 14.9 months. Sequelae included 11 malunions, 4 nonunions, 15 cases with avascular necrosis (AVN and 3 neglected posterior locked dislocations. Follow up investigation included radiological assessment and clinical evaluation using the Constant score and a visual analogue pain scale. Results. After a mean follow up of 82.5 months the median Constant score was 75.7 points, improved by 60% in comparison to preoperative values. Greater tuberosity displacement, large cuff tears and severe malunion were the factors most affected outcome. No cases of stem loosening or severe migration were noted. 60% of the patients were able to do activities up to shoulder level compared with 24% before reconstruction. Conclusions. Late shoulder hemiarthroplasty is technically difficult and the results are inferior to those reported for acute humeral head replacement, nonetheless remains a satisfactory reconstructive option when primary treatment fails.

  12. Rehabilitation of children with lesions of the proximal humeral metaepiphysis using transosseous distraction osteosynthesis technique

    Directory of Open Access Journals (Sweden)

    Юрий Евгеньевич Гаркавенко

    2015-09-01

    Full Text Available We present an analysis of the treatment of 39 children with a shortening of the humerus after sustained osteomyelitis. Variants of lesions of the proximal humerus metaepiphysis are highlighted, and the differentiated approach to therapeutic measures depending on the identified changes resulted in a positive outcome.

  13. Morphometric analysis of septal aperture of humerus

    Directory of Open Access Journals (Sweden)

    Raghavendra K, Anil kumar Reddy Y, Shirol VS, Daksha Dixit, Desai SP

    2014-04-01

    Full Text Available Introduction: Lower end of humerus shows olecranon and coronoid fossae separated by a thin bony septum, sometimes it may deficient and shows foramen which communicates both the fossae called Septal aperture, which is commonly referred as supratrochlear foramen (STF. Materials & Methods: We have studied 260 humeri (126 right side and 134 left side, measurements were taken by using vernier caliper, translucency septum was observed by keeping the lower end of humerus against the x-ray lobby. Results: A clear cut STF was observed in 19.2% bones, translucency septum was observed in 99 (91.6% humeri on the right side and 95 (93.1% humeri on the left sides respectively (Table – 1. Clinical significance: The presence of STF is always associated with the narrow medullary canal at the lower end of humerus, Supracondylar fracture of humerus is most common in paediatric age group, medullary nailing is done to treat the fractures in those cases the knowledge about the STF is very important for treating the fractures. It has been observed in x-ray of lower end of the humerus the STF is comparatively radiolucent, it is commonly seen as a type of ‘pseudolesions’ in an x-ray of the lower end of humerus and it may mistake for an osteolytic or cystic lesions. Conclusion: The present study can add data into anthropology and anatomy text books regarding STF and it gives knowledge of understanding anatomical variation of distal end of the humerus, which is significant for anthropologists, orthopaedic surgeons and radiologists in habitual clinical practice.

  14. [Complex fracture-dislocation of the proximal interphalangeal joint. A case report and focus on palmar proximal interphalangeal fractures-dislocations].

    Science.gov (United States)

    Lawson, E; Thomsen, L; Hans-Moevi Akué, A; Falcone, M-O

    2013-10-01

    The palmar fracture-dislocation of the proximal interphalangeal (PIP) joint of fingers is an uncommon injury. We report a complex form in a 16-year old teenager, associating a palmar fracture-dislocation and a fracture of the base of the middle phalanx with the dorsal fragment dislocated between the neck of the proximal phalange and the palmar plate. The management was surgical with open reduction and fixation of the fragments by K-wires and temporary PIP arthrorisis. The result at 6months of follow- up after removal of the wires and physiotherapy was satisfactory. The patient was painless with a range of motion of 115°. Clinically, the sagittal and frontal stability of the joint both in flexion and extension was maintained. Osseous healing was obtained on X-ray control. The patient went back to his usual activities. A focus on palmar fracture-dislocations of PIP joint is presented through incidence, mechanism and treatment. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  15. SPECIFICS OF DIAPHYSEAL HUMERUS FRACTURES HEALING IN PATIENTS TREATED BY ILIZAROV EXTERNAL FIXATION

    Directory of Open Access Journals (Sweden)

    A. N. Erokhin

    2017-01-01

    Full Text Available Based on the literature data analysis a hypothesis was made that specific features of humeral diaphyseal fractures consolidation process in result of Ilizarov method treatment depend on their quantitative characteristics.Purpose of the study – to develop quantitative characteristics of diaphyseal humerus fractures and to analyze their correlation to the terms of bone fragments healing.Materials and methods. The authors studied X-rays of forty one patient with diaphyseal humerus fractures; age of patients ranged from 21 to 60 years (median – 37 years, there were 19 male and 22 female patients. The authors worked out the formulas using Weasis software for quantitative characteristics of diaphyseal humerus fractures: distance of the fracture site from proximal metaphysis of the humerus, extension of the fracture line and degree of bone fragments displacement. During statistical analysis of the recorded data the average standard deviation, median, minimum, maximum, 25th percentile and 75th percentile were calculated. The Shapiro-Wilk test was used to check consistency of recorded data with normal distribution of characteristics. Correlation analysis was performed by calculation of Kendall and Pearson coefficients. Statistical processing of reported data was done by means of unpaired criteria: non-parametric Wilcoxon test and parametric Student t-test. When comparing two samples a null hypothesis was rejected at the level of test significance p≤0.05. The authors utilized Microsoft Office Excel 2007 and AtteStat, version 13.1.Results. Statistical analysis of the samples including comminuted and spiral fractures of humeral diaphysis demonstrated that the level of the fracture was within 40.9±19.9% and distributed from 11.6% to 72.4% along the diaphysis. Correlation analysis demonstrated statistically valid moderate negative relation between the level of fracture site and consolidation period (Pearson correlation coefficient r = -0.46; р = 0

  16. Humerus fractures in llamas and alpacas: seven cases (1998-2004).

    Science.gov (United States)

    Newman, Kenneth D; Anderson, David E

    2007-01-01

    To describe treatment and outcome of humerus fractures in llamas and alpacas. Retrospective study. Llamas (n=4) and alpacas (3) with humerus fracture. Medical records (January 1, 1998-August 1, 2004) were reviewed for small camelids with a humeral fracture. Retrieved data were signalment, history, physical examination and radiographic findings, surgical and medical treatment, and outcome. Humeral fracture occurred in 7 of 38 (18%) camelids admitted with fractures. Affected animals were aged from 1 month to 3 years old. Fracture configuration included long-oblique (n=4), short-oblique (2), and Salter-Harris Type II fracture of the proximal physis (1). One adult llama was managed by stall confinement and surgical repair was attempted in the other camelids: fixation by screws inserted in lag fashion (n=3), intramedullary pinning and fixation by screws inserted in lag fashion (1), rush pinning (1), and bone plating (1). A Velpeau sling was used for additional support in 3 animals. All fractures healed but temporary radial nerve paresis occurred in 3 animals. Limb shortening and permanent lameness occurred in the llama managed conservatively. Humerus fractures in small camelids are amenable to surgical repair which may offer better long-term outcome than medical treatment alone. Surgical treatment of humerus fractures should have a good prognosis in llamas and alpacas. In select cases, minimally invasive techniques, such as rush pinning or fixation by screws inserted in lag fashion are sufficient for fracture healing.

  17. Surgeons agree more on treatment recommendations than on classification of proximal humeral fractures

    DEFF Research Database (Denmark)

    Brorson, Stig; Olsen, Bo Sanderhoff; Frich, Lars Henrik

    2012-01-01

    Orthopaedic surgeons disagree considerably when classifying fractures of the proximal humerus. However, the clinical implications of low observer agreement remain unclear. The purpose of the study was to compare the agreement on Neer classification with the agreement on treatment recommendations....

  18. The factors influencing the decision making of operative treatment for proximal humeral fractures

    NARCIS (Netherlands)

    Hageman, M.G.; Jayakumar, P.; King, J.D.; Guitton, T.G.; Doornberg, J.N.; Ring, D.; Poelhekke, L.M.S.J.

    2015-01-01

    BACKGROUND: The factors influencing the decision making of operative treatment for fractures of the proximal humerus are debated. We hypothesized that there is no difference in treatment recommendations between surgeons shown radiographs alone and those shown radiographs and patient information.

  19. Comprehensive Characterization of Minichromosome Maintenance Complex (MCM) Protein Interactions Using Affinity and Proximity Purifications Coupled to Mass Spectrometry.

    Science.gov (United States)

    Dubois, Marie-Line; Bastin, Charlotte; Lévesque, Dominique; Boisvert, François-Michel

    2016-09-02

    The extensive identification of protein-protein interactions under different conditions is an important challenge to understand the cellular functions of proteins. Here we use and compare different approaches including affinity purification and purification by proximity coupled to mass spectrometry to identify protein complexes. We explore the complete interactome of the minichromosome maintenance (MCM) complex by using both approaches for all of the different MCM proteins. Overall, our analysis identified unique and shared interaction partners and proteins enriched for distinct biological processes including DNA replication, DNA repair, and cell cycle regulation. Furthermore, we mapped the changes in protein interactions of the MCM complex in response to DNA damage, identifying a new role for this complex in DNA repair. In summary, we demonstrate the complementarity of these approaches for the characterization of protein interactions within the MCM complex.

  20. A STUDY OF FUNCTIONAL OUTCOME OF FRACTURES OF UPPER END HUMERUS TREATED BY PHILOS PLATE

    Directory of Open Access Journals (Sweden)

    Ananthula Krishna

    2015-10-01

    Full Text Available Proximal humeral fractures account for about 5% of all injuries to the appendicular skeleton. The majority of proximal humeral fractures are either un - displaced or minimally displaced which can be managed conservatively. Only 20% of proximal humeral fractu res need surgical intervention. Many surgical techniques have been described. Over the last 3 decades, various modalities of fixations have been evolved for the treatment of these injuries (trans - osseous suturing, percutaneous pinning, tension band wiring, plating, nailing, arthroplasty. The proximal humerus internal locking system (PHILOS plate, a fixed - angle construct has been developed to maintain angular stability under load and to improve screw fixation in osteoporotic bones. In our study 29 patients with unstable proximal humerus fractures were treated with open reduction and internal fixation using PHILOS plate. In 85% of cases the results were excellent to good. In this study, w e observed that the locking compression plate is an advantageous implan t in the treatment of these cases due to its angular stability particularly in comminuted fractures and in osteoporotic bones.

  1. DNAH11 Localization in the Proximal Region of Respiratory Cilia Defines Distinct Outer Dynein Arm Complexes.

    Science.gov (United States)

    Dougherty, Gerard W; Loges, Niki T; Klinkenbusch, Judith A; Olbrich, Heike; Pennekamp, Petra; Menchen, Tabea; Raidt, Johanna; Wallmeier, Julia; Werner, Claudius; Westermann, Cordula; Ruckert, Christian; Mirra, Virginia; Hjeij, Rim; Memari, Yasin; Durbin, Richard; Kolb-Kokocinski, Anja; Praveen, Kavita; Kashef, Mohammad A; Kashef, Sara; Eghtedari, Fardin; Häffner, Karsten; Valmari, Pekka; Baktai, György; Aviram, Micha; Bentur, Lea; Amirav, Israel; Davis, Erica E; Katsanis, Nicholas; Brueckner, Martina; Shaposhnykov, Artem; Pigino, Gaia; Dworniczak, Bernd; Omran, Heymut

    2016-08-01

    Primary ciliary dyskinesia (PCD) is a recessively inherited disease that leads to chronic respiratory disorders owing to impaired mucociliary clearance. Conventional transmission electron microscopy (TEM) is a diagnostic standard to identify ultrastructural defects in respiratory cilia but is not useful in approximately 30% of PCD cases, which have normal ciliary ultrastructure. DNAH11 mutations are a common cause of PCD with normal ciliary ultrastructure and hyperkinetic ciliary beating, but its pathophysiology remains poorly understood. We therefore characterized DNAH11 in human respiratory cilia by immunofluorescence microscopy (IFM) in the context of PCD. We used whole-exome and targeted next-generation sequence analysis as well as Sanger sequencing to identify and confirm eight novel loss-of-function DNAH11 mutations. We designed and validated a monoclonal antibody specific to DNAH11 and performed high-resolution IFM of both control and PCD-affected human respiratory cells, as well as samples from green fluorescent protein (GFP)-left-right dynein mice, to determine the ciliary localization of DNAH11. IFM analysis demonstrated native DNAH11 localization in only the proximal region of wild-type human respiratory cilia and loss of DNAH11 in individuals with PCD with certain loss-of-function DNAH11 mutations. GFP-left-right dynein mice confirmed proximal DNAH11 localization in tracheal cilia. DNAH11 retained proximal localization in respiratory cilia of individuals with PCD with distinct ultrastructural defects, such as the absence of outer dynein arms (ODAs). TEM tomography detected a partial reduction of ODAs in DNAH11-deficient cilia. DNAH11 mutations result in a subtle ODA defect in only the proximal region of respiratory cilia, which is detectable by IFM and TEM tomography.

  2. Solid aneurysmal bone cyst in the humerus

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Tetsuji; Marui, Takashi; Akisue, Toshihiro; Mizuno, Kosaku [Dept. of Orthopaedic Surgery, Kobe University School of Medicine, Chuo-Ku (Japan)

    2000-08-01

    We report on a 69-year-old woman with a solid variant of aneurysmal bone cyst (solid ABC) in the left humerus with a pathological fracture. Radiographically, the lesion exhibited a relatively well-defined osteolytic lesion in the diaphysis of the left humerus. On magnetic resonance (MR) imaging, the medullary lesion exhibited a homogeneous signal intensity isointense with surrounding normal muscles on the T1-weighted images and a mixture of low and high signal intensity on the T2-weighted images. Contrast-enhanced T1-weighted images revealed diffuse enhancement of the entire lesion. The pathological study showed a proliferation of fibroblasts, histiocytes, chronic inflammatory cells and numerous multinucleated giant cells in a collagenous matrix. Abundant osteoid formation in the matrix was observed, but the cells were devoid of nuclear atypia. Aneurysmal cystic cavities were absent. A review of the English literature found 22 cases of solid ABC of the long bones. (orig.)

  3. Clear-cell chondrosarcoma of the humerus

    OpenAIRE

    Elojeimy, Saeed; Ahrens, William A.; Howard, Brian; Patt, Joshua C.; Stone, Taylor; Kneisl, Jeffrey S.; Bhargava, Puneet

    2015-01-01

    Clear-cell chondrosarcoma is a rare, low-grade variant of chondrosarcoma characterized by slow growth, low metastatic potential, and a predilection for local recurrence long after treatment. We report an unusually aggressive case of clear-cell chondrosarcoma of the humerus with early metastasis to multiple bony sites including femur, thoracic and lumbar spine, sacrum, and iliac bone. Our purpose is to alert physicians to the sarcoma's potential for aggressive behavior, necessitating closer an...

  4. Repair of chronic rupture of the achilles tendon using 2 intratendinous flaps from the proximal gastrocnemius-soleus complex.

    Science.gov (United States)

    El Shewy, Mohamed Taha; El Barbary, Hassan Magdy; Abdel-Ghani, Hisham

    2009-08-01

    Chronic rupture of the Achilles tendon is a surgical challenge, owing to the presence of a gap between the retracted ends, which renders direct repair almost impossible. In this study, 2 intratendinous distally based flaps fashioned from the proximal gastrocnemiussoleus complex are used to bridge the gap between the retracted edges of the ruptured Achilles tendon. The flaps are placed in the same line of pull of the ruptured tendon, in an effort to make the graft mimic the original biomechanics as much as possible. Case series; Level of evidence, 4. Eleven patients (9 male and 2 female) with neglected ruptures of the Achilles tendon with retracted ends were included in this study. Two flaps fashioned from the proximal gastrocnemiussoleus complex were rotated over themselves, passed through the proximal stump, and then securely inserted into a previously prepared bed in the distal stump. The patients were followed up for a period of 6 to 9 years. At the final follow-up, all patients were able to return to their preinjury level of activity within a period of 6 to 9 months. The mean preoperative American Orthopedic Foot and Ankle Society score was 42.27, whereas it was 98.91 at the final follow-up, with a range of 88 (in 1 patient) to 100 points (in 10 patients). All 11 patients showed statistically significant improvement according to the Holz rating system. This technique allows for a bridging of the defect present in chronic ruptures of Achilles tendons, with a minimum of complications and a good final outcome.

  5. Selenolate complexes of CYP101 and the heme-bound hHO-1/H25A proximal cavity mutant.

    Science.gov (United States)

    Jiang, Yongying; Ortiz de Montellano, Paul R

    2008-05-05

    Thiolate and selenolate complexes of CYP101 (P450cam) and the H25A proximal cavity mutant of heme-bound human heme oxygenase-1 (hHO-1) have been examined by UV-vis spectroscopy. Both thiolate and selenolate ligands bound to the heme distal side in CYP101 and gave rise to characteristic hyperporphyrin spectra. Thiolate ligands also bound to the proximal side of the heme in the cavity created by the H25A mutation in hHO-1, giving a Soret absorption similar to that of the H25C hHO-1 mutant. Selenolate ligands also bound to this cavity mutant under anaerobic conditions but reduced the heme iron to the ferrous state, as shown by the formation of a ferrous CO complex. Under aerobic conditions, the selenolate ligand but not the thiolate ligand was rapidly oxidized. These results indicate that selenocysteine-coordinated heme proteins will not be stable species in the absence of a redox potential stabilizing effect.

  6. Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus.

    Science.gov (United States)

    Ring, David; Gulotta, Lawrence; Chin, Kingsley; Jupiter, Jesse B

    2004-08-01

    Although olecranon osteotomy provides excellent exposure of the distal humerus, enthusiasm for this approach has been limited by reports suggesting numerous complications. It has been suggested that specific techniques for creating and repairing an olecranon osteotomy may help limit complications. This paper describes a technique for olecranon osteotomy using an apex, distal, chevron-shaped osteotomy, Kirschner wires directed out the anterior ulnar cortex distal to the coronoid process and bent 180degrees and impacted into the olecranon proximally, and two 22- gauge, figure-of-eight, stainless steel tension wires. A single surgeon used this technique for exposure of a fracture (16 patients) or nonunion (29 patients) of the distal humerus in 45 consecutive patients. One patient returned to activity too soon, had loosening of the wire fixation, and required a second operation for plate fixation of the ulna. The remaining 44 osteotomies (98%) healed with good alignment within 6 months. There were no broken or migrated wires prior to healing. Twelve patients (27%) had removal of the wires used to repair the olecranon: in 6 patients, this was for symptoms related to the wires (13%); 1 for septic olecranon bursitis, and 5 at the time of another procedure (elbow capsular release in 4 patients and submuscular ulnar nerve transposition in 1). Olecranon osteotomy can be used for exposure of the distal humerus with a low rate of complications when specific techniques are used.

  7. Shear-induced reorganization of renal proximal tubule cell actin cytoskeleton and apical junctional complexes.

    Science.gov (United States)

    Duan, Yi; Gotoh, Nanami; Yan, Qingshang; Du, Zhaopeng; Weinstein, Alan M; Wang, Tong; Weinbaum, Sheldon

    2008-08-12

    In this study, we demonstrate that fluid shear stress (FSS)-induced actin cytoskeletal reorganization and junctional formation in renal epithelial cells are nearly completely opposite the corresponding changes in vascular endothelial cells (ECs) [Thi MM et al. (2004) Proc Natl Acad Sci USA 101:16483-16488]. Mouse proximal tubule cells (PTCs) were subjected to 5 h of FSS (1 dyn/cm(2)) to investigate the dynamic responses of the cytoskeletal distribution of filamentous actin (F-actin), ZO-1, E-cadherin, vinculin, and paxillin to FSS. Immunofluorescence analysis revealed that FSS caused basal stress fiber disruption, more densely distributed peripheral actin bands (DPABs), and the formation of both tight junctions (TJs) and adherens junctions (AJs). A dramatic reinforcement of vinculin staining was found at the cell borders as well as the cell interior. These responses were abrogated by the actin-disrupting drug, cytochalasin D. To interpret these results, we propose a "junctional buttressing" model for PTCs in which FSS enables the DPABs, TJs, and AJs to become more tightly connected. In contrast, in the "bumper-car" model for ECs, all junctional connections were severely disrupted by FSS. This "junctional buttressing" model explains why a FSS of only 1/10 of that used in the EC study can cause a similarly dramatic, cytoskeletal response in these tall, cuboidal epithelial cells; and why junctional buttressing between adjacent cells may benefit renal epithelium in maximizing flow-activated, brush border-dependent, transcellular salt and water reabsorption.

  8. Fractures around a previous fixation of proximal femur. A simple solution to a complex problem.

    Directory of Open Access Journals (Sweden)

    Fernando Manuel Bidolegui

    2016-05-01

    Full Text Available The number of hip fractures in the elderly growth with the increase in life expectancy. Therefore meet with a femur fractured, distal to a previously  implant fixation used in intertrochanteric femur fractures as dynamic hip screw or fixed angle plate, is not an uncommon scenario despite year mortality of hip fracture of 30 to 50%. Given this situation, we used a retrograde intramedullary nail associated with extracting screws percutaneously prior implant. We present 8 cases in patients with an average age of 85.6 years, 5 female and 3 male with a time from the proximal femur fixation to the  new fracture average 3.5 years. Will we track 36 months and we evaluated postoperative mobility and pain getting a consolidation of the fracture in all cases. We found this technique effective; capable of achieving stable fixation without adding morbidity due to the possibility of overlapping two implants decreasing the possibility of potential new interimplantes fracture.

  9. Determination of sex from radiographic measurements of the humerus by discriminant function analysis in Saudi population, Qassim region, KSA.

    Science.gov (United States)

    Shehri, Fahad Al; Soliman, Khaled E A

    2015-08-01

    Diagnosis of sex from skeleton or individual bone plays an important role in identifying unknown bodies, parts of bodies or skeletal remains for forensic purposes. This study aims to examine the applicability of the measurements taken from the humerus to assess sex, and to contribute to establishing discriminant function equations for Saudi populations for medico legal applications. Archived X-ray radiographs of humerus for 387 patients (216 males & 171 females) who attended the orthopedic clinics at Suleiman Al-Habib Hospital, Qassim region, KSA in the period from January 2011 to December 2013 were reviewed and analyzed. Five dimensions, including maximum length, vertical head diameter, diameter of head+greater tubercle, right-left diameter at midshaft, and epicondylar breadth were taken and subjected to Univariate and multivariate discriminant function analysis. The studied radiographic dimensions of the humerus indicate that there are significant differences (p<0.05) between the males and females measurements while the difference between right and left measurements was not significant. The findings revealed that the proximal part of the humerus has greater diagnostic accuracy than distal and middle parts. Accuracy of correct classification varies between 68.0% (epicondylar breadth) and 90.4% (vertical head diameter) for univariate analyses. When the multivariate analyses were conducted, three functions were produced, with the accuracy of ranging between 88.4% and 94.3%. These findings suggested that the dimensions of the humerus, especially the measurements taken from the proximal parts, could be used successfully for sex diagnosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Quantification of spatial structure of human proximal tibial bone biopsies using 3D measures of complexity

    DEFF Research Database (Denmark)

    Saparin, Peter I.; Thomsen, Jesper Skovhus; Prohaska, Steffen

    2005-01-01

    3D data sets of human tibia bone biopsies acquired by a micro-CT scanner. In order to justify the newly proposed approach, the measures of complexity of the bone architecture were compared with the results of traditional 2D bone histomorphometry. The proposed technique is able to quantify......Changes in trabecular bone composition during development of osteoporosis are used as a model for bone loss in microgravity conditions during a space flight. Symbolic dynamics and measures of complexity are proposed and applied to assess quantitatively the structural composition of bone tissue from...

  11. Hypertrophic Nonunion Humerus Mimicking an Enchondroma

    Directory of Open Access Journals (Sweden)

    N. K. Magu

    2014-01-01

    Full Text Available Introduction. Although fractures of humeral shaft show excellent results with conservative management, nonunion does occur. Case Report. We bring forth the case of a young male with a 1.5-year-old hypertrophic nonunion of the humerus mimicking an enchondroma. The initial X-ray images of the patient appeared to be an enchondroma, which only on further evaluation and histopathological analysis was diagnosed conclusively to be a hypertrophic nonunion. Discussion. Enchondromas are often incidentally diagnosed benign tumours. It is however not common to misdiagnose a hypertrophic nonunion to be an enchondroma. We present this case to highlight the unique diagnostic dilemma the treating team had to face.

  12. Outcome of Management of Humerus Diaphysis Non-union This ...

    African Journals Online (AJOL)

    jen

    Nonunion after conservative treatment can be successfully treated by open reduction and internal fixation. A nonunion of a diaphyseal fracture of the humerus can present a major functional problem. The main of our study was to document the outcome of management of non united diaphyseal humerus fractures with plate ...

  13. Outcome of management of humerus diaphysis non-union | Sitati ...

    African Journals Online (AJOL)

    Background: The majority of diaphyseal humerus fractures heal uneventfully when treated nonoperatively, however, nonunion is not a rare event. Nonunion after conservative treatment can be successfully treated by open reduction and internal fixation. A nonunion of a diaphyseal fracture of the humerus can present a ...

  14. Organization of proximal signal initiation at the TCR:CD3 complex.

    Science.gov (United States)

    Guy, Clifford S; Vignali, Dario A A

    2009-11-01

    The series of events leading to T-cell activation following antigen recognition has been extensively investigated. Although the exact mechanisms of ligand binding and transmission of this extracellular interaction into a productive intracellular signaling sequence remains incomplete, it has been known for many years that the immunoreceptor tyrosine activation motifs (ITAMs) of the T-cell receptor (TCR):CD3 complex are required for initiation of this signaling cascade because of the recruitment and activation of multiple protein tyrosine kinases, signaling intermediates, and adapter molecules. It however remains unclear why the TCR:CD3 complex requires 10 ITAMs, while many other ITAM-containing immune receptors, such as Fc receptors (FcRs) and the B cell receptor (BCR), contain far fewer ITAMs. We have recently demonstrated that various parameters of T cell development and activation are influenced by the number, as well as location and type, of ITAMs within the TCR:CD3 complex and hence propose that the TCR is capable of 'scalable signaling' that facilitates the initiation and orchestration of diverse T-cell functions. While many of the underlying mechanisms remain hypothetical, this review intends to amalgamate what we have learned from conventional biochemical analyses regarding initiation and diversification of T-cell signaling, with more recent evidence from molecular and fluorescent microscopic analyses, to propose a broader purpose for the TCR:CD3 ITAMs. Rather than simply signal initiation, individual ITAMs may also be responsible for the differential recruitment of signaling and regulatory molecules which ultimately affects T-cell development, activation and differentiation.

  15. outcome of plate osteosynthesis in the management of proximal

    African Journals Online (AJOL)

    through decreased bone mineral density, disruption of bone micro-architecture and reduction in non- collagenous proteins. Proximal humerus fractures are difficult to manage, particularly in the osteoporotic bone, where the fracture is usually .... is followed by pendulum shoulder exercises which gradually graduate to active ...

  16. Management of proximal humeral fractures in the nineteenth century: an historical review of preradiographic sources

    DEFF Research Database (Denmark)

    Brorson, Stig

    2011-01-01

    The diagnosis and treatment of fractures of the proximal humerus have troubled patients and medical practitioners since antiquity. Preradiographic diagnosis relied on surface anatomy, pain localization, crepitus, and impaired function. During the nineteenth century, a more thorough understanding ...... of the pathoanatomy and pathophysiology of proximal humeral fractures was obtained, and new methods of reduction and bandaging were developed.......The diagnosis and treatment of fractures of the proximal humerus have troubled patients and medical practitioners since antiquity. Preradiographic diagnosis relied on surface anatomy, pain localization, crepitus, and impaired function. During the nineteenth century, a more thorough understanding...

  17. Surgical Technique: Treatment of Distal Humerus Nonunions.

    Science.gov (United States)

    Donders, Johanna C E; Lorich, Dean G; Helfet, David L; Kloen, Peter

    2017-10-01

    Open reduction and internal fixation of distal humerus fractures is standard of care with good to excellent outcome for most patients. However, nonunions of the distal humerus still occur. These are severely disabling problems for the patient and a challenge for the treating physician. Fortunately, a combination of standard nonunion techniques with new plate designs and fixation methods allow even the most challenging distal humeral nonunion to be treated successfully. The purpose of this manuscript is to describe our current technique in treating distal humeral nonunion as it has evolved over the last four decades. We have now follow-up on 62 treated patients. A few key steps are essential to obtain bone healing while regaining or preserving elbow motion. These include careful planning, extensile exposure, release of the ulnar nerve, capsular release and mobilization of the distal fragment, debridement, and finally stable fixation after alignment with application of bone graft. The vast majority of distal humeral nonunions can be treated successfully with open reduction and internal fixation. Important components of the treatment plan are careful preoperative planning, extensile approach, debridement, and solid fixation with-locking-plates and liberal use of bone graft.

  18. A method for designing plates in treatments of proximal humeral fracture and distal radial fracture

    Directory of Open Access Journals (Sweden)

    Lin Wang

    2016-11-01

    Full Text Available The purpose of this paper was to quickly design fixation plates for fractured proximal humerus and distal radius according to the requirements of surgical treatment. Therefore, a new method to quickly design cloverleaf plate appropriate for proximal humerus and volar plate appropriate for distal radius is put forward. First, three-dimensional (3D reconstruction models of fractured proximal humerus and distal radius were generated based on deforming mean parametric models of proximal humerus and distal radius, respectively. Second, based on region-of-interest marked on the 3D reconstruction model of proximal humerus and distal radius, abutted surfaces of cloverleaf plate and volar plate were established, respectively. Then, parametric abutted surface was established after setting rational parameters for the surface of the cloverleaf plate. Parametric abutted surface of volar plate was established using the same method. Finally, parametric cloverleaf plate and volar plate are generated through thickening their respective parametric abutted surfaces. The parametric plates, acting as templates, accelerate and simplify the design process and therefore allow users to construct plate with editing valid parameters easily. Group of cloverleaf plates and volar plates with different sizes were generated quickly, showing that the proposed method is feasible and effective.

  19. A geometric morphometric study of sex differences in the scapula, humerus and ulna of Chaetophractus villosus (Xenarthra, Dasypodidae

    Directory of Open Access Journals (Sweden)

    Francisco Acuña

    Full Text Available ABSTRACT Sexual differences in some of the components of the pectoral girdle and forelimb of Chaetophractus villosus (Desmarest, 1804 were investigated by means of geometric morphometrics. A total of 15 scapulae (7 males, 8 females and 50 humeri-ulnae complexes (24 males, 26 females were examined. No size differences were detected between sexes for any of the bones, but shape differences were found for the humerus and the ulna that enhance the in-forces or the related in-levers. Females had a more robust humerus, with an enlarged deltoid tuberosity, a more spherical head, higher tubercular and epicondylar widths, and more developed supracondylar crests. The ulna of the females was characterised by a more pronounced curvature along its main axis, a caudal displacement of the lateral fossa, a longer olecranon, and a deeper trochlear notch. For both bones, the discriminant analysis classified correctly all the specimens according to their sex. A small percentage of the variance (5.2% for the humerus; 6.8% for the ulna was explained by allometry. The morphological traits found for the humerus and ulna of the females suggest an increased structural strength that could result in powerful digging strokes while keeping shoulder and elbow stabilisation, suggesting a fossorial advantage over males.

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

    Science.gov (United States)

    Brorson, Stig

    2009-07-01

    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.

  1. Pinning technique for shoulder fractures in adolescents: computer modelling of percutaneous pinning of proximal humeral fractures

    Science.gov (United States)

    Mehin, Ramin; Mehin, Afshin; Wickham, David; Letts, Merv

    2009-01-01

    Background In the technique of percuatenous pinning of proximal humerus fractures, the appropriate entry site and trajectory of pins is unknown, especially in the adolescent population. We sought to determine the ideal entry site and trajectory of pins. Methods We used magnetic resonance images of nonfractured shoulders in conjunction with radiographs of shoulder fractures that were treated with closed reduction and pinning to construct 3-dimensional computer-generated models. We used engineering software to determine the ideal location of pins. We also conducted a literature review. Results The nonfractured adolescent shoulder has an articular surface diameter of 41.3 mm, articular surface thickness of 17.4 mm and neck shaft angle of 36°. Although adolescents and adults have relatively similar shoulder skeletal anatomy, they suffer different types of fractures. In our study, 14 of 16 adolescents suffered Salter–Harris type II fractures. The ideal location for the lateral 2 pins in an anatomically reduced shoulder fracture is 4.4 cm and 8.0 cm from the proximal part of the humeral head directed at 21.2° in the coronal plane relative to the humeral shaft. Conclusion Operative management of proximal humerus fractures in adolescents requires knowledge distinct from that required for adult patients. This is the first study to examine the anatomy of the nonfractured proximal humerus in adolescents. This is also the first study to attempt to model the positioning of percutaneous proximal humerus pins. PMID:20011155

  2. Biomechanical comparison of orthogonal versus parallel double plating systems in intraarticular distal humerus fractures

    Directory of Open Access Journals (Sweden)

    Ata C. Atalar

    2017-01-01

    Conclusion: Our study showed that both plating systems had similar biomechanical stabilities when anatomic plates with distal locking screws were used in intraarticular distal humerus fractures in artificial humerus models.

  3. Use of Titanium Elastic Nails in the Adult Diaphyseal Humerus Fractures

    OpenAIRE

    Upadhyay AS; Lil NA

    2017-01-01

    INTRODUCTION: Humerus shaft fractures in adults can be managed conservatively with functional braces or operatively with plate osteosynthesis or with intramedullary nailing. Conventionally humerus intramedullary nailing is done either using humerus interlocking nails or Enders nails. In this study we analyse the outcome of humerus shaft fractures (upper and middle third) managed with closed ante- grade intramedullary titanium elastic nailing in terms of union rates, union time, functional res...

  4. A Case Report of an Unusual Case of Tuberculous Osteomyelitis Causing Spontaneous Pathological Fracture of Humerus in a Middle Aged Female.

    Science.gov (United States)

    Birole, Umesh; Ranade, Ashish; Mone, Mahesh

    2017-01-01

    Tuberculosis is a major health problem worldwide. Extrapulmonary tuberculosis is often secondary to some primary foci in lungs. There are reports of tuberculous osteomyelitis involving maxilla, ulna, femur, and shoulder joint but none have reported pathological fracture in humeral diaphysis due to tuberculosis osteomyelitis without shoulder joint involvement. We report a case of pathological fracture of humerus diaphysis due to tuberculous osteomyelitis with normal articular space. We noticed favorable outcome following surgery and antitubercular drugs. A 62-year-old female diabetic patient presented with complaints of pain in the right shoulder of 2 weeks duration and inability to raise right arm. Initial clinical evaluation revealed local rise of temperature, tenderness over the right shoulder and proximal arm and restricted range of movements in all plane. Neurologically, the patient was normal. Erythrocyte sedimentation rate was raised. Computed tomography chest showed small area of consolidation in the left upper lobe. Plain radiograph of the right shoulder with humerus showed transverse fracture of proximal shaft of the right humerus. J-needle biopsy was done from proximal humerus fracture site. Histopathological examination of biopsy tissue from fracture site confirmed granuloma with epithelioid and Langhan's giant cells. Mantoux test and culture for acid-fast bacilli were non-conclusive. Based on histopathology report, we concluded this to be tuberculous osteomyelitis of humerus and the patient was started on category 1 antitubercular drugs, under Revised National Tuberculosis Control Programme as per revised WHO guidelines. We performed open debridement and fixation of fracture with rush nail. Initial follow-up 4 months, post-operative and plain radiograph showed overall improvement in general condition of the patient, weight gain, and good fracture healing. One year following index surgery, rush nails were removed due to pain at insertion site. Fracture

  5. Humerus shaft fractures - where are we today?

    DEFF Research Database (Denmark)

    Strohm, P C; Reising, K; Hammer, T

    2011-01-01

    Humeral shaft fractures account for about 1-3% of all fractures. These fractures are regarded as the domain of non-surgical management. This is certainly still the contemporary view but there is an obvious trend towards surgical stabilization. Surgical treatment of humeral shaft fractures has...... nonetheless been greatly facilitated by the development of new implants. In particular, a new generation of nails that general permit immediate mobilization have become available for improved management of longitudinal and multi-segmental fractures. Retrograde and antegrade nails have advantages...... and disadvantages and selection procedure is often based on the distal or proximal location of the fracture. Plates also offer an alternative for certain indications and have advantages at the proximal and distal shaft in particular. If there is primary lesion of the radial nerve, exploration is not very advisable...

  6. The factors influencing the decision making of operative treatment for proximal humeral fractures

    NARCIS (Netherlands)

    Hageman, Michiel G. J. S.; Jayakumar, Prakash; King, John D.; Guitton, Thierry G.; Doornberg, Job N.; Ring, David

    2015-01-01

    The factors influencing the decision making of operative treatment for fractures of the proximal humerus are debated. We hypothesized that there is no difference in treatment recommendations between surgeons shown radiographs alone and those shown radiographs and patient information. Secondarily, we

  7. Surgical treatment with an angular stable plate for complex displaced proximal humeral fractures in elderly patients: a randomized controlled trial.

    Science.gov (United States)

    Fjalestad, Tore; Hole, Margrethe Ø; Hovden, Inger Anette Hynås; Blücher, Judith; Strømsøe, Knut

    2012-02-01

    The objective of the study was to evaluate functional outcome, patient self-assessment, and radiographic outcome at 1 year in displaced three- and four-part proximal humeral fractures (OTA group 11-B2 and 11-C2). Randomized controlled trial. Academic medical center. Fifty patients aged 60 years or older with displaced three- or four-part proximal humeral fractures and no previous shoulder injuries were randomized either to surgical treatment or to conservative closed treatment. Twenty-five patients were included in each group. Forty-eight patients completed 12-month follow-up. Two surgical patients died within 3 months. The surgically treated group had a standardized surgical treatment with open reduction and internal fixation using an angular stable plate and cerclages. Instructed physical therapy started the third postoperative day. The conservative treatment group had a standardized nonoperative treatment that included closed reduction if displacement between the head and metaphyseal shaft fragment exceeded 50% of the diaphyseal diameter. Physical therapy started on the fifteenth postoperative day. The main outcome was the mean difference in Constant score between the injured and noninjured shoulder at 12 months. The secondary outcomes were patient self-assessment (American Shoulder and Elbow Surgeons score) and radiographic ratings at 12 months. At 12 months, mean Constant scores favored conservative treatment by 2.4 points (nonsignificant; P = 0.62). There was no significant difference in mean patient self-assessment. However, radiographic outcomes were significantly better for surgically treated patients. There is no evidence of a difference in functional outcome at 1-year follow-up between surgical treatment and conservative treatment of displaced proximal humeral fractures in elderly patients.

  8. Proximal Hypospadias

    Science.gov (United States)

    Kraft, Kate H.; Shukla, Aseem R.; Canning, Douglas A.

    2011-01-01

    Hypospadias results from abnormal development of the penis that leaves the urethral meatus proximal to its normal glanular position. Meatal position may be located anywhere along the penile shaft, but more severe forms of hypospadias may have a urethral meatus located at the scrotum or perineum. The spectrum of abnormalities may also include ventral curvature of the penis, a dorsally redundant prepuce, and atrophic corpus spongiosum. Due to the severity of these abnormalities, proximal hypospadias often requires more extensive reconstruction in order to achieve an anatomically and functionally successful result. We review the spectrum of proximal hypospadias etiology, presentation, correction, and possible associated complications. PMID:21516286

  9. Traumatisk distal humerus-epifysiolyse hos nyfødt

    DEFF Research Database (Denmark)

    Al-Aubaidi, Zaid; Nielsen, Keld Daubjerg

    2010-01-01

    Traumatic distal humerus epiphysiolysis (TDHE) is a rare injury in infants with an incidence of about 1:35,000 births. It is primarily a birth injury, but it is also seen in cases of battered child syndrome. Because of its rare occurrence and the diagnostic difficulties, the lesion may...... initial diagnosis. We present a case of TDHE as a birth injury....

  10. Management of Supracondylar Fractures of the Humerus in Children ...

    African Journals Online (AJOL)

    Background : Supracondylar fractures are the most common elbow fractures in children and account for 3 to 7% of all fractures.. Objectives : The purpose of the study was to review and analyze the treatment pattern of supracondylar humerus fractures in children. Methods : 112 children with supracondylar fractures were ...

  11. 'Special K' and a Loss of Cell-To-Cell Adhesion in Proximal Tubule-Derived Epithelial Cells: Modulation of the Adherens Junction Complex by Ketamine

    Science.gov (United States)

    Hills, Claire E.; Jin, Tianrong; Siamantouras, Eleftherios; Liu, Issac K-K; Jefferson, Kieran P.; Squires, Paul E.

    2013-01-01

    Ketamine, a mild hallucinogenic class C drug, is the fastest growing ‘party drug’ used by 16–24 year olds in the UK. As the recreational use of Ketamine increases we are beginning to see the signs of major renal and bladder complications. To date however, we know nothing of a role for Ketamine in modulating both structure and function of the human renal proximal tubule. In the current study we have used an established model cell line for human epithelial cells of the proximal tubule (HK2) to demonstrate that Ketamine evokes early changes in expression of proteins central to the adherens junction complex. Furthermore we use AFM single-cell force spectroscopy to assess if these changes functionally uncouple cells of the proximal tubule ahead of any overt loss in epithelial cell function. Our data suggests that Ketamine (24–48 hrs) produces gross changes in cell morphology and cytoskeletal architecture towards a fibrotic phenotype. These physical changes matched the concentration-dependent (0.1–1 mg/mL) cytotoxic effect of Ketamine and reflect a loss in expression of the key adherens junction proteins epithelial (E)- and neural (N)-cadherin and β-catenin. Down-regulation of protein expression does not involve the pro-fibrotic cytokine TGFβ, nor is it regulated by the usual increase in expression of Slug or Snail, the transcriptional regulators for E-cadherin. However, the loss in E-cadherin can be partially rescued pharmacologically by blocking p38 MAPK using SB203580. These data provide compelling evidence that Ketamine alters epithelial cell-to-cell adhesion and cell-coupling in the proximal kidney via a non-classical pro-fibrotic mechanism and the data provides the first indication that this illicit substance can have major implications on renal function. Understanding Ketamine-induced renal pathology may identify targets for future therapeutic intervention. PMID:24009666

  12. 'Special k' and a loss of cell-to-cell adhesion in proximal tubule-derived epithelial cells: modulation of the adherens junction complex by ketamine.

    Science.gov (United States)

    Hills, Claire E; Jin, Tianrong; Siamantouras, Eleftherios; Liu, Issac K-K; Jefferson, Kieran P; Squires, Paul E

    2013-01-01

    Ketamine, a mild hallucinogenic class C drug, is the fastest growing 'party drug' used by 16-24 year olds in the UK. As the recreational use of Ketamine increases we are beginning to see the signs of major renal and bladder complications. To date however, we know nothing of a role for Ketamine in modulating both structure and function of the human renal proximal tubule. In the current study we have used an established model cell line for human epithelial cells of the proximal tubule (HK2) to demonstrate that Ketamine evokes early changes in expression of proteins central to the adherens junction complex. Furthermore we use AFM single-cell force spectroscopy to assess if these changes functionally uncouple cells of the proximal tubule ahead of any overt loss in epithelial cell function. Our data suggests that Ketamine (24-48 hrs) produces gross changes in cell morphology and cytoskeletal architecture towards a fibrotic phenotype. These physical changes matched the concentration-dependent (0.1-1 mg/mL) cytotoxic effect of Ketamine and reflect a loss in expression of the key adherens junction proteins epithelial (E)- and neural (N)-cadherin and β-catenin. Down-regulation of protein expression does not involve the pro-fibrotic cytokine TGFβ, nor is it regulated by the usual increase in expression of Slug or Snail, the transcriptional regulators for E-cadherin. However, the loss in E-cadherin can be partially rescued pharmacologically by blocking p38 MAPK using SB203580. These data provide compelling evidence that Ketamine alters epithelial cell-to-cell adhesion and cell-coupling in the proximal kidney via a non-classical pro-fibrotic mechanism and the data provides the first indication that this illicit substance can have major implications on renal function. Understanding Ketamine-induced renal pathology may identify targets for future therapeutic intervention.

  13. 'Special k' and a loss of cell-to-cell adhesion in proximal tubule-derived epithelial cells: modulation of the adherens junction complex by ketamine.

    Directory of Open Access Journals (Sweden)

    Claire E Hills

    Full Text Available Ketamine, a mild hallucinogenic class C drug, is the fastest growing 'party drug' used by 16-24 year olds in the UK. As the recreational use of Ketamine increases we are beginning to see the signs of major renal and bladder complications. To date however, we know nothing of a role for Ketamine in modulating both structure and function of the human renal proximal tubule. In the current study we have used an established model cell line for human epithelial cells of the proximal tubule (HK2 to demonstrate that Ketamine evokes early changes in expression of proteins central to the adherens junction complex. Furthermore we use AFM single-cell force spectroscopy to assess if these changes functionally uncouple cells of the proximal tubule ahead of any overt loss in epithelial cell function. Our data suggests that Ketamine (24-48 hrs produces gross changes in cell morphology and cytoskeletal architecture towards a fibrotic phenotype. These physical changes matched the concentration-dependent (0.1-1 mg/mL cytotoxic effect of Ketamine and reflect a loss in expression of the key adherens junction proteins epithelial (E- and neural (N-cadherin and β-catenin. Down-regulation of protein expression does not involve the pro-fibrotic cytokine TGFβ, nor is it regulated by the usual increase in expression of Slug or Snail, the transcriptional regulators for E-cadherin. However, the loss in E-cadherin can be partially rescued pharmacologically by blocking p38 MAPK using SB203580. These data provide compelling evidence that Ketamine alters epithelial cell-to-cell adhesion and cell-coupling in the proximal kidney via a non-classical pro-fibrotic mechanism and the data provides the first indication that this illicit substance can have major implications on renal function. Understanding Ketamine-induced renal pathology may identify targets for future therapeutic intervention.

  14. Humerus shaft fractures - where are we today?

    Science.gov (United States)

    Strohm, P C; Reising, K; Hammer, T; Sudkamp, N P; Jaeger, M; Schmal, H

    2011-01-01

    Humeral shaft fractures account for about 1-3% of all fractures. These fractures are regarded as the domain of non-surgical management. This is certainly still the contemporary view but there is an obvious trend towards surgical stabilization. Surgical treatment of humeral shaft fractures has nonetheless been greatly facilitated by the development of new implants. In particular, a new generation of nails that general permit immediate mobilization have become available for improved management of longitudinal and multi-segmental fractures. Retrograde and antegrade nails have advantages and disadvantages and selection procedure is often based on the distal or proximal location of the fracture. Plates also offer an alternative for certain indications and have advantages at the proximal and distal shaft in particular. If there is primary lesion of the radial nerve, exploration is not very advisable, but in the absence of remission exploration can be conducted after several months with the same degree of success. Since the published literature offers no comparative studies with a high level of evidence, our statement can only be regarded as an up-to-date recommendation in the hope that future prospective randomized studies will address this issue.

  15. The Adequacy of Diagnosis and Treatment for Osteoporosis in Patients with Proximal Humeral Fractures

    OpenAIRE

    Kim, Tae In; Choi, Jun Ha; Kim, Sae Hoon; Oh, Joo Han

    2016-01-01

    Background The purpose of this study was to evaluate whether physicians' practice was adequate for the diagnosis and treatment of osteoporosis in patients with proximal humeral fracture over the age of 50 years, which is one of major osteoporotic fractures. Methods A retrospective nation-wide cohort study was performed using data collected in 2010 by the Korean Health Insurance Review Agency. The incidences of fractures around the hip, spine, and proximal humerus in patients more than 50 year...

  16. Solitary eosinophilic granuloma of humerus in a 2-month-old infant: A case report with 3 years follow-up

    Directory of Open Access Journals (Sweden)

    Prateek S Joshi

    2015-01-01

    Full Text Available Eosinophilic granulomais (EG a benign self-limiting disease which belongs to the spectrum of Langerhans cell histiocytosis. It is characterized by single or multiple skeletal lesions involving skull, mandible, ribs, spine and long bones predominately in children <12 years. We report a relatively rare case of left proximal humerus solitary EG in a month old infant who was brought to us with reduced movements of left upper limb and swelling of left shoulder. X-ray revealed osteolytic lesion in left upper humerus. No associated lesions were revealed by other imaging modalities. Open biopsy and curettage of lesion revealed proliferation of histiocytes with an infiltration of eosinophils. Immunohistochemistry was positive for S-100 and CD1a. Hence, diagnosis of solitary EG was made. Baby was followed up every 6 monthly for 3 years. There was no evidence of recurrence or detection of new lesion elsewhere at last follow-up.

  17. SURGICAL OUTCOME OF DIAPHYSEAL FRACTURES OF HUMERUS BY ANTEGRADE INTERLOCKING NAILING IN CLOSED REDUCTION

    Directory of Open Access Journals (Sweden)

    Koramutla Harsha

    2015-03-01

    Full Text Available BACKGROUND: Fractures involving the shaft of humerus are commonly encountered by orthopedic surgeons in day to day practice. Humeral shaft fracture can be treated using intramedullary fixation technique. Flexibl e intramedullary nails like Rush nail, Enders nail have been used utilizing ante grade and retrograde methods. This technique has largely replaced plating method very often. But, retrograde nailing can be regarded as a minimally invasive procedure and just ifiable to use for fixation of isolated humeral shaft fractures in certain situation. In this study we have evaluated the effectiveness of surgical and functional outcomes of closed ante grade interlocking nailing in the management of diaphyseal fractures of humerus. METHODS: A series of 30 patients with diaphyseal fractures of humerus were treated with ante grade interlocking nailing during October 2008 to October 2010. All the patients were followed up 6 weeks, 12 weeks and 24 weeks and results were analy sed. X rays were taken to assess radiological union of fracture during the follow up. Assessment of fracture union and shoulder and elbow movement was recorded. Final evaluation was done at the end of 6 months. Data was presented as mean ± SD, actual numbe rs and percentages. Wilcoxo n test and chi - square test were used appropriately. RESULTS: All 30 patients in our study were followed up for a minimum period of 6 months. 56.7%cases were male patients 43.3% were female patients. More than 50 % of cases in the series were between the ages of 18 - 35 years. 60% fractures were comminuted 6.6% were of oblique type, 33.3% were of transverse type. The average time interval from the time of admission to the time of surgery was 3 days. The most common mode of injury was road traffic accident. Commented fractures are predominant in our study. Clinical outcome was 60% of cases had excellent results and 30 % had moderate result. 3 patients (10% had poor result, due to limitation of shoulder

  18. Proximal focal humeral deficiency in a large breed dog.

    Science.gov (United States)

    Kalff, S; Gemmill, T

    2012-01-01

    A 26-week-old female Boerboel was referred for evaluation of progressive left thoracic limb lameness. Computed tomography and radiographic evaluation revealed radiolucency of the caudal region of the proximal humeral metaphysis, absence of the humeral head, and gross distortion of the glenoid. Given the severe glenohumeral deformation, arthrodesis of the left shoulder was performed using orthogonal locking bone plates, lag screw fixation, and bone grafting. Despite late implant failure, arthrodesis was successful in this case, and satisfactory limb function was restored. To the author's knowledge, this is the first report of a case of a focal developmental deficiency of the proximal humerus reported in a dog.

  19. Dedifferentiated chondrosarcoma of right proximal femur

    Directory of Open Access Journals (Sweden)

    Sachin A Badge

    2016-01-01

    Full Text Available Dedifferentiated chondrosarcoma (DDCS comprises approximately 10% of all chondrosarcomas. The tumor generally occurs after the age of 50 years, with equal distribution among males and females. It is most often located in the bones of the pelvis, the proximal femur or humerus, the distal femur, and the ribs. Regardless of treatment, the prognosis is ominous with 90% of patients dying with distant metastases within 2 years. We report a case of DDCS of right proximal femur in a 73-year-old woman. The most important factors affecting survival are early recognition of the radiographic features, adequate histological sampling, and wide-margin resection of the lesion. So for the correct histopathological diagnosis the biopsy sample should be adequate to visualize both cartilaginous and noncartilaginous sarcomatous component which helps to increase the survival of patients before the distant metastasis occurs.

  20. Minimally invasive plate osteosynthesis for proximal humeral fractures.

    Science.gov (United States)

    Koljonen, Paul Aarne; Fang, Christian; Lau, Tak Wing; Leung, Frankie; Cheung, Nigel W K

    2015-08-01

    To report the outcome after minimally invasive plate osteosynthesis (MIPO) through the deltoid-splitting approach for proximal humeral fractures. 10 men and 30 women aged 37 to 88 years underwent MIPO through the deltoid-splitting approach using the Proximal Humerus Internal Locking System or the Locking Proximal Humerus Plate for 2-part (n=18), 3-part (n=20), and 4-part (n=2) proximal humeral fractures. The rehabilitation protocol was standardised. All 40 patients were followed up at 3 months, 34 (85%) at 6 months, 30 (75%) at one year, and 13 (33%) at 2 years. Two patients had malunion. No patient had avascular necrosis, infection, nerve palsy, or nonunion. The mean Constant score at one year and 2 years was 75 and 87.5, respectively. The Constant score at 6 months correlated to that at one year (r=0.926, pfracture grade, or hand dominance. MIPO for fixation of proximal humeral fractures using a locking plate is safe and effective in enabling an early return of shoulder function.

  1. Controversies in the management of intra-articular fractures of distal humerus in adults

    Science.gov (United States)

    Babhulkar, Sudhir; Babhulkar, Sushrut

    2011-01-01

    Background: The surgical approach, type of olecranon osteotomy, method of stabilization of osteotomy, type of fracture stabilization, orthogonal vs parallel plate fixation, need for transposition of ulnar nerve, place for primary total elbow replacement, and type of rehabilitation schedule after surgical fracture treatment are the controversial issues in the treatment of complex intra-articular distal humerus fractures (C2 and C3) in adults. Severe comminution, bone loss, and osteoporosis at the site of distal articular fractures of humerus often lead to unsatisfactory results due to inadequate fixation. We hereby report the outcome of a series of intracondylar fractures of the humerus treated by open reduction and internal fixation and discuss the controversies in light of published literature. Materials and Methods: One hundred and eighty-four patients of intra-articular fractures of distal humerus (C2 and C3) were operated by posterior transolecranon approach between January 1980 and December 2008. Initially, in the first part Chevron intra-articular osteotomy (n=108) was performed out of which 94 have been published in another publication. In later second part (1993 onward), extra-articular olecranon osteotomy (n=76) was routinely performed. Both columns were stably fixed by orthogonal methods; (n=174) however, during the last 2 years, in 10 patients with severe comminution with bone loss, stabilization was achieved by parallel plating. The osteotomy was routinely stabilized by tension band wiring with two parallel K-wires introduced up to the anterior ulnar cortex. The results were evaluated by the staging system of Caja et al. at a minimum follow-up of 2 years. Results: In the first part of the study (n=94), there was delayed union in 4% (n=4), with the fracture taking more than 20 weeks for union. There was delayed union of ulnar osteotomy (n=3) and failure of one tension band wiring, requiring revision. Some loss of motion was seen in 20% of cases and these

  2. Synthesis and modeling of uniform complex metal oxides by close-proximity atmospheric pressure chemical vapor deposition.

    Science.gov (United States)

    Hoye, Robert L Z; Muñoz-Rojas, David; Musselman, Kevin P; Vaynzof, Yana; MacManus-Driscoll, Judith L

    2015-05-27

    A close-proximity atmospheric pressure chemical vapor deposition (AP-CVD) reactor is developed for synthesizing high quality multicomponent metal oxides for electronics. This combines the advantages of a mechanically controllable substrate-manifold spacing and vertical gas flows. As a result, our AP-CVD reactor can rapidly grow uniform crystalline films on a variety of substrate types at low temperatures without requiring plasma enhancements or low pressures. To demonstrate this, we take the zinc magnesium oxide (Zn(1-x)Mg(x)O) system as an example. By introducing the precursor gases vertically and uniformly to the substrate across the gas manifold, we show that films can be produced with only 3% variation in thickness over a 375 mm(2) deposition area. These thicknesses are significantly more uniform than for films from previous AP-CVD reactors. Our films are also compact, pinhole-free, and have a thickness that is linearly controllable by the number of oscillations of the substrate beneath the gas manifold. Using photoluminescence and X-ray diffraction measurements, we show that for Mg contents below 46 at. %, single phase Zn(1-x)Mg(x)O was produced. To further optimize the growth conditions, we developed a model relating the composition of a ternary oxide with the bubbling rates through the metal precursors. We fitted this model to the X-ray photoelectron spectroscopy measured compositions with an error of Δx = 0.0005. This model showed that the incorporation of Mg into ZnO can be maximized by using the maximum bubbling rate through the Mg precursor for each bubbling rate ratio. When applied to poly(3-hexylthiophene-2,5-diyl) hybrid solar cells, our films yielded an open-circuit voltage increase of over 100% by controlling the Mg content. Such films were deposited in short times (under 2 min over 4 cm(2)).

  3. Medieval and early modern approaches to fractures of the proximal humerus: an historical review

    DEFF Research Database (Denmark)

    Brorson, S.

    2010-01-01

    dissections 'naturalistic' observations are rarely found. In Renaissance sources, knowledge of the musculoskeletal system useful for the understanding of shoulder pathology appears. The anatomical drawings by Leonardo da Vinci (1452-1519) demonstrate knowledge of the biomechanical properties of the shoulder...

  4. Medieval and early modern approaches to fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, S.

    2010-01-01

    dissections 'naturalistic' observations are rarely found. In Renaissance sources, knowledge of the musculoskeletal system useful for the understanding of shoulder pathology appears. The anatomical drawings by Leonardo da Vinci (1452-1519) demonstrate knowledge of the biomechanical properties of the shoulder...

  5. Neurons in the preBötzinger complex and VRG are located in proximity to arterioles in newborn mice

    DEFF Research Database (Denmark)

    Falk, Sarah; Rekling, Jens C

    2008-01-01

    and localization of active respiratory neurons in the brainstem of newborn mice at the level of the preBötzinger complex (PBC) and ventral respiratory group. The brainstem is supplied with perforating arteries, which enter primarily in the midline and in a circumscribed region mid-laterally in the medulla...... of arterioles is found. We conclude that the striking co-localization of medullary arterioles and the PBC/VRG could imply that respiratory neurons may derive part of their glucose and oxygen consumption directly from arterioles, and that humoral factors affecting ventilation may reach respiratory neurons...... by precapillary transport mechanisms....

  6. Surgical treatment of extra-articular distal-third diaphyseal fractures of the humerus using a modified posterior approach and an extra-articular plate.

    Science.gov (United States)

    Páramo-Díaz, P; Arroyo-Hernández, M; Rodríguez Vega, V; Aroca-Peinado, M; León-Baltasar, J L; Caba-Doussoux, P

    To evaluate the clinical and radiological outcomes of these fractures treated through a modified posterior approach with a distal humerus plate. Between 2013 and 2015 we performed a retrospective study of these fractures surgically treated in our centre. older than 18 years old, no pathological fractures, follow up 1 year at least. 23 patients underwent surgery, mean age 45 years old, with an average follow-up of 18 months. Patient characteristics, aetiology and type of fractures were recorded. The surgery was performed using Gerwin modified posterior approach with a posterolateral distal humerus plate. Clinical results were evaluated using Quick DASH, MEPS, VAS. Radiological results were also evaluated. Complications associated with treatment and radial nerve palsy incidence were recorded as well. Type of fracture according AO/OTA: six 12-A, seven 12-B, ten 12-C. 23 patients progressed to union. After one year: QD 6.43, VAS 0.66, MEPS 88.88. No failure of internal fixation. Two superficial infections. 15 excellent results, 5 good, and 3 fair, with no poor results. Surgical fixation of these fractures through a modified posterior approach with a posterolateral plate minimises iatrogenic nerve injury, provides better visualisation of the proximal humerus, provides stable fixation of these injuries and results in high union rates and overall excellent functional results. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Perturbation of the Quinone-binding Site of Complex II Alters the Electronic Properties of the Proximal [3Fe-4S] Iron-Sulfur Cluster*

    Science.gov (United States)

    Ruprecht, Jonathan; Iwata, So; Rothery, Richard A.; Weiner, Joel H.; Maklashina, Elena; Cecchini, Gary

    2011-01-01

    Succinate-ubiquinone oxidoreductase (SQR) and menaquinol-fumarate oxidoreductase (QFR) from Escherichia coli are members of the complex II family of enzymes. SQR and QFR catalyze similar reactions with quinones; however, SQR preferentially reacts with higher potential ubiquinones, and QFR preferentially reacts with lower potential naphthoquinones. Both enzymes have a single functional quinone-binding site proximal to a [3Fe-4S] iron-sulfur cluster. A difference between SQR and QFR is that the redox potential of the [3Fe-4S] cluster in SQR is 140 mV higher than that found in QFR. This may reflect the character of the different quinones with which the two enzymes preferentially react. To investigate how the environment around the [3Fe-4S] cluster affects its redox properties and catalysis with quinones, a conserved amino acid proximal to the cluster was mutated in both enzymes. It was found that substitution of SdhB His-207 by threonine (as found in QFR) resulted in a 70-mV lowering of the redox potential of the cluster as measured by EPR. The converse substitution in QFR raised the redox potential of the cluster. X-ray structural analysis suggests that placing a charged residue near the [3Fe-4S] cluster is a primary reason for the alteration in redox potential with the hydrogen bonding environment having a lesser effect. Steady state enzyme kinetic characterization of the mutant enzymes shows that the redox properties of the [3Fe-4S] cluster have only a minor effect on catalysis. PMID:21310949

  8. Stress shielding of the humerus in press-fit anatomic shoulder arthroplasty: review and recommendations for evaluation.

    Science.gov (United States)

    Denard, Patrick J; Raiss, Patric; Gobezie, Reuben; Edwards, T Bradley; Lederman, Evan

    2018-02-05

    Uncemented press-fit humeral stems were developed with the goal of decreasing operative time, preserving bone stock, and easing revision. In recent years, short stems and stemless humeral implants have also become available. These press-fit humeral implants have varying designs that can lead to changes in stress distribution in the proximal humerus. Such stress shielding manifests as bony adaptations and may affect long-term functional outcome and the ability to perform revision. However, current studies of humeral fixation during total shoulder arthroplasty are complicated because a variety of classification systems have been used to report findings. The purpose of this report is to review the current literature on press-fit fixation of the humeral component during total shoulder arthroplasty and propose minimum requirements for radiographic descriptions of stress shielding. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  9. latrogenic fracture of humerus – complication of a diagnostic error in a shoulder dislocation: a case report

    Directory of Open Access Journals (Sweden)

    Ahmad Riaz

    2007-07-01

    Full Text Available Abstract Shoulder dislocation is the commonest dislocation presenting to the emergency department, anterior being more common than posterior. The latter being less common has a tendency of being missed; this is supported by many cases in the literature. Kocher's method is one of the many methods of reducing anterior dislocation; there are many reported complications of employing this method. To the best of our knowledge we are reporting the first case of an iatrogenic fracture of the proximal humerus, due to the use of Kocher's method of shoulder reduction in a posterior dislocation following a diagnostic error which led to an avoidable difficult surgical intervention. We also discuss the mechanism of the iatrogenic fracture and the measures that can be undertaken to prevent it.

  10. Tendon transfers in radial nerve palsy with fractures of the humerus ...

    African Journals Online (AJOL)

    Case 1: A 25 year old right handed male soldier who was referred to Kenyatta National Hospital (KNH) in February 2008, from Burundi, with non-union of the left humerus and wrist drop. He sustained a compound fracture of the humerus and wrist drop following a gunshot injury a year earlier. Open reduction, plating of the ...

  11. Les fractures de l'extremite proximale de l'humerus chez l'enfant au ...

    African Journals Online (AJOL)

    Mots clés : Fractures, humérus, enfants, Togo. Humerus upper end fractures in children at Tokoin Teaching Hospital of Lome. This retrospective study, carried on files of children treated between January 2005 and December 2009 from humerus upper end fractures (HUEF), aimed to specify the epidemiological, diagnostic ...

  12. The amount of impaction and loss of reduction in osteoporotic proximal humeral fractures after surgical fixation.

    Science.gov (United States)

    Carbone, S; Papalia, M

    2016-02-01

    After surgical fixation, osteoporotic proximal humeral fractures often show high impaction and loss of reduction. This study aims at assessing the amount of impaction and loss of reduction at a short and medium follow-up. We found an alarming percentage of cases showing these complications in the first postoperative months. This study seeks to quantify the amount of humeral head impaction and loss of reduction in a consecutive series of osteoporotic proximal humerus fractures treated with a locking plate. A series of displaced proximal humerus fractures were prospectively treated with minimally invasive reduction and ostheosynthesis using a locking plate. Diagnosis and classification of fractures were based on X-ray examination and CT scan. Proximal humerus cortical bone thickness (CBTAVG) was studied to assess osteoporosis. Amount of loss of reduction and head fragment impaction were noted at 3 and 18 months of follow-up. Constant score was calculated at 6 and 18 months of follow-up. Thirty-one osteoporotic fractures were studied. Most of the fractures (21, 67.7 %) had a CBTAVG of less than 4 mm. At 3 months of follow-up, 7 cases (22.5 %) had significant loss of reduction and the mean amount of impaction was 2.8 mm. At 18 months of follow-up, only 1 additional fracture showed loss of reduction and mean impaction was 3 mm (p proximal humerus fractures may present an important impaction and loss of reduction in the first 3 months after surgery even if treated with a rigid device and multiple head screws. Surgeons treating these osteoporotic fractures should be aware of these complications even when using a rigid device.

  13. Flowerpot sequestrum of the Humerus Neglect for 10 years!!

    Science.gov (United States)

    Sharma, Rakesh

    2012-01-01

    Neglected cases of osteomyelitis are not uncommon. We present a case of humerus osteomyelitis neglected for 10 years and presented with a sequestrum protruding out of the arm in the shape of a flowerpot. Such a long duration of neglect and a startling presentation are rare and have implications not only on healthcare but also reflect the socio-economic and cultural fabric of the society. 22 year old lady presented with history of bone jutting out of right arm since last 10 years. She had a trivial injury to the arm 10 years back followed by pain and fever. She was treated by local osteopath and 'registered' doctors but developed wound over the arm with purulent discharge. On and off treatment with dressing was continued with symptomatic relief but in few weeks bone fragment started protruding out of the wound. The size of bone protruding from the wound increased gradually with on and off history of discharge since 10 years. Clinically a flowerpot shaped sequestrum was seen protruding from the arm. Radiographs showed a defined diaphyseal sequestrum of the humerus with continuity of the bone maintained by new bone formation. Sequestrectomy was done and at one year follow up patient was fine with no recurrence of infection. Lack of health infrastructure, ignorance, and other social and cultural factors lead to such bad wounds. Even with such long history a single surgery for debridement and sequestrectomy was all that was needed for healing the patient.

  14. Study on Impact Loading and Humerus Injury for Baseball

    Science.gov (United States)

    Sakai, Shinobu; Oda, Juhachi; Yonemura, Shigeru; Sakamoto, Jiro

    In the United States and Japan, baseball is a very popular sport played by many people. However, the ball used is hard and moves fast. A professional baseball pitcher in good form can throw a ball at speeds upwards of 41.7m/s (150km/hr). If a ball at this speed hits the batter, serious injury can occur. In this paper we will describe our investigations on the impact of a baseball with living tissues by finite element analysis. Baseballs were projected at a load cell plate using a specialized pitching machine. The dynamic properties of the baseball were determined by comparing the wall-ball collision experimentally measuring the time history of the force and the displacement using dynamic finite element analysis software (ANSYS/ LS-DYNA). The finite element model representing a human humerus and its surrounding tissue was simulated for balls pitched at variable speeds and pitch types (knuckle and fastball). In so doing, the stress distribution and stress wave in the bone and soft tissue were obtained. From the results, the peak stress of the bone nearly yielded to the stress caused by a high fast ball. If the collision position or direction is moved from the center of the upper arm, it is assumed that the stress exuded on the humerus will be reduced. Some methods to reduce the severity of the injury which can be applied in actual baseball games are also discussed.

  15. Surgical treatment of supracondylar humerus fractures in children.

    Science.gov (United States)

    Reising, K; Schmal, H; Kohr, M; Kuminack, K; Südkamp, N P; Strohm, P C

    2011-01-01

    Surgical techniques for the treatment of supracondylar fractures in children are repeatedly the subject of discussion. The aim of the present study was to compare experience with the technique of crossed Kirschner wires at our own hospital with current literature. In the period from 2000-2006 a total of 86 children aged 1.7 to 12.7 years were treated by means of crossed K-wire osteosynthesis. Follow up was conducted at an average of 32 months. Outcomes were evaluated based on von Laer's criteria. Reported complications were migration of the K-wires in 7% of cases and secondary dislocation and re-operation in 4% of cases. Lesion of the radial nerve was diagnosed postoperatively in two cases. Hospital stay was 1.5 days on average. Postoperative immobilization in an upper arm splint and implant removal after 6 weeks on average. 57% of the children received physiotherapy during the course of treatment. Slight varization was found in 11% of children and an unsatisfactory range of motion in 13%. Satisfactory outcomes were recorded for 83% of patients. K-wire osteosynthesis is associated with a low complication rate and continues to be a safe standard procedure for the stabilization of supracondylar humerus fractures. Key words: supracondylar humerus fracture, Kirschner wires, paediatric fractures.

  16. The accuracy of gestational age predicted from femur and humerus length in Saanen goats using ultrasonography

    Directory of Open Access Journals (Sweden)

    Mohamed Abdelghafar Rihab

    2012-01-01

    Full Text Available Serial transabdominal ultrasonographic scanning was performed to measure femur and humerus length of foetuses of Saanen goats to establish their gestational stage. Data were obtained from 38 goats that became pregnant after artificial insemination. Animals were restrained in a supine position on a special table designed for this purpose. Humerus and femur length were measured at weekly intervals starting from week 8 of gestation till the end of gestation. Real-time ultrasound scanner equipped with switchable frequency (5-7.5 MHz micro convex probe was used in the present study. Humerus and femur length showed strong positive correlation with gestational age (r2 = 0.95. Measurements of humerus and femur of foetuses are useful indicators to predict gestational age at the 2nd and 3rd trimesters in Saanen goats. Measuring of only one bone length is quite enough. Incorporating of both measurements within a multiple regression equation did not improve predictive capacity of the bones. The results of the study were used to construct reference charts and gestational equations in Saanen goats utilizing humerus and femur measurements. In Sudan, this is the first study utilizing measurements of the femur and humerus and the first study comparing the length of the humerus and femur for predicting gestational age in Saanen goats.

  17. Treatment of proximal humeral fractures using anatomical locking plate: correlation of functional and radiographic results

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Tenor Junior

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To correlate the functional outcomes and radiographic indices of proximal humerus fractures treated using an anatomical locking plate for the proximal humerus. METHODS: Thirty-nine patients with fractures of the proximal humerus who had been treated using an anatomical locking plate were assessed after a mean follow-up of 27 months. These patients were assessed using the University of California Los Angeles (UCLA score and their range of motion was evaluated using the method of the American Academy of Orthopedic Surgeons on the operated shoulder and comparative radiographs on both shoulders. The correlation between radiographic measurements and functional outcomes was established. RESULTS: We found that 64% of the results were good or excellent, according to the UCLA score, with the following means: elevation of 124°; lateral rotation of 44°; and medial rotation of thumb to T9. The type of fracture according to Neer's classification and the patient's age had significant correlations with the range of motion, such that the greater the number of parts in the fracture and the greater the patient's age were, the worse the results also were. Elevation and UCLA score were found to present associations with the anatomical neck-shaft angle in anteroposterior view; fractures fixed with varus deviations greater than 15° showed the worst results (p < 0.001. CONCLUSION: The variation in the neck-shaft angle measurements in anteroposterior view showed a significant correlation with the range of motion; varus deviations greater than 15° were not well tolerated. This parameter may be one of the predictors of functional results from proximal humerus fractures treated using a locking plate.

  18. What is the Optimal Reconstruction Option after the Resection of Proximal Humeral Tumors? A Systematic Review.

    Science.gov (United States)

    Dubina, Andrew; Shiu, Brian; Gilotra, Mohit; Hasan, S Ashfaq; Lerman, Daniel; Ng, Vincent Y

    2017-01-01

    The proximal humerus is a common location for both primary and metastatic bone tumors. There are numerous reconstruction options after surgical resection. There is no consensus on the ideal method of reconstruction. A systematic review was performed with a focus on the surgical reconstructive options for lesions involving the proximal humerus. A total of 50 articles and 1227 patients were included for analysis. Reoperation rates were autograft arthrodesis (11%), megaprosthesis (10%), RSA (17%), hemiarthroplasty (26%), and osteoarticular allograft (34%). Mechanical failure rates, including prosthetic loosening, fracture, and dislocation, were highest in allograft-containing constructs (APC, osteoarticular allograft, arthrodesis) followed by arthroplasty (hemiarthroplasty, RSA, megaprosthesis) and lowest for autografts (vascularized fibula, autograft arthrodesis). Infections involving RSA (9%) were higher than hemiarthroplasty (0%) and megaprosthesis (4%). Postoperative function as measured by MSTS score were similar amongst all prosthetic options, ranging from 66% to 74%, and claviculo pro humeri (CPH) was slightly better (83%). Patients were generally limited to active abduction of approximately 45° and no greater than 90°. With resection of the rotator cuff, deltoid muscle or axillary nerve, function and stability were compromised even further. If the rotator cuff was sacrificed but the deltoid and axillary nerve preserved, active forward flexion and abduction were superior with RSA. Various reconstruction techniques for the proximal humerus lead to relatively similar functional results. Surgical choice should be tailored to anatomic defect and functional requirements.

  19. Multiple neural injuries in a pediatric supracondylar humerus fracture

    Directory of Open Access Journals (Sweden)

    Mehmet Erdil

    2012-09-01

    Full Text Available Neurological problems following paediatric elbow fracture is a clinically challenging problem. The main causes of neurological injury are traction injuries, impingement or direct trauma related with bony fragments and iatrogenic injuries. Anterior interosseous nerve is most commonly injured nerve in cases of extension fractures. At flexion type fractures ulnar nerve is the major traumatised nerve by iatrogenic manuplation. Multiple neural injuries related with these types of fractures are extremely rare. Neural injuries of paediatric cases have tendency to recover easily. In cases of persisting functional impairment surgical intervention may be needed. Herein a pediatric case with both medial and ulnar nerve injuries following elbow fracture was presented. J Clin Exp Invest 2012; 3 (3: 438-442Key words: Supracondylar humerus fracture, child elbow trauma, nevre injury, iatrogenic

  20. Proximal renal tubular acidosis

    Science.gov (United States)

    Renal tubular acidosis - proximal; Type II RTA; RTA - proximal; Renal tubular acidosis type II ... by alkaline substances, mainly bicarbonate. Proximal renal tubular acidosis (Type II RTA) occurs when bicarbonate is not ...

  1. Metachronous aneurysmal bone cysts with involvement of the humerus and the thoracic vertebrae

    Energy Technology Data Exchange (ETDEWEB)

    Donigan, Jonathan A.; McCarthy, Edward F. [Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (United States); Kebaish, Khaled M. [Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (United States); Johns Hopkins University School of Medicine, 601 N. Caroline Street, Suite 5-244, Baltimore, MD 21287 (United States)

    2003-08-01

    Metachronous aneurysmal bone cysts are rare. We report on a 32-year-old man who presented with an aneurysmal bone cyst of the thoracic spine 15 years subsequent to diagnosis of aneurysmal bone cyst of the humerus. (orig.)

  2. Epihyseal Separation of Lower end Humerus in A Neonate-Diagnostic and Management Difficulty

    OpenAIRE

    Patil, Mallanagouda N; Palled, Eranna

    2015-01-01

    Introduction: Birth injuries are common phenomenon. But commonly encountered birth injuries are clavicle fracture, humerus fractures and uncommonly femur fracture. Incidence of Distal humerus Epiphyseal injuries as birth injury are rare. As the first secondary centre around elbow-capitellum appears at 3-9 months, its radilological assessment of alignment with elbow or the radius shaft is not possible in neonates. It is difficult to differentiate elbow dislocation from epiphyseal injury in neo...

  3. The developmental spectrum of proximal radioulnar synostosis

    Energy Technology Data Exchange (ETDEWEB)

    Elliott, Alison M. [University of Manitoba, Winnipeg Regional Health Association Program of Genetics and Metabolism, Winnipeg, MB (Canada); University of Manitoba, Department of Paediatrics and Child Health, Winnipeg, MB (Canada); University of Manitoba, Department of Biochemistry and Medical Genetics, Winnipeg, MB (Canada); University of Manitoba, WRHA Program of Genetics and Metabolism, Departments of Paediatrics and Child Health, Biochemistry and Medical Genetics, Winnipeg, MB (Canada); Kibria, Lisa [University of Manitoba, Department of School of Medical Rehabilitation, Winnipeg, MB (Canada); Reed, Martin H. [University of Manitoba, Department of Paediatrics and Child Health, Winnipeg, MB (Canada); University of Manitoba, Department of Biochemistry and Medical Genetics, Winnipeg, MB (Canada); University of Manitoba, Department of Diagnostic Imaging, Winnipeg, MB (Canada)

    2010-01-15

    Proximal radioulnar synostosis is a rare upper limb malformation. The elbow is first identifiable at 35 days (after conception), at which stage the cartilaginous anlagen of the humerus, radius and ulna are continuous. Subsequently, longitudinal segmentation produces separation of the distal radius and ulna. However, temporarily, the proximal ends are united and continue to share a common perichondrium. We investigated the hypothesis that posterior congenital dislocation of the radial head and proximal radioulnar fusion are different clinical manifestations of the same primary developmental abnormality. Records were searched for ''proximal radioulnar fusion/posterior radial head dislocation'' in patients followed at the local Children's Hospital and Rehabilitation Centre for Children. Relevant radiographic, demographic and clinical data were recorded. Ethics approval was obtained through the University Research Ethics Board. In total, 28 patients met the inclusion criteria. The majority of patients (16) had bilateral involvement; eight with posterior dislocation of the radial head only; five had posterior radial head dislocation with radioulnar fusion and two had radioulnar fusion without dislocation. One patient had bilateral proximal radioulnar fusion and posterior dislocation of the left radial head. Nine patients had only left-sided involvement, and three had only right-sided involvement.The degree of proximal fusion varied, with some patients showing 'complete' proximal fusion and others showing fusion that occurred slightly distal to the radial head: 'partially separated.' Associated disorders in our cohort included Poland syndrome (two patients), Cornelia de Lange syndrome, chromosome anomalies (including tetrasomy X) and Cenani Lenz syndactyly. The suggestion of a developmental relationship between posterior dislocation of the radial head and proximal radioulnar fusion is supported by the fact that both anomalies

  4. ULNAR NEURITIS ASSOCIATED WITH GUN STOCK DEFORMITY FOLLOWING SUPRACONDYLAR FRACTURE OF HUMERUS

    Directory of Open Access Journals (Sweden)

    Sunita Morhan

    2014-04-01

    Full Text Available Background: This case report describes a patient who was referred to physiotherapist from a hand surgeon. Among the fractures around the elbow joint, radial head fracture and fracture of distal end of radius are common among adults. The occurrence of Supracondylar fractures are more commonly seen in children when compared to adults. One of the complications of this fracture is malunion resulting in Gun stock deformity. The main Purpose of this case report is to explore, 1. The complication associated with gunstock deformity 2. Chances of iatrogenic nerve injury after manipulation under anesthesia. 3.Long term supervised rehabilitation approach. Case Description: A 40 years old male patient referred to our Physiotherapy department by a hand surgeon. After the initial evaluation, findings revealed limitation in right elbow movement and tingling and numbness sensation in little and half of ring fingers in his right side. This patient underwent ulnar nerve transposition surgery followed by rehabilitation. His physiotherapy session includes electrotherapeutic agents for pain relief, passive mobilization of elbow and strengthening program for his flexors and extensors of elbow for a period of one year. Outcome: The outcome of the long term rehabilitation approach for a patient with ulnar neuropathy secondary to gunstock deformity after ulnar nerve transposition surgery is good. The patients tingling and numbness decreased and the range of elbow movement improved significantly. Discussion: Most common complications of fracture of distal end of humerus include malunion,ischemic contracture and nerve injuries. The relative incidence of iatrogenic nerve injuries associatedwith this fracture has been reported as being 2%-6%. Nerve injuries after Supracondylar humeral fractures occur primarily due to tenting or entrapment of the nerve on the sharp proximal humeral fragment, while iatrogenic injuries occur either during closed manipulation or percutaneous

  5. Hemiarthroplasty for the treatment of complex proximal humeral fractures: does a trabecular metal prosthesis make a difference? A prospective, comparative study with a minimum 3-year follow-up.

    Science.gov (United States)

    Li, Fenglong; Zhu, Yiming; Lu, Yi; Liu, Xin; Wu, Guan; Jiang, Chunyan

    2014-10-01

    Proper positioning and healing of the greater tuberosity are key for functional shoulder recovery after hemiarthroplasty for complex proximal humeral fractures. The purpose of this study was to compare the outcomes after hemiarthroplasty between a trabecular metal prosthesis and a conventional prosthesis in the treatment of complex proximal humeral fractures. A prospective, comparative study was performed. We compared a trabecular metal shoulder prosthesis for the treatment of complex proximal humeral fractures in a cohort of 35 consecutive patients (TM group) with a conventional prosthesis in a cohort of 38 consecutive patients (conventional group). All the patients, with a mean age of 63.9 years, were prospectively followed-up for a mean time of 4.6 years (range, 3-6 years) after surgery. At the last follow-up, radiographic complication rates related to the greater tuberosity were lower in the TM group (6.1%) than in the conventional group (25.7%) (P = .028). The mean functional shoulder scores, as well as mean active forward elevation and external rotation, were better in the TM group than in the conventional group. Radiographic complication rates related to the greater tuberosity were significantly lower in the TM group than in the conventional group. The functional shoulder scores and active forward elevation and external rotation were all better in the TM group than in the conventional group. These findings could imply better healing potential of the greater tuberosity after hemiarthroplasty with a trabecular metal prosthesis to treat complex proximal humeral fractures. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  6. Indications for computed tomography (CT-) diagnostics in proximal humeral fractures

    DEFF Research Database (Denmark)

    Bahrs, Christian; Rolauffs, Bernd; Südkamp, Norbert P

    2009-01-01

    diagnostics depending on the fractured parts. METHODS: In a prospective diagnostic study in two level 1 trauma centers, 44 patients with proximal humeral fractures were diagnosed with conventional X-rays (22 AP + axillary views, 22 AP + scapular Y-views) and CT (multi-planar reconstruction (MPR) and maximum...... a significantly better assessment of the relevant structures than conventional diagnostics (p X-rays with AP view and a high-quality axillary view are useful for primary diagnostics of the fracture......--independently of the number of fractured parts--when the proximal humerus and the shoulder joint are not presented with sufficient X-ray-quality to establish a treatment plan....

  7. Minimally invasive plate osteosynthesis for humerus diaphyseal fractures

    Directory of Open Access Journals (Sweden)

    M Shantharam Shetty

    2011-01-01

    Full Text Available Background: Minimally invasive plate osteosynthesis (MIPO technique is reported as a satisfactory procedure for the treatment of humeral shaft fractures by the anterior approach by several authors. However, none of the published reports had a significant follow-up nor have they reported patient outcomes. We evaluated the clinical, radiographic, and functional outcome over a minimum follow-up of 2 years using the same MIPO technique to humeral shaft fracture. Materials and Methods: 32 adult patients with diaphyseal fractures of the humerus treated with MIPO between June 2007 and October 2008 were included in the study. Patients with metabolic bone disease, polytrauma, and Gustilo and Anderson type 3 open fractures with injury severity score >16 were excluded from the study. All cases were treated with closed indirect reduction and locking plate fixation using the MIPO technique. The surgery time, radiation exposure, and time for union was noted. The shoulder and elbow function was assessed using the UCLA shoulder and Mayo elbow performance scores, respectively. Results: Of the 32 patients in the study, 19 were males and 13 were females. The mean age was 39 years (range: 22-70 years. Twenty-seven of the thirty-two patients (84.3% had the dominant side fractured. We had eight cases of C2 type; five cases of C1 and A2 type; four cases of B2 type; three cases each of B3, B1, and A1 type; and one case of A3 type of fracture. The mean surgical time was 91.5 minutes (range: 70-120 minutes and mean radiation exposure was 160.3 seconds (range: 100-220 seconds. The mean radiological fracture union time was 12.9 weeks (range: 10-20 weeks. Shoulder function was excellent in 27 cases (84.3% and good in remaining 5 cases (15.6% on the UCLA score. Elbow function was excellent in 26 cases (81.2%, good in 5 cases (15.6%, and fair in 1 case (3.1% who had an associated olecranon fracture that was fixed by tension band wire in the same sitting. Conclusion: MIPO of

  8. Is central skeleton bone quality a predictor of the severity of proximal humeral fractures?

    Science.gov (United States)

    Lee, Seung Yeol; Kwon, Soon-Sun; Kim, Tae Hoon; Shin, Sang-Jin

    2016-12-01

    The objectives of this study were to evaluate the correlation between bone attenuation around the shoulder joint assessed on conventional computed tomography (CT) and bone mineral density (BMD) based on dual-energy X-ray absorptiometry (DEXA) of the central skeleton and the correlation between the bone quality around the shoulder joint and the severity of the fracture pattern of the proximal humerus. A total of 200 patients with proximal humeral fracture who underwent preoperative 3-dimensional shoulder CT as well as DEXA within 3 months of the CT examination were included. Fracture types were divided into simple and comminuted fracture based on the Neer classification. After reliability testing, bone attenuation of the glenoid, three portions of the humeral head, and metaphysis was measured by placing a circular region of interest on the center of each bony region on CT images. Partial correlation analysis was used to assess the correlation between the bone quality around the shoulder joint on CT and the BMD on the central skeleton after adjusting for age and body mass index. Partial correlations between fracture classification and CT/DEXA results were also evaluated. Bone attenuation measurements of the glenoid and humeral head showed good to excellent reliability (intraclass correlation coefficient, 0.623-0.998). Bone attenuation of the central portion of the humeral head on CT showed a significant correlation with the BMD of L1, L4, the femoral neck, and femoral trochanter (correlation coefficient, 0.269-0.431). Bone attenuation of other areas showed a lower correlation with BMD by DEXA. As the level of the Neer classification increased from a 2 to 4-part fracture, bone attenuation of the central humeral head decreased significantly (r=-0.150, p=0.034). However, the BMD on DEXA was not a predictive factor for comminuted fracture of the proximal humerus. DEXA examination of the central skeleton may not reflect the bone quality of the proximal humerus and

  9. Combination tibial plateau leveling osteotomy and transverse corrective osteotomy of the proximal tibia for the treatment of complex tibial deformities in 12 dogs.

    Science.gov (United States)

    Weh, Jennifer L; Kowaleski, Michael P; Boudrieau, Randy J

    2011-08-01

    To describe a surgical technique, and outcome, for treatment of proximal tibial deformity (varus, valgus, excessive tibial plateau angle [eTPA], tibial torsion and patellar luxation) by combined tibial plateau leveling osteotomy (TPLO) and transverse corrective osteotomy. Cases series. Dogs (n=12; 19 stifle joints). Medical records of dogs that had combination TPLO and transverse corrective osteotomy, were reviewed. Pre- and postoperative tibial angulation, tibial torsion, tibial plateau angle (TPA), corrective osteotomy technique, method of fixation, and complications were recorded. In hospital re-evaluation of limb function and alignment and length of time to radiographic healing were reviewed. Long-term outcome was assessed by visual analog scale (VAS) questionnaire and owner telephone interview. Proximal tibial varus or valgus was present in 68.4%; 73.7% had eTPA; and 47.4% had both. Medial patellar luxation (MPL) was present in 57.9%, of which 47.4% had tibial tuberosity displacement. Severe tibial torsion was present in 68.4%. Mean pre- and postoperative TPA was 37.5° and 5.7°, respectively. The mean postoperative mechanical medial proximal tibial angle (mMPTA) and mechanical medial distal tibial angle (mMDTA) were 92.2° (range, 88-96°) and 96.1° (range, 94-101°), respectively. Postoperative surgical complications were documented in 21.0%, which included implant loosening or breakage (5.3%), seroma (5.3%), septic arthritis (5.3%), and infection of the proximal tibia (5.3%). All complications were considered major because they required additional surgery. Mean time to document radiographic healing was 10.4 weeks. In-hospital re-evaluation of lameness was obtained at the same time; 82.4% were not lame or had a mild lameness, 17.6% had severe lameness (2/3 with infection). The VAS evaluation revealed excellent results and owner satisfaction in all ten dogs in which long-term follow-up was obtained. Long-term clinical outcome of combination TPLO and

  10. Biomechanical Evaluation of the Effect of Intramedullary Fibular Graft in Proximal Humeral Fractures

    Directory of Open Access Journals (Sweden)

    Tugrul Bulut

    2017-01-01

    Full Text Available Aim: The aim of this study is to investigate the biomechanical effect of intramedullary fibular grafts in two-part proximal humeral fracture models. We also investigated two different positions of an intramedullary fibular graft in terms of fracture stability. Material and Method: A total of 21 two-part humeral neck fracture models were randomly separated into 3 groups. All fracture models were fixed with anatomic locking plates and 3.5mm locking screws. An intramedullary fibular graft was placed parallel to the long axis of the humerus in group I and at an approximately 135 degree angle, so as to support the calcar and medial column of the humeral neck, in group II. No fibular graft was used in the control group. All models were tested with a uniaxial electromechanic device at 20 degrees abduction that mimics the primary axial loads and shear forces with early active abduction. Values of loading and stiffness were measured. Results: No statistically significant difference was found for loading and stiffness values between groups. Discussion: These results were interpreted to mean that the presence or positioning of a fibular graft makes no additional contribution to the stability of two-part proximal humeral neck fractures with an anatomically reduced medial column fixed by a locking plate and screws. In conclusion, it is not necessary to utilize an intramedullary fibular graft in proximal humerus fractures when anatomic reduction is obtained. An unaccompanied locking plate and screws are adequate for these cases. Although using a fibular graft in proximal humerus fractures is a popular technique, it should be reserved for unstable osteoporotic fractures in which the medial column cannot be reduced.

  11. Treatment of supracondylar fracture of the humerus in children by skeletal traction in a brace.

    Science.gov (United States)

    Matsuzaki, K; Nakatani, N; Harada, M; Tamaki, T

    2004-03-01

    In 1980, we developed a specially designed brace for treating supracondylar fractures of the humerus in children, along with an easy and safe technique of reduction by skeletal traction. This method, which takes into consideration only the medial tilting and anterior angulation of the distal fragment, achieves complete reduction, ignoring any lateral, posterior and minor rotational displacements of the fragment. Skeletal traction is applied through a screw inserted into the olecranon and the angulation at the fracture site is reduced regardless of the anatomical position without manipulation. We treated 193 children with displaced supracondylar fractures of the humerus using this method between 1980 and 2001. Only four children (2%) developed cubitus varus. The majority obtained an excellent range of movement at the elbow; one had a 25 degree limitation of flexion. This technique is an effective and easy method of treating supracondylar fractures of the humerus in children.

  12. Reverse shoulder arthroplasty in 3 and 4 part proximal humeral fractures in patients aged more than 65 years: Results and complications.

    Science.gov (United States)

    Villodre-Jiménez, J; Estrems-Díaz, V; Diranzo-García, J; Bru-Pomer, A

    The treatment of 3and 4 part proximal humeral fractures in elderly patients is still controversial. The frequent co-existence of poor quality bone and rotator cuff abnormalities in patients with multiple clinical conditions and with difficulties for physical rehabilitation leads to disappointing clinical results, even when the radiological images are acceptable. To evaluate the clinical, radiological, and functional results in patients over 65 years old with complex proximal humerus fractures treated with reverse shoulder arthroplasty. A prospective review was carried out on 30 patients (26 women and 4 men) with proximal humeral fractures treated with reverse shoulder arthroplasty in our department. The mean age was 74.9 years (SD=6.3), and the mean follow-up was 34.5 months (SD=19.3). Clinical and functional results were acceptable, with a mean forward flexion of 124° and a mean external rotation of 13°. The mean abbreviated Constant abbreviated score was 49.1 (SD=14.1), 27 (SD=6.3) in the UCLA scale, and 32.2 (SD=19.2) in the QuickDASH questionnaire. The large majority (80%) of the patients are pain free, and they do not need medication to do daily activities. The complication rate was 13.3%. We consider that reverse shoulder arthroplasty is a valid option to treat 3and 4 part proximal humeral fractures in elderly patients. The surgical goals should include the anatomical reconstruction of the tuberosities, avoiding enlargement of the operated arm greater than 2cm. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Clinical outcomes of minimally invasive open reduction and internal fixation by screw and washer for displaced greater tuberosity fracture of the humerus.

    Science.gov (United States)

    Yoon, Tae-Hwan; Choi, Chong-Hyuk; Choi, Yun-Rak; Oh, Jong-Taek; Chun, Yong-Min

    2018-01-03

    The purpose of this study was to investigate clinical and radiologic outcomes of open reduction and internal fixation with a screw and washer for a displaced greater tuberosity fracture of the proximal humerus through a small incision. We retrospectively reviewed 29 patients who underwent open reduction and internal fixation with a screw and washer for a greater tuberosity fracture of the proximal humerus. After surgery, the patients were immobilized in a brace for 4 weeks. To determine clinical outcomes, we evaluated a visual analog scale pain score; the Subjective Shoulder Value; the University of California, Los Angeles shoulder score; the American Shoulder and Elbow Surgeons score; and active range of motion. All patients achieved bone union within 3 months after surgery. At the 2-year follow-up, the mean visual analog scale pain score was 1.1 ± 1.1; Subjective Shoulder Value, 93.4 ± 5.3; University of California, Los Angeles shoulder score, 31.2 ± 2.7; and American Shoulder and Elbow Surgeons score, 92.6 ± 6.7. Mean active forward flexion, external rotation, and internal rotation were 144° ± 16°, 33° ± 11°, and 13.3 ± 1.7, respectively. Postoperatively, 9 patients (31%) had stiffness and pain refractory to conservative treatment and underwent arthroscopic release. Although minimal open reduction and screw and washer fixation resulted in bone union in all cases, the incidence of postoperative stiffness was relatively high in patients with displaced greater tuberosity fractures because of prolonged immobilization after surgery. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. Multiset proximity spaces

    Directory of Open Access Journals (Sweden)

    A. Kandil

    2016-10-01

    Full Text Available A multiset is a collection of objects in which repetition of elements is essential. This paper is an attempt to explore the theoretical aspects of multiset by extending the notions of compact, proximity relation and proximal neighborhood to the multiset context. Examples of new multiset topologies, open multiset cover, compact multiset and many identities involving the concept of multiset have been introduced. Further, an integral examples of multiset proximity relations are obtained. A multiset topology induced by a multiset proximity relation on a multiset M has been presented. Also the concept of multiset δ- neighborhood in the multiset proximity space which furnishes an alternative approach to the study of multiset proximity spaces has been mentioned. Finally, some results on this new approach have been obtained and one of the most important results is: every T4- multiset space is semi-compatible with multiset proximity relation δ on M (Theorem 5.10.

  15. Correlation analysis of cortical geometry of tibia and humerus of white leghorns using clinical quantitative computed tomography and microcomputed tomography scans.

    Science.gov (United States)

    Regmi, P; Cox, A G; Robison, C I; Karcher, D M

    2017-08-01

    Peripheral quantitative computed tomography (QCT) has been used in poultry bone research in recent years to analyze cortical and cross-sectional geometry. For QCT to be used as a standard research tool for analysis of bones of laying hens (cortical thickness correlate the cortical parameters measured using clinical CT scans with the measurements from micro-CT, the current gold standard. A total of 15 tibiae and 14 humeri of Lohmann White hens was scanned using clinical CT and micro-CT. Reconstruction of the scans generated images with final voxel resolution of 195 μm for clinical CT scans and 46 μm for micro-CT scans. Cortical and total area were measured using MIMICS® software at proximal, middle, and distal locations of 20 mm sections of humerus diaphysis and 30 mm sections of tibia diaphysis. The total area for proximal and middle locations as well as proximal cortical area measurements for humeri produced strong correlation coefficients (R ≥ 0.70). Moderate strength correlation coefficients (R = 0.40 to 0.60) in humeri were seen in middle and distal cortical areas. Distal total area in humeri displayed a weak correlation coefficient (R ≤ 0.3; P = 0.25). Overall, tibiae demonstrated a weaker correlation. Proximal and middle cortical areas indicated moderate correlation coefficients (R = 0.40 to 0.60), while proximal and middle total areas accompanied by distal cortical and total area displayed weak correlation coefficients (R ≤ 0.3). Only the middle cortical area measurement for tibiae was significant (P = 0.03). These results indicate stronger correlation for humeri measurements among the scans than tibia. Overall, cross-sectional area measurements were only low to moderately correlated between clinical and micro-CT scans. © 2017 Poultry Science Association Inc.

  16. Les fractures supracondyliennes de l'humerus chez l'enfant au Chu ...

    African Journals Online (AJOL)

    Mots clés : Fracture supracondylienne, humérus, enfants, Togo. Supracondylar humeral fractures in children at Tokoin Teaching Hospital (Togo). This retrospective descriptive study included all children treated in the Department of pediatric surgery of Tokoin Teaching Hospital for supracondylar fracture of humerus (SCFH).

  17. Interventions for treating proximal humeral fractures in adults

    DEFF Research Database (Denmark)

    Handoll, Helen H G; Brorson, Stig

    2015-01-01

    that early mobilisation resulted in better recovery and less pain in people with mainly minimally displaced fractures. There was evidence of little difference between the two groups in shoulder complications (2/127 early mobilisation versus 3/132 delayed mobilisation; 4 trials) and fracture displacement...... supervised exercise in a swimming pool plus home exercise.Eight trials, involving 567 older participants, evaluated surgical intervention for displaced fractures. There was high quality evidence of no clinically important difference in patient-reported shoulder and upper-limb function at one- or two......BACKGROUND: Fracture of the proximal humerus, often termed shoulder fracture, is a common injury in older people. The management of these fractures varies widely. This is an update of a Cochrane Review first published in 2001 and last updated in 2012. OBJECTIVES: To assess the effects (benefits...

  18. [Resection of an aneurysmal bone cyst in the proximal humerus with a non-vascularized fibular graft. Case report].

    Science.gov (United States)

    Lima-Ramírez, P G; Chavarría-Jacinto, J; Martínez-Asención, P; Montiel-Jarquín, A J; Barragán-Hervella, R G; Salvatori-Rubí, J J; Domínguez-Cid, M I

    2015-01-01

    An aneurysmal bone cyst is a benign lesion involving the marrow of long bones; it accounts for 6% of primary bone lesions and may occur as a secondary lesion with other benign or malignant bone tumors. We describe herein the case of a seven year-old female with an aneurysmal bone cyst which was diagnosed clinically, radiographically and with a CAT scan, and confirmed with histopathology. Resection was performed using the eggshell technique and a non-vascularized left fibular bone graft. The patient did well up to the fourth postoperative year, which is consistent with what has been reported in world literature.

  19. Proximal Probes Facility

    Data.gov (United States)

    Federal Laboratory Consortium — The Proximal Probes Facility consists of laboratories for microscopy, spectroscopy, and probing of nanostructured materials and their functional properties. At the...

  20. Displaced proximal humeral fractures: an Indian experience with locking plates

    Directory of Open Access Journals (Sweden)

    Aggarwal Sameer

    2010-08-01

    Full Text Available Abstract Background The treatment of displaced proximal humerus fractures, especially in elderly, remains controversial. The objective of this study was to evaluate functional outcome of locking plate used for fixation of these fractures after open reduction. We also attempted to evaluate the complications and predictors of loss of fixation for such an implant. Methods Over two and a half years, 56 patients with an acute proximal humerus fracture were managed with locking plate osteosynthesis. 47 of these patients who completed a minimum follow up of 1 year were evaluated using Constant score calculation. Statistical analysis was done using SPSS 16 and a p value of less than 0.05 was taken as statistically significant. Results The average follow up period was around 21.5 months. Outcomes were excellent in 17%, good in 38.5%, moderate in 34% while poor in 10.5%. The Constant score was poorer for AO-OTA type 3 fractures as compared to other types. The scores were also inferior for older patients (> 65 years old. Complications included screw perforation of head, AVN, subacromial impingement, loss of fixation, axillary nerve palsy and infection. A varus malalignment was found to be a strong predictor of loss of fixation. Conclusion Locking plate osteosynthesis leads to satisfactory functional outcomes in all the patients. Results are better than non locking plates in osteoporotic fractures of the elderly. However the surgery has steep learning curve and various complications could be associated with its use. Nevertheless we believe that a strict adherence to the principles of locking plate use can ensure good result in such challenging fractures.

  1. Ilizarov′s method for treatment of nonunion of diaphyseal fractures of the humerus

    Directory of Open Access Journals (Sweden)

    Kiran Manish

    2010-01-01

    Full Text Available Background: Nonunion in diaphyseal fractures of the humerus can be treated by various modalities like plating and bone grafting, exchange nailing, fibular strut grafting and Ilizarov′s method of ring fixation. To achieve union in infected nonunion in which multiple surgeries have already been done is further challenging. We conducted a prospective study wherein the outcome of the treatment of nonunion of diaphyseal fractures of the humerus by Ilizarov′s method was analyzed. Materials and Methods: Nineteen patients with diaphyseal nonunion of the humerus were treated by Ilizarov′s external fixator. These included nonunion after plating (n=11, intramedullary nailing (n=1 or conservative methods (n=7. In post-surgical infected nonunion (n=6, the implants were removed, debridement done, bone fragments were docked followed by application of ring fixator and compression. In aseptic nonunion (n=13, distraction for three weeks followed by compression was the protocol. Early shoulder and elbow physiotherapy was instituted. The apparatus was removed after clinical and radiological union and the results were assessed for bone healing and functional status. Results: Fracture union was achieved in all the 19 cases. Pin site infection was seen in 2 cases (10.52%. The bone healing results were excellent in eighteen cases (94.73% and good in one case (5.26%.The functional results were found to be excellent in fourteen cases (73.68%, good in four (21.05% and fair in one case (5.26%. Conclusion: Ilizarov′s method is an excellent option for treatment of septic and aseptic non union of diaphyseal fractures of the humerus as it addresses all the problems associated with non union of the humerus like infection, deformity and joint stiffness.

  2. Use of Titanium Elastic Nails in the Adult Diaphyseal Humerus Fractures.

    Science.gov (United States)

    Upadhyay, A S; Lil, N A

    2017-07-01

    Introduction: Humerus shaft fractures in adults can be managed conservatively with functional braces or operatively with plate osteosynthesis or with intramedullary nailing. Conventionally humerus intramedullary nailing is done either using humerus interlocking nails or Enders nails. In this study we analyse the outcome of humerus shaft fractures (upper and middle third) managed with closed ante-grade intramedullary titanium elastic nailing in terms of union rates, union time, functional results and complications. Materials and Methods: A retrospective analysis of 25 patients treated with ante-grade intramedullary titanium elastic nailing was done during the period of August 2014 to June 2016 at our tertiary care centre. Skeletally mature patients with closed and acute fractures of the upper and middle shaft humerus of both sexes were included in the study. Results: Twenty-five (100%) fractures united with an average consolidation time of 14.98 weeks (10-32 weeks), and no fractures ended in non-union. Nail impingement was seen in two (8%), shoulder stiffness in one (4%). Functional results were excellent in 22 (88%), moderate in two (8%) and poor in one (4%). There were 17 males and eight females with an average age of 39.08 years (range: 18-65 years). The average duration of hospital stay was 3.84±2.30 days. Conclusion: Closed ante-grade intramedullary titanium elastic nailing offers a safe and reliable method of fixing fractures of upper humeral shaft in adults. This method provides early fracture union, high union rates and less complications, in addition to early rehabilitation and reduces the hospital stay.

  3. Use of Titanium Elastic Nails in the Adult Diaphyseal Humerus Fractures

    Directory of Open Access Journals (Sweden)

    Upadhyay AS

    2017-07-01

    Full Text Available INTRODUCTION: Humerus shaft fractures in adults can be managed conservatively with functional braces or operatively with plate osteosynthesis or with intramedullary nailing. Conventionally humerus intramedullary nailing is done either using humerus interlocking nails or Enders nails. In this study we analyse the outcome of humerus shaft fractures (upper and middle third managed with closed ante- grade intramedullary titanium elastic nailing in terms of union rates, union time, functional results and complications. MATERIALS AND METHODS: A retrospective analysis of 25 patients treated with ante-grade intramedullary titanium elastic nailing was done during the period of August 2014 to June 2016 at our tertiary care centre. Skeletally mature patients with closed and acute fractures of the upper and middle shaft humerus of both sexes were included in the study. RESULTS: Twenty-five (100% fractures united with an average consolidation time of 14.98 weeks (10-32 weeks, and no fractures ended in non-union. Nail impingement was seen in two (8%, shoulder stiffness in one (4%. Functional results were excellent in 22 (88%, moderate in two (8% and poor in one (4%. There were 17 males and eight females with an average age of 39.08 years (range: 18-65 years. The average duration of hospital stay was 3.84±2.30 days. CONCLUSION: Closed ante-grade intramedullary titanium elastic nailing offers a safe and reliable method of fixing fractures of upper humeral shaft in adults. This method provides early fracture union, high union rates and less complications, in addition to early rehabilitation and reduces the hospital stay.

  4. Assessing Quality and Safety in Pediatric Supracondylar Humerus Fracture Care.

    Science.gov (United States)

    Iobst, Christopher A; Stillwagon, Matthew; Ryan, Deidre; Shirley, Eric; Frick, Steven L

    Recently, there has been an emphasis on improving quality, safety, and value in the delivery of health care in the United States. The American Board of Orthopedic Surgery (ABOS) has developed a performance improvement questionnaire (PIQ) for orthopaedic surgeons managing pediatric supracondylar humerus fracture (PSCHF). Using the supracondylar PIQ as a guide, this study evaluates the process of measuring the outcomes and variations in care to PSCHF patients among pediatric orthopaedic surgeons. An 88-question survey incorporating the ABOS PIQ was administered to 35 pediatric orthopaedic surgeons at 3 institutions. A retrospective chart review of patients who received operative management of a PSCHF during 2013 was performed. Each of the 17 eligible surgeons supplied 5 patients for a total of 85 patients. Medical records and radiographic imaging were reviewed using the ABOS PIQ data collection sheet. This data collection sheet encompasses the preoperative assessment, intraoperative treatment and assessment, and clinical and radiographic outcomes of patients with PSCHF. A total of 35 surgeons from 6 hospitals completed the online PSCHF survey. Uniform consensus among all 35 surgeons was identified in 21/79 of the questions (27%). Consensus among surgeons within a hospital group but not with surgeons from the other groups was identified in 39/79 (49%) of the questions. No consensus among the surveyed surgeons could be identified in 19/79 (24%) of the questions. For the 85 PSCHF patients the average age was 6 years, and 37% of fractures were type II, 57% of fractures were type III, and there was 1 flexion type. Ninety percent of the patients received a preoperative dose of antibiotics and the postoperative immobilization placed in the operating room was changed in the clinic before pin removal in 58% of the cases. Pins were removed at 3 weeks in 60%, 4 weeks in 30%, 5 weeks in 7%, and after 5 weeks in 3% of the patients and no malunions occurred. Pin tract infection

  5. Conservative treatment, plate fixation, or prosthesis for proximal humeral fracture. A prospective randomized study

    Directory of Open Access Journals (Sweden)

    Launonen Antti P

    2012-09-01

    Full Text Available Abstract Background Proximal humerus fracture is the third most common fracture type after hip and distal radius fracture in elderly patients. A comprehensive study by Palvanen et al. demonstrated an increase in the annual fracture rate of 13.7% per year over the past 33 years. Should this trend continue, the fracture rate would triple over the next three decades. The increasing incidence of low-energy fractures raises questions about the optimal treatment in terms of functional outcome, pain, and rehabilitation time, as well as the economical impact. Despite the high incidence and costs of proximal humerus fractures, there is currently no valid scientific evidence for the best treatment method. Several publications, including a Cochrane review outline the need for high-quality, well-designed randomized controlled trials. Methods/Design The study is a prospective, randomized, national multi-center trial. The hypothesis of the trial is that surgical treatment of displaced proximal humerus fractures achieves better functional outcome, pain relief, and patient satisfaction compared to conservative treatment. The trial is designed to compare conservative and surgical treatment of proximal humerus fractures in patients 60 years and older. The trial includes two strata. Stratum I compares surgical treatment with locking plates to conservative treatment for two-part fractures. Stratum II compares multi-fragmented fractures, including three- and four-part fractures. The aim of Stratum II is to compare conservative treatment, surgical treatment with the Philos locking plate, and hemiarthroplasty with an Epoca prosthesis. The primary outcome measure will be the Disabilities of the Arm, Shoulder and Hand (DASH score and the secondary outcome measures will be the EuroQol-5D (EQ-5D value, OSS, Constant-Murley Score, VAS, and 15D. Recruiting time will be 3 years. The results will be analyzed after the 2-year follow-up period. Discussion This publication

  6. Immediate intensive mobilization compared with immediate conventional mobilization for the impacted osteoporotic conservatively treated proximal humeral fracture: a randomized controlled trial.

    Science.gov (United States)

    Carbone, S; Razzano, C; Albino, P; Mezzoprete, R

    2017-12-01

    To select in a 2-year survey of proximal humerus fractures accessing the emergency department, a population of osteoporotic stable impacted fractures and to randomize them into two groups, one with an immediate intensive mobilization program and the other with an immediate conventional mobilization program. In emergency department, patients with clinical signs of shoulder girdle fracture were submitted to standard X-ray examination and CT scan. Patients with stable (absence of metaphyseal comminution or fifth fragment) osteoporotic (cortical bone thickness lower than 6 mm) impacted (Is any part of metaphysis or head impacted into the shaft? YES/NO) proximal humerus fractures were selected for randomization in one of the two groups. Group 1: early intensive mobilization; Group 2: early conventional mobilization. Functional and radiographic assessment was recorded at 3, 6 and 12 months of follow-up. In the considered period, 120 patients were affected by a stable impacted osteoporotic proximal humerus fracture. At the final follow-up, 36 patients in group 1 and 39 patients in group 2 were available for statistical analysis. Functional and radiographic scores were comparable, with a trend of significance in favor of group 2. No fracture in any of the group showed significant loss of reduction respect to 6 months of follow-up. 4 (10%) and 1 (2.5%) patients in groups 1 and 2 were not compliant with the rehabilitation program (p = 0.037). This randomized controlled trial showed that impacted osteoporotic proximal humerus fractures can be managed non-operatively with an early conventional rehabilitation program composed by 10 sessions of passive motion twice a week, followed by recovery of active range of motion for further 10 sessions thrice a week, while no advantage is given by a more aggressive rehabilitation regimen. Self-assisted exercises should be explained to patients to maximize the effects of the assisted program. Level 1, randomized controlled double

  7. The antiquity of riverine adaptations in Iniidae (Cetacea, Odontoceti) documented by a humerus from the late Miocene of the Ituzaingó Formation, Argentina.

    Science.gov (United States)

    Gutstein, Carolina Simon; Cozzuol, Mario Alberto; Pyenson, Nicholas D

    2014-06-01

    "River dolphins" are a paraphyletic group of toothed whales (Odontoceti) that represent independent secondary invasions of freshwater habitats. Different "river dolphin" lineages display suites of convergent morphological specializations that commonly reflect adaptations to riverine and freshwater environments, such as longirostry, reduced orbits, and wide, paddle-like flippers. One lineage, the Iniidae, is presently endemic to South America, and includes several extinct Neogene taxa along with their sole extant genus, Inia (the Amazon River dolphin). We report here a humerus recovered from the late Miocene deposits of the Ituzaingó Formation in the Paraná Basin of Argentina. The specimen exhibits diagnostic features of the family Iniidae, including a scapular-sternal joint of the humerus, which is a unique anatomical connection among mammals. This joint permits enhanced parasagittal adduction of the flipper as a control surface, relative to other odontocetes, providing Inia with a high degree of maneuverability in its structurally complex and heterogenous riverine habitat. This unique anatomical connection, here documented from the late Miocene (∼9 million years-6.5 million years old), not only provides the oldest diagnostic record for Iniidae, but it also indicates a similar habitat use for this lineage, a finding coincident with the current paleoenvironmental interpretation for the Ituzaingó Formation. Copyright © 2014 Wiley Periodicals, Inc.

  8. Three-dimensional assessment of curvature, torsion, and canal flare index of the humerus of skeletally mature nonchondrodystrophic dogs.

    Science.gov (United States)

    Smith, Emily J; Marcellin-Little, Denis J; Harrysson, Ola L A; Griffith, Emily H

    2017-10-01

    OBJECTIVE To assess 3-D geometry of the humerus of dogs and determine whether the craniocaudal canal flare index (CFI) is associated with specific geometric features. SAMPLE CT images (n = 40) and radiographs (38) for 2 groups of skeletally mature nonchondrodystrophic dogs. PROCEDURES General dimensions (length, CFI, cortical thickness, and humeral head offset), curvature (shaft, humeral head, and glenoid cavity), version (humeral head and greater tubercle), and torsion were evaluated on CT images. Dogs were allocated into 3 groups on the basis of the craniocaudal CFI, and results were compared among these 3 groups. The CT measurements were compared with radiographic measurements obtained for another group of dogs. RESULTS Mean ± SD humeral head version was -75.9 ± 9.6° (range, -100.7° to -59.4°). Mean mechanical lateral distal humeral angle, mechanical caudal proximal humeral angle, and mechanical cranial distal humeral angle were 89.5 ± 3.5°, 50.2 ± 4.5°, and 72.9 ± 7.8°, respectively, and did not differ from corresponding radiographic measurements. Mean humeral curvature was 20.4 ± 4.4° (range, 9.6° to 30.5°). Mean craniocaudal CFI was 1.74 ± 0.18 (range, 1.37 to 2.10). Dogs with a high craniocaudal CFI had thicker cranial and medial cortices than dogs with a low craniocaudal CFI. Increased body weight was associated with a lower craniocaudal CFI. Radiographic and CT measurements of craniocaudal CFI and curvature differed significantly. CONCLUSIONS AND CLINICAL RELEVANCE CT-based 3-D reconstructions allowed the assessment of shaft angulation, torsion, and CFI. Radiographic and CT measurements of shaft curvature and CFI may differ.

  9. Extraarticular bony ankylosis in a child with supracondylar fracture of humerus

    Directory of Open Access Journals (Sweden)

    Naranje Sameer

    2012-11-01

    Full Text Available 【Abstract】 Myositis ossificans is defined as forma-tion of bone at the site of injured muscle. It is one of the rare complications of supracondylar fracture of humerus in children. Myositis mass usually develops on the anterior aspect in the brachialis muscle and produces restriction of range of motion, but complete ankylosis is rare. To the best of our knowledge, this is the first case to be reported in the literature as a consequence of myositis ossificans traumatica. In this case, a six-year-old child presented to the casualty department with pain in the right elbow after a fall on out-stretched hand during play. After surgical excision through the anterior approach, the child had no symptoms referable to the elbow and a residual flexion deformity of 15 degrees with further painless flexion up to 100 degrees at last follow-up of one year after surgery. Key words: Humerus; Fractures, Bone; Myositis; Ankylosis

  10. Granulocytic sarcoma of humerus, an unusual association of acute myeloblastic leukemia--a case report.

    Science.gov (United States)

    Khunger, J M; Sharma, M P; Talib, V H

    2000-10-01

    Ganulocytic sarcoma (Chloroma) is a tumour of rare variety usually in assocoiation with granulocytic leukemia. It is related to soft tissue with extramedullay infiltration. We present a case of granulocytic sarcoma of humerus which preceded the initial clinical manifestation of acute myeloid leukemia in a young patient which ultimately proved to be FABM2 variety. Though many tissues are affected by this tumour but the most favoured site is the bone.

  11. Type III Supracondylar Humerus Fractures in Children: Open Reduction and Pinning

    Directory of Open Access Journals (Sweden)

    Firat Ozan

    2016-04-01

    Full Text Available Aim: Supracondylar humerus fractures are the most common type of fractures involving the elbow region in children. Open reduction is a successful method for the management of displaced supracondylar fractures, with the most important advantages being complete anatomical reduction by visualising the fracture line and the lower level of risk for iatrogenic neurovascular injuries. In the present study, we assessed outcomes of open reduction and cross-pinning employed in the surgical management of paediatric Gartland type III supracondylar humerus fractures. Material and Method: The study included 18 children with Gartland extension type III supracondylar humerus fractures (13 boys, 5 girls; mean age: 7.3 ± 2.02 years; range, 3%u201312. There were fractures in the right elbows of 11 patients (61.1% and in the left elbows of seven (38.8%. The mean operative time was 53.3 ± 8.5 minutes (range, 45%u201370. The mean length of hospital stay was 1.7 ± 0.75 days (range, 1%u20133, while the mean follow-up time was 2.2 ± 0.6 years (range, 1.5%u20134. Results: According to the Flynn criteria, excellent results were obtained in six patients (33.3%, and good results in 12 (61.7% regarding changes in the carrying angle of the elbow. Functional assessment results were excellent for 14 patients (77.7% and good for four (22.3% regarding their loss of joint movement. Radiographic examinations revealed an average Baumann%u2019s angle of 75.6° (range, 70%u201385. Discussion: Good clinical outcomes can be achieved through the management of Gartland extension type III supracondylar humerus fractures using the open reduction technique. The most important disadvantage, however, is the post-surgical appearance of the elbow incision scar.

  12. OUTCOME OF GARTLAND TYPE – II SUPRACONDYLAR FRACTURES OF HUMERUS TREATED BY CONSERVATIVE METHOD

    Directory of Open Access Journals (Sweden)

    Dinesh Mitra

    2015-08-01

    Full Text Available BACKGROUND: The current literatures recommend operative method (closed reduction and pinning for type II supracondylar fractures of humerus. But some surgeons still prefer conservative method for type II supracondylar fractures of humerus. We pr esent results of 14 cases of type II supracondylar fractures treated with CR and AE POP immobilization . The purpose of this study is to evaluate the outcome of conservative treatment in management of type II supracondylar fracture of humerus. MATERIALS AND METHODS: Fourteen children treated by conservative methods (CR & AE POP between January 2013 and December 2014 is included in this study. The mean age group is 6.8 years (3 years - 11 years. The patient follow up is done for a minimum of 10 - 12 weeks. Treatment outcome is based on final clinical and radiological assessments and grading of results was done using Flynn’s criteria. RESULTS: Gartland type II fracture gives 82% excellent results and 28 % good results as per Flynn’s criteria. Of the 14 patien ts only two cases required re manipulation. Surgical intervention was not needed for any of the patients. No patients in this study developed compartment syndrome / cubitus varus deformity. CONCLUSION: Satisfactory results can be obtained with conservative treatment (closed reduction and above elbow POP if proper selection of the patient and careful clinical and radiological follow up is done

  13. The Influence of Psychiatric Comorbidity on Inpatient Outcomes following Distal Humerus Fractures

    Directory of Open Access Journals (Sweden)

    Leonard T. Buller

    2016-01-01

    Full Text Available Background. The influence of psychiatric comorbidity on outcomes following inpatient management of upper extremity fractures is poorly understood. Methods. The National Hospital Discharge Survey was queried to identify patients admitted to US hospitals with distal humerus fractures between 1990 and 2007. Patients were subdivided into 5 groups: depression, anxiety, schizophrenia, dementia, and no psychiatric comorbidity. Multivariable logistic regression analysis identified independent risk factors for adverse events, requirement of blood transfusion, and discharge to another inpatient facility. Results. A cohort representative of 526,185 patients was identified as having a distal humerus fracture. Depression, anxiety, and dementia were independently associated with higher odds of in-hospital adverse events (P<0.001. Depression was associated with higher odds of inpatient blood transfusion (P<0.001. Depression, schizophrenia, and dementia were associated with higher odds of nonroutine discharge to another inpatient facility (P<0.001. Patients with a diagnosis of schizophrenia had a mean of 12 (P<0.001 more days of care than patients with no psychiatric comorbidity. Discussion. Patients with comorbid psychiatric illness who are admitted to hospitals with distal humerus fractures are at increased risk of inpatient adverse events and posthospitalization care.

  14. Comparison between the spatial subchondral support plate and the proximal humeral locking plate in the treatment of unstable proximal humeral fractures.

    Science.gov (United States)

    Zhang, Fan; Zhu, Lei; Yang, Di; Yang, Peng; Ma, Jun; Fu, Qiang; Chen, Aimin

    2015-06-01

    The aim of our study was to evaluate the effect of the S3 (spatial subchondral support) humeral plate and to compare the clinical outcomes and complications after ORIF (open reduction and internal fixation) of proximal humeral fractures using either a S3 plate or a PHLP (proximal humeral locking plate). A total of 144 patients with displaced unstable proximal humeral fractures were treated with either a S3 plate or a PHLP. Each patient had a follow-up at least for one year. We retrospectively collected the data and compared the shoulder functional outcome as well as complications of these two methods. During the one-year follow-up, the average Constant scores gradually improved for both groups. Patients treated with use of an S3 plate had better functional results at three and six months (P fracture types (Neer classified) were not significantly different between the S3 and PHLP group (P > 0.05). The complication rate was comparable between the two groups (P > 0.05). The treatment using an S3 plate for displaced unstable proximal humeral fractures resulted in a good union rate and functional outcome, which is comparable to the PHLP treatment. The S3 humerus plate can be considered as an effective implant for ORIF of displaced unstable proximal humeral fractures.

  15. Ammonia transport in the proximal tubule.

    Science.gov (United States)

    Hamm, L L; Simon, E E

    1990-01-01

    The transport of ammonia in the proximal tubule is a complex interaction of a number of processes. Ammonia transport in the proximal tubule is clearly bidirectional; ammonia is secreted into the early proximal tubule lumen, but later in the proximal tubule, efflux out of the lumen may result in net ammonia reabsorption. Two mechanisms of ammonia transport have clearly been established: NH3 diffusion and NH4+ transport on the Na(+)-H+ exchanger. The relative contribution of these pathways to ammonia transport is still unsettled. Other pathways for ammonia transport, particularly NH4+ efflux out of the lumen, may be important as well. A variety of factors may modulate ammonia transport: plasma, cell and luminal pH, luminal flow rate, luminal potassium, and angiotensin II. Each of these factors also alters ammonia production rates and in most circumstances, ammonia transport appears to follow ammonia production rates.

  16. Capacitive proximity sensor

    Science.gov (United States)

    Kronberg, James W.

    1994-01-01

    A proximity sensor based on a closed field circuit. The circuit comprises a ring oscillator using a symmetrical array of plates that creates an oscillating displacement current. The displacement current varies as a function of the proximity of objects to the plate array. Preferably the plates are in the form of a group of three pair of symmetric plates having a common center, arranged in a hexagonal pattern with opposing plates linked as a pair. The sensor produces logic level pulses suitable for interfacing with a computer or process controller. The proximity sensor can be incorporated into a load cell, a differential pressure gauge, or a device for measuring the consistency of a characteristic of a material where a variation in the consistency causes the dielectric constant of the material to change.

  17. Neighborhoods and manageable proximity

    Directory of Open Access Journals (Sweden)

    Stavros Stavrides

    2011-08-01

    Full Text Available The theatricality of urban encounters is above all a theatricality of distances which allow for the encounter. The absolute “strangeness” of the crowd (Simmel 1997: 74 expressed, in its purest form, in the absolute proximity of a crowded subway train, does not generally allow for any movements of approach, but only for nervous hostile reactions and submissive hypnotic gestures. Neither forced intersections in the course of pedestrians or vehicles, nor the instantaneous crossing of distances by the technology of live broadcasting and remote control give birth to places of encounter. In the forced proximity of the metropolitan crowd which haunted the city of the 19th and 20th century, as well as in the forced proximity of the tele-presence which haunts the dystopic prospect of the future “omnipolis” (Virilio 1997: 74, the necessary distance, which is the stage of an encounter between different instances of otherness, is dissipated.

  18. Atrofia muscular proximal familiar

    Directory of Open Access Journals (Sweden)

    José Antonio Levy

    1962-09-01

    Full Text Available Os autores relatam dois casos de atrofia muscular proximal familiar, moléstia caracterizada por déficit motor e atrofias musculares de distribuição proximal, secundárias a lesão de neurônios periféricos. Assim, como em outros casos descritos na literatura, foi feito inicialmente o diagnóstico de distrofia muscular progressiva. O diagnóstico correto foi conseguido com auxílio da eletromiografia e da biopsia muscular.

  19. Functional Outcome Of Proximal Humeral Fractures Treated With Philos Plate In Adults.

    Science.gov (United States)

    Aliuddin, Akram Muhammad; Idrees, Zaki; Rahim Najjad, Muhammad Kazim; Ali Shah, Syed Amir

    2016-01-01

    Proximal humeral fractures account for 4-5% of all fractures. Most fractures are minimally displaced and can be managed non-operatively in adults. Displaced and unstable fractures are difficult to manage and should be treated to achieve painless shoulder and full function. Our aim was to evaluate the functional outcome of proximal humerus fractures (Neers classification 2 part, 3 part and 4 part) treated with PHILOS (Proximal humeral internal locking system). We retrospectively reviewed 22 patients who had proximal humerus fractures treated with PHILOS plate from Jan 2012 to June 2013 conducted at Orthopaedic Department Liaquat National Hospital. Clinical outcome was measured using DASH (disability of arm, shoulder and hand) Score System. Radiological union was assessed by serial X rays. Two patients were lost to follow up. Mean age was 40 years (20-70). Mean follow up was 6 months. 4 patients had two-part fracture, 10 patients had three-part and 6 patients had four-part fracture. Radiological union was achieved in average 8.31 weeks (±1.37SD). Average DASH score in young patients was 15.14 (±1.91SD) and in elderly was 31.66 (±4.08SD). One case of implant failure was noted. Better results in younger patients were achieved as compared to elderly proved by DASH score. Increase in number of fracture parts and delay in treatment did not affect the outcome. Our study concluded that this implant provides stable fixation in younger patients with good quality bone sufficient to allow mobilization.

  20. Normal ranges for fetal femur and humerus diaphysis length during the second trimester in an Iranian population.

    Science.gov (United States)

    Tahmasebpour, Ahmad-Reza; Pirjani, Reihaneh; Rahimi-Foroushani, Abbas; Ghaffari, Saeed Reza; Rahimi-Sharbaf, Fatemeh; Masrour, Farzaneh Fattahi

    2012-07-01

    Shortening of the fetal long bones is a sonographic soft marker for screening of Down syndrome in the second trimester that can be influenced by ethnicity. The purpose of this study was to provide normal reference ranges for femur and humerus diaphysis length during the second trimester of pregnancy in an Iranian population. This cross-sectional study was performed on 3011 singleton fetuses at 15 to 28 weeks' menstrual age. The relationship between menstrual age and both femur and humerus diaphysis length was determined, and percentile values for each menstrual week were provided. The median femur diaphysis length ranged from 18.05 mm at 15 menstrual weeks to 52.20 mm at 28 menstrual weeks, and the mean humerus diaphysis length ranged from 17.65 mm at 15 menstrual weeks to 48.10 mm at 28 menstrual weeks. There was a linear relationship between menstrual age and both femur diaphysis length (R² = 0.957) and humerus diaphysis length (R² = 0.941). We have provided normal reference ranges for femur and humerus diaphysis length during the second trimester of pregnancy in an Iranian population.

  1. [Experimental proximal carpectomy. Biodynamics].

    Science.gov (United States)

    Kuhlmann, J N

    1992-01-01

    Proximal carpectomy was performed in 10 fresh cadavre wrists. Dynamic x-rays were taken and the forces necessary to obtain different movements before and after the operation were measured. Comparison of these parameters clearly defines the advantages and limitations of carpectomy and indicates the reasons.

  2. Proximate Analysis of Coal

    Science.gov (United States)

    Donahue, Craig J.; Rais, Elizabeth A.

    2009-01-01

    This lab experiment illustrates the use of thermogravimetric analysis (TGA) to perform proximate analysis on a series of coal samples of different rank. Peat and coke are also examined. A total of four exercises are described. These are dry exercises as students interpret previously recorded scans. The weight percent moisture, volatile matter,…

  3. Proximal Tibial Bone Graft

    Science.gov (United States)

    ... the Big Toe Ailments of the Smaller Toes Diabetic Foot Treatments Currently selected Injections and other Procedures Treatments ... from which the bone was taken if the foot/ankle surgeries done at the same time allow for it. ... problems after a PTBG include infection, fracture of the proximal tibia and pain related ...

  4. Spatial Proximity and Intercompany Communication: Myths and Realities

    OpenAIRE

    Aguilera, Anne; Lethiais, Virginie; Alain RALLET

    2015-01-01

    Spatial proximity is credited with numerous virtues in the economic literature. In particular, for a company to be located near other companies is seen as conducive to the development of business relations. Spatial proximity is also considered to contribute to the quality and efficiency of these relations by facilitating face-to-face meetings that foster the exchange of complex knowledge and, in particular, the emergence of innovation. This article explores the notion of spatial proximity in ...

  5. [Results after internal fixation of humerus distal fractures in patients over than 65 years old].

    Science.gov (United States)

    Serrano-Mateo, L; Lopiz, Y; León-Serrano, C; García-Fernández, C; López-Durán-Stern, L; Marco, F

    2014-01-01

    Distal humerus fractures in the elderly frequently associated with poor bone quality and comminution, making it harder to achieve proper osteosynthesis. Our aim is to evaluate the radiological and functional results of open reduction and internal fixation of these fractures. Retrospective study of 26 patients treated by open reduction and internal fixation between the years 2005-2010. Mean follow-up was 42 months. At final follow-up, a radiography evaluation (Knirk and Jupiter score) and clinical examination using Mayo Elbow Performance Score and Quick-Disabilities of the Arm, Shoulder and Hand Score was performed. Mean age of the group was 76.8 years (65-89), with 83% of the patients being female. Sixteen patients suffered type C fractures and 8 type A by AO classification. All underwent posterior surgical approach. Mean elbow flexion reached 118.86°, with a mean extension deficit of 25°. More than 3-quarters (79.1%) of the patients showed 0-1 grade degenerative changes on the X-ray films at final follow-up. Functional results reached an average 19.87 points on Quick-Disabilities of the Arm, Shoulder and Hand Score, and 85 points on Mayo Elbow Performance Score scores. Non-union occurred in 2 cases: distal humerus in one patient and olecranon osteotomy in another. Ulnar nerve neuropraxia was recorded in 2 cases, and radial nerve in one. All 3 recovered uneventfully. Revision surgery was required, with 2 patients needing hardware removal and one a new fixation. Treatment by open reduction and internal fixation with plating in elderly people for type A and C distal humerus fractures gives good functional results regarding this population, and thus scarcely disturbs their quality of life. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

  6. Percutaneous K wire fixation in pediatric lateral condylar fractures of humerus: A prospective study.

    Science.gov (United States)

    Lal Sahu, R

    We evaluated the radiographic and clinical functional results of K-wire fixation in the treatment of displaced lateral condyle fractures of the humerus. A prospective longitudinal study was undertaken in our hospital during the period December 2010-December 2014. A total number of 85 children (18 girls and 67 boys) mean age 7.76 years; range 2-13 years with displaced (>2mm) lateral condyle fractures of the humerus. All the patients were treated by close reduction and internal fixation with two K-wires for three weeks. The fractures were classified according to the criteria by Milch and Badelon and functional results were evaluated according to the criteria by Hardacre et al. The mean follow-up period was 24 months (range: 20-28 months). All children achieved union in a mean time of 3 weeks (range: 2.5-6 weeks). Functional results were excellent in 91.75% children and good in 7.05% children. Full range of elbow motion was achieved in all the patients. None of the patients had instability postoperatively. Post-operatively, 5.88% children got pin tract infection, which was superficial and healed after removing pins and oral antibiotic administration. Percutaneous K-wire fixation is an effective treatment for unstable displaced lateral condylar fractures of the humerus in children. If fracture displacement after closed reduction exceeds 2mm, open reduction and internal fixation is recommended. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. [Complex injury of the elbow joint].

    Science.gov (United States)

    Regel, G; Seekamp, A; Blauth, M; Klemme, R; Kuhn, K; Tscherne, H

    1996-02-01

    High-velocity trauma now often results in complex injuries to the upper extremity, and especially the elbow joint. These can lead to both an enormous reduction in the range of motion of the shoulder, elbow and wrist joints, in severe cases with complete loss of upper extremity function. A complex injury is defined as a fracture and/or dislocation of the elbow in association with (1) a serial injury of the upper extremity, (2) a severe soft tissue trauma, or (3) concomitant injury to vessels or nerves. Serial fractures, in particular can lead to enormous problems with treatment and are often associated with special complications. A standardized operative approach therefore seems essential. An analysis of our patient populations was made to compare the frequency of different injury types, develop specific treatment regimens, and document the clinical course. We made a retrospective analysis of patients admitted to our facility between 1981 and 1992, with particular reference to cause of accident, severity of injury (ISS), type of fracture of the upper extremity (according to the AO classification), extent of soft tissue trauma and whether closed or open, and the concomitant injuries (vascular, compartment and nerve lesions). Type and sequence of therapy and any complications were noted, and the clinical course up to consolidation was recorded. The functional result (i.e., ROM, neurology) was observed at primary discharge and 12 weeks, 6 months and 2 years later. In the time period mentioned 224 complex injuries of the elbow region were noted. Often MVAs were the cause of the complex trauma (39% car/30% motorcycle). The average injury severity was scored as 32 (ISS) in these, mostly polytraumatized, patients (68%). The most frequent fracture combination at the elbow region was combined with C2/C3 fractures of the distal humerus (57%) and proximal ulna (43%). A very commonly seen complex injury was the Monteggia equivalent, with fracture dislocation of the proximal

  8. PERBANDINGAN ANTARA KOMBINASI LATIHAN STABILISASI BAHU DAN TRAKSI HUMERUS KE INFERIOR DENGAN KOMBINASI LATIHAN FUNGSIONAL BAHU DAN TRAKSI HUMERUS KE INFERIOR DALAM MENURUNKAN DISABILITAS BAHU DAN LENGAN PADA SUBACROMIAL IMPINGEMENT SYNDROME MAHASISWA AKAD

    Directory of Open Access Journals (Sweden)

    Mawaddah -

    2015-08-01

    Full Text Available Shoulder impingement causing interference on the motion of the shoulder joint activities and result in functional activity disorder. These injuries usually are caused by faulty movement, overuse, poor posture, occupational factors and trauma. This will cause a burden on one part of the body and cause imbalances in anatomy, which will eventually lead to disruption of the body that experienced work. This study aimed to investigate the effect of functional shoulder exercise and traction humerus to inferior with shoulder stabilization exercises and traction humerus to inferior to the decline in the shoulder and arm disabilities in subacromial impingement syndrome. This research method was experimental clinical trials with pre test and post test group design. Population student Academy Physiotherapy Widya Husada Semarang, which consists of 3 men and 12 women, aged between 18-21 years, divided into two groups. Group I was given Shoulder Stabilization exercises and Traction humerus to Inferior (n=7 and group II Functional Shoulder Exercise and Traction humerus to Inferior (n=8. This research was conducted for 3 weeks. Measurement of the value of disability shoulder and arm by using the Shoulder Pain and Disability Index (SPADI. The test results on the group I average value pre 34.17, SB = 6.31, and the average value of post 11.54, SB = 4.02, p = 0.001 found significant differences obtained test results paired sample t-test, and testing group II average value pre 40.18, SB = 3.53, and the average value of post 7.82, SB = 1.57, p = 0.001 found significant differences obtained test results paired sample t-test. Comparison of Group I and II, p = 0.005 there were significant differences, test results obtained independent sample t-test. Conclusions: The combination of shoulder stabilization exercises and traction humerus to inferior can reduce disability shoulder and arm on subacromial impingement syndrome. The combination functional shoulder exercise and

  9. Improved comfort and function of arm prosthesis after implantation of a Humerus-T-Prosthesis in trans-humeral amputees.

    Science.gov (United States)

    Witsø, Eivind; Kristensen, Tomm; Benum, Pål; Sivertsen, Svein; Persen, Leif; Funderud, Are; Magne, Tordis; Aursand, Hans Petter; Aamodt, Arild

    2006-12-01

    The use of arm prosthesis in trans-humeral amputees is limited; due to the cone form of the amputation stump. A Humerus-T-Prosthesis was implanted in three patients to create artificial humerus condyles. Two of the patients were successfully rehabilitated with the application of a new type trans-humeral arm prosthesis. This arm prosthesis had a socket which is suspended and stabilized by the humerus and implant only. Traction and rotational stability were secured by adjustable pressure adaptation around the artificial condyles. The third patient developed a pressure wound over the lateral part of the artificial condyle that later healed. He also was subject to a new trauma with a fracture of the ipsilateral scapula and until now has had limited the use of his new arm prosthesis. It was concluded that this new concept for prosthesis fitting of trans-humeral amputees looks promising, but alternative designs of the implant should be tested.

  10. Factors Associated with the Transfer of Pediatric Patients with Supracondylar Humerus Fractures to a Level I Pediatric Trauma Center.

    Science.gov (United States)

    Russo, Glenn S; Ferrucci, Allen M; Miller, Christopher P; Dean, Ethan W; Strohbehn, Garth W; Dean, Natalie E; Sharkey, Melinda S

    2015-09-01

    To compare the characteristics of pediatric patients with supracondylar humerus fractures transferred to a level I pediatric trauma center to those who presented directly to our institution. Retrospective chart review of patients with a supracondylar humerus fracture during a 42-month period (2008-2011) at a major level I pediatric trauma center were reviewed. Of 195 patients, 37 were transferred from outside hospitals. After multivariable analysis, it was determined that transferred patients were significantly more likely to present on the weekends (p = 0.003) and require operative treatment (p patients. Injuries requiring operative treatment and presentation on a weekend were independent predictors of the transfer of pediatric patients with supracondylar humerus fractures.

  11. Medial Condyle Fracture (Kilfoyle Type III of the Distal Humerus with Transient Fishtail Deformity after Surgery

    Directory of Open Access Journals (Sweden)

    Motoki Sonohata

    2017-01-01

    Full Text Available A “Fishtail deformity” is one of the well-known complications following pediatric lateral condyle or supracondylar fractures of the humerus. We herein report a case of medial condyle fracture (Kilfoyle type III in an 11-year-old boy. He had a transient “fishtail deformity” of the trochlear groove after open reduction and internal fixation. As occurred in the current case, the bone remodeling and the improvement of ischemia of the trochlea after medial condyle fracture may be associated with the likelihood of recovery from transient “fishtail deformity.”

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

    DEFF Research Database (Denmark)

    Brorson, Stig

    2009-01-01

    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 li...... of written sources points toward a multifaceted approach to the diagnosis, reduction, and bandaging of humeral fracture in Ancient Egypt, Greece, and Rome......., 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...

  13. Compartment syndrome of the upper arm after closed reduction and percutaneous pinning of a supracondylar humerus fracture.

    Science.gov (United States)

    Diesselhorst, Matthew M; Deck, Jason W; Davey, Joseph P

    2014-03-01

    Supracondylar fractures of the humerus are the most frequently seen elbow fractures in children. One of the most feared complications of this fracture, that is, compartment syndrome of the forearm is seen rarely. Compartment syndrome of the upper arm is an even more rare occurrence and to date, has not been reported in association with an isolated supracondylar humerus fracture in a child. A 9-year-old boy was cared for at our facility for a severe (Gartland type III) supracondylar humerus fracture and developed a compartment syndrome in the perioperative period. A clinical, radiographic, and literature review of this case was undertaken to better define this occurrence. This patient sustained a closed supracondylar humerus fracture in association with a motor and sensory deficit of the radial nerve. Because of the severity of the deformity, a provisional reduction was performed in the emergency department. Eleven hours after the injury, a routine closed reduction and percutaneous pinning was performed. Although significant swelling was noted at that time, compartment syndrome was not clinically suspected. He was observed as an inpatient because of this persistent swelling. Over the next day, he developed considerable tenderness over the anterior arm and mobile wad musculature, hence, compartment pressure measurements were made. These confirmed a compartment syndrome in the anterior compartment of the arm and equivocally in the mobile wad. An urgent compartment release of the arm was done, which resulted in full recovery. This is the first report of a compartment syndrome of the arm after an isolated supracondylar humerus fracture in a child. The presence of the associated fracture made the classic signs of compartment syndrome difficult to assess. Ultimately, muscle tenderness and compartment pressure measurement were most helpful in making this diagnosis. A high index of suspicion should be maintained for compartment syndrome of the arm as well as the forearm

  14. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi

    2015-01-01

    -displaced femoral neck fractures and prosthesis for displaced among the elderly; and sliding hip screw for stabile- and intramedullary nails for unstable- and sub-trochanteric fractures) but they are based on a variety of criteria and definitions - and often leave wide space for the individual surgeons' subjective...... guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation. METHODS: By a PubMed search in March 2015 six studies of surgical treatment pathways covering all types of proximal femoral fractures with publication after 1995 were identified. Also we...... searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  15. Proximal humeral fractures

    OpenAIRE

    Mauro, Craig S.

    2011-01-01

    Proximal humeral fractures may present with many different configurations in patients with varying co-morbities and expectations. As a result, the treating physician must understand the fracture pattern, the quality of the bone, other patient-related factors, and the expanding range of reconstructive options to achieve the best functional outcome and to minimize complications. Current treatment options range from non-operative treatment with physical therapy to fracture fixation using percuta...

  16. Stability of tuberosity reattachment in proximal humeral hemiarthroplasty.

    Science.gov (United States)

    Frankle, Mark A; Ondrovic, Leo E; Markee, Blaine A; Harris, M Lance; Lee, William E

    2002-01-01

    Hemiarthroplasty can be an effective treatment for 4-part fractures of the proximal humerus; however, results are often unpredictable. Proper surgical technique is critical for success. Reconstruction of the displaced tuberosities should attempt to impart maximal interfragmentary stability. To our knowledge, a comparison of different tuberosity reconstruction methods has not been reported. We evaluated 5 techniques of tuberosity reattachment on 8 humeri. Four-part fractures were simulated by an oscillating saw in fresh-frozen cadaveric shoulders. In the control construct, the greater and lesser tuberosities were attached to the humeral shaft with nylon strap ties (2.4 x l mm) applied at 9.1 N with closure of the rotator interval. Five anatomic reconstructions were then performed:(1) the control tuberosities were attached to each other with strap ties, and (2) the control tuberosities were attached to each other with strap ties, incorporating the anterior fin of the prosthesis. To each of these 3 constructs, a circumferential cerclage (4.8 x 1.25-mm strap tie) applied at 39.2 N was placed around the tuberosities and incorporated into the medial hole of the prosthesis (techniques 3, 4, and 5). Through use of a robot articulator at a rate of 10 degrees /s, passive external rotation from 0 degrees to 60 degrees was performed on the control and the 5 test constructs of each specimen. Interfragmentary displacement of the bony fragments was measured with mercury strain gauges and strain calculated. This strain was minimal and statistically less (P <.05) in those constructs in which a cerclage was used. Incorporation of the nylon strap into the fin of the prosthesis did not enhance stability. In those constructs in which a cerclage was used, maximal displacement was 0.14 +/- 0.7 mm (38% +/- 19% strain), as compared with 0.72 +/- 0.5 mm (204% +/- 133% strain) without it. Reconstruction of 4-part proximal humerus fractures with hemiarthroplasty should incorporate a

  17. Osteossíntese das fraturas da extremidade proximal do úmero com sistema de placa de ângulo fixo com parafusos bloqueados: técnica e resultados Osteosynthesis of proximal humeral end fractures with fixed angle plate and locking screws: technique and results

    Directory of Open Access Journals (Sweden)

    Marcio Cohen

    2009-04-01

    Full Text Available OBJETIVO: Descrever os resultados do tratamento cirúrgico das fraturas da extremidade proximal do úmero com a placa de sistema bloqueado Philos. MÉTODOS: Entre março de 2003 e outubro de 2004 foram avaliados, de forma prospectiva, 24 de 26 pacientes com fratura da extremidade proximal do úmero tratados com a placa Philos. A média de seguimento foi de 12 meses e da idade dos pacientes, de 57 anos. Seis pacientes tinham fraturas em quatro partes, 11 em três partes e nove em duas partes. A avaliação clínica foi feita por meio dos critérios da University of California at Los Angeles (UCLA. RESULTADOS: A média do escore da UCLA foi de 30 pontos (17-35. Todas as fraturas consolidaram. Em três pacientes a fratura consolidou em varo. Nesses, o índice da UCLA médio foi de 27 pontos. CONCLUSÃO: A osteossíntese com a placa Philos permite fixação estável com bom resultado funcional.OBJECTIVE: Describe the results of proximal humeral fractures surgically treated with the Philos locking plate system. METHOD: Between March 2003 and October 2004 we prospectively reviewed 24 of 26 patients with proximal humerus fractures treated with a Philos plate. The mean follow-up time was 12 months and the mean age of patients was 57 years. Six patients had four-part proximal humerus fractures, 11 patients had three-part proximal humerus fractures, and nine patients had two-part proximal humerus fractures. Clinical evaluation was performed using the University of California at Los Angeles (UCLA criteria. RESULTS: The mean UCLA score was 30 points (17-34. All fractures showed union. Three patients showed fracture union at varus position. The mean UCLA score for these patients was 27 points. CONCLUSION: Osteosynthesis with Philos plate provides a stable fixation method with good functional outcome.

  18. [Disorders of sex development and proximal hypospadias].

    Science.gov (United States)

    Oswald, J

    2016-01-01

    Children with ambiguous genitalia due to different chromosome or gonadal sex are a particular challenge concerning the diagnostic and therapeutic implications. Proximal hypospadias patients with normal gonadal development should be distinguished from children with DSD (disorders of sex development) to guarantee normal gender identity and the best possible surgical therapy. This paper focuses on the terminology, embryology, and pathophysiology of the different manifestations of DSD. The state of knowledge about this disease pattern with particular emphasis on proximal hypospadias based on national and international scientific discussions is presented. The different clinical pictures as well as therapeutic options of DSD with a special focus on recent literature and giving particular attention to patients with proximal hypospadias are presented. Because of the complexity of patients suffering from disorders of sex development an interdisciplinary DSD healthcare team including a paediatric endocrinologist as well as paediatric urologist should be provided. These specialists enable an accurate diagnosis in severe hypospadias patients without reference to DSD diseases patterns.

  19. Flexion type supracondylar humerus fractures: 12 year experience of a pediatric orthopedics clinic.

    Science.gov (United States)

    Turgut, Ali; Kalenderer, Önder; Bozoğlan, Muhammet; Bacaksız, Tayfun; Ağuş, Haluk

    2015-01-01

    This study aims to review flexion type supracondylar humerus fractures in children and treatment options. Forty-seven patients (26 males, 21 females; mean age 8.6±3.2 years; range 4 to 15 years) who admitted to and were hospitalized in a pediatric orthopedics clinic between January 2002 and January 2014 due to flexion type supracondylar humerus fracture were included in this retrospective study. Fractures were classified according to Wilkins modification of Gartland system. Closed reduction and percutaneous pinning (CRPP) were administered in all patients with type 2 and 3 fractures. An overhead traction or open reduction was applied when closed reduction could not be achieved with three manipulations. Patients were evaluated clinically and radiologically. The results were graded according to Flynn criteria. Four patients with type 1 fracture were treated conservatively. Of the remaining patients, we were able to perform CRPP successfully in 36 (83.7%). While six patients (14%) were treated with open reduction and internal fixation, one patient (2.1%) was treated with overhead traction. The results were excellent or good in 44 patients (93.7%). Compared with extension type fractures, these fractures are seen in older children and are rarer. One should be prepared to perform open reduction especially for type 3 fractures. In our study, results of patients with type 3 fractures treated with CRPP were superior.

  20. Intrathoracic fracture-dislocation of the humerus - case report and literature review

    Directory of Open Access Journals (Sweden)

    Wilson Carlos Sola Junior

    Full Text Available ABSTRACT Shoulder fracture-dislocations are uncommon. Those associated with intrathoracic dislocation are very rare conditions, resulting from high-energy trauma; usually, the affected limb is in an abduction position. In Brazil, there is only one report of a teenager with displacement of the epiphysis into the chest cavity; the present is the first adult patient report of intrathoracic dislocation of the humerus. The authors present the case of a patient female, aged 56 years, who was hit by motorcycle and thrown approximately 5 meters away. She was rescued on site with thoracic, pelvic, and right upper limb trauma. Her chest was drained due to pneumothorax and multiple fractures of ribs; she was diagnosed with fracture-dislocation in four parts, with intrathoracic dislocation of the humeral head. Displaced forearm bones fracture was also diagnosed; the olecranon, scaphoid, and ischiopubic fractures were not displaced. The patient underwent a joint procedure with a cardiothoracic surgery team to remove the humeral head through thoracotomy and chest drainage; subsequently, a partial arthroplasty of the humerus was performed, with graft from the humeral head and fixation of forearm fractures. Conservative treatment was chosen for the other fractures. After three months, all fractures were healed with gradual functional improvement. The patient remained in physiotherapy and orthopedic monitoring, having been discharged from the thoracic surgery; in a severe depressive episode, the patient committed suicide after 11 months of the trauma.

  1. Supracondylar humerus fractures in children: the effect of weather conditions on their risk.

    Science.gov (United States)

    Sinikumpu, Juha-Jaakko; Pokka, Tytti; Hyvönen, Hanna; Ruuhela, Reija; Serlo, Willy

    2017-02-01

    Supracondylar humerus fractures are the most common fractures of the elbow in children. Many environmental factors such as weather conditions may affect the risk of these fractures. The purpose of the study was to analyze the effect of weather conditions (temperature, rainfall, wind) on fracture risk in children weather service and the association of weather conditions and fractures were analyzed. A majority (79.7%, N = 181) of the fractures occurred on dry days versus rainy days (20.3%) (P = 0.011), and risk of a fracture was 3.5-fold higher on dry days as compared with rainy days (crude OR 3.5, 3.41-3.59, P weather was warm, instead of cool or hot, when the majority of the fractures (N = 147, 64.8%) occurred (P = 0.008): Warm temperatures (15-24.9 °C) increased the fracture risk 2.6-fold (crude OR 2.64, 2.59-2.70, P change according to the wind speed (P = 0.171). The findings were similar through the school term and summer vacation. Dry and warm weather conditions increase the risk of outdoor supracondylar humerus fractures in children during the time period with the absence of snow cover.

  2. Accurate application of a precontoured-locking plate for proximal humeral fractures in Asians: a cadaveric study.

    Science.gov (United States)

    Kwak, Ji-Yong; Park, Hyung-Bin; Jung, Gu-Hee

    2016-10-01

    The purpose of this study was to identify the optimal position for a precontoured-locking plating (PHILOS(®)) of the proximal humerus in Asians in terms of conformity and to determine the prevalence of screw exits in the position of the highest conformity. Twenty adult humeri and 14 cadaveric shoulders were included in this study. After placing the precontoured plate in the well-fitted position on the humerus, we measured the distance between the upper margin of the plate and the tip of greater tuberosity (GT) (distance A) and the distance between the anterior margin of the plate and lateral border of the bicipital groove (BG) (distance B). The prevalence of K-wire exits was assessed. In the 14 cadaver shoulders, the mutual relation between the most inferior locking sleeve of the optimally positioned plate and the axillary nerve was evaluated to assess the potential for axillary nerve injury. The precontoured plate was well-fitted and remained in a relatively constant position in all specimens. Distance A was an average of 3.6 mm (range 1.4-5.5 mm), and distance B was an average of 2.5 mm (range 0-4.6 mm). The K wire closest to the BG pierced it in four cases (20 %), and most inferior K wires exited at an average distance of 3.8 mm (range 1.6-9.0 mm) from the inferior articular margin of the humeral head. Regarding involvement of the BG, articular width was the only significant variable in the logistic regression model, with an odds' ratio of 0.610. The axillary nerve was located at an average vertical distance of 59.7 mm (range 51.8-66.9 mm) from the tip of the GT in a vertically neutral position. The results did not differ between the left and right sides (t = 0.326, p = 0.755). Although the axillary nerve was slightly inferior to the most inferior locking holes of the proximal humerus, it was located in the path of their locking sleeves on the deltoid muscle. The optimal position for the highest conformity led to ideal fixation of the proximal

  3. Methods and theory in bone modeling drift: comparing spatial analyses of primary bone distributions in the human humerus.

    Science.gov (United States)

    Maggiano, Corey M; Maggiano, Isabel S; Tiesler, Vera G; Chi-Keb, Julio R; Stout, Sam D

    2016-01-01

    This study compares two novel methods quantifying bone shaft tissue distributions, and relates observations on human humeral growth patterns for applications in anthropological and anatomical research. Microstructural variation in compact bone occurs due to developmental and mechanically adaptive circumstances that are 'recorded' by forming bone and are important for interpretations of growth, health, physical activity, adaptation, and identity in the past and present. Those interpretations hinge on a detailed understanding of the modeling process by which bones achieve their diametric shape, diaphyseal curvature, and general position relative to other elements. Bone modeling is a complex aspect of growth, potentially causing the shaft to drift transversely through formation and resorption on opposing cortices. Unfortunately, the specifics of modeling drift are largely unknown for most skeletal elements. Moreover, bone modeling has seen little quantitative methodological development compared with secondary bone processes, such as intracortical remodeling. The techniques proposed here, starburst point-count and 45° cross-polarization hand-drawn histomorphometry, permit the statistical and populational analysis of human primary tissue distributions and provide similar results despite being suitable for different applications. This analysis of a pooled archaeological and modern skeletal sample confirms the importance of extreme asymmetry in bone modeling as a major determinant of microstructural variation in diaphyses. Specifically, humeral drift is posteromedial in the human humerus, accompanied by a significant rotational trend. In general, results encourage the usage of endocortical primary bone distributions as an indicator and summary of bone modeling drift, enabling quantitative analysis by direction and proportion in other elements and populations. © 2015 Anatomical Society.

  4. The Adequacy of Diagnosis and Treatment for Osteoporosis in Patients with Proximal Humeral Fractures.

    Science.gov (United States)

    Kim, Tae In; Choi, Jun Ha; Kim, Sae Hoon; Oh, Joo Han

    2016-09-01

    The purpose of this study was to evaluate whether physicians' practice was adequate for the diagnosis and treatment of osteoporosis in patients with proximal humeral fracture over the age of 50 years, which is one of major osteoporotic fractures. A retrospective nation-wide cohort study was performed using data collected in 2010 by the Korean Health Insurance Review Agency. The incidences of fractures around the hip, spine, and proximal humerus in patients more than 50 years of age, the frequencies of diagnostic bone density scan for osteoporosis, and the prescription for the osteoporosis medication were analyzed and compared. A search of database identified 48,351 hip fractures, 141,208 spine fractures, and 11,609 proximal humeral fractures in patients more than 50 years of age in 2010. Among these patients, 12,097 (25.0%) of hip fractures, 41,962 (29.7%) of spine fractures, and 1,458 (12.6%) of proximal humeral fractures underwent diagnostic bone density scan (p fractures, 27,261 (19.3%) of spine fractures, and 639 (5.5%) of proximal humeral fractures were managed with at least one medication approved for the treatment of osteoporosis (p fractures, 7,271 (5.2%) of spine fractures, and 188 (1.6%) of proximal humeral fractures received diagnostic bone density scans as well as osteoporosis medications (p proximal humeral fractures over the age of 50 years. Additional study and educational programs are necessary to improve this care gap, beginning with physicians who are responsible for the fracture treatment and shoulder diseases.

  5. Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation

    NARCIS (Netherlands)

    Claessen, Femke M. A. P.; Stoop, Nicky; Doornberg, Job N.; Guitton, Thierry G.; van den Bekerom, Michel P. J.; Ring, David; Spoor, A. B.; Chauhan, A.; Wahegaonkar, A. L.; Shafritz, A. B.; Garcia G, A. E.; Miller, A. N.; Barquet, A.; Kristan, A.; Apard, T.; Armstrong, A. D.; Berner, A.; Jubel, A.; Kreis, B. E.; Babis, C. G.; Sutker, B.; Sears, B. W.; Nolan, B. M.; Crist, B. D.; Cross, B. J.; Wills, B. P.; Barreto, C. J.; Ekholm, C.; Swigart, C.; Oliveira Miranda, C. D.; Manke, C.; Zalavras, C.; Goldfarb, C. A.; Cassidy, C.; Walsh, C. J.; Jones, C. M.; Garnavos, C.; Young, C.; Moreno-Serrano, C. L.; Lomita, C.; Klostermann, C.; van Deurzen, D. F.; Rikli, D. A.; Polatsch, D.; Beingessner, D.; Drosdowech, D.; Eygendaal, D.; Patel, M.; Brilej, D.; Walbeehm, E. T.; Ballas, E. G.; Ibrahim, E. F.; Melamed, E.; Stojkovska Pemovska, E.; Hofmeister, E.; Hammerberg, E. M.; Kaplan, F. T.; Suarez, F.; Fernandes, C. H.; Lopez-Gonzalez, F.; Walter, F. L.; Frihagen, F.; Kraan, G. A.; Kontakis, G.; Dyer, G. S.; Kohut, G.; Panagopoulos, G.; Hernandez, G. R.; Porcellini, G.; Bayne, G. J.; Merrell, G.; DeSilva, G.; Della Rocca, G. J.; Bamberger, H. B.; Broekhuyse, H.; Durchholz, H.; Kodde, I. F.; McGraw, I.; Harris, I.; Pountos, I.; Wiater, J. M.; Choueka, J.; Kazanjian, J. E.; Gillespie, J. A.; Biert, J.; Fanuele, J. C.; Johnson, J. W.; Greenberg, J. A.; Abrams, J.; Hall, J.; Fischer, J.; Scheer, J. H.; Itamura, J.; Capo, J. T.; Braman, J.; Rubio, J.; Ortiz, J. A.; Filho, J. E.; Nolla, J.; Abboud, J.; Conflitti, J. M.; Abzug, J. M.; Patiño, J. M.; Rodríguez Roiz, J. M.; Adams, J.; Bishop, J.; Kabir, K.; Chivers, K.; Prommersberger, K.; Egol, K.; Rumball, K. M.; Dickson, K.; Jeray, K.; Poelhekke, L. M.; Campinhos, L. A.; Mica, L.; Borris, L. C.; Adolfsson, L. E.; Schulte, L. M.; Elmans, L.; Lane, L. B.; Paz, L.; Taitsman, L.; Guenter, L.; Austin, L. S.; Waseem, M.; Palmer, M. J.; Abdel-Ghany, M. I.; Richard, M. J.; Rizzo, M.; Pirpiris, M.; Di Micoli, M.; Bonczar, M.; Loebenberg, M. I.; Richardson, M.; Mormino, M.; Menon, M.; Soong, M.; Wood, M. M.; Meylaerts, S. A.; Darowish, M.; Nancollas, M.; Prayson, M.; Grafe, M. W.; Kessler, M. W.; Kaminaris, M. D.; Pirela-Cruz, M. A.; McKee, M.; Merchant, M.; Tyllianakis, M.; Shafi, M.; Powell, A. J.; Shortt, N. L.; Felipe, N. E.; Parnes, N.; Bijlani, N.; Elias, N.; Akabudike, N. M.; Rossiter, N.; Lasanianos, N. G.; Kanakaris, N. K.; Brink, O.; van Eerten, P. V.; Paladini, P.; Martineau, P. A.; Appleton, P.; Levin, P.; Althausen, P.; Evans, P. J.; Jebson, P.; Krause, P.; Schandelmaier, P.; Peters, A.; Dantuluri, P.; Blazar, P.; Andreas, P.; Inna, P.; Quell, M.; Ramli, R. M.; de Bedout, R.; Ranade, A. B.; Ashish, S.; Smith, R. M.; Babst, R. H.; Omid, R.; Buckley, R.; Jenkinson, R.; Gilbert, R. S.; Page, R. S.; Papandrea, R.; Zura, R. D.; Gray, R. L.; Wagenmakers, R.; Pesantez, R.; van Riet, R.; Calfee, R. P.; van Helden, S. H.; Bouaicha, S.; Kakar, S.; Kaplan, S.; Scott, F. D.; Kaar, S. G.; Mitchell, S.; Rowinski, S.; Dodds, S.; Kennedy, S. A.; Beldner, S.; Schepers, T.; Guitton, T. G.; Gosens, T.; Baxamusa, T.; Taleb, C.; Tosounidis, T.; Wyrick, T.; Begue, T.; DeCoster, T.; Dienstknecht, T.; Varecka, T. F.; Mittlmeier, T.; Fischer, T. J.; Chesser, T.; Omara, T.; Bafus, T.; Siff, T.; Havlicek, T.; Sabesan, V. J.; Nikolaou, V. S.; Philippe, V.; Giordano, V.; Vochteloo, A. J.; Batson, W. A.; Hammert, W. C.; Satora, W.; Weil, Y.; Ruch, D.; Marsh, L.; Swiontkowski, M.; Hurwit, S.

    2016-01-01

    Purpose Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after

  6. Proximal third humeral shaft fractures -- a fracture entity not fully characterized by conventional AO classification.

    Science.gov (United States)

    Stedtfeld, H W; Biber, R

    2014-01-01

    The retrospective study was made to evaluate the fracture patterns at the proximal humeral shaft for which the long version of a standard proximal humeral nail (PHNLV) has been used. The indication has been decided by the individual surgeons. Over a five year period 72 consecutive PHNLV cases of an acute fracture were identified and were included in the study. Mean patient age was 68.9 years. Gender ratio was m/f=22/50. 86.1% of the patients fractured their humerus by a fall, the rest by a high velocity accident. We analysed patient comorbidity, ASA score, osteoporosis, social status before accident, additional injuries affecting local soft tissues or other anatomic regions. We analysed the expansion of the fractures, dividing the humerus into five zones. Fracture morphology was categorized according to the standard AO/ASIF classification (if applicable). Comorbidities were found in 76.4% of the patients. Almost all patients (93.1%) had been living independently at home before the accident. 47.2% of patients had osteoporosis in their medical history. Five patients (6.9%) had a primary palsy of the radial nerve. Six fractures chosen for PHNLV fixation were clearly restricted to the humeral head. The remaining 66 fractures were located in the humeral shaft (AO region 12). There were 5 segmental fractures. Of the remaining 67 fractures affecting the proximal third of the humeral shaft 49.3 percent extended into the humeral head. 98 percent of these fractures displayed spiral morphology. Proximal humeral shaft fractures are amazingly similar to subtrochanteric and distal tibial shaft fractures: Spiral fracture types with different grades of comminution are absolutely dominant; a great proportion of the fractures extend into the humeral head with growing tendency of displacement if located closer to the humeral head. Diverging traction of deltoid and pectoralis muscle causes typical displacement if the fracture line runs in between their attachments substantiating the

  7. Complexity

    Indian Academy of Sciences (India)

    Rahul Pandit

    2008-10-31

    Oct 31, 2008 ... ”The more complex a thing is, the more you can talk about it.” - attributed to Giorgio Parisi. ▻ ”C'est magnifique, mais ce n'est pas de la science.” (It is magnificent, but not all of it is science.) - attributed ... Earliest examples: theoretical computer science, algorithmic complexity, etc. ▻ Rapid progress after the ...

  8. [Case-control study on suture-assisted locking plate for the treatment of proximal humeral fractures in elderly].

    Science.gov (United States)

    Dai, Zhang-sheng; Huang, Jie-miao; Zhuang, Xun-rong; Chen, Shou-bo; Wu, Shi-qiang; Yao, Xue-dong; Ye, Hui

    2014-12-01

    To explore clinical effects of suturing-assisted locking plate in treating elderly proximal humeral fractures. From January 2005 to January 2013, 55 elderly patients with three- and four-part fractures of proximal humeral fractures were divided into treatment group and control group. In treatment group, there were 31 patients including 12 males, and 19 females aged from 65 to 85 with an average of (74.00±5.42) years old, and treated with suturing-assisted locking plates; 19 patients were Neer 3-part fractures, and 12 patients were Neer 4-part fractures of proximal humerus; 23 patients were suffered from low-energy injuries and 8 patients were caused by high-energy injuries. In control group, there were 24 patients including 7 males, and 17 females aged from 65 to 85 with an average of (72.79±5.34) years old, and treated with locking plates; 16 patients were Neer 3-part fractures, and 8 patients were Neer 4-part fractures of proximal humerus; 17 patients were suffered from low-energy injuries and 7 patients were caused by high-energy injuries. Operative time, blood loss during operation, and bone healing time between two groups were observed and compared. Postoperative Neer scoring were used to evaluate recovery of shoulder joint function. All patients were followed up from 6 to 24 months with an average of 16.1 months. In treatment group, blood loss was (495.806±143.150) ml, function of Neer scoring was 22.645±2.443, range of action was 18.194±2.613, anatomy was 7.935±1.504 and total score of Neer scoring was 77.161±8.335; while in control group, blood loss was (641.667±169.851) ml, function of Neer scoring was 13.958±1.989, range of action was 13.083±2.165, anatomy was 5.500±1.978 and total score of Neer scoring was 58.792±7.313. There were sigificant difference between two groups in these indexes. Suturing-assisted locking plate for the treatment of proximal humerus fractures in elderly, has advantages of less blood loss, simple fracture reduction and

  9. [Reconstruction of condyle in treatment of refractory condylar nonunion and defect of humerus].

    Science.gov (United States)

    Niu, Yunfei; Zhang, Chuncai; Yu, Baoqing; Xu, Shuogui; Wang, Jialin; Su, Jiacan; Zhang, Peng; Guan, Huapeng; Liu, Xinwei; Li, Zhuodong

    2008-01-01

    To discuss the strategy of condylar reconstruction in the treatment of refractory condylar nonunion and defect of humerus. From September 1998 to September 2005, 18 patients with refractory condylar nonunion concomitant withdefect of humerus were treated. The series included 12 males and 6 females, aged 18 to 60 years. According to AO/ASIF system, primal fractures were classified, including 5 cases of type A3, 2 cases of type B1, 4 cases of type C2 and 7 cases of type C3 fractures. Condylar nonunion and defect of humerus were confirmed by preoperative X-ray. Defective bone mass was 1-4 cm2. The mean extension and flexion of elbow joint was 21.5 degrees (5-65 degrees) and 95.8 degrees (85.0-123.5 degrees) respectively. According to Cassebaum scoring system, the excellent and good rate was 27.8% (excellent in 1 case and good in 4 cases). Time from injury to operation averaged 22.8 months (7-52 months). All patients were operated with approach of olecranon osteotomy. Bone defect was reconstructed with iliac autograft. Shape memory compressive connector, Kirschner wire, cannulated nail, anatomic plates and reconstruction plates were used to fix. Eighteen patients were followed up 12-86 months (mean 27.6 months). All the incisions healed by first intention. No bone block displacement,loosening or breakage of internal fixation occurred. The time of bone union averaged 5.7 months (4-8 months). The mean extension and flexion of elbow joint were 11.4 degrees (0-44.5 degrees) and 128.6 degrees (105.5-144.5 degrees) 1 year after operation. Ectopicossification formed in 1 case at anterior part of elbow 4 months after operation. According to Cassebaum scoring system,the results were excellent in 8 cases, good in 6 cases, fair in 3 cases and poor in 1 case. The excellent and good rate was 77.8%. The shape of humeral condyle can be reconstructed with iliac autograft. Compressive internal fixation of bone block can promote bone union. Anatomical reconstruction, rigid internal

  10. Some Properties of Fuzzy Soft Proximity Spaces

    Science.gov (United States)

    Demir, İzzettin; Özbakır, Oya Bedre

    2015-01-01

    We study the fuzzy soft proximity spaces in Katsaras's sense. First, we show how a fuzzy soft topology is derived from a fuzzy soft proximity. Also, we define the notion of fuzzy soft δ-neighborhood in the fuzzy soft proximity space which offers an alternative approach to the study of fuzzy soft proximity spaces. Later, we obtain the initial fuzzy soft proximity determined by a family of fuzzy soft proximities. Finally, we investigate relationship between fuzzy soft proximities and proximities. PMID:25793224

  11. The Role of Nerve Exploration in Supracondylar Humerus Fracture in Children with Nerve Injury

    Directory of Open Access Journals (Sweden)

    Anuar RIM

    2015-11-01

    Full Text Available The supracondylar humerus fracture (SCHF in children is common and can be complicated with nerve injury either primarily immediate post-trauma or secondarily posttreatment. The concept of neurapraxic nerve injury makes most surgeons choose to ‘watch and see’ the nerve recovery before deciding second surgery if the nerve does not recover. We report three cases of nerve injury in SCHF, all of which underwent nerve exploration for different reasons. Early reduction in the Casualty is important to release the nerve tension before transferring the patient to the operation room. If close reduction fails, we proceed to explore the nerve together with open reduction of the fracture. In iatrogenic nerve injury, we recommend nerve exploration to determine the surgical procedure that is causing the injury. Primary nerve exploration will allow early assessment of the injured nerve and minimize subsequent surgery.

  12. The surgical management of severely displaced supracondylar fracture of the humerus in childhood.

    Science.gov (United States)

    Ogunlade, S O; Alonge, T O; Omololu, A B; Salawu, S A

    2004-12-01

    A total of 28 children with severely displaced supracondylar fractures of the humerus were operated between January 1997 and December 2001 using the posterior approach raising a tongue of triceps and stabilisation of the fractures with two crossed Kirschner wires. All the supracondylar humeral fractures were extension type. The mean age was 6.9 years with male/female ratio 1.5:1. Fall at home accounted for 85.7% of the cases while 67.9% presented with injury to the left elbow. In 92.9% of the children the triceps muscle power was grade 5, 71.4% could flex the elbow joint beyond 120 angle and only 10.7% had 15 degrees of extension lag at the elbow joint at six months. All had within normal carrying angle with 64.3% having carrying angle between 0 degrees - 10 degrees. The scar was cosmetically acceptable in 27 patients (96.4% ) at six-months.

  13. Indications for computed tomography (CT- diagnostics in proximal humeral fractures: a comparative study of plain radiography and computed tomography

    Directory of Open Access Journals (Sweden)

    Weise Kuno

    2009-04-01

    Full Text Available Abstract Background Precise indications for computed tomography (CT in proximal humeral fractures are not established. The purpose of this study was a comparison of conventional radiographic views with different CT reconstructions with 2 D and 3 D imaging to establish indications for additional CT diagnostics depending on the fractured parts. Methods In a prospective diagnostic study in two level 1 trauma centers, 44 patients with proximal humeral fractures were diagnosed with conventional X-rays (22 AP + axillary views, 22 AP + scapular Y-views and CT (multi-planar reconstruction (MPR and maximum intensity projection (MIP with 2 D and 3 D imaging. 3 observers assessed the technical image quality, the assessment of the relevant anatomical structures (2-sample-t-test and the percentage of the osseous overlap of the proximal humerus (Welch-test using a scoring system. The quality of the different diagnostic methods was assessed according to the number of fractured parts (Bonferroni-Holm adjustment. Results There was significantly more overlap of the fractured region on the scapular Y-views (mean 71.5%, range 45–90% than on axillary views (mean 56.2%, range 10.5–100%. CT-diagnostics allowed a significantly better assessment of the relevant structures than conventional diagnostics (p Conclusion Conventional X-rays with AP view and a high-quality axillary view are useful for primary diagnostics of the fracture and often but not always show a clear presentation of the relevant bony structures such as both tuberosities, the glenoid and humeral head. CT with thin slices technology and additional 3 D imaging provides always a clear presentation of the fractured region. Clinically, a CT should be performed – independently of the number of fractured parts – when the proximal humerus and the shoulder joint are not presented with sufficient X-ray-quality to establish a treatment plan.

  14. Outcomes of Pediatric Supracondylar Fractures of Humerus Treated by Posterior Triceps Splitting Approach

    Directory of Open Access Journals (Sweden)

    Rajeev Dwivedi

    2016-06-01

    Full Text Available Introduction: Close reductions and percutaneous pinning is the gold standard treatment for supracondylar fracture  of humerus. Open reduction and internal fixation is indicated in patients with unacceptable closed reduction, neurovascular compromise, and open fractures. Open reduction can be performed through various approaches. Every approach has their advantages and limitations. The aim of this study was  to assess the functional outcome of pediatric supracondylar fracture of humerus treated by posterior triceps splitting approach. Methods: This was a prospective evaluation of 20 consecutive patients with displaced pediatric supracondylar humeral fractures operated by triceps spitting posterior approach in our institution for two years. At initial presentation, 19 cases were Gartland III  and one was flexion variant of injury. Complications such as reduction loss, pin migration, infection, osteonecrosis of any part of the elbow, bone healing, and functional results were evaluated. Flynn criteria were used to evaluate the final results. Results: Twenty patients underwent open reduction and internal fixation by triceps splitting approach. Thirteen patients were male and seven were female with M:F ratio of 1.86:1. The mean age was 6.8 yr (SD=2.74, range 2-14. All the fractures united by six weeks; mean time for union was 4.5 wk (SD=0.94. All patients were assessed at six months using Flynn clinical and radiological criteria. Results were satisfactory in all patients. Conclusion: Posterior triceps splitting approach is simple, safe and has good functional and radiological outcome. We recommend this approach  for open reduction and internal fixation in pediatric supracondylar fracture.

  15. PROXIMITY MANAGEMENT IN CRISIS CONDITIONS

    Directory of Open Access Journals (Sweden)

    Ion Dorin BUMBENECI

    2010-01-01

    Full Text Available The purpose of this study is to evaluate the level of assimilation for the terms "Proximity Management" and "Proximity Manager", both in the specialized literature and in practice. The study has two parts: the theoretical research of the two terms, and an evaluation of the use of Proximity management in 32 companies in Gorj, Romania. The object of the evaluation resides in 27 companies with less than 50 employees and 5 companies with more than 50 employees.

  16. Avascular necrosis in proximal humeral fractures in patients treated with operative fixation: a meta-analysis.

    Science.gov (United States)

    Xu, Jiaming; Zhang, Changqing; Wang, Tao

    2014-04-27

    Proximal humeral fractures are common lesions of the elderly, but there are no established treatment guidelines. A surgical treatment for comminuted and displaced fractures of the proximal humerus was developed and is still evolving. The aim of this study was to perform a quantitative review to evaluate the risk of avascular necrosis (AVN) in patients with proximal humeral fractures who were treated by operative fixation compared with conservative treatment. We searched the PubMed, MEDLINE, Springer, Elsevier Science Direct, Cochrane Library, Google Scholar, China National Knowledge Infrastructure (in Chinese), and Wanfang database (in Chinese) up to December 2013 to identify studies related to operative fixation and AVN in patients with proximal humeral fractures. Seven studies with a total of 291 patients (142 operative fixation cases and 149 conservative treatment cases) with proximal humeral fractures were considered in the meta-analysis. The overall meta-analysis showed no significant difference in the incidence of AVN between the two groups [odds ratio (OR) 1.42, 95% confidence interval (CI) 0.33-6.11, p = 0.64]. The subgroup meta-analysis by study design (retrospective/prospective), sample size (≤40/>40), and ethnicity (European/Asian) demonstrated similar results. However, the subgroup analysis by specific operative approach (plate fixation/tension band wiring fixation/others) indicated that plate fixation was associated with a higher rate of AVN than conservative treatment (OR 0.20, 95% CI 0.05-0.76, p = 0.019). Plate fixation was associated with a higher risk of AVN development than conservative treatment in patients with proximal humeral fractures.

  17. Minimally invasive plate osteosynthesis for proximal humeral fractures: clinical and radiologic outcomes according to fracture type.

    Science.gov (United States)

    Sohn, Hoon-Sang; Shin, Sang-Jin

    2014-09-01

    This study evaluated the clinical and radiologic outcomes, according to fracture type, of proximal humeral fractures treated by the minimally invasive plate osteosynthesis (MIPO) technique. Of 85 patients with proximal humeral fractures who were treated by the MIPO technique, 62 were evaluated: 27 with 2-part fractures, 24 with 3-part fractures, and 11 with 4-part fractures. An additional inferomedial screw or fibular allograft was used when severe medial cortical comminution was found in the proximal humerus. Clinical and radiographic outcomes were evaluated during the follow-up of 37 months. There was a significant difference in the Constant scores of patients with 4-part fractures compared with those with 3-part fractures (P = .039). The neck-shaft angle in 4-part fractures (121° ± 3°) at final follow-up was significantly lower compared with other fracture types (2-part: 129° ± 9°, P = .036; 3-part: 129° ± 2°, P = .031). Complication rates (72.7%) of 4-part fractures were significantly higher than with other fracture types (2-part, 7.4%; 3-part, 20.8%; P = .001). Sixteen fractures were fixed with an additional inferomedial screw, and 3 patients had insertion of a fibular allograft. Satisfactory clinical and radiologic outcomes were obtained by the MIPO technique in proximal humeral fractures. In addition, medial cortical support can be performed with an inferomedial screw or fibular allograft in the MIPO technique. However, the MIPO technique for 4-part fractures showed relatively inferior outcomes compared with 2- and 3-part fractures. Conversion to open plating is also considered if adequate reduction, that is, a neck-shaft angle >120°, is not able to be obtained in the MIPO technique for 4-part fractures of the proximal humerus. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  18. Protein biomarker validation via proximity ligation assays.

    Science.gov (United States)

    Blokzijl, A; Nong, R; Darmanis, S; Hertz, E; Landegren, U; Kamali-Moghaddam, M

    2014-05-01

    The ability to detect minute amounts of specific proteins or protein modifications in blood as biomarkers for a plethora of human pathological conditions holds great promise for future medicine. Despite a large number of plausible candidate protein biomarkers published annually, the translation to clinical use is impeded by factors such as the required size of the initial studies, and limitations of the technologies used. The proximity ligation assay (PLA) is a versatile molecular tool that has the potential to address some obstacles, both in validation of biomarkers previously discovered using other techniques, and for future routine clinical diagnostic needs. The enhanced specificity of PLA extends the opportunities for large-scale, high-performance analyses of proteins. Besides advantages in the form of minimal sample consumption and an extended dynamic range, the PLA technique allows flexible assay reconfiguration. The technology can be adapted for detecting protein complexes, proximity between proteins in extracellular vesicles or in circulating tumor cells, and to address multiple post-translational modifications in the same protein molecule. We discuss herein requirements for biomarker validation, and how PLA may play an increasing role in this regard. We describe some recent developments of the technology, including proximity extension assays, the use of recombinant affinity reagents suitable for use in proximity assays, and the potential for single cell proteomics. This article is part of a Special Issue entitled: Biomarkers: A Proteomic Challenge. © 2013.

  19. Indications and limitations of the fixator TGF "Gex-Fix" in proximal end humeral fractures.

    Science.gov (United States)

    Parlato, A; D'Arienzo, A; Ferruzza, M; Galvano, N; D'Arienzo, M

    2014-12-01

    The incidence of fractures of the humerus has increased exponentially in recent years. The most used classifications for humerus fracture are morphological (Neer), biological (AO/ASIF) and descriptive (Hertel). The types of surgical treatment for humerus fracture include prosthetic replacement and synthesis using different devices, including the Tension Guide Fixator (TGF), Gex-Fix. External fixation for displaced proximal humeral fractures avoids dissection and soft tissue stripping and has been reported by some authors to be associated with higher union rates, a lower incidence of avascular necrosis, less scarring of the scapulohumeral interface, and faster rehabilitation compared with open reduction and internal fixation. Other authors have reported that external fixation does not ensure acceptable reduction and fracture stability, particularly in patients with osteoporosis. The external fixation technique involves the introduction of Steinmann's pin to keep manual reduction, the introduction of two K-wires in the humeral head, the removal of the Steinmann's pin, and the introduction of two fiches on the humeral shaft. Hub connectors are mounted on the wires and on the chips to connect the outer bar and tensioning system. A total of 84 patients aged 42-84 years with proximal end humeral fractures (66% had two-part fractures) were treated with Fixator TGF in this study from December 2007 to June 2012. The postoperative recovery was earlier and the active-assisted motion was less painful than has been reported with other surgical techniques. The TGF was removed without anaesthesia at the outpatient clinic at a mean of 7 weeks (range 5-8 weeks) after surgery, and there was no loss of reduction or secondary displacement after removal. These results, after five years of experience, confirm that the best indication for this fixator is two- or three-part fractures because the device enables early active mobilisation. The limitations of this fixator are evident in

  20. Little Leaguer's shoulder (proximal humeral epiphysiolysis): MRI findings in four boys

    Energy Technology Data Exchange (ETDEWEB)

    Obembe, Olufolajimi O.; Gaskin, Cree M.; Anderson, Mark W. [UVA Health Sciences Center, Department of Radiology, P.O. Box 800170, Charlottesville, VA (United States); Taffoni, Matthew J. [Piedmont Radiological Associates, Salisbury, NC (United States)

    2007-09-15

    Shoulder pain is a common problem among adolescent athletes. A possible cause of such pain that can be diagnosed on MRI is a stress injury to the proximal humerus known as Little Leaguer's shoulder (proximal humeral epiphysiolysis). Our objective was to describe the MRI appearance of Little Leaguer's shoulder. Four patients (all boys; age range 11-15 years; median 13 years) with clinical, plain radiographic, and MR imaging findings of Little Leaguer's shoulder were studied retrospectively. MRI demonstrated focal physeal widening in all four boys with extension of physeal signal intensity into the metaphysis on T1-weighted and gradient echo coronal and sagittal sequences. T2-weighted sequences were of limited use in demonstrating the physeal widening, which is critical to the diagnosis. Abnormal high T2-signal intensity was seen in the metaphysis adjacent to the focal physeal widening in all the boys. Focal extension of normal physeal T1-weighted and gradient echo signal intensity into the adjacent metaphysis is a sign of stress injury in the proximal humeral physis (Little Leaguer's shoulder). Children should suspend the offending sport to allow healing. (orig.)

  1. [Arthroscopic fracture management in proximal humeral fractures].

    Science.gov (United States)

    Lill, H; Katthagen, C; Jensen, G; Voigt, C

    2013-04-01

    Arthroscopy has become increasingly more established in the treatment of proximal humeral fractures. In addition to the known advantages of minimally invasive surgery fracture and implant positioning can be optimized and controlled arthroscopically and relevant intra-articular concomitant pathologies (e.g. biceps tendon complex and rotator cuff) can be diagnosed and treated. Arthroscopic techniques have proven to be advantageous in the treatment of various entities of greater tuberosity fractures, lesser tuberosity fractures (suture bridging technique) and subcapital humeral fractures (arthroscopic nailing). This article presents an overview on innovative arthroscopic modalities for treating proximal humeral fractures, describes the surgical techniques and the advantages compared to open procedures as well as initial clinical results.

  2. Hydatid disease of scapula and upper third of humerus treated by en bloc excision and fibular bone grafting

    Directory of Open Access Journals (Sweden)

    Chari P

    2007-01-01

    Full Text Available 35-year-old male patient presented with gradually increasing painful swelling of the right shoulder, which was incised and drained and wound persisted as a discharging sinus on the anterolateral aspect of the deltoid region with seropurulent discharge. A clinical diagnosis of tuberculosis of the shoulder was made. Plain skiagram of the right shoulder revealed multicystic lesion involving the entire scapula and upper third of the humerus with loss of joint space and pathological fracture at the junction of upper one-third and lower two-thirds of the humerus. A clinico-radiological diagnosis of hydatid disease was made. In view of the extensive involvement of the scapula with stiff shoulder and an active sinus, a two-stage surgical procedure was performed. Stage 1 consisted of en bloc excision of the scapula, upper half of the humerus and lateral end of the clavicle. Stage II surgery, consisting of fibular bone grafting. Tablet albendazole (400 mg, thrice daily was given as systemic scolicidal agent. This case is reported in view of it′s rarity and to highlight the management.

  3. Isometric measurement of wrist-extensor power following surgical treatment of displaced lateral condylar fracture of the humerus in children.

    Science.gov (United States)

    Chou, Po-Hsin; Feng, Chi-Kuang; Chiu, Fang-Yao; Chen, Tain-Hsiung

    2008-10-01

    Muscle disability is a common sequel after fracture management. Previous research has shown divergent results concerning muscle-power recovery after bone healing. This study has investigated the muscle function of wrist extensors after lateral condylar fracture in children, as evaluated by a hand-held dynamometer and compared with sex- and age-matched children. From 1999 to 2004, 20 patients (13 boys and seven girls; mean age: 9 years and 4 months) with displaced lateral condylar fracture of the humerus were treated by open reduction and internal fixation with Kirschner wires (K-wire). The duration of K-wire fixation was 35 days and the mean follow-up time was 50 months. A total of 180 healthy age-, sex- and weight-matched children were used as control groups. A paired Student's test was applied for the analysis of statistical significance. The range of motion of the elbow and radiographic findings were not significantly different between the injured limb and normal control groups. The maximum isometric power of wrist-extensor muscles after surgical treatment of lateral condylar fracture of the humerus in final follow-up was not statistically different from that in the normal control children. Muscle power therefore recovers to its normal status after the healing of lateral condylar fracture of the humerus in children.

  4. Shoulder 3D range of motion and humerus rotation in two volleyball spike techniques: injury prevention and performance.

    Science.gov (United States)

    Seminati, Elena; Marzari, Alessandra; Vacondio, Oreste; Minetti, Alberto E

    2015-06-01

    Repetitive stresses and movements on the shoulder in the volleyball spike expose this joint to overuse injuries, bringing athletes to a career threatening injury. Assuming that specific spike techniques play an important role in injury risk, we compared the kinematic of the traditional (TT) and the alternative (AT) techniques in 21 elite athletes, evaluating their safety with respect to performance. Glenohumeral joint was set as the centre of an imaginary sphere, intersected by the distal end of the humerus at different angles. Shoulder range of motion and angular velocities were calculated and compared to the joint limits. Ball speed and jump height were also assessed. Results indicated the trajectory of the humerus to be different for the TT, with maximal flexion of the shoulder reduced by 10 degrees, and horizontal abduction 15 degrees higher. No difference was found for external rotation angles, while axial rotation velocities were significantly higher in AT, with a 5% higher ball speed. Results suggest AT as a potential preventive solution to shoulder chronic pathologies, reducing shoulder flexion during spiking. The proposed method allows visualisation of risks associated with different overhead manoeuvres, by depicting humerus angles and velocities with respect to joint limits in the same 3D space.

  5. The infrastructure of psychological proximity

    DEFF Research Database (Denmark)

    Nickelsen, Niels Christian Mossfeldt

    2015-01-01

    ). The experience of psychological proximity between patient and nurse is provided through confidence, continuity and the practical set-up. This constitutes an important enactment of skillfulness, which may render telemedicine a convincing health service in the future. Methodology: The study draws on a pilot...... (Langstrup & Winthereik 2008). This study contributes by showing the infrastructure of psychological proximity, which is provided by way of device, confidence, continuity and accountability....

  6. TACTICS OF TREATMENT IN CHILDREN WITH INTRAARTICULAR FRACTURES OF THE DISTAL HUMERUS

    Directory of Open Access Journals (Sweden)

    Y. N. Proshchenko

    2012-01-01

    Full Text Available Material and methods. The authors studied 121 patients with intra-articular fractures of the distal humerus in age from 3 to 18 years. In the study group (consisted of 81 patients the displacement of the distal fragment retained after a single unsuccessful reduction. In these children open reduction and fixation were performed. In cases of damaged neurovascular bundle the authors carried out revision and reconstruction of damaged nerve and vascular trunks. The control group consisted of 40 children who were treated conservatively (closed reposition. Follow-up was at least 6 months after discharge. Results. Evaluation of the functional results showed improvement in 67,0% of patients in the study group and 33,0% - in the control group. In study group a good anatomic result was achieved in 73 (90% patients, satisfactory - in 6 (7,5% and poor - in 2 (2,5%. In the control group a good anatomical results were obtained in 7 (17,5% patients, satisfactory - in 14 (35%, poor -in 19 (47,5%. Conclusion. Indications for surgical treatment: secondary displacement of bone fragments after a single failure or closed reduction. Elimination of fragment displacement prevents posttraumatic contractures and deformities of the upper extremity, and contribute to the full restoration of elbow joint function.

  7. Results of lateral pin fixation for the displaced supracondylar fracture of humerus in children

    Directory of Open Access Journals (Sweden)

    HK Gupta

    2012-09-01

    Full Text Available Supracondylar fracture is common fracture in children and choice of treatment in displaced fracture is closed reduction and percutaneous pinning. There are different methods of fixation techniques described and practiced. This study was undertaken to evaluate the results of lateral pin fixation for the displaced supracondylar fracture of humerus in children. 25 children with displaced Supracondylar fracture were treated with closed reduction and percutaneous lateral fixation by two K-wires. Above elbow slab applied for 4 weeks (mean 28.4 days ± SD 2.27 followed by physiotherapy and were followed for mean of 73.24 days( ± SD 3.66 days. The Flynn’s grading system was used to evaluate functional and cosmetic outcome. Loss in Baumann’s angle was measures. All the patient had satisfactory outcome with excellent to good grading as per Flynn’s criteria. The mean Baumann’s angle loss was 5.52 degrees(SD ± 1.75. Two pin tract infections noted which responded to oral cloxacillin for 5 days. No neurovascular or serious complication noted. In view of results obtained, lateral K -wire fixation provided good fracture stability, good union and satisfactory outcome with minimal complication and virtually no iatrogenic nerve injury. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 13-17 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6820

  8. Calibrating animal-borne proximity loggers.

    Science.gov (United States)

    Rutz, Christian; Morrissey, Michael B; Burns, Zackory T; Burt, John; Otis, Brian; St Clair, James J H; James, Richard

    2015-06-01

    Growing interest in the structure and dynamics of animal social networks has stimulated efforts to develop automated tracking technologies that can reliably record encounters in free-ranging subjects. A particularly promising approach is the use of animal-attached 'proximity loggers', which collect data on the incidence, duration and proximity of spatial associations through inter-logger radio communication. While proximity logging is based on a straightforward physical principle - the attenuation of propagating radio waves with distance - calibrating systems for field deployment is challenging, since most study species roam across complex, heterogeneous environments.In this study, we calibrated a recently developed digital proximity-logging system ('Encounternet') for deployment on a wild population of New Caledonian crows Corvus moneduloides. Our principal objective was to establish a quantitative model that enables robust post hoc estimation of logger-to-logger (and, hence, crow-to-crow) distances from logger-recorded signal-strength values. To achieve an accurate description of the radio communication between crow-borne loggers, we conducted a calibration exercise that combines theoretical analyses, field experiments, statistical modelling, behavioural observations, and computer simulations.We show that, using signal-strength information only, it is possible to assign crow encounters reliably to predefined distance classes, enabling powerful analyses of social dynamics. For example, raw data sets from field-deployed loggers can be filtered at the analysis stage to include predominantly encounters where crows would have come to within a few metres of each other, and could therefore have socially learned new behaviours through direct observation. One of the main challenges for improving data classification further is the fact that crows - like most other study species - associate across a wide variety of habitats and behavioural contexts, with different signal

  9. The role of reverse shoulder arthroplasty in management of proximal humerus fractures with fracture sequelae: a systematic review of the literature

    National Research Council Canada - National Science Library

    James Holton; Tahir Yousri; George Arealis; Ofer Levy

    2017-01-01

    .... These patients are frequently elderly with significant medical comorbidities. Due to the age of the patient there is frequently rotator cuff deficiency and therefore the reverse shoulder arthroplasty (RSA...

  10. Arthroscopic-assisted plate fixation for displaced large-sized comminuted greater tuberosity fractures of proximal humerus: a novel surgical technique.

    Science.gov (United States)

    Park, Sang-Eun; Jeong, Jae-Jung; Panchal, Karnav; Lee, Jong-Yun; Min, Hyung-Ki; Ji, Jong-Hun

    2016-12-01

    The purpose of the present study was to describe the use of a novel hybrid surgical technique-arthroscopic-assisted plate fixation-and evaluate its clinical and anatomical outcomes in the management of large, displaced greater tuberosity (GT) fractures with comminution. From 2009 to 2011, this novel technique was performed in 11 patients [2 men and 9 women; median age, 64 years (range 41-83 years)] with large, comminuted GT fractures, with fragment displacements of >5 mm. The preoperative mean posterior and superior migration of the fractured fragment, as measured on computed tomography (CT), was 19.5 and 5.5 mm, respectively. Two patients had shoulder fracture-dislocation, and three had associated undisplaced surgical neck fracture. The mean duration between injury and surgery was 4 days. The mean follow-up duration was 26 months. At the final follow-up, the mean postoperative ASES, UCLA and SST scores were 84, 29, and 8, respectively. The mean range of motion was as follows: forward flexion, 138°; abduction, 135°; external rotation at the side, 19°; and internal rotation, up to the L2 level. The mean posterior and superior displacements of fracture fragments on postoperative CT scan [0.7 ± 0.8 mm (range 0-2.1 mm) and 2.8 ± 0.5 mm (range 3.4-5.3 mm), respectively] were significantly improved (p fracture fragment was noted in 1 patient at 4 weeks, after corrective reduction and fixation surgery. The novel arthroscopic-assisted anatomical plate fixation technique was found to be effective in reducing large-sized, displaced, comminuted GT fractures and in allowing concurrent management of intra-articular pathologies and early functional rehabilitation. Compared with the conventional plate fixation or arthroscopic suture anchor fixation technique, arthroscopic-assisted plate fixation enabled accurate restoration of the medial footprint of the GT fracture and provided an effective buttress to the large-sized GT fracture fragments. Retrospective clinical study, Level IV.

  11. Psychological responses to the proximity of climate change

    Science.gov (United States)

    Brügger, Adrian; Dessai, Suraje; Devine-Wright, Patrick; Morton, Thomas A.; Pidgeon, Nicholas F.

    2015-12-01

    A frequent suggestion to increase individuals' willingness to take action on climate change and to support relevant policies is to highlight its proximal consequences, that is, those that are close in space and time. But previous studies that have tested this proximizing approach have not revealed the expected positive effects on individual action and support for addressing climate change. We present three lines of psychological reasoning that provide compelling arguments as to why highlighting proximal impacts of climate change might not be as effective a way to increase individual mitigation and adaptation efforts as is often assumed. Our contextualization of the proximizing approach within established psychological research suggests that, depending on the particular theoretical perspective one takes on this issue, and on specific individual characteristics suggested by these perspectives, proximizing can bring about the intended positive effects, can have no (visible) effect or can even backfire. Thus, the effects of proximizing are much more complex than is commonly assumed. Revealing this complexity contributes to a refined theoretical understanding of the role that psychological distance plays in the context of climate change and opens up further avenues for future research and for interventions.

  12. Direct U-series analysis of the Lezetxiki humerus reveals a Middle Pleistocene age for human remains in the Basque Country (northern Iberia).

    Science.gov (United States)

    de-la-Rúa, Concepción; Altuna, Jesús; Hervella, Monserrat; Kinsley, Leslie; Grün, Rainer

    2016-04-01

    In 1964, a human humerus was found in a sedimentary deposit in Lezetxiki Cave (Basque Country, northern Iberia). The first studies on the stratigraphy, associated mammal faunal remains and lithic implements placed the deposits containing the humerus into the Riss glacial stage. Direct chronometric evidence has so far been missing, and the previous chronostratigraphic framework and faunal dating gave inconsistent results. Here we report laser ablation U-series analyses on the humerus yielding a minimum age of 164 ± 9 ka, corresponding to MIS 6. This is the only direct dating analysis of the Lezetxiki humerus and confirms a Middle Pleistocene age for this hominin fossil. Morphometric analyses suggest that the Lezetxiki humerus has close affinities to other Middle Pleistocene archaic hominins, such as those from La Sima de los Huesos at Atapuerca. This emphasizes the significance of the Lezetxiki fossil within the populations that predate the Neanderthals in south-western Europe. It is thus an important key fossil for the understanding of human evolution in Europe during the Middle Pleistocene, a time period when a great morphological diversity is observed but whose phylogenetic meaning is not yet fully understood. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Closed reduction and percutaneous annulated screw fixation in the treatment of comminuted proximal humeral fractures.

    Science.gov (United States)

    Yu, Zhe; Zheng, Lianhe; Yan, Xiaodong; Li, Xiaoxiang; Zhao, Jian; Ma, Bao'an

    2017-01-01

    Displaced proximal humeral fractures remain a challenge to orthopedic surgeons. The purpose of this study was to evaluate the functional and radiological outcomes of patients with comminuted proximal humeral fractures treated with closed reduction and percutaneous screw fixation (CRPF). The authors retrospectively reviewed 38 cases of displaced proximal humeral fractures (2-, 3- or 4-part fractures according to the Neer classification) that were treated using the CRPF technique from May 2009 to April 2013. From this group 26 patients were followed up for a period ranging from 9 to 24 months (averaging 12.9 months) and evaluated for the functional and radiological outcomes by a series of standard questionnaires and measurements. The fractures in all 26 patients were healed within an average time of 14.6 weeks (ranging from 11 to 27 weeks), and the mean interval between the operation and fully functional activity was 18.6 weeks (ranging from 15 to 32 weeks). At the final follow-up visit, no patient showed shoulder instability; the mean range of abduction motion was 146.5° (ranging from 72° to 180°). For all patients, no statistically significant difference in the functional outcomes was observed between their 6-month and final follow-up visits; or in the radiological findings between their immediate post-operative and final follow-up examinations. The CRPF technique is a safe and effective therapeutic option for comminuted proximal humeral fractures. Good stability is obtained and aggressive impairment of the soft tissue and periosteum around the fracture is avoided, which allows for an early painless range of motion. The technique promotes bone healing, prevents ischemic osteonecrosis of the head of the humerus and leads to few complications.

  14. Cubesat Proximity Operations Demonstration (CPOD)

    Science.gov (United States)

    Villa, Marco; Martinez, Andres; Petro, Andrew

    2015-01-01

    The CubeSat Proximity Operations Demonstration (CPOD) project will demonstrate rendezvous, proximity operations and docking (RPOD) using two 3-unit (3U) CubeSats. Each CubeSat is a satellite with the dimensions 4 inches x 4 inches x 13 inches (10 centimeters x 10 centimeters x 33 centimeters) and weighing approximately 11 pounds (5 kilograms). This flight demonstration will validate and characterize many new miniature low-power proximity operations technologies applicable to future missions. This mission will advance the state of the art in nanosatellite attitude determination,navigation and control systems, in addition to demonstrating relative navigation capabilities.The two CPOD satellites are scheduled to be launched together to low-Earth orbit no earlier than Dec. 1, 2015.

  15. Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Jia-Guo Zhao

    Full Text Available There are three main surgical techniques to treat humeral shaft fractures: open reduction and plate fixation (ORPF, intramedullary nail (IMN fixation, and minimally invasive percutaneous osteosynthesis (MIPO. We performed a network meta-analysis to compare three surgical procedures, including ORPF, IMN fixation, and MIPO, to provide the optimum treatment for humerus shaft fractures.MEDLINE, EMBASE, Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, and Cochrane library were researched for reports published up to May 2016. We only included randomized controlled trials (RCTs comparing two or more of the three surgical procedures, including the ORPF, IMN, and MIPO techniques, for humeral shaft fractures in adults. The methodological quality was evaluated based on the Cochrane risk of bias tool. We used WinBUGS1.4 to conduct this Bayesian network meta-analysis. We used the odd ratios (ORs with 95% confidence intervals (CIs to calculate the dichotomous outcomes and analyzed the percentages of the surface under the cumulative ranking curve.Seventeen eligible publications reporting 16 RCTs were included in this study. Eight hundred and thirty-two participants were randomized to receive one of three surgical procedures. The results showed that shoulder impingement occurred more commonly in the IMN group than with either ORPF (OR, 0.13; 95% CI, 0.03-0.37 or MIPO fixation (OR, 0.08; 95% CI, 0.00-0.69. Iatrogenic radial nerve injury occurred more commonly in the ORPF group than in the MIPO group (OR, 11.09; 95% CI, 1.80-124.20. There were no significant differences among the three procedures in nonunion, delayed union, and infection.Compared with IMN and ORPF, MIPO technique is the preferred treatment method for humeral shaft fractures.

  16. Comparison of two approaches of infraclavicular brachial plexus block for orthopaedic surgery below mid-humerus

    Directory of Open Access Journals (Sweden)

    Vikas Trehan

    2010-01-01

    Full Text Available The brachial plexus in infraclavicular region can be blocked by various approaches. Aim of this study was to compare two approaches (coracoid and clavicular regarding success rate, discomfort during performance of block, tourniquet tolerance and complications. The study was randomised, prospective and observer blinded. Sixty adult patients of both sexes of ASA status 1 and 2 requiring orthopaedic surgery below mid-humerus were randomly assigned to receive nerve stimulator guided infraclavicular brachial plexus block either by lateral coracoid approach (group L, n = 30 or medial clavicular approach (group M, n = 30 with 25-30 ml of 0.5% bupivacaine. Sensory block in the distribution of five main nerves distal to elbow, motor block (Grade 1-4, discomfort during performance of block and tourniquet pain were recorded by a blinded observer. Clinical success of block was defined as the block sufficient to perform the surgery without any supplementation. All the five nerves distal to elbow were blocked in 77 and 67% patients in groups L and M respectively. Successful block was observed in 87 and 73% patients in groups L and M, respectively (P > 0.05. More patients had moderate to severe discomfort during performance of block due to positioning of limb in group M (14 vs. 8 in groups M and L. Tourniquet was well tolerated in most patients with successful block in both groups. No serious complication was observed. Both the approaches were equivalent regarding success rate, tourniquet tolerance and safety. Coracoid approach seemed better as positioning of operative limb was less painful, coracoids process was easy to locate and the technique was easy to learn and master.

  17. Gartland type I supracondylar humerus fractures in children: is splint immobilization enough?

    Science.gov (United States)

    Cuomo, Anna V; Howard, Andrew; Hsueh, Sophia; Boutis, Kathy

    2012-11-01

    The primary objective of this study was to determine if Gartland type I supracondylar humerus (SCH) fractures undergo significant displacement resulting in a change in management when treated with a long-arm splint. Secondary objectives included measured changes at follow-up in displacement and/or angulation. This was a retrospective review of children who presented with elbow injuries to a children's hospital. Patients were included if they were diagnosed with a Gartland type I SCH fracture, managed with a long-arm splint, and had at least 1 follow-up visit 2 to 3 weeks from the emergency department visit. The primary outcome was the proportion of cases that required the placement of a circumferential cast and/or an operative intervention. Secondary outcomes included the proportion of cases with significant changes in displacement on any view, Baumann or the lateral humerocapitellar angle, and/or category of position of anterior humeral line relative to capitellum. Of 804 elbow injuries that presented from 2003 to 2008, 53 patients met the inclusion criteria. The median age of the patients was 4.1 years (interquartile range, 3.4-6.1 years) years. Of the 53, there were no cases that required a change in management. One case had a change in the humerocapitellar angle, and another had a change of 1 category in position of the capitellum relative to the anterior humeral line. There were no other cases of significant changes in displacement or angulation. These data support that Gartland type I SCH fractures can be treated effectively with long-arm posterior splinting for the duration of therapy.

  18. A PROSPECTIVE STUDY OF SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN TREATED BY CLOSED REDUCTION

    Directory of Open Access Journals (Sweden)

    Ch. Imobi

    2015-08-01

    Full Text Available There is no universal agreement regarding the management of displaced supracondylar fracture of the humerous in children. According to some orthopaedic surgeon almost all supracondylar humeral fractures should be treated operatively by reduction and pinning. While according to others closed reduction and pinning should be used for Gartland type II and some type III fractures. We present 50 cases of displaced supracondylar fracture treated by closed manipulative reduction under G.A. and immobilization with a posterior plaster of paris slab and collar and cuff. OBJECTIVE : T o assess the functional results of the injured elbow and to study the incidence of change in the carrying angle of the elbow. MATERIALS AND METHODS: This prospective study was conducted in 50 patients with extension type of displaced supracondylar fractures of humerus in children (Gartland type II and type III treated by closed manipulative reduction and immobilization in flexion of the elbow with a posterior plaster of paris slab and collar and cuff. Patients were followed up for 6 months. Flexion type of supracondylar fracture and those fractures which are absolutely indicated for operative intervention, Viz an open fracture and severe vascular compromise were excluded from the study. The range of movement and carrying angle was measured with the help of a Goniometer and Flynn criteria were used for functional assessment. RESULTS: At the end of follow up period, the end results were graded as excellent in 40%, good in 42%, fair in 12% and poor in 6%. A satisfactory result was therefore obtained in 94% and unsatisfactory result in 6% of the 50 patients who were followed and evaluated. CONCLUSION: This closed method of treatment for all practical proposes produces least complications, shorter hospital stay, can be expected to yield reproducible consistent satisfactory results not surpassed by any other method of treatment.

  19. Arthroscopic percutaneous inverted mattress suture fixation of isolated greater tuberosity fracture of humerus.

    Science.gov (United States)

    Jang, Suk-Hwan; Song, Han-Eui; Choi, Seung-Hyuk

    2018-01-01

    The purpose of the study was to evaluate the clinical and radiographic outcomes of treatment in patients with isolated greater tuberosity (GT) fractures of humerus using arthroscopic percutaneous inverted mattress suture fixation technique. We attempted to use the arthroscopic percutaneous inverted mattress suture fixation technique in 17 consecutive cases with isolated displaced GT fractures. Fourteen patients were successfully treated without switching to other methods and were available for follow-up at a mean of 22 months (range: 17-38 months) after surgery. For assessment of clinical outcomes, we evaluated the range of motion and the visual analog scale (VAS) score, the shoulder index of the American Shoulder and Elbow Surgeons (ASES), and the Korean Shoulder Scale (KSS). At the final follow-up, the VAS improved to 1.0 points (range: 0-3), the mean ASES score improved to 86.9 points (range: 78.3-100) and the KSS improved to 88.6 points (range: 82-100) postoperatively. Mean union time was 10 weeks. Mean forward flexion was 167.8° (range: 140-180°), mean external rotation in neutral position was 36° (range: 20-70°), and mean internal rotation was at the 12th thoracic level (range: T6-L3) at final follow-up. Three cases were switched to open surgery after attempted arthroscopic technique due to large fragment or osteoporosis. In select cases, the arthroscopic percutaneous inverted mattress suture fixation of GT fracture is a simple and reproducible technique with encouraging early results.

  20. Risk of Adverse Outcomes in Euploid Pregnancies With Isolated Short Fetal Femur and Humerus on Second-Trimester Sonography.

    Science.gov (United States)

    Kaijomaa, Marja; Ulander, Veli-Matti; Ryynanen, Markku; Stefanovic, Vedran

    2016-12-01

    The purpose of this study was to evaluate pregnancies with isolated short fetal femur and humerus on second-trimester sonography. Short fetal long bones are known to be associated with aneuploidy and structural anomalies. In this study, we wanted to show the risk of adverse pregnancy outcomes in euploid and nonanomalous pregnancies. Singleton pregnancies with short femur and humerus were included. Pregnancies with normal fetal bone lengths and age-matched mothers were selected as controls. The study group included 30 pregnancies with short fetal femur and humerus, and the control group included 60 normal pregnancies. The overall odds ratio for an adverse pregnancy outcome in the study group was 24.9. Preterm delivery occurred significantly more frequently (odds ratio, 20.8; P < .001), and one-third of pregnancies were complicated by preeclampsia. In the group with short long bones, the odds ratio for a pathologic umbilical Doppler flow pattern was 45.2 (P < .001), and birth weight was significantly lower (P < .001). Also, 3 (10.3%) stillbirths and 4 (13.3%) cases of early neonatal death were recorded in this group. These complications were not recorded in the control group. The risk of emergency cesarean delivery was significantly higher in the group with short long bones (odds ratio, 11.8; P < .001). The risk of adverse pregnancy outcomes is significant in euploid and nonanomalous pregnancies with isolated short long bones. Close follow-up is needed during pregnancy. © 2016 by the American Institute of Ultrasound in Medicine.

  1. Clinical and radiological outcomes of unstable proximal humeral fractures treated with a locking plate and fibular strut allograft.

    Science.gov (United States)

    Panchal, Karnav; Jeong, Jae-Jung; Park, Sang-Eun; Kim, Weon-Yoo; Min, Hyung-Ki; Kim, Ju-Yeong; Ji, Jong-Hun

    2016-03-01

    To evaluate the clinical and radiological outcomes of unstable proximal humeral fractures (PHFs) treated with a locking plate and fibular strut allograft. This study included 36 patients [7 men, 29 women; mean age, 68 years (range, 22-94 years)] with unstable PHFs with medial column disruption. All patients were treated with open reduction and internal fixation using a locking plate and fibular strut allograft. Post-operative assessment included clinical outcomes, shoulder range of motion, radiographic examination, and any complications. Post-operative radiological assessment including the humerus neck-shaft angle (NSA) and the humeral head height was performed. At the mean two year follow-up visit, the mean American Shoulder and Elbow Society (ASES) and University of California, Los Angeles (UCLA) scores were 77 and 28, respectively. According to the UCLA rating scale, the result was excellent in six, good in 20, fair in six, and poor in four cases. According to the Paavolainen method, 31 patients had good results with an NSA of 130 ± 10°; three patients showed fair results with an NSA of 100-120°, and two patients experienced a poor result with an NSA of humeral head height, the mean loss of reduction was measured as 1.6 mm (from 10.8 or 9.2 mm). Varus collapse and avascular necrosis of the humeral head was noted in two patients for each condition. For unstable proximal humerus fractures, particularly in elderly patients with severe osteoporosis or in younger patients with a four-part fracture, locking plate fixation with a fibular strut allograft provided rigid medial support and showed satisfactory clinical and radiological outcomes.

  2. SHORT COMMUNICATION PROXIMATE COMPOSITION, MINERAL ...

    African Journals Online (AJOL)

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    SHORT COMMUNICATION. PROXIMATE COMPOSITION, MINERAL CONTENT AND ANTINUTRITIONAL. FACTORS OF SOME CAPSICUM (Capsicum annum) VARIETIES GROWN IN. ETHIOPIA. Esayas K.1, Shimelis A.2, Ashebir F.3, Negussie R.3, Tilahun B.4 and Gulelat D.4*. 1Hawassa University, Department of Food ...

  3. Irreducible Proximal Interphalangeal Joint Dislocation of the Fourth ...

    African Journals Online (AJOL)

    Dislocation of the interphalangeal joint of the toe is a very rare injury and there are only few published reports. Most of the cases reported are those of the hallucal interphalangeal joint. There are only very few reports of complex dislocations of the proximal interphalangeal joint of the fourth toe in the world literature. Nigerian ...

  4. Surgical Interventions for the Treatment of Supracondylar Humerus Fractures in Children: Protocol of a Systematic Review.

    Science.gov (United States)

    Carrazzone, Oreste Lemos; Belloti, João Carlos; Matsunaga, Fabio Teruo; Mansur, Nacime Salomão Barbachan; Matsumoto, Marcelo Hide; Faloppa, Flavio; Tamaoki, Marcel Jun Sugawara

    2017-11-21

    The treatment of supracondylar humerus fracture in children (SHFC) is associated with complications such as functional deficit, residual deformity, and iatrogenic neurological damage. The standard treatment is closed reduction and percutaneous Kirschner wire fixation with different configurations. Despite this fact, there is still no consensus on the most effective technique for the treatment of these fractures. The aim of this systematic review will be to evaluate the effect of surgical interventions on the treatment of Gartland type II and III SHFC by assessing function, complications, and error as primary outcomes. Clinical outcomes such as range of motion and pain and radiographic outcomes will also be judged. A systematic review of randomized controlled trials or quasi-randomized controlled trials evaluating the surgical treatment of SHFC will be carried out in the Cochrane Central Register of Controlled Trials, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde, and Excerpta Medica Database. The search will also occur at ongoing and recently completed clinical trials in selected databases. Data management and extraction will be performed using a data withdrawal form and by analyzing the following: study method characteristics, participant characteristics, intervention characteristics, results, methodological domains, and risk of bias. To assess the risk of bias of the included trials, the Cochrane Risk of Bias Tool will be used. Dichotomous outcome data will be analyzed as risk ratios, and continuous outcome data will be expressed as mean differences, both with 95% confidence intervals. Also, whenever possible, subgroup analysis, sensitivity analysis, and assessment of heterogeneity will be performed. Following the publication of this protocol, searches will be run and included studies will be deeply analyzed. We hope to obtain final results in the next few months and have the final paper published by the end of 2018. This study was funded

  5. Foam padding in casts accommodates soft tissue swelling and provides circumferential strength after fixation of supracondylar humerus fractures.

    Science.gov (United States)

    Seehausen, Derek A; Kay, Robert M; Ryan, Deirdre D; Skaggs, David L

    2015-01-01

    Varying casting techniques are used after surgical treatment of pediatric supracondylar humerus fractures. The goals are to maintain fracture reduction, while accommodating soft tissue swelling and minimizing the risk of compartment syndrome. A retrospective chart review of consecutive patients aged 0 to 14 years who underwent surgical treatment of supracondylar humerus fractures over a 9½-year period at a pediatric trauma center was performed. A new method of casting, in which one half inch sterile foam is applied directly to the skin and overwrapped by circumferential fiberglass, is presented and compared with traditional casts. A total of 541 consecutive patients were included. Foam had been used in 35% (190/541) of patients. Foam was used significantly more frequently in Gartland type 3 fractures (133/314 patients, 42%) than in type 2 fractures (57/227 patients, 25%) (Pfiberglass casting. This method offers the theoretical advantage of the strength of a circumferential cast, plus the benefit of allowing for swelling. Although the novel foam and cast combination was used in more severe fractures, results were comparable to traditional casts and may reduce the need for cast splitting. Therapeutic-Level III.

  6. Secondary aneurysmal bone cyst in the distal humerus after resection of intra-articular nodular fasciitis of the elbow.

    Science.gov (United States)

    Yamamoto, Michiro; Urakawa, Hiroshi; Nishida, Yoshihiro; Hirata, Hitoshi

    2015-07-22

    Nodular fasciitis most often occurs within subcutaneous tissues, but may also arise within skeletal muscle, dermis, vessels, peripheral nerves and, although rarely, within joints. Knowledge regarding the cause of aneurysmal bone cysts, its natural history, and the results of treatment is limited. Secondary aneurysmal bone cysts are associated with other neoplastic processes. Intra-articular nodular fasciitis in the elbow joint has not been reported previously, nor has the development of aneurysmal bone cyst secondary to intra-articular nodular fasciitis in the elbow joint. We report an unusual case of a Japanese 13-year-old boy who presented with a 1-year history of right elbow pain. The onset of pain was insidious, without antecedent trauma. On physical examination, the range of motion of the elbow was limited. Grip strength was reduced in the affected extremity. Incisional biopsy was performed and histologic findings revealed nodular fasciitis in the elbow joint. After tumor excision, a secondary aneurysmal bone cyst in the distal humerus developed. Endoscopy-assisted curettage and artificial bone grafting were performed. One year after surgery, a plain radiography showed no recurrence, and the patient returned to his daily activities without any symptoms. An aneurysmal bone cyst in the distal humerus developed after excision of intra-articular nodular fasciitis arising in the elbow. The secondary aneurysmal bone cyst successfully healed after endoscopy-assisted curettage and artificial bone grafting. The findings of this case suggest that these two tumors reside in the same biologic spectrum defined as USP6-induced tumors.

  7. Open Reduction and Internal Fixation of displaced Supracondylar Fractures of Humerus with Crossed K-wires via Medial Approach

    Directory of Open Access Journals (Sweden)

    S Hussain

    2014-07-01

    Full Text Available This study aimed at evaluating the medial approach for open reduction and internal fixation of Gartland type 3 displaced supracondylar fractures of humerus in children. A prospective, single centre study of on displaced supracondylar humerus fractures in 42 children was carried out at our institute. All fractures were managed with open reduction and internal fixation with crossed K-wires via medial approach. The mean follow-up was 12 months and patients were assessed according to Flynn’s criteria. No patients had post-operative ulnar nerve injury. Cubitus varus was not seen in any patient. Superficial pin tract infection occurred in three patients that subsided with anti-septic dressings and antibiotics. No deep infection occurred. 88.09 % patients showed satisfactory results as per Flynn’s criteria. The medial approach provides an excellent view of the supracondylar area. The approach is convenient due to a lower risk for ulnar nerve injury and better acceptability of the medial incisional scar.

  8. Lactated Ringer's solution or 0.9% sodium chloride as fluid therapy in pigeons (Columba livia submitted to humerus osteosynthesis

    Directory of Open Access Journals (Sweden)

    Adriano B. Carregaro

    2015-01-01

    Full Text Available The study aimed to compare the effects of intraosseous infusion of lactated Ringer's and 0.9% sodium chloride solutions on the electrolytes and acid-base balance in pigeons submitted to humerus osteosynthesis. Eighteen pigeons were undergoing to isoflurane anesthesia by an avalvular circuit system. They were randomly assigned into two groups (n=9 receiving lactated Ringer's solution (LR or 0.9% sodium chloride (SC, in a continuous infusion rate of 20mL/kg/h, by using an intraosseous catheter into the tibiotarsus during 60-minute anesthetic procedure. Heart rate (HR, and respiratory rate (RR were measured every 10 min. Venous blood samples were collected at 0, 30 and 60 minutes to analyze blood pH, PvCO2, HCO3 -, Na+ and K+. Blood gases and electrolytes showed respiratory acidosis in both groups during induction, under physical restraint. This acidosis was evidenced by a decrease of pH since 0 min, associated with a compensatory response, observed by increasing of HCO3 - concentration, at 30 and 60 min. It was not observed any changes on Na+ and K+ serum concentrations. According to the results, there is no reason for choosing one of the two solutions, and it could be concluded that both fluid therapy solutions do not promote any impact on acid-base balance and electrolyte concentrations in pigeons submitted to humerus osteosynthesis.

  9. Anthropometric measurements of the scapula, humerus, radius and ulna in Labrador dogs with and without elbow dysplasia.

    Science.gov (United States)

    Davidson, P T; Bullock-Saxton, J; Lisle, A

    2008-11-01

    To determine if anthropometric measurements of the Labrador scapula, humerus, ulna and radius, or their ratios, are related to the presence of elbow dysplasia (ED). Digital calliper measurements of the lengths of the left scapula, humerus, radius and ulna, and their ratios, were analysed by gender in 103 volunteer Labradors (41 dogs, 62 bitches) against the ED radiological scores derived by the International Elbow Working Group (IEWG). The IEWG score is an umbrella score used to classify for ED and includes fragmented coronoid process, osteochondritis dessicans, incongruity and ununited anconeal process, the last of which occurs rarely in Labradors. Of the 103 Labradors studied, 31 were diagnosed radiographically with ED (20 bitches (32%), 11 (27%) dogs). Scapula length was significantly shorter for bitches with ED (P = 0.02), but not for dogs with ED. However, dogs showed a trend for a difference in the ulna:radius ratio (P = 0.06), which bitches did not. Although a greater percentage of bitches than dogs had ED in this study, the difference was not statistically significant. Labrador bitches diagnosed with ED have a shorter scapula, which is a new finding associated with this condition. The difference in presentation associated with gender is unexpected and further research is recommended.

  10. New classification of proximal humeral fractures

    Energy Technology Data Exchange (ETDEWEB)

    Seemann, W.R.; Rupp, H.G.; Siebler, G.

    1986-08-01

    Neer's classification of humeral fractures was proved on 657 patients. This classification enables the radiologist to estimate the risk of avascular necrosis of the head of the humerus. The problematic group is that of four part lesions, which has a 19% incidence of humeral head necrosis. Since in this group minimal osteosynthesis produces better functional results than extensive osteosynthesis, a detailed pre-operative radiological description of the fracture type is necessary in order to spare the patient from extensive surgery which could have unsatisfactory results.

  11. Photoactivated In Vivo Proximity Labeling.

    Science.gov (United States)

    Beck, David B; Bonasio, Roberto

    2017-06-19

    Identification of molecular interactions is paramount to understanding how cells function. Most available technologies rely on co-purification of a protein of interest and its binding partners. Therefore, they are limited in their ability to detect low-affinity interactions and cannot be applied to proteins that localize to difficult-to-solubilize cellular compartments. In vivo proximity labeling (IPL) overcomes these obstacles by covalently tagging proteins and RNAs based on their proximity in vivo to a protein of interest. In IPL, a heterobifunctional probe comprising a photoactivatable moiety and biotin is recruited by a monomeric streptavidin tag fused to a protein of interest. Following UV irradiation, candidate interacting proteins and RNAs are covalently biotinylated with tight spatial and temporal control and subsequently recovered using biotin as an affinity handle. Here, we describe experimental protocols to discover novel protein-protein and protein-RNA interactions using IPL. © 2017 by John Wiley & Sons, Inc. Copyright © 2017 John Wiley & Sons, Inc.

  12. Prox-1 Automated Proximity Operations

    Science.gov (United States)

    2016-01-13

    on demonstrating the functionality required to meet minimum mission success criteria. The minimum mission includes on- orbit spacecraft checkout of...also includes deployment of LightSail-B from the P-POD, and imaging of LightSail-B for 20 minutes as it recedes from Prox-1. small satellite ; proximity...criteria. The minimum mission includes on- orbit spacecraft checkout of all spacecraft subsystems, including flight qualification of the following new

  13. Treatment of comminuted proximal humeral fractures using locking plate with strut allograft.

    Science.gov (United States)

    Cha, Hongeun; Park, Ki-Beom; Oh, Seungbae; Jeong, Jinyoung

    2017-05-01

    This study compared the radiologic outcome of fixation using locking plate only with fixation using locking plate with an endosteal strut allograft in the treatment of comminuted proximal humeral fracture. Among 52 patients with comminuted proximal humeral fracture, 32 patients underwent fixation with locking plate only, and 20 patients underwent fixation using locking plate with an endosteal strut allograft. The strut allograft was inserted into the intramedullary cavity of the humerus to support the humeral head and fixed with the locking plate. Immediate postoperative radiologic findings were compared with those of 6 months or more after the surgery, and loss of anatomic fixation was defined if the varus malalignment of neck-shaft angle (NSA) was more than 5° or if the change of humeral head height (HHH) was more than 3 mm. In the locking plate-only group, 22 of 32 patients (69%) showed the change in NSA of more than 5°, with an average of 10.2°. The HHH change in 20 patients (62.5%) was more than 3 mm, with an average of 4 mm. Among 20 patients who underwent locking plate with the endosteal strut allograft, the average NSA and HHH change was 3° and 1 mm, respectively. Varus malalignment was evident in 2 patients (10%). The HHH change was more than 3 mm in 1 patient (5%). Fixation using a locking plate with an endosteal strut allograft can be considered a reasonable option to maintain the anatomic reduction in elderly patients with comminuted proximal humeral fracture. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. Biomechanical effect of medial cortical support and medial screw support on locking plate fixation in proximal humeral fractures with a medial gap: a finite element analysis.

    Science.gov (United States)

    Yang, Pan; Zhang, Ying; Liu, Jian; Xiao, Jin; Ma, Li Min; Zhu, Chang Rong

    2015-01-01

    This finite element analysis aimed to examine the effect of medial cortical support and medial screw support on loads at the implant-bone interface of locking plate fixation of proximal humeral fractures with a medial gap. An intact humerus from a healthy volunteer was used as the basis for a 3-dimensional (3D) computer-aided design (CAD) model. The 3D CAD model of the locking plate system was based on information in the manufacturer's catalogue. The proximal part of the humerus was osteotomized to create standard three-part fractures, which were then divided into a -MSC group (which lacked medial cortical support, and in which fractures with a 5-mm medial bone gap simulated this lack) and +MCS group (which had medial cortical support, and in which fractures with medial cortical-to-cortical contact simulated this). Both fracture groups were respectively fixed with either +MSS (in which medial screw support was simulated by the addition of two calcar screws to the locking plate system), or with -MSS (in which the lack of medial screw support was simulated by absence of the two additional calcar screws to the locking plate system). All the modeling was conducted to represent 90° arm abduction. On the screw-bone interface, medial screw support and medial cortical support decreased maximum shear stress by 17% and 23% respectively. On the locking plate, medial screw support and medial cortical support decreased maximum von Mises stress by 11% and 22% respectively. However, a combination of these two appeared to decrease maximum shear stress by 56% for the screw-bone interface, and maximum von Mises stress by 54% for the locking plate. Placement of calcar screws combined with good medial cortical contact in varus in locking plate fixation of proximal humeral fractures with a medial gap may provide optimal stability for the fixation.

  15. PROXIMATE AND ELEMENTAL COMPOSITION OF WHITE GRUBS

    African Journals Online (AJOL)

    DR. AMINU

    PROXIMATE AND ELEMENTAL COMPOSITION OF WHITE GRUBS. 1 Alhassan, A. J. 1M .S. Sule, 1J. ... ABSTRACT. This study determined the proximate and mineral element composition of whole white grubs using standard methods of analysis. Proximate ... days, before pulverized to powder and kept in plastic container.

  16. Clinical study of emergency treatment and selective closed reduction for the treatment of supracondylar humerus fracture in children

    Directory of Open Access Journals (Sweden)

    Wei Zhong

    2016-11-01

    Full Text Available Objective: To study the effect of emergency treatment, selective closed reduction combined with percutaneous Kirschner wire fixation on the treatment of Gartland type-II and type-III supracondylar humerus fracture. Methods: Children who sustained the Gartland type-II and type-III supracondylar fractures of humerus treated with selective closed reduction combined with percutaneous Kirschner wire fixation in our hospital from May 2012 to August 2015 were analyzed retrospectively. They were divided into group A (emergency operation group and group B (selective operation group according to different operation timing. Perioperative situation, blood biochemical parameters, swelling degree and elbow joint function of affected limb were compared between two groups. Results: Operation time for patients of group A was significantly shorter than that of group B [(17.19 ± 2.85 vs. (21.43 ± 3.91 min], and frequency of fluoroscopy during operation of group A was obviously less than that of group B [(6.03 ± 0.95 vs. (7.61 ± 0.92 times]. Swelling index of affected limb in group A at 3 days, 5 days and 7 days after injury was all significantly lower than that in group B [(1.20 ± 0.17 vs. (1.38 ± 0.14, (1.13 ± 0.13 vs. (1.30 ± 0.18, (1.02 ± 0.15 vs. (1.22 ± 0.15]. Hospital for special surgery score at 1 week, 2 weeks, 3 and 4 weeks after removing Kirschner wire had no significant difference between group A and B (88.75 ± 10.18 vs. (89.14 ± 10.52, (94.22 ± 10.85 vs. (93.85 ± 11.08, (95.52 ± 11.27 vs. (95.92 ± 12.19, (95.43 ± 10.96 vs. (96.02 ± 11.38. Contents of serum alanine transaminase, aspertate aminotransferase, total protein, albumin and C-reactive protein in perioperative period had no obvious difference between patients in group A and B. Conclusions: Emergency closed reduction combined with percutaneous Kirschner wire fixation for Gartland type-II and type-III supracondylar humerus fracture in children has less trauma, low swelling degree

  17. The Applications of Finite Element Analysis in Proximal Humeral Fractures

    Science.gov (United States)

    Ye, Yongyu; You, Wei; Zhu, Weimin; Cui, Jiaming; Chen, Kang

    2017-01-01

    Proximal humeral fractures are common and most challenging, due to the complexity of the glenohumeral joint, especially in the geriatric population with impacted fractures, that the development of implants continues because currently the problems with their fixation are not solved. Pre-, intra-, and postoperative assessments are crucial in management of those patients. Finite element analysis, as one of the valuable tools, has been implemented as an effective and noninvasive method to analyze proximal humeral fractures, providing solid evidence for management of troublesome patients. However, no review article about the applications and effects of finite element analysis in assessing proximal humeral fractures has been reported yet. This review article summarized the applications, contribution, and clinical significance of finite element analysis in assessing proximal humeral fractures. Furthermore, the limitations of finite element analysis, the difficulties of more realistic simulation, and the validation and also the creation of validated FE models were discussed. We concluded that although some advancements in proximal humeral fractures researches have been made by using finite element analysis, utility of this powerful tool for routine clinical management and adequate simulation requires more state-of-the-art studies to provide evidence and bases. PMID:29081829

  18. The Applications of Finite Element Analysis in Proximal Humeral Fractures

    Directory of Open Access Journals (Sweden)

    Yongyu Ye

    2017-01-01

    Full Text Available Proximal humeral fractures are common and most challenging, due to the complexity of the glenohumeral joint, especially in the geriatric population with impacted fractures, that the development of implants continues because currently the problems with their fixation are not solved. Pre-, intra-, and postoperative assessments are crucial in management of those patients. Finite element analysis, as one of the valuable tools, has been implemented as an effective and noninvasive method to analyze proximal humeral fractures, providing solid evidence for management of troublesome patients. However, no review article about the applications and effects of finite element analysis in assessing proximal humeral fractures has been reported yet. This review article summarized the applications, contribution, and clinical significance of finite element analysis in assessing proximal humeral fractures. Furthermore, the limitations of finite element analysis, the difficulties of more realistic simulation, and the validation and also the creation of validated FE models were discussed. We concluded that although some advancements in proximal humeral fractures researches have been made by using finite element analysis, utility of this powerful tool for routine clinical management and adequate simulation requires more state-of-the-art studies to provide evidence and bases.

  19. Clinical applicability of resin infiltration for proximal caries.

    Science.gov (United States)

    Altarabulsi, Mohammad Basel; Alkilzy, Mohammad; Splieth, Christian H

    2013-02-01

    Resin infiltration is a new microinvasive treatment to arrest the progress of proximal initial caries lesions. This study evaluated the clinical applicability of proximal caries infiltration. In the study population of 50 children, adolescents, and young adults (mean age, 17.3 ± 6.4 years), 10 dentists at the University of Greifswald, Greifswald, Germany, applied the infiltration material Icon on noncavitated proximal lesions in permanent and primary teeth as described by the manufacturer. The applicability was evaluated using two questionnaires filled out by clinicians and patients assessing the comfort, complexity, time, and difficulties of the application in comparison to a filling. The results showed good patient satisfaction with the procedure. The mean time for infiltration (24.3 ± 7.4 minutes), which included rubber dam application (7.7 ± 4 minutes) and the effort were perceived to be comparable to or even easier than a composite filling by clinicians. In three patients (6%), it was not possible to gain sufficient proximal space for the application of an infiltration. The location of the infiltrated tooth, separation problems, and the routine of clinicians with the infiltration technique had an effect on the duration of the infiltration. A clear learning curve with a reduction of treatment time for subsequent treatments was observed (P proximal lesion showed good clinical applicability for clinicians and very high acceptance by patients.

  20. Timing of surgery for open reduction and internal fixation of displaced proximal humeral fractures.

    Science.gov (United States)

    Siebenbürger, Georg; Van Delden, Dustin; Helfen, Tobias; Haasters, Florian; Böcker, Wolfgang; Ockert, Ben

    2015-10-01

    Open reduction and internal fixation is one established method for treatment of displaced fractures of the proximal humerus. However, the timing of surgery and its effect on complications have not yet been investigated in the literature. Hence, aim of this study was to analyze the occurrence of complication following locked plating of proximal humeral fractures when surgery was delayed in comparison to early intervention. Between February 2002 and November 2010, 497 patients with displaced proximal humeral fractures were treated by open reduction and locked plating. 329 patients were available for follow-up with a minimum of 12 months after surgery. Outcome analysis included radiographic evidence of loss of fixation (> 10° of secondary displacement), screw-cutout and avascular head necrosis. Outcomes were analyzed with regards to age, gender and fracture pattern and were compared between time intervals in which the primary surgery had been conducted; early intervention (5 days). Of 329 patients (68.4% women; median age at time of surgery: 69.9 years, 95% Confidence Interval (CI) 68.2, 71.2) the median time between fracture incident and surgical intervention was 3.2 days (95%CI: 3.1, 3.3). Surgery was performed in a 2-part fracture at a median of 3.3 days (95%CI: 3.2, 3.4) after trauma, in a 3-part fracture after 3.3 days (95%CI: 3.1, 3.4), in a 4-part fracture 2.9 days (95%CI: 2.8, 3.0), in head split type fracture 2.2 days (95%CI: 2.0, 2.4) and in dislocation type fracture 0.8 days after trauma (95%CI: 0.7, 0.9, p = 0.40). Loss of fixation was observed in 12.8% (n = 42 patients), of which in 4.9% (n = 16) screw cutout was evident and in 6.8% of cases (n = 20) avascular head necrosis was diagnosed. Patients in which complication was observed were treated at median 2.5 days after trauma (95% CI, 1.8, 3.2), in comparison, patients without evidence of complications were treated at a median of 3.2 days (95% CI, 2.8-3.8, p = 0.35). The odds ratio regarding occurrence

  1. Finger Proximal Interphalangeal Joint Dislocation.

    Science.gov (United States)

    Ramponi, Denise; Cerepani, Mary Jo

    2015-01-01

    Finger dislocations are common injuries that are often managed by emergency nurse practitioners. A systematic physical examination following these injuries is imperative to avoid complications. Radiographic views, including the anteroposterior, lateral, and oblique views, are imperative to evaluate these finger dislocations. A dorsal dislocation of the proximal interphalangeal (PIP) joint is the most common finger dislocation type often easily reduced. A volar PIP dislocation can often be difficult to reduce and may result in finger deformity. Finger dislocations should be reduced promptly. Referral to an orthopedic hand specialist is required if the dislocation is unable to be reduced or if the finger joint is unstable following reduction attempts.

  2. Equilibrium properties of proximity effect

    Energy Technology Data Exchange (ETDEWEB)

    Esteve, D.; Pothier, H.; Gueron, S.; Birge, N.O.; Devoret, M.

    1996-12-31

    The proximity effect in diffusive normal-superconducting (NS) nano-structures is described by the Usadel equations for the electron pair correlations. We show that these equations obey a variational principle with a potential which generalizes the Ginzburg-Landau energy functional. We discuss simple examples of NS circuits using this formalism. In order to test the theoretical predictions of the Usadel equations, we have measured the density of states as a function of energy on a long N wire in contact with a S wire at one end, at different distances from the NS interface. (authors). 12 refs.

  3. Comparison of two different locking plates for two-, three- and four-part proximal humeral fractures--results of an international multicentre study.

    Science.gov (United States)

    Konrad, Gerhard; Hirschmüller, Anja; Audige, Laurent; Lambert, Simon; Hertel, Ralf; Südkamp, Norbert P

    2012-05-01

    The aim of this study was to compare the functional outcome, quality of restoration, and complication rate after open reduction and internal fixation (ORIF) of displaced or unstable 2-, 3- and 4-part humeral fractures using two different locking plates. The data used in this analysis was prospectively collected in two large multicentre studies in 15 European Level 1 trauma centres. A total of 318 patients with proximal humeral fractures were treated with ORIF using either the locking proximal humerus plate (LPHP) or proximal humeral internal locking system (PHILOS). Outcome measurements included Constant and Neer scores, evaluation of local pain at the fracture site and complications, and radiographic assessment at one year. At one year, the mean Constant scores (relative to the contralateral shoulder) improved significantly for both groups and were above 80% for 2-, 3-, and 4-part fractures. A significantly shorter surgical time, less pain at the fracture site, and better functional outcome was achieved by PHILOS-treated patients with 2-part fractures throughout the one-year follow-up month and with 3-part fractures at three months (p fractures, and no difference in the complication rates (p > 0.05). PHILOS and LPHP can be considered as useful implants for ORIF of displaced and unstable proximal humeral fractures. There was a slight advantage of the PHILOS system with regard to operative time and functional outcome, especially for the treatment of 2- and 3-part fractures.

  4. Difficulty in Clinical Evaluation of Radial Nerve Injury due to Multiple Trauma to the Humerus, Wrist, and Hand

    Directory of Open Access Journals (Sweden)

    Balik Mehmet Sabri

    2014-01-01

    Full Text Available Radial nerve damage is frequently encountered in humeral fractures. The radial nerve is primarily damaged when the humerus gets fractured, while secondary damage maybe due to post-traumatic manipulations and surgical exploration. High impact traumatic nerve injury, serious neuropathic pain, lack of response to therapeutic interventions, and indifference to the Tinel test are indications for surgical intervention. Since most humeral fracture-induced low impact radial nerve injuries resolve spontaneously, conservative therapy is preferred. We present a patient with humeral fracture-associated radial nerve injury, accompanied with digital amputation and flexor tendon avulsion on the same arm. These injuries required immediate surgery, thus rendering the clinical evaluation of the radial nerve impossible. We would like to highlight and discuss the inherent difficulties associated with multiple trauma of the upper arm.

  5. The utility of radiographs prior to pin removal after operative treatment of supracondylar humerus fractures in children.

    Science.gov (United States)

    Schlechter, John A; Dempewolf, Michael

    2015-08-01

    To determine the safety, utility, and efficacy of pin removal prior to radiographs during the postoperative care of surgically treated displaced pediatric supracondylar humerus fractures. Retrospective review of 532 children with supracondylar humerus fractures treated with closed reduction and pinning from 2007 to 2012. Group 1: children who had their splint/cast removed and radiographs prior to pin removal. Group 2: children with radiographs taken after removal. Data recorded and analyzed included: demographic and radiographic data at the time of surgery and at final follow-up, including the number of radiographs taken prior to pin removal and if pins were ever retained after radiographs were performed on the date of intended removal. There was no difference between the groups' demographics. The number of postoperative radiographs taken prior to pin removal ranged from zero to two. No statistically significant change in Baumann's (p = 0.79) or lateral humeral capitellar angles (p = 0.19) was noted between the groups. No children in group 1 (0/438) had their pins retained after radiographs were taken on the date of intended removal. Obtaining postoperative radiographs prior to pin removal, although commonplace, is not necessary. If fracture stability is noted intraoperatively, and there is an uneventful postoperative course, it is safe and effective to discontinue immobilization and remove pins prior to X-ray. This is safely done without change in alignment or clinical sequelae. Doing so can aid in clinic flow, may decrease child anxiety, and limit multiple cast room visits. Level III therapeutic study.

  6. Mouse model of proximal tubule endocytic dysfunction.

    Science.gov (United States)

    Weyer, Kathrin; Storm, Tina; Shan, Jingdong; Vainio, Seppo; Kozyraki, Renata; Verroust, Pierre J; Christensen, Erik I; Nielsen, Rikke

    2011-11-01

    Several studies have indicated the central role of the megalin/cubilin multiligand endocytic receptor complex in protein reabsorption in the kidney proximal tubule. However, the poor viability of the existing megalin-deficient mice precludes further studies and comparison of homogeneous groups of mice. Megalin- and/or cubilin-deficient mice were generated using a conditional Cre-loxP system, where the Cre gene is driven by the Wnt4 promoter. Kidney tissues from the mice were analysed for megalin and cubilin expression by quantitative reverse transcription-polymerase chain reaction, western blotting and immunohistochemistry. Renal albumin uptake was visualized by immunohistochemistry. Twenty-four-hour urine samples were collected in metabolic cages and analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis and western blotting. Urinary albumin/creatinine ratios were measured by ELISA and the alkaline picrate method. The Meg(lox/lox);Cre(+), Cubn(lox/lox);Cre(+) and Meg(lox/lox), Cubn(lox/lox);Cre(+) mice were all viable, fertile and developed normal kidneys. Megalin and/or cubilin expression, assessed by immunohistology and western blotting, was reduced by >89%. Consistent with this observation, the mice excreted megalin and cubilin ligands such as transferrin and albumin in addition to low-molecular weight proteins. We further show that megalin/cubilin double-deficient mice excrete albumin with an average of 1.45 ± 0.54 mg/day, suggesting a very low albumin concentration in the glomerular ultrafiltrate. We report here the efficient genetic ablation of megalin, cubilin or both, using a Cre transgene driven by the Wnt4 promoter. The viable megalin/cubilin double-deficient mice now allow for detailed large-scale group analysis, and we anticipate that the mice will be of great value as an animal model for proximal tubulopathies with disrupted endocytosis.

  7. Surgeons agree more on treatment recommendations than on classification of proximal humeral fractures

    Directory of Open Access Journals (Sweden)

    Brorson Stig

    2012-06-01

    Full Text Available Abstract Background Orthopaedic surgeons disagree considerably when classifying fractures of the proximal humerus. However, the clinical implications of low observer agreement remain unclear. The purpose of the study was to compare the agreement on Neer classification with the agreement on treatment recommendations. Methods We conducted a multi-centre observer-study. Five experienced shoulder surgeons independently assessed a consecutive series of 193 radiographs at two occasions three months apart. All pairs of radiographs were classified according to Neer. Subsequently, the observers were asked to recommend one of three treatment modalities for each case: non-operative treatment, locking plate osteosynthesis, or hemiarthroplasty. Results At both classification rounds mean kappa-values for inter-observer agreement on treatment recommendations (0.48 and 0.52 were significantly higher than the agreement on Neer classification (0.33 and 0.36 (p  Conclusions We found a significantly higher agreement on treatment recommendations compared to agreement on fracture classification. The low observer agreement on the Neer classification reported in several observer studies may have less clinical importance than previously assumed. However, inter-observer agreement did not exceed moderate levels.

  8. Semiconductor detectors with proximity signal readout

    Energy Technology Data Exchange (ETDEWEB)

    Asztalos, Stephen J. [XIA, LLC, Hayward, CA (United States)

    2014-01-30

    Semiconductor-based radiation detectors are routinely used for the detection, imaging, and spectroscopy of x-rays, gamma rays, and charged particles for applications in the areas of nuclear and medical physics, astrophysics, environmental remediation, nuclear nonproliferation, and homeland security. Detectors used for imaging and particle tracking are more complex in that they typically must also measure the location of the radiation interaction in addition to the deposited energy. In such detectors, the position measurement is often achieved by dividing or segmenting the electrodes into many strips or pixels and then reading out the signals from all of the electrode segments. Fine electrode segmentation is problematic for many of the standard semiconductor detector technologies. Clearly there is a need for a semiconductor-based radiation detector technology that can achieve fine position resolution while maintaining the excellent energy resolution intrinsic to semiconductor detectors, can be fabricated through simple processes, does not require complex electrical interconnections to the detector, and can reduce the number of required channels of readout electronics. Proximity electrode signal readout (PESR), in which the electrodes are not in physical contact with the detector surface, satisfies this need.

  9. One-stage surgical correction of proximal hypospadias.

    Science.gov (United States)

    Joseph, V T

    2003-01-01

    Proximal hypospadias poses major problems in surgical correction owing to the complexity and severity of the abnormalities, leading to the use of staged repairs to correct this condition. However, with precise definition of the components of this deformity a single-stage operation can be developed and applied successfully for surgical correction of this condition. Twenty-six patients with severe proximal hypospadias were subjected to a one-stage repair. Excision of proximal fibrotic dartos tissue and removal of dysplastic urethral plate tissue corrected chordee completely. Urethral reconstruction was then performed by tubularising a flap of dorso-lateral preputial skin which was then anastomosed to the proximal urethra. The glandular part of the urethra was reconstructed using the distal part of the flap as an onlay graft over the meatal groove. The suture lines were covered with a layer of dartos tissue and skin closure was completed by transposing dorsal skin to surface the ventral penile shaft. A urethral catheter was left in for 10 days. All patients have been followed up after surgery from 1 to 5 years with a median period of 2 years. There were no fistulas. Two patients had mild stenosis at the meatus which responded to dilatation. One patient developed a stricture at the proximal anastomosis which required secondary correction. All other patients achieved satisfactory correction, both in terms of voiding and in the cosmetic appearance of the genitalia. Single-stage repair of hypospadias can be successfully applied in the correction of severe proximal hypospadias. It requires meticulous dissection and careful design of reconstructive techniques. The end results are comparable to staged procedures and morbidity is significantly lower.

  10. Complications in proximal humeral fractures.

    Science.gov (United States)

    Calori, Giorgio Maria; Colombo, Massimiliano; Bucci, Miguel Simon; Fadigati, Piero; Colombo, Alessandra Ines Maria; Mazzola, Simone; Cefalo, Vittorio; Mazza, Emilio

    2016-10-01

    Necrosis of the humeral head, infections and non-unions are among the most dangerous and difficult-to-treat complications of proximal humeral fractures. The aim of this work was to analyse in detail non-unions and post-traumatic bone defects and to suggest an algorithm of care. Treatment options are based not only on the radiological frame, but also according to a detailed analysis of the patient, who is classified using a risk factor analysis. This method enables the surgeon to choose the most suitable treatment for the patient, thereby facilitating return of function in the shortest possible time. The treatment of such serious complications requires the surgeon to be knowledgeable about the following possible solutions: increased mechanical stability; biological stimulation; and reconstructive techniques in two steps, with application of biotechnologies and prosthetic substitution. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. The Applications of Finite Element Analysis in Proximal Humeral Fractures

    OpenAIRE

    Yongyu Ye; Wei You; Weimin Zhu; Jiaming Cui; Kang Chen; Daping Wang

    2017-01-01

    Proximal humeral fractures are common and most challenging, due to the complexity of the glenohumeral joint, especially in the geriatric population with impacted fractures, that the development of implants continues because currently the problems with their fixation are not solved. Pre-, intra-, and postoperative assessments are crucial in management of those patients. Finite element analysis, as one of the valuable tools, has been implemented as an effective and noninvasive method to analyze...

  12. A Review of Management Options for Proximal Humeral Fractures

    OpenAIRE

    Jordan, Robert W; Modi, Chetan S

    2014-01-01

    Proximal humeral fractures are common and although the majority can be managed non-operatively, the optimal treatment of displaced or complex fractures remains controversial. Non-operative treatment is typically selected for minimally displaced fractures where union rates are high and good or excellent outcomes can be expected in approximately 80% of cases. The aims of surgical fixation are to restore articular surface congruency, alignment and the relationship between the tuberosities and th...

  13. [Case-control study on close manipulative reduction combined with minimally invasive percutaneous plate fixation for the treatment of proximal humeral fractures].

    Science.gov (United States)

    Liu, Yin-Wen; Wei, Xiao-En; Gao, Ning-Yang; Li, Zhi-Qiang; Kuang, Yong; Zhan, Hong-Sheng; Shi, Yin-Yu; Zheng, Yu-Xin

    2014-04-01

    To compare the clinical effects of close manipulative reduction combined with minimally invasive percutaneous plate fixation(MIPPO) and conventional open reduction and internal fixation (ORIF) for the treatment of proximal humerus fractures. From April 2008 to March 2013, among the 75 patients with fractures of proximal humerus, 26 patients were male and 49 patients were female, ranging in age from 22 to 80 years; 18 patients had injuries caused by traffic accident and 57 patients had injuries caused by falling down. According to Neer classification, there were 49 cases of two-part fractures and 26 cases of three-part fractures. All the patients were divided into two groups: MIPPO group and ORIF group. There were 12 males and 21 females in the MIPPO group,including 22 cases of Neer two parts and 11 cases of Neer three parts, who were treated with close manipulative reduction combined with MIPPO. While the other 42 patients were in the ORIF group,including 16 males and 26 females. Among those patients,27 cases belonged to Neer two parts and 15 cases of Neer three parts, who were treated with ORIF. Length of the incision, blood loss, operating time, early postoperative pain(recorded by VAS), neck-shaft angle of proximal humerus and postoperative function of shoulder(recorded by Constant-Murley score, including pain, function, ROM and muscle length) were compared. The mean lengths of incision were (6.74 +/- 0.38) cm in MIPPO group and (16.82 +/- 1.74) cm in ORIF group;blood losses were (110.15 +/- 29.49) ml in MIPPO group and (326.19 +/- 59.71) ml in ORIF group; operation times were (48.60 +/- 10.18) min in MIPPO group and (68.84-16.22) min in ORIF group. VAS of patients in MIPPO group on the 1st and 3rd days postoperatively were lower than those of patients in the ORIF group. The postoperative radiographs verified good position of all screws and satisfactory reduction of bone fracture reduction in both groups. All the patients were followed up,and the durig ranged

  14. Prognosis-Based Shoulder Hemiarthroplasty After Resection of Proximal Humeral Malignancy.

    Science.gov (United States)

    Chen, Chao-Ming; Wu, Po-Kuei; Tsai, Shang-Wen; Chen, Cheng-Fong; Chen, Wei-Ming

    2017-07-19

    After wide excision of proximal humeral bony malignancy, prognosis-based reconstruction was performed at Taipei Veterans General Hospital. Bone prosthesis composite (BPC) was carried out among patients with a favored prognosis, while cement-spacer prosthesis composite (CSPC) was preserved for patients with poor prognosis. The aim of our study is to compare the clinical outcomes between the BPC and CSPC reconstruction procedures. From January 2000 to December 2014, we retrospectively reviewed the clinical outcomes of 34 patients who underwent shoulder hemiarthroplasty following wide excision of a malignant lesion of the proximal humerus, 15 of whom were treated with a BPC reconstruction and 19 cases were treated with a CSPC reconstruction. The mean postoperative follow-up was 51.9 months for the BPC group and 29.0 months for the CSPC group. At the end of the study, four patients (two in the BPC group and two in the CSPC group) developed local recurrence. Thirteen patients (1 in the BPC group and 12 in the CSPC group) had died of disease progression. The postoperative visual analogue scale score of BPC and CSPC groups was similar (P = 0.262). Functional outcome, measured using the Musculoskeletal Tumor Society score and shoulder range of motion, favored the BPC procedure (P BPC procedure (P BPC procedure, the CSPC procedure continues to be a safe and cost-effective shoulder hemiarthroplasty procedure for patients with low-demanding activities and when a poor disease prognosis is expected. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  15. Proximity sensor technology for manipulator end effectors

    Science.gov (United States)

    Johnston, A. R.

    1975-01-01

    Optical proximity sensing techniques which could be used to help control the critical grasping phase of a remote manipulation are described. The proximity sensors described use a triangulation geometry to detect a surface located in a pre-determined region. The design of the proximity sensors themselves is discussed, as well as their application to manipulator control with a local control loop, and possibilities for future development are discussed.

  16. Proximate composition and antinutrient content of pumpkin ...

    African Journals Online (AJOL)

    Proximate composition and antinutrient content of pumpkin ( Cucurbita pepo ) and sorghum ( Sorghum bicolor ) flour blends fermented with Lactobacillus plantarum , Aspergillus niger and Bacillus subtilis.

  17. Visualizing cellular interactions with a generalized proximity reporter.

    Science.gov (United States)

    Sellmyer, Mark A; Bronsart, Laura; Imoto, Hiroshi; Contag, Christopher H; Wandless, Thomas J; Prescher, Jennifer A

    2013-05-21

    Interactions among neighboring cells underpin many physiological processes ranging from early development to immune responses. When these interactions do not function properly, numerous pathologies, including infection and cancer, can result. Molecular imaging technologies, especially optical imaging, are uniquely suited to illuminate complex cellular interactions within the context of living tissues in the body. However, no tools yet exist that allow the detection of microscopic events, such as two cells coming into close proximity, on a global, whole-animal scale. We report here a broadly applicable, longitudinal strategy for probing interactions among cells in living subjects. This approach relies on the generation of bioluminescent light when two distinct cell populations come into close proximity, with the intensity of the optical signal correlating with relative cellular location. We demonstrate the ability of this reporter strategy to gauge cell-cell proximity in culture models in vitro and then evaluate this approach for imaging tumor-immune cell interactions using a murine breast cancer model. In these studies, our imaging strategy enabled the facile visualization of features that are otherwise difficult to observe with conventional imaging techniques, including detection of micrometastatic lesions and potential sites of tumor immunosurveillance. This proximity reporter will facilitate probing of numerous types of cell-cell interactions and will stimulate the development of similar techniques to detect rare events and pathological processes in live animals.

  18. Screw augmentation reduces motion at the bone-implant interface: a biomechanical study of locking plate fixation of proximal humeral fractures.

    Science.gov (United States)

    Schliemann, Benedikt; Seifert, Robert; Rosslenbroich, Steffen B; Theisen, Christina; Wähnert, Dirk; Raschke, Michael J; Weimann, Andre

    2015-12-01

    Shear forces at the bone-implant interface lead to a loss of reduction after locking plate fixation of proximal humeral fractures. The aim of the study was to analyze the roles of medial support screws and screw augmentation in failure loads and motion at the bone-implant interface after locking plate fixation of proximal humeral fractures. Unstable 3-part fractures were simulated in 6 pairs of cadaveric humeri and were fixed with a DiPhos-H locking plate (Lima Corporate, Udine, Italy). An additional medial support screw was implanted in 1 humerus of every donor. The opposite humerus was stabilized with a medial support screw and additional bone cement augmentation of the 2 anteriorly directed head screws. Specimens were loaded in the varus bending position. Stiffness, failure loads, plate bending, and the motion at the bone-implant interface were evaluated using an optical motion capture system. The mean load to failure was 669 N (standard deviation [SD], 117 N) after fixation with medial support screws alone and 706 N (SD, 153 N) after additional head screw augmentation (P = .646). The initial stiffness was 453 N/mm (SD, 4.16 N/mm) and 461 N/mm (SD, 64.3 N/mm), respectively (P = .594). Plate bending did not differ between the 2 groups. However, motion at the bone-implant interface was significantly reduced after head screw augmentation (P < .05). The addition of bone cement to augment anteriorly directed head screws does not increase stiffness and failure loads but reduces motion at the bone-implant interface. Thus, the risk of secondary dislocation of the head fragment may be reduced. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Shoulder arthroscopy combined to hardware removal in proximal humeral fractures: a series of 58 cases with a mean follow-up of 2 years.

    Science.gov (United States)

    Maroun, Ch; Aliani, D; Hass, A; Werthel, J D; Vidil, Anne; Valenti, Ph

    2017-04-01

    Proximal humerus fractures are common injuries. Locking plates and anterograde medullary nails are the two most common fixation devices used when open reduction and internal fixation (ORIF) is indicated. Complications related to fracture and to hardware are numerous, especially shoulder stiffness. The goal of this study is to report the clinical outcomes of gleno-humeral arthroscopic arthrolysis combined with hardware removal. A total of 58 patients (25 men, 33 women) with a mean age of 58 years (24-79) were reviewed retrospectively. Forty of them were active workers (5 heavy workers), and 18 were retired. A total of 24 fractures were reported after sport accident, 26 after domestic accident, and 8 after high energy trauma. Thirty-four patients with 3 or 4 part fractures (fracture through the anatomic neck and tuberosities), 20 patients with two part (displaced surgical neck) fracture and 4 cases of fracture of the tuberosities were operated. We combined a gleno-humeral arthrolysis by arthroscopy and a removal of the hardware using the previous incision for the plate or by arthroscopy for the nail. The average follow-up was 23 months (range 6-60). Pain in Constant Murley score (CS) increased from 7.3 ± 3.8 points preoperatively to 13 ± 2.76 points post-operatively (p humeral arthrolysis by arthroscopy combined with hardware removal after proximal humerus ORIF in one step is safe and beneficial for post-traumatic stiffness of the shoulder. It provides significant pain relief and increase of range of motion and allows to treat associated articular pathology.

  20. Skeletal traction and delayed percutaneous fixation of complicated supracondylar humerus fractures due to delayed or unsuccessful reductions and extensive swelling in children.

    Science.gov (United States)

    Ağuş, Haluk; Kalenderer, Onder; Kayali, Cemil; Eryanilmaz, Gürkan

    2002-04-01

    The functional and radiological results of 13 supracondylar humerus fractures of 13 children were evaluated to determine the efficiency of delayed percutaneous fixation of the fractures after a period of skeletal overhead traction. All the fractures were complicated by delayed reduction, extensive swelling or unsuccessful reduction manipulations. As the unfavourable preexisting factors subsided under skeletal traction, anatomical reduction and fixation of fractures by percutaneous pinning were performed under general anesthesia. The average follow-up period was 21 months. Bauman and lateral capitellohumeral angles were measured and statistically analyzed. Functional and cosmetic results were evaluated by physical examination of the elbows. There were 11 excellent and two fair functional results while all cosmetic results were excellent or good. As a result, skeletal traction and delayed percutaneous pinning is accepted as an alternative method of treatment for complicated supracondylar humerus fractures in children.

  1. Comparative limb bone loading in the humerus and femur of the tiger salamander: testing the 'mixed-chain' hypothesis for skeletal safety factors.

    Science.gov (United States)

    Kawano, Sandy M; Economy, D Ross; Kennedy, Marian S; Dean, Delphine; Blob, Richard W

    2016-02-01

    Locomotion imposes some of the highest loads upon the skeleton, and diverse bone designs have evolved to withstand these demands. Excessive loads can fatally injure organisms; however, bones have a margin of extra protection, called a 'safety factor' (SF), to accommodate loads that are higher than normal. The extent to which SFs might vary amongst an animal's limb bones is unclear. If the limbs are likened to a chain composed of bones as 'links', then similar SFs might be expected for all limb bones because failure of the system would be determined by the weakest link, and extra protection in other links could waste energetic resources. However, Alexander proposed that a 'mixed-chain' of SFs might be found amongst bones if: (1) their energetic costs differ, (2) some elements face variable demands, or (3) SFs are generally high. To test whether such conditions contribute to diversity in limb bone SFs, we compared the biomechanical properties and locomotor loading of the humerus and femur in the tiger salamander (Ambystoma tigrinum). Despite high SFs in salamanders and similar sizes of the humerus and femur that would suggest similar energetic costs, the humerus had lower bone stresses, higher mechanical hardness and larger SFs. SFs were greatest in the anatomical regions where yield stresses were highest in the humerus and lowest in the femur. Such intraspecific variation between and within bones may relate to their different biomechanical functions, providing insight into the emergence of novel locomotor capabilities during the invasion of land by tetrapods. © 2016. Published by The Company of Biologists Ltd.

  2. A Case Report of an Unusual Case of Tuberculous Osteomyelitis Causing Spontaneous Pathological Fracture of Humerus in a Middle Aged Female

    OpenAIRE

    Birole, Umesh; Ranade, Ashish; Mone, Mahesh

    2017-01-01

    Introduction: Tuberculosis is a major health problem worldwide. Extrapulmonary tuberculosis is often secondary to some primary foci in lungs. There are reports of tuberculous osteomyelitis involving maxilla, ulna, femur, and shoulder joint but none have reported pathological fracture in humeral diaphysis due to tuberculosis osteomyelitis without shoulder joint involvement. We report a case of pathological fracture of humerus diaphysis due to tuberculous osteomyelitis with normal articular spa...

  3. Delayed presentation of fracture of lateral condyle of humerus in pediatric age group treated by ORIF and ulnar peg grafting: A case series

    Directory of Open Access Journals (Sweden)

    Nishikant Kumar

    2015-01-01

    Full Text Available Background: Fractures of lateral condyle of humerus in pediatric age group, the most common being distal humerus epiphyseal injury, are commonly associated with delayed presentation to terminal health care providers. Reasons accounted might be at every level, right from the patient to the physician. In the backdrop of existing disputed treatment strategy operative v/s non-operative treatment of fractures having more than 3-week duration of injury, same were treated by open reduction and k wire fixation using ulnar peg graft. Final functional result was evaluated with longest follow up of over 1 year. Materials and Methods: Twenty children having fracture of lateral condyle of humerus with duration of trauma more than 3 week were included in the prospective study. Age ranged from 5 years to 15 years. Average age was 8 years. Among the 20 patients, 8 were male and 12 were female. Average time of presentation was after 5 weeks of injury. Seven patients had milch type 1 injury and 13 patients had milch type II injury. All patients were treated by open reduction and internal fixation using k wires and ulnar peg graft. The follow-up period was over 1 year. Result: Results were evaluated using radiograph, and functional results were evaluated using the Liverpool elbow scoring system. In the present series, all fractures united with 92% excellent, 5% good, and 3% poor results. Poor results were associated with greater displacement of fracture, prior repeated attempts of close reduction, and history of massage. Conclusion: Being an epiphyseal injury and a common occurrence, fracture of lateral condyle of humerus in pediatric age group are commonly maltreated, with error contributed right from parents to even physician. Common reasons of delayed presentation are ignorance on parents′ side, malpractice by some bone-setters, poorly done radiograph, inaccurate radiographic interpretation by the physician, and poor selection of treatment methods.

  4. Bilateral Humerus and Right Femur Fracture in a Newborn after Cesarean Section for Breech Presentation in a Twin Pregnancy: A Very Rare Case Report

    Science.gov (United States)

    Rahul, P; Grover, Amit Rakesh; Ajoy, S M

    2017-01-01

    Introduction: The most common fractures during vaginal delivery occur in the clavicle, humerus, and femur. Cesarean section reduces the chances of a child having a birth injury. However, in some difficult extractions, long bone fractures may occur. Cesarean section further reduces the incidence of birth injuries, especially in a breech delivery. Maneuvers employed during cesarean section, energetic traction, improper uterine incisions, and contracted uterus may cause these injuries. In the medical literature, there are few articles highlighting the occurrence of long bone fractures during cesarean section. There has been no case reported with a combined bilateral humerus and femur fracture in the medical literature. Case Report: A 2-day-old neonate born after cesarean section for breech presentation in a twin pregnancy presented with restricted movements of both his arms and right leg. Infantogram revealed bilateral humerus and right femur fracture. Biochemical tests were normal, and there were no other findings on clinical examination. There was no evidence of child abuse or any positive family history. Child was splinted for 3 weeks. X-rays suggested good callus at the fracture site of the right femur and bilateral humerus fracture were united. Conclusion: To conclude, we would like to emphasize that long bone fractures can happen with cesarean section also. To prevent such untoward complications, during delivery of the baby the surgeon should be very careful, avoid energetic traction and should plan his incisions. Appropriate relaxation of the uterus must be achieved. Clavicles and other long bones should be palpated after a difficult delivery. However, it is important to note that long bone fractures in children heal rapidly without the need for any major intervention. PMID:28630830

  5. The theoretical simulation on electrostatic distribution of 1st proximity region in proximity focusing low-light-level image intensifier

    Science.gov (United States)

    Zhang, Liandong; Bai, Xiaofeng; Song, De; Fu, Shencheng; Li, Ye; Duanmu, Qingduo

    2015-03-01

    Low-light-level night vision technology is magnifying low light level signal large enough to be seen by naked eye, which uses the photons - photoelectron as information carrier. Until the micro-channel plate was invented, it has been possibility for the realization of high performance and miniaturization of low-light-level night vision device. The device is double-proximity focusing low-light-level image intensifier which places a micro-channel plate close to photocathode and phosphor screen. The advantages of proximity focusing low-light-level night vision are small size, light weight, small power consumption, no distortion, fast response speed, wide dynamic range and so on. It is placed parallel to each other for Micro-channel plate (both sides of it with metal electrode), the photocathode and the phosphor screen are placed parallel to each other. The voltage is applied between photocathode and the input of micro-channel plate when image intensifier works. The emission electron excited by photo on the photocathode move towards to micro-channel plate under the electric field in 1st proximity focusing region, and then it is multiplied through the micro-channel. The movement locus of emission electrons can be calculated and simulated when the distributions of electrostatic field equipotential lines are determined in the 1st proximity focusing region. Furthermore the resolution of image tube can be determined. However the distributions of electrostatic fields and equipotential lines are complex due to a lot of micro-channel existing in the micro channel plate. This paper simulates electrostatic distribution of 1st proximity region in double-proximity focusing low-light-level image intensifier with the finite element simulation analysis software Ansoft maxwell 3D. The electrostatic field distributions of 1st proximity region are compared when the micro-channel plates' pore size, spacing and inclination angle ranged. We believe that the electron beam movement

  6. Functional outcome following proximal humeral interlocking system plating for displaced proximal humeral fractures

    OpenAIRE

    Thyagarajan David; Haridas Samarth; Jones Denise; Dent Colin; Evans Richard; Williams Rhys

    2009-01-01

    Aim: To assess the functional outcome following internal fixation with the PHILOS (proximal humeral interlocking system) for displaced proximal humeral fractures. Patients and Methods: We reviewed 30 consecutive patients treated surgically with the proximal humeral locking plate for a displaced proximal humeral fracture. Functional outcome was determined using the American Shoulder and Elbow Society (ASES) score and Constant Murley score. Results: Average age of the patients was 58 years...

  7. Best Proximity Points for a New Class of Generalized Proximal Mappings

    Directory of Open Access Journals (Sweden)

    Tayyab Kamran

    2017-03-01

    Full Text Available The best proximity points are usually used to find the optimal approximate solution of the operator equation Tx = x, when T has no fixed point. In this paper, we prove some best proximity point theorems for nonself multivalued operators, following the foot steps of Basha and Shahzad [Best proximity point theorems for generalized proximal contractions, Fixed Point Theory Appl., 2012, 2012:42].

  8. Preliminary phytochemical screening, proximate and elemental ...

    African Journals Online (AJOL)

    The seed powder of Moringa oleifera was analysed for its phytochemical, proximate and elemental composition using Folin-Denis spectrophotometric method, gravimetric method and energy dispersing X-ray fluorescence (EDXRF) transmission emission technique respectively. The seed powder had the following proximate ...

  9. Bimalleolar ankle fracture with proximal fibular fracture

    NARCIS (Netherlands)

    Colenbrander, R. J.; Struijs, P. A. A.; Ultee, J. M.

    2005-01-01

    A 56-year-old female patient suffered a bimalleolar ankle fracture with an additional proximal fibular fracture. This is an unusual fracture type, seldom reported in literature. It was operatively treated by open reduction and internal fixation of the lateral malleolar fracture. The proximal fibular

  10. Grouping by Proximity in Haptic Contour Detection

    Science.gov (United States)

    Overvliet, Krista E.; Krampe, Ralf Th.; Wagemans, Johan

    2013-01-01

    We investigated the applicability of the Gestalt principle of perceptual grouping by proximity in the haptic modality. To do so, we investigated the influence of element proximity on haptic contour detection. In the course of four sessions ten participants performed a haptic contour detection task in which they freely explored a haptic random dot display that contained a contour in 50% of the trials. A contour was defined by a higher density of elements (raised dots), relative to the background surface. Proximity of the contour elements as well as the average proximity of background elements was systematically varied. We hypothesized that if proximity of contour elements influences haptic contour detection, detection will be more likely when contour elements are in closer proximity. This should be irrespective of the ratio with the proximity of the background elements. Results showed indeed that the closer the contour elements were, the higher the detection rates. Moreover, this was the case independent of the contour/background ratio. We conclude that the Gestalt law of proximity applies to haptic contour detection. PMID:23762364

  11. Proximate analysis on four edible mushrooms ADEDAYO ...

    African Journals Online (AJOL)

    Michael Horsfall

    Vol. 15 (1) 9 - 11. Full-text Available Online at www.bioline.org.br/ja. Proximate analysis on four edible mushrooms. ADEDAYO, MAJEKODUNMI RACHEL. Nigerian Stored Product Research Institute, P.M.B.3032, Kano. ABSTRACT: Proximate study was conducted on four edible mushrooms commonly found in farmlands in.

  12. Proximate Sources of Collective Teacher Efficacy

    Science.gov (United States)

    Adams, Curt M.; Forsyth, Patrick B.

    2006-01-01

    Purpose: Recent scholarship has augmented Bandura's theory underlying efficacy formation by pointing to more proximate sources of efficacy information involved in forming collective teacher efficacy. These proximate sources of efficacy information theoretically shape a teacher's perception of the teaching context, operationalizing the difficulty…

  13. Phytochemical screening, proximate analysis and anticonvulsant ...

    African Journals Online (AJOL)

    Spigelia anthelmia is used traditionally in Southern Nigeria for the treatment of infant convulsion and epilepsy. This study investigated the phytochemical constituents, proximate analysis and anticonvulsant effect of the methanolic extract of Spigelia anthelmia. Phytochemical evaluation and proximate analysis was carried ...

  14. Intramedullary compression device for proximal ulna fracture.

    Science.gov (United States)

    Hong, Choon Chiet; Han, Fucai; Decruz, Joshua; Pannirselvam, Vinodhkumar; Murphy, Diarmuid

    2015-02-01

    Proximal ulna fractures account for 20% of all proximal forearm fractures. Many treatment options are available for such fractures, such as cast immobilisation, plate and screw fixation, tension band wiring and intramedullary screw fixation, depending on the fracture pattern. Due to the subcutaneous nature of the proximal forearm, it is vulnerable to open injuries over the dorsal aspect of the proximal ulna. This may in turn prove challenging, as it is critical to obtain adequate soft tissue coverage to reduce the risk of implant exposure and bony infections. We herein describe a patient with a Gustillo III-B open fracture of the proximal ulna, treated with minimally invasive intramedullary screw fixation using a 6.0-mm cannulated headless titanium compression screw (FusiFIX, Péronnas, France).

  15. Postnatal Changes in Humerus Cortical Bone Thickness Reflect the Development of Metabolic Bone Disease in Preterm Infants

    Directory of Open Access Journals (Sweden)

    Shuko Tokuriki

    2016-01-01

    Full Text Available Objective. To use cortical bone thickness (CBT of the humerus to identify risk factors for the development of metabolic bone disease in preterm infants. Methods. Twenty-seven infants born at <32 weeks of gestational age, with a birth weight of <1,500 g, were enrolled. Humeral CBT was measured from chest radiographs at birth and at 27-28, 31-32, and 36–44 weeks of postmenstrual age (PMA. The risk factors for the development of osteomalacia were statistically analyzed. Results. The humeral CBT at 36–44 weeks of PMA was positively correlated with gestational age and birth weight and negatively correlated with the duration of mechanical ventilation. CBT increased with PMA, except in six very early preterm infants in whom it decreased. Based on logistic regression analysis, gestational age and duration of mechanical ventilation were identified as risk factors for cortical bone thinning. Conclusions. Humeral CBT may serve as a radiologic marker of metabolic bone disease at 36–44 weeks of PMA in preterm infants. Cortical bones of extremely preterm infants are fragile, even when age is corrected for term, and require extreme care to lower the risk of fractures.

  16. Proximal Alternating Direction Method with Relaxed Proximal Parameters for the Least Squares Covariance Adjustment Problem

    Directory of Open Access Journals (Sweden)

    Minghua Xu

    2014-01-01

    Full Text Available We consider the problem of seeking a symmetric positive semidefinite matrix in a closed convex set to approximate a given matrix. This problem may arise in several areas of numerical linear algebra or come from finance industry or statistics and thus has many applications. For solving this class of matrix optimization problems, many methods have been proposed in the literature. The proximal alternating direction method is one of those methods which can be easily applied to solve these matrix optimization problems. Generally, the proximal parameters of the proximal alternating direction method are greater than zero. In this paper, we conclude that the restriction on the proximal parameters can be relaxed for solving this kind of matrix optimization problems. Numerical experiments also show that the proximal alternating direction method with the relaxed proximal parameters is convergent and generally has a better performance than the classical proximal alternating direction method.

  17. The Life Saving Effects of Hospital Proximity

    DEFF Research Database (Denmark)

    Bertoli, Paola; Grembi, Veronica

    We assess the lifesaving effect of hospital proximity using data on fatality rates of road-traffic accidents. While most of the literature on this topic is based on changes in distance to the nearest hospital triggered by hospital closures and use OLS estimates, our identification comes from......) increases the fatality rate by 13.84% on the sample average. This is equal to a 0.92 additional death per every 100 accidents. We show that OLS estimates provide a downward biased measure of the real effect of hospital proximity because they do not fully solve spatial sorting problems. Proximity matters...

  18. Deformity and functional outcome after treatment for supracondylar humerus fractures in children: a 5- to 10-year follow-up of 139 supracondylar humerus fractures treated by plaster cast, skeletal traction or crossed wire fixation.

    Science.gov (United States)

    Young, Sven; Fevang, Jonas M; Gullaksen, Gunnar; Nilsen, Per T; Engesæter, Lars B

    2010-10-01

    At Haukeland University Hospital (HUH), we used overhead skeletal traction for displaced supracondylar humerus fractures (SCHF) in children until closed reduction and crossed wire fixation was introduced in the early 1990s. Though there are obvious and well-documented benefits of wire fixation, the aim of this study was to document and compare the results and complication rates for both methods. One hundred and thirty-nine patients treated for SCHF between 1988 and 1998 were available for follow-up. Of these, 40 children were treated with a plaster cast, 46 with overhead skeletal traction and 45 with crossed wire fixation. Eight children were treated with open reduction and crossed wires. The mean time to follow-up was 7.1 years [standard deviation (SD) 3.2]. The length of hospital stay was 2 days for those treated with crossed wire fixation compared to 11 days for traction (P skeletal traction or wire fixation, but there were more reoperations in the traction group (P = 0.04). Patients treated solely with a plaster cast had a mean of 4° increased extension of the affected elbow compared to 1° in the crossed pin fixation group (P = 0.02). Though this has little clinical relevance, it does indicate improved reduction in the operated patients, as one would expect. The introduction of crossed wire fixation has significantly reduced the number of days for which patients are hospitalised for SCHF. The rate of nerve injuries in Gartland type 3 fractures is high. Despite the fact that this study includes the first patients to be treated with crossed wire fixation at our institution, no significant increase in the risk of complications could be found compared to skeletal traction.

  19. Proximity and Collaboration in European Nanotechnology

    NARCIS (Netherlands)

    Cunningham, S.W.; Werker, C.

    2011-01-01

    Collaborations are particularly important for the development and deployment of technology. We analyze the influence of organizational, technological and geographical proximity on European nanotechnology collaborations with the help of a publication dataset and additional geographical information.

  20. Promoting proximal formative assessment with relational discourse

    Science.gov (United States)

    Scherr, Rachel E.; Close, Hunter G.; McKagan, Sarah B.

    2012-02-01

    The practice of proximal formative assessment - the continual, responsive attention to students' developing understanding as it is expressed in real time - depends on students' sharing their ideas with instructors and on teachers' attending to them. Rogerian psychology presents an account of the conditions under which proximal formative assessment may be promoted or inhibited: (1) Normal classroom conditions, characterized by evaluation and attention to learning targets, may present threats to students' sense of their own competence and value, causing them to conceal their ideas and reducing the potential for proximal formative assessment. (2) In contrast, discourse patterns characterized by positive anticipation and attention to learner ideas increase the potential for proximal formative assessment and promote self-directed learning. We present an analysis methodology based on these principles and demonstrate its utility for understanding episodes of university physics instruction.

  1. Proximate composition and cholesterol concentrations of ...

    African Journals Online (AJOL)

    STORAGESEVER

    2009-05-18

    DWB) for raw and fried samples, respectively, but decreased to 295.20 ... Key words: Rhynchophorus phoenicis, Oryctes monoceros, proximate composition, cholesterol, heat treatment. INTRODUCTION. Insects have played ...

  2. COMPARATIVE ANALYSIS OF PROXIMATE COMPOSITIONS OF ...

    African Journals Online (AJOL)

    Babatunde Emmanuel

    2011-10-06

    Oct 6, 2011 ... Fish allows for protein improved nutrition in that it has a high biological value in terms of high ... marine algae upon which the fish feed [11]. ... Proximate composition of catfish Clarias gariepinus and Tarpon atlanticus were.

  3. Phytochemical screening, proximate analysis and acute toxicity ...

    African Journals Online (AJOL)

    Phytochemical screening, proximate analysis and acute toxicity studies were carried out on the leaf extract of Cola lepidota, in accordance with established standard procedures. The proximate analysis reveals a moisture content of 27.43 ± 3.11 % w/w, total ash value 9.32 ± 0.27 % w/w, acid insoluble ash 3.12 ± 1.05 % w/w ...

  4. Proximate, Mineral and Phytochemical Composition of Dioscorea ...

    African Journals Online (AJOL)

    ADOWIE PERE

    ABSTRACT: Proximate, mineral and phytochemical composition of Dioscorea dumetorum tubers was investigated using standard procedures. Proximate analysis included in g% dry weight: crude protein (6.44 ± 0.32), crude fat (0.75 ± 0.04), crude fibre (15.00 ± 0.56), total ash. (3.45 ± 0.20) and a moisture content of 70.04 ...

  5. Painful Spastic Hip Dislocation: Proximal Femoral Resection

    OpenAIRE

    Albiñana, Javier; Gonzalez-Moran, Gaspar

    2002-01-01

    The dislocated hip in a non-ambulatory child with spastic paresis tends to be a painful interference to sleep, sitting upright, and perineal care. Proximal femoral resection-interposition arthroplasty is one method of treatment for this condition. We reviewed eight hips, two bilateral cases, with a mean follow-up of 30 months. Clinical improvement was observed in all except one case, with respect to pain relief and sitting tolerance. Some proximal migration was observed in three cases, despit...

  6. Nanocrystal Bioassembly: Asymmetry, Proximity, and Enzymatic Manipulation

    Energy Technology Data Exchange (ETDEWEB)

    Claridge, Shelley A. [Univ. of California, Berkeley, CA (United States)

    2008-05-01

    Research at the interface between biomolecules and inorganic nanocrystals has resulted in a great number of new discoveries. In part this arises from the synergistic duality of the system: biomolecules may act as self-assembly agents for organizing inorganic nanocrystals into functional materials; alternatively, nanocrystals may act as microscopic or spectroscopic labels for elucidating the behavior of complex biomolecular systems. However, success in either of these functions relies heavily uponthe ability to control the conjugation and assembly processes.In the work presented here, we first design a branched DNA scaffold which allows hybridization of DNA-nanocrystal monoconjugates to form discrete assemblies. Importantly, the asymmetry of the branched scaffold allows the formation of asymmetric2assemblies of nanocrystals. In the context of a self-assembled device, this can be considered a step toward the ability to engineer functionally distinct inputs and outputs.Next we develop an anion-exchange high performance liquid chromatography purification method which allows large gold nanocrystals attached to single strands of very short DNA to be purified. When two such complementary conjugates are hybridized, the large nanocrystals are brought into close proximity, allowing their plasmon resonances to couple. Such plasmon-coupled constructs are of interest both as optical interconnects for nanoscale devices and as `plasmon ruler? biomolecular probes.We then present an enzymatic ligation strategy for creating multi-nanoparticle building blocks for self-assembly. In constructing a nanoscale device, such a strategy would allow pre-assembly and purification of components; these constructs can also act as multi-label probes of single-stranded DNA conformational dynamics. Finally we demonstrate a simple proof-of-concept of a nanoparticle analog of the polymerase chain reaction.

  7. Proximity sensor system development. CRADA final report

    Energy Technology Data Exchange (ETDEWEB)

    Haley, D.C. [Oak Ridge National Lab., TN (United States); Pigoski, T.M. [Merrit Systems, Inc. (United States)

    1998-01-01

    Lockheed Martin Energy Research Corporation (LMERC) and Merritt Systems, Inc. (MSI) entered into a Cooperative Research and Development Agreement (CRADA) for the development and demonstration of a compact, modular proximity sensing system suitable for application to a wide class of manipulator systems operated in support of environmental restoration and waste management activities. In teleoperated modes, proximity sensing provides the manipulator operator continuous information regarding the proximity of the manipulator to objects in the workspace. In teleoperated and robotic modes, proximity sensing provides added safety through the implementation of active whole arm collision avoidance capabilities. Oak Ridge National Laboratory (ORNL), managed by LMERC for the United States Department of Energy (DOE), has developed an application specific integrated circuit (ASIC) design for the electronics required to support a modular whole arm proximity sensing system based on the use of capacitive sensors developed at Sandia National Laboratories. The use of ASIC technology greatly reduces the size of the electronics required to support the selected sensor types allowing deployment of many small sensor nodes over a large area of the manipulator surface to provide maximum sensor coverage. The ASIC design also provides a communication interface to support sensor commands from and sensor data transmission to a distributed processing system which allows modular implementation and operation of the sensor system. MSI is a commercial small business specializing in proximity sensing systems based upon infrared and acoustic sensors.

  8. Transformations through Proximity Flying: A Phenomenological Investigation

    Science.gov (United States)

    Holmbom, Maria; Brymer, Eric; Schweitzer, Robert D.

    2017-01-01

    Participation in extreme sports has been linked to personal transformations in everyday life. Descriptions of lived experience resulting from transformative experiences are limited. Proximity flying, a relatively new discipline involving BASE jumping with a wingsuit where participants fly close to solid structures, is arguably one of the most extreme of extreme sports. The aim of this paper, part of a larger phenomenological study on the lived experience of proximity flying, is to explicate the ways in which participating in proximity flying influences the everyday lives of participants. Interpretative phenomenological analysis was used to explicate the lived experience of six proximity pilots. An analysis of interview transcripts revealed three significant themes describing the lived experience of participants. First, experiences of change were described as positive and skills developed through proximity flying were transferable into everyday life. Second, transformative experiences were considered fundamental to participants’ perspectives on life. Third, experience of transformation influenced their sense of personal identity and facilitated flourishing in other aspects of everyday life. Participants were clear that their experiences in proximity flying facilitated a profound process of transformation which manifest as changes in everyday capabilities and behaviors, values and sense of identity. PMID:29104552

  9. [RESEARCH PROGRESS OF BIOMECHANICS OF PROXIMAL ROW CARPAL INSTABILITY].

    Science.gov (United States)

    Guo, Jinhai; Huang, Fuguo

    2015-01-01

    To review the research progress of the biomechanics of proximal row carpal instability (IPRC). The related literature concerning IPRC was extensively reviewed. The biomechanical mechanism of the surrounding soft tissue in maintaining the stability of the proximal row carpal (PRC) was analyzed, and the methods to repair or reconstruct the stability and function of the PRC were summarized from two aspects including basic biomechanics and clinical biomechanics. The muscles and ligaments of the PRC are critical to its stability. Most scholars have reached a consensus about biomechanical mechanism of the PRC, but there are still controversial conclusions on the biomechanics mechanism of the surrounding soft tissue to stability of distal radioulnar joint when the triangular fibrocartilage complex are damaged and the biomechanics mechanism of the scapholunate ligament. At present, there is no unified standard about the methods to repair or reconstruct the stability and function of the PRC. So, it is difficult for clinical practice. Some strides have been made in the basic biomechanical study on muscle and ligament and clinical biomechanical study on the methods to repair or reconstruct the stability and function of PRC, but it will be needed to further study the morphology of carpal articular surface and the adjacent articular surface, the pressure of distal carpals to proximal carpal and so on.

  10. Cystic Lesions in the Greater Tuberosity of the Humerus: The Relation to Rotator Cuff Tears and Age

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Gang Deuk; Oh, Jung Taek [Wonkwang University Hospital, Iksan (Korea, Republic of)

    2008-12-15

    This study was designed to investigate the location of cystic lesions in the greater tuberosity of the humerus and the relationship to rotator cuff tears and age. A total of 78 patients (age range, 19-82 years; mean age, 51 years) who underwent arthroscopy or open surgery after MR arthrography (MRA) for a painful shoulder were enrolled in the study. The location of the cystic lesions were classified as 'A' for a supraspinatus insertion site, as 'C' for an infraspinatus insertion site, as 'B' for both a supraspinatus and infraspinatus insertion site, as 'BG' for a site posterior to the bicipital groove and as 'P' for a site at the bare area of the humeral head. The location of cystic lesions and supraspinatus and infraspinatus tears were evaluated on MRA. Statistical analyses used the chi-squared test and logistic regression. 'BG' and 'A' cystic lesions were related to the presence of a supraspinatus tear, 'C' cystic lesions were related to the presence of an infraspinatus tear and 'B' cystic lesions were related to the presence of both supraspinatus and infraspinatus tears (p < 0.05). 'P' cystic lesions were not related to the presence of rotator cuff tears. The incidence of cystic lesions increased with age, but with no statistical correlation. Cystic lesions at the supraspinatus and infraspinatus insertion sites are useful to predict the presence of a rotator cuff tear, but cystic lesions were not age related

  11. Active cheerleading with radial nerve palsy following supracondylar humerus fracture [Cheerleading mit Radialisparese nach suprakondylärer Humerusfraktur

    Directory of Open Access Journals (Sweden)

    Herold, Christian

    2013-10-01

    Full Text Available [english] Cheerleading is associated with substantial morbidity. As such, cheerleading fall-related injuries may cause serious to fatal outcomes especially falls from attempted pyramids. We report on a female adolescent cheerleader age 14 suffering a supracondylar humerus fracture related to a fall from a pyramid. Unfortunately, lateral pinning led to complete iatrogenic radial nerve palsy. However, given an intriguing compensatory athletic function of the wrist she was able to perform cheerleading artistic figures such as flic-flac within four months after the injury with a radial nerve palsy, which is highlighted in an attached video. 18 months after the radial palsy she was admitted to our hospital and underwent neuroma resection of the initially transsected radial nerve at the elbow and sural nerve grafting for radial nerve palsy.[german] Cheerleading kann zu verschiedensten Unfällen führen. Insbesondere bei dem Versuch Pyramiden zu bilden sind bereits Todesfälle aufgetreten. Wir berichten von einer 14-jährigen Cheerleaderin welche bei dem Versuch eine Pyramide zu bilden stürzte und sich eine suprakondyläre Humerusfraktur zuzog. Bei der osteosynthetischen Versorgung kam es leider zu einer kompletten Durchtrennung des N. radialis. Dennoch konnte sie bei der gegebenen erstaunlichen Kompensation ihrer Handgelenksgeweglichkeit weiterhin schwierige Cheerleading Übungen wie Flick-Flack durchführen, was im beigefügten Video verdeutlicht wird. 18 Monate nach Eintreten der Radialisparese wurde sie in unserer Klinik vorstellig und es wurde nach einer Neuromresektion eine Suralis Interposition zur Nervenrekonstruktion durchgeführt.

  12. Immobilization after pinning of supracondylar distal humerus fractures in children: use of the A-frame cast.

    Science.gov (United States)

    McKeon, Kathleen E; O'Donnell, June C; Bashyal, Ravi; Hou, Clifford C; Luhmann, Scott J; Dobbs, Matthew B; Gordon, J Eric

    2012-01-01

    Circumferential casts can contribute to elevated compartment pressures in the setting of acute swelling. We have developed a novel casting method (A-frame cast) that allows cast placement while leaving the antecubital fossa free of casting material. The purpose of this study was to evaluate the safety, efficacy, and complications associated with acute placement of this definitive cast after closed reduction percutaneous pinning (CRPP) of acute supracondylar distal humerus fractures. A retrospective medical record reviewed 436 patients treated with CRPP of supracondylar fractures by 3 surgeons who routinely used an A-frame cast over a 12-year period. All complications or the need for cast modification were noted. Patients with open reduction, ipsilateral fractures, or patients lost to follow-up were excluded. There were 387 patients who met inclusion criteria, including 204 type 2 fractures and 183 type 3 fractures. Forty-three patients had preoperative nerve palsy and 1 had preoperative vascular injury. Of these 387 patients, 369 (95.3%) had an uneventful postoperative course. Nineteen patients (4.9%) required either cast splitting (15) or strict elevation (4) secondary to pain and swelling. Seven of these 19 patients had preoperative nerve palsy and 1 had preoperative vascular injury. The average time from procedure to cast splitting was 17.6 hours. No patients lost their reduction or required a second surgical procedure related to a complication from casting. An "A-frame" cast provides sturdy immobilization without increased risk of compartment syndrome after CRPP of supracondylar fractures in the pediatric population. Consideration should be given to splitting the cast prophylactically in patients with preoperative neurological or vascular deficits. IV-Case Series.

  13. [Case-control study on close reduction and plaster slab fixation combined with plaster external traction for the treatment of pediatric Gartland type III supracondylar humerus fractures].

    Science.gov (United States)

    Kang, Yu-Xiang; Wei, Xiao-Chun; Li, Hai-Ming

    2014-07-01

    To compare the therapeutic effects between close reduction and plaster slab fixation combined with plaster external traction and operation for the treatment of pediatric closed Gartland type III supracondylar humerus fractures without neurovascular injury complications. From June 2009 to June 2012, 151 children with closed Gartland III supracondylar humerus fractures were retrospectively studied and divided into two groups, including 87 boys and 64 girls, ranging in age from 1 to 12 years old with an average of 5.3 years old. Among them, 76 children (conservative group) were treated with close reduction and plaster slab fixation combined with plaster external traction; 75 children (operation group) underwent surgical operation. The time of elbow joint function exercise, the healing time of fracture, the function recovery of elbow joint and carrying angle was recorded and analyzed. The therapeutic effects were evaluated by the Flynn criteria system. All patients were followed up from 6 to 36 months (18.3 months on average). The average time of fracture healing and elbow joint functional exercise of the conservative group was shorter than those of operation group (P 0.05). According to Flynn criteria system, in conservative group, the result was excellent in 31 cases, good in 35, fair in 7, and poor in 3; in operation group, 27 in excellent, 30 in good, 17 in fair and 1 in poor; there was no significant difference between two groups in therapeutic effects (P > 0.05). Close reduction and plaster slab fixation combined with plaster external traction in treatment of pediatric closed Gartland type III supracondylar humerus fractures without neurovascular injury complications,which has similar effect to surgical treatment, and the time of fracture healing and elbow joint function exercise are significantly shorter.

  14. Humeral Tip-apex-distance as a Prognostic Marker for Proximal Humeral Fractures in 203 Patients

    Science.gov (United States)

    Saul, Dominik; Himmelmann, Tobias; Dresing, Klaus

    2017-01-01

    Background: Humeral head fractures and their postoperative outcome remain a challenging problem in surgical daily routine. Predictive factors for loss of fixation are rare. Objective: Determination of predictive factors for the failure of osteosynthesis with the loss of fixation or migration of screws in humeral head fractures. Method: From 1995 to 2011, 408 patients with proximal humeral fractures [mean age 66.6 years, 50.9-82.3 years] and osteosynthesis were analyzed. Two hundred and three received open reduction internal fixation (ORIF) with the PHILOS® plate. The non-locking plate was used in 80, the locking plate in 16 and humeral head prosthesis in 26 patients, in addition to 23 patients undergoing other procedures. Intraoperative reduction that achieved an anatomical alignment of the medial aspect of the humerus (humeral calcar) was assessed in 94 patients by postoperative X-ray analysis. The loss of fixation was evaluated by a follow-up of three to five X-rays and measurement of the humeral tip-apex-distance (HTAD). Results: For stable fixed fractures with an intact calcar, percentual HTAD was significantly higher than for unstable fixed fractures (p=0.04). Morbidity, such as hypertension, orthopedic operations or diabetes, strongly influenced the HTAD, while postoperative passive motion treatment modestly affected the HTAD over time. Conclusion: The anatomic reconstruction of the calcar, leading to stable fixation of humeral head fractures, can significantly prevent an overproportioned decrease in the HTAD in postoperative X-rays and seems to be vital in multimorbid patients. Measurement of the HTAD over time delivers a tool for early detection of secondary loss of fixation. PMID:28567159

  15. The amount of humeral head impaction of proximal humeral fractures fixed with the Humerusblock device.

    Science.gov (United States)

    Carbone, Stefano; Moroder, Philipp; Arceri, Valerio; Postacchini, Roberto; Gumina, Stefano

    2014-07-01

    The Humerusblock is a minimally invasive device allowing fixation of proximal humeral fractures. A drawback of the device is possible K-wire perforation of the head with the need for early removal of the implant. We assessed the amount of humeral head impaction and its role in the postoperative varus/valgus deviation of the humeral head in fractures of the upper humerus treated with Humerusblock. Fractures were classified according to the Codman-Lego system. The length of the posteromedial metaphyseal extension and integrity of medial hinge were measured; metaphyseal comminution was assessed. Accuracy of fracture reduction was classified as excellent to poor. An original method of measurement of amount of postoperative impaction of the humeral head was developed. The impaction and varus/valgus inclination of the heads were measured comparing postoperative and three-month follow-up radiographs. Constant score and its relation to sintering was calculated at 12-month follow-up. Forty-three fractures were available for follow-up. The amount of humeral head impaction was 3.9 mm on average and was directly correlated with patient's age, sex, Codman-Lego classification, varus inclination and mataphyseal comminution. The postoperative cervico-diaphyseal angle was restored in 35 cases, with 81 % good results. The Humerusblock was removed in 41 % of cases because of K-wire perforation of the humeral head. A negative correlation was found between impaction and Constant score. The amount of humeral head impaction is related to patients' age, sex, and fracture patterns, being the most prone to compaction those with metaphyseal comminution. Humeral head impaction negatively affects final Constant score.

  16. Total elbow arthroplasty in distal humerus fracture in patients older than 65 years.

    Directory of Open Access Journals (Sweden)

    Gerardo Gallucci

    2016-05-01

    Full Text Available Objective To report the clinical-functional results of the treatment of humeral distal fractures with a total elbow prosthesis in patients older than 65 years old. Material and methods This retrospective paper was performed in two surgical centers. Criteria inclusion were: patients with humeral distal fractures, > 65 years, operated on with Coonrad-Morrey prostheses, and with a follow-up of  >1 year. Twenty-one patients were included. Twenty were women with an average age of 79 years old. According to AO classification, 13 fractures were type C3, 7 C2 and 1 A2. All patientes were operated on without desinsertion of the extensor mechanism. Average follow-up was 40 months. Results Flexo-extension was 123-17°, with a total arc of mobility of 106° (80 % of the contralateral side. Pain according to AVE was 1. The MEPI was 83 points: 8 patients had excellent results, 11 good, 1 regular and 1 bad. Average DASH score was 24 points. Conclusion Treatment of humeral distal fractures with total elbow arthoplasty in patients older than 65 years old, may lead to a good option of treatment, but indications must be limited to patients with complex fractures, bad bone quality, with osteoporosis and low functional demands.

  17. Simple radiographic assessment of bone quality is associated with loss of surgical fixation in patients with proximal humeral fractures.

    Science.gov (United States)

    Newton, Ashley W; Selvaratnam, Veenesh; Pydah, Satya K; Nixon, Matthew F

    2016-04-01

    This study aimed to determine if the ratio of cortical thickness to shaft diameter of the humerus, as measured on a simple anterior-posterior shoulder radiograph, is associated with surgical fixation failure. 64 consecutive fractures in 63 patients (mean age 66.1 years, range 35-90) operated with surgical fixation between March 2011 and July 2014 using PERI-LOC locking plate and screws (Smith and Nephew, UK) were identified. Predictors of bone quality were measured from preoperative radiographs, including ratio of the medial cortex to shaft diameter (medial cortical ratio, MCR). Loss of fixation (displacement, screw cut out, or change in neck-shaft angle >4 degrees) was determined on follow-up radiographs. Loss of fixation occurred in 14 patients (21.9%) during the follow up. Patients were older in the failure group 72.8 vs. 64.2 years (p=0.007). The MCR was significantly lower in patients with failed fixation 0.170 vs 0.202, p=0.019. Loss of fixation is three times more likely in patients with a MCR fracture parts led to increased failure rate (p=0.0005). Medial cortex ratio is significantly associated with loss of surgical fixation and may prove to be a useful adjunct for clinical decision making in patients with proximal humeral fractures. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Influence of plate material and screw design on stiffness and ultimate load of locked plating in osteoporotic proximal humeral fractures.

    Science.gov (United States)

    Katthagen, Jan Christoph; Schwarze, Michael; Warnhoff, Mara; Voigt, Christine; Hurschler, Christof; Lill, Helmut

    2016-03-01

    The main purpose was to compare the biomechanical properties of a carbon-fibre reinforced polyetheretherketone (CF-PEEK) composite locking plate with pre-existing data of a titanium-alloy plate when used for fixation of an unstable 2-part fracture of the surgical neck of the humerus. The secondary purpose was to compare the mechanical behaviour of locking bolts and conventional locking cancellous screws. 7 pairs of fresh frozen human humeri were allocated to two equal groups. All specimens were fixed with the CF-PEEK plate. Cancellous screws (PEEK/screw) were compared to locking bolts (PEEK/bolt) for humeral head fixation. Stiffness, fracture gap deflection and ultimate load as well as load before screw perforation of the articular surface were assessed. Results were compared between groups and with pre-existing biomechanical data of a titanium-alloy plate. The CF-PEEK plate featured significantly lower stiffness compared to the titanium-alloy plate (P0.05). The CF-PEEK plate has more elastic properties and significantly increases movement at the fracture site of an unstable proximal humeral fracture model compared to the commonly used titanium-alloy plate. The screw design however does neither affect the constructs primary mechanical behaviour in the constellation tested nor the load before screw perforation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Interventions for treating proximal humeral fractures in adults.

    Science.gov (United States)

    Handoll, Helen H G; Brorson, Stig

    2015-11-11

    Fracture of the proximal humerus, often termed shoulder fracture, is a common injury in older people. The management of these fractures varies widely. This is an update of a Cochrane Review first published in 2001 and last updated in 2012. To assess the effects (benefits and harms) of treatment and rehabilitation interventions for proximal humeral fractures in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and other databases, conference proceedings and bibliographies of trial reports. The full search ended in November 2014. We considered all randomised controlled trials (RCTs) and quasi-randomised controlled trials pertinent to the management of proximal humeral fractures in adults. Both review authors performed independent study selection, risk of bias assessment and data extraction. Only limited meta-analysis was performed. We included 31 heterogeneous RCTs (1941 participants). Most of the 18 separate treatment comparisons were tested by small single-centre trials. The main exception was the surgical versus non-surgical treatment comparison tested by eight trials. Except for a large multicentre trial, bias in these trials could not be ruled out. The quality of the evidence was either low or very low for all comparisons except the largest comparison.Nine trials evaluated non-surgical treatment in mainly minimally displaced fractures. Four trials compared early (usually one week) versus delayed (three or four weeks) mobilisation after fracture but only limited pooling was possible and most of the data were from one trial (86 participants). This found some evidence that early mobilisation resulted in better recovery and less pain in people with mainly minimally displaced fractures. There was evidence of little difference between the two groups in shoulder complications (2/127 early mobilisation versus 3/132 delayed mobilisation; 4 trials) and

  20. Industrial Computed Tomography using Proximal Algorithm

    KAUST Repository

    Zang, Guangming

    2016-04-14

    In this thesis, we present ProxiSART, a flexible proximal framework for robust 3D cone beam tomographic reconstruction based on the Simultaneous Algebraic Reconstruction Technique (SART). We derive the proximal operator for the SART algorithm and use it for minimizing the data term in a proximal algorithm. We show the flexibility of the framework by plugging in different powerful regularizers, and show its robustness in achieving better reconstruction results in the presence of noise and using fewer projections. We compare our framework to state-of-the-art methods and existing popular software tomography reconstruction packages, on both synthetic and real datasets, and show superior reconstruction quality, especially from noisy data and a small number of projections.

  1. Correlation between social proximity and mobility similarity.

    Science.gov (United States)

    Fan, Chao; Liu, Yiding; Huang, Junming; Rong, Zhihai; Zhou, Tao

    2017-09-20

    Human behaviors exhibit ubiquitous correlations in many aspects, such as individual and collective levels, temporal and spatial dimensions, content, social and geographical layers. With rich Internet data of online behaviors becoming available, it attracts academic interests to explore human mobility similarity from the perspective of social network proximity. Existent analysis shows a strong correlation between online social proximity and offline mobility similarity, namely, mobile records between friends are significantly more similar than between strangers, and those between friends with common neighbors are even more similar. We argue the importance of the number and diversity of common friends, with a counter intuitive finding that the number of common friends has no positive impact on mobility similarity while the diversity plays a key role, disagreeing with previous studies. Our analysis provides a novel view for better understanding the coupling between human online and offline behaviors, and will help model and predict human behaviors based on social proximity.

  2. Infiltrating/sealing proximal caries lesions

    DEFF Research Database (Denmark)

    Martignon, S; Ekstrand, K R; Gomez, J

    2012-01-01

    This randomized split-mouth controlled clinical trial aimed at assessing the therapeutic effects of infiltration vs. sealing for controlling caries progression on proximal surfaces. Out of 90 adult students/patients assessed at university clinics and agreeing to participate, 39, each with 3...... differences in lesion progression between infiltration and placebo (P = 0.0012) and between sealing and placebo (P = 0.0269). The study showed that infiltration and sealing are significantly better than placebo treatment for controlling caries progression on proximal lesions. No significant difference...... proximal lesions identified radiographically around the enamel-dentin junction to the outer third of the dentin, were included. Lesions were randomly allocated for treatment to test-A (Infiltration: ICON-pre-product; DMG), test-B (Sealing: Prime-Bond-NT; Dentsply), or control-C (Placebo). Primary outcome...

  3. Knowledge networks in the Dutch aviation industry: The proximity paradox

    NARCIS (Netherlands)

    Broekel, T.; Boschma, R.A.

    2012-01-01

    The importance of geographical proximity for interaction and knowledge sharing has been discussed extensively in recent years. There is increasing consensus that geographical proximity is just one out of many types of proximities that might be relevant. We argue that proximity may be a crucial

  4. A novel suture anchor constructed of cortical bone for rotator cuff repair: a biomechanical study on sheep humerus specimens.

    Science.gov (United States)

    Guo, Qi; Li, Chunbao; Qi, Wei; Li, Hongliang; Lu, Xi; Shen, Xuezhen; Qu, Feng; Liu, Yujie

    2016-09-01

    The aim of this study was to evaluate biomechanical properties of a new type of suture anchors constructed of human cortical allograft bone and compare it with the similar standard titanium screw anchor for rotator cuff tears in sheep humerus model. Twenty-four paired sheep humeri were harvested from 12 male sheep aged 18 months. Specimens were divided into cortical bone anchor group and titanium screw anchor group. The anchors loaded with two sutures were placed at the footprint of infraspinatus tendon. Cyclic loading test was performed from 10 to 60 N at 1 Hz for 500 cycles and followed by a load-to-failure test at 33 mm/sec. A paired t-test was used to compare the biomechanical properties of the anchors of each type. No anchors failed during the cyclic phase, and the cortical bone anchors were all pulled out intact. The cyclic displacement of the cortical bone anchor was not significantly greater than that of the titanium screw anchor (P > 0.05). Student's t test showed no statistically significant difference between anchors in terms of failure load (cortical bone anchor: 304.74 ± 64.46 N versus titanium screw anchor: 328.45 ± 89.58 N; P = 0.213), ultimate load (cortical bone anchor: 325.82 ± 76.45 N versus titanium screw anchor: 345.61 ± 83.56 N; P = 0.183), yield load (cortical bone anchor: 273.78 ± 44.75 N versus titanium screw anchor: 284.72 ± 56.37 N; P = 0.326) or stiffness (cortical bone anchor: 52.97 ± 14.28 N/mm versus titanium screw anchor: 62.38 ± 18.35 N/mm; P = 0.112). In vitro, this experimental study suggested no statistically significant difference in initial fixation stability between the new type anchor and titanium screw anchor at a chosen level of significance (P suture anchor constructed of cortical bone provides comparable initial fixation strength to a similar metallic anchor for rotator cuff repair.

  5. A COMPARATIVE STUDY OF FUNCTIONAL OUTCOMES OF FRACTURE SHAFT HUMERUS IN ADULTS TREATED WITH DYNAMIC COMPRESSION PLATING AND INTERLOCKING NAILING

    Directory of Open Access Journals (Sweden)

    Nagesh Desai

    2015-02-01

    Full Text Available INTRODUCTION: Opti m al m ethod of hu m eral shaft f r acture f i xation remains in debate till date. Two techniq u es under study include i n tra m edullary nailing and dyna m ic co m pression plate fixation. Plating provides satisfactory results but requires extensive dissection and m eticulous radial nerve protection. Theoretical advantage of intra m ed u llary nailing included less invasive surgery, undisturbed fractu r e hemato m a and use of load sharing device support. Purpose of this study is to co m p are o u tco m es of each m ethod of fixation for fracture shaft of humerus. MATERIALS AND METHODS: P atients with diaphyseal fractures of the hu m erus were divided in two groups of 20 treated with dynam i c co m pression plate or w i th i n tra m edullary interlocking nail. Postoperatively both groups received sa m e type of physiotherapy. They were followed up regularly . T i me taken for radiological union in two groups was co m pared. After satisfactory radiological un i on, functional out c o m e was assessed by “Disabilities of Hand, Shoulder and Elbow (DASH Questionnaire”. RESULTS: F unctional outco m e was better in DCP group co m pared to int e rloc ki ng nailing group which was statistically significant ( P = 0.062. Rate of healing was marginally better in DCP group as compared to I.M nail. CONCLUSION: W e are of opi n i on that when s u r ge r y is opted as a c h oice of treat m ent, both modalities of treat m ent i.e. dyn a m i c co m pression plating and interlocking nailing are good as far as union of fracture is concerned, but considering number of co m plications and functional outco m e, we opine that d y na m i c co m p ression plating o f f ers bett e r result than anteg r ade i n te r l ocking nailing with respect to pain and function of shoulder joint

  6. When physiology becomes pathology: the role of magnetic resonance imaging in evaluating bone marrow oedema in the humerus in elite tennis players with an upper limb pain syndrome.

    Science.gov (United States)

    Hoy, G; Wood, T; Phillips, N; Connell, D; Hughes, D C

    2006-08-01

    Upper limb stresses are well recognised in tennis, and the normal physiological responses of the humerus to externally applied forces are well defined. Changes to both the microscopic and macroscopic bony architecture are often not apparent on plain radiographs in the early stages of a stress reaction. Bone scintigraphy is more sensitive, but not very specific to subtle changes, as is computer aided tomography. Magnetic resonance imaging (MRI) scans are now used to assess many musculoskeletal injuries, and may allow earlier recognition of changes. This study reports on eight high level tennis players (seven professionals, one highly ranked amateur), who all presented during the course of the 2002 Australian Open and its lead up events. All had an upper limb pain syndrome centred around the elbow. Each underwent an MRI scan. A group of asymptomatic players also had scans of the same area to serve as controls. All symptomatic patients had various levels of bone marrow oedema in their distal humerus, some with periosteal reactions, although most without. No scans revealed a cortical breach. The management of these reactions is problematic in players on an international circuit, as review is sporadic and not always coordinated. The timetabling of international tournaments means it is difficult for top players to obtain adequate rest to avoid injury. Awareness of this early overuse reaction needs to be raised to allow preventive and therapeutic options to be considered to reduce the incidence of this humeral stress response producing an upper limb pain syndrome.

  7. preliminary phytochemical screening, proximate and elemental

    African Journals Online (AJOL)

    DR. AMINU

    ABSTRACT. The seed powder of Moringa oleifera was analysed for its phytochemical, proximate and elemental composition using Folin-Denis spectrophotometric method, gravimetric method and energy dispersing X-ray fluorescence (EDXRF) transmission emission technique respectively. The seed powder had the ...

  8. Proximate, mineral composition, antioxidant activity, and total ...

    African Journals Online (AJOL)

    Four varieties of the red pepper fruits (Capsicum species) were evaluated for chemical composition, antioxidant activity and total phenolic contents using standard analytical technique, ferric-ion reducing antioxidant potential (FRAP) assay and Folin-Colcalteau method respectively. The proximate composition values ...

  9. 9__43 - 50__Tijjani_Proximate

    African Journals Online (AJOL)

    User

    Sena et al., 1998). In Nigeria, the plant is commonly consumed by the Hausa speaking communities as a spice and a sauce (Ibrahim et al., 2012). However, during preparation the leaves and stem are not carefully separated before processing of food. Thus, the present study was aimed at evaluating the proximate, minerals ...

  10. Phytochemistry and proximate composition of ginger ( Zingiber ...

    African Journals Online (AJOL)

    ... a little crude fibre content of 0.92 %. The results indicated that ginger rhizome is an excellent natural remedy for a wide range of ailments. Keywords: Zingiber officinale, spice, rhizome, phytochemistry, proximate analysis, Zingiberaceae, zingerone, methanolic extraction. Journal of Pharmaceutical and Allied Sciences, Vol.

  11. DEPRESSIONARY EFFECT OF PROXIMITY OF RESIDENTIAL ...

    African Journals Online (AJOL)

    Osondu

    2012-10-24

    Oct 24, 2012 ... opinions are analyzed and it revealed that the site has major impacts on the residents perceived quality of life, security and ... Key words: Landfill, Property value, Health and safety, Residential property, Solous. Introduction. The location ... Proximity to landfills and hazardous waste sites can severely affect ...

  12. Renal fibrosis: Primacy of the proximal tubule.

    Science.gov (United States)

    Gewin, Leslie S

    2018-02-06

    Tubulointerstitial fibrosis (TIF) is the hallmark of chronic kidney disease and best predictor of renal survival. Many different cell types contribute to TIF progression including tubular epithelial cells, myofibroblasts, endothelia, and inflammatory cells. Previously, most of the attention has centered on myofibroblasts given their central importance in extracellular matrix production. However, emerging data focuses on how the response of the proximal tubule, a specialized epithelial segment vulnerable to injury, plays a central role in TIF progression. Several proximal tubular responses such as de-differentiation, cell cycle changes, autophagy, and metabolic changes may be adaptive initially, but can lead to maladaptive responses that promote TIF both through autocrine and paracrine effects. This review discusses the current paradigm of TIF progression and the increasingly important role of the proximal tubule in promoting TIF both in tubulointerstitial and glomerular injuries. A better understanding and appreciation of the role of the proximal tubule in TIF has important implications for therapeutic strategies to halt chronic kidney disease progression. Copyright © 2017 International Society of Matrix Biology. Published by Elsevier B.V. All rights reserved.

  13. 182 179 Comparative Study on the Proximate

    African Journals Online (AJOL)

    2008-12-02

    Dec 2, 2008 ... Key words: Annona squamosa, Fruits, Proximate, Minerals, nutrient density. INTRODUCTION. Sugar apple (Annona squamosa) also called. “Gwanda masar” in Hausa belong to the family. Annonacae. The most widely grown of all the species are A. muricata, A. cherimola, A reticulata, A. senegalensis and ...

  14. Phytochemical Screening, Proximate and Mineral Composition of ...

    African Journals Online (AJOL)

    Leaves of sweet potato (Ipomoea batatas) grown in Tepi area was studied for their class of phytochemicals, mineral and proximate composition using standard analytical methods. The phytochemical screening revealed the presence of alkaloids, flavonoid, terpenoids, saponins, quinones, phenol, tannins, amino acid and ...

  15. Phytochemical screening, proximate and elemental analysis of ...

    African Journals Online (AJOL)

    Citrus sinensis was screened for its phytochemical composition and was evaluated for the proximate and elemental analysis. The phytochemical analysis indicated the presence of reducing sugar, saponins, cardiac glycosides, tannins and flavonoids. The elemental analysis indicated the presence of the following mineral ...

  16. Phytochemical Screening and Proximate Analysis of Newbouldia ...

    African Journals Online (AJOL)

    The study was conducted to assess the phytochemical and proximate composition of Newboudia laevis leaves and Allium sativum bulb extracts. The leaves and bulbs extracts were analyzed for their chemical composition and antinutritional factors (ANFs) which include moisture, crude protein, crude fat, crude fiber, total ash ...

  17. Disability occurrence and proximity to death

    NARCIS (Netherlands)

    Klijs, Bart; Mackenbach, Johan P.; Kunst, Anton E.

    2010-01-01

    Purpose. This paper aims to assess whether disability occurrence is related more strongly to proximity to death than to age. Method. Self reported disability and vital status were available from six annual waves and a subsequent 12-year mortality follow-up of the Dutch GLOBE longitudinal study.

  18. [Four family members with proximal myotonic myopathy

    NARCIS (Netherlands)

    Tieleman, A.A.; Velden, M.P. van der; Visser, M.C.; Wokke, J.H.J.; Scheffer, H.; Engelen, B.G.M. van

    2004-01-01

    A 41-year-old woman had a 15-year history of pain in her thighs and arms, which also became weaker, and a decrease in visual acuity. Her 35-year-old brother, their 38-year-old sister and their 64-year-old mother also had myalgia, myotonia and proximal muscle weakness, and the women also had

  19. Phytochemical screening, proximate and elemental analysis of ...

    African Journals Online (AJOL)

    ... was about 0.01 in concentration. Proximate analysis also shows that it has a high nutritional value such as carbohydrate, fibre, Ash, fat and protein. These results recommended the consumption of these peels of desired physiochemical properties as sources of food fibres or low-calorie bulk ingredients in food applications ...

  20. Proximate composition and consumer acceptability of African ...

    African Journals Online (AJOL)

    The aim of the study was to assess the organoleptic differences of Clarias gariepinus smoked with two different energy sources, Anogeissus leiocarpus and Tamarindus indica with the help of a hedonic scale and to determine possible proximate composition difference between the smoked products. Smoking of the fishes ...

  1. Controllable proximity effect in superconducting hybrid devices

    NARCIS (Netherlands)

    Bakurskiy, S.V.

    2015-01-01

    This thesis is devoted to the study of controllable proximity effects in superconductors, both in terms of fundamental aspects and applications. As a part of this thesis theoretical description was suggested for a number of structures with superconducting electrodes and multiple interlayers. These

  2. Proximate, chemical compositions and sulphur concentrations on ...

    African Journals Online (AJOL)

    0, 10, 20, 50, 100, 150, 200, 250 and 300 ppm) on the nutritional value and the proximate composition of six selected mango cultivars (Tommy Atkins, Peach, Saber, Sunshine, Keitt and Vhavenda) grown in South Africa. The study shows that ...

  3. Proximate composition, bread characteristics and sensory ...

    African Journals Online (AJOL)

    This study was carried out to investigate proximate composition, bread characteristics and sensory evaluation of cocoyam-wheat composite breads at different levels of cocoyam flour substitution for human consumption.A whole wheat bread (WWB) and cocoyam-composite breads (CCB1,CCB 2 and CCB 3) were prepared ...

  4. Evaluation of the Proximate, Chemical and Phytochemical ...

    African Journals Online (AJOL)

    The increased interest in the utilization of the leaves of Moringa oleifera necessitated this study which evaluated the proximate, chemical and phytochemical composition, especially the presence of anti- physiological and toxic factors in the leaves. The results of the phytochemical analyses were: alkaloid 1.24 ± 0.141%; ...

  5. comparative proximate composition and antioxidant vitamins

    African Journals Online (AJOL)

    DR. AMINU

    ABSTRACT. The proximate composition and antioxidant vitamins analysis of two varieties of honey (dark amber and light amber) were carried out using standard methods. The values for moisture, ash, crude lipid, crude protein and crude carbohydrate contents of the two honeys, (light amber and dark amber) are 9.39 ...

  6. Proximate composition and cholesterol concentrations of ...

    African Journals Online (AJOL)

    Proximate composition and cholesterol concentrations of Rhynchophorus phoenicis and Oryctes monoceros larvae subjected to different heat treatments. ... 514.63 mg/100g dry weight basis (DWB) for raw and fried samples, respectively, but decreased to 295.20 mg/100 g DWB in the smoke-dried samples. Similarly, the ...

  7. Preliminary Phytochemical Screening, Elemental and Proximate ...

    African Journals Online (AJOL)

    The study aimed at phytochemical screening, elemental and proximate composition of two varieties of Cyperus esculentus (tiger nut) big yellow and small brown nuts using standard methods. The phytochemicals tested for were alkaloid, saponin, tannin, glycoside, flavonoid, steroid and resin. All the aforementioned ...

  8. Phytochemical screening, proximate and elemental analysis of ...

    African Journals Online (AJOL)

    Michael Horsfall

    2009). The aim of this study was to analyses the extract of. Citrus sinensis peels for the phytochemical, proximate and elemental composition. MATERIALS AND METHODS. Plant materials Fresh peels of Citrus sinensis were collected from Uselu market in Benin City, Edo. State, Nigeria. It was identified and authenticated by.

  9. Keldysh proximity action for disordered superconductors

    Indian Academy of Sciences (India)

    Abstract. We review a novel approach to the superconductive proximity effect in dis- ordered normal–superconducting (N–S) structures. The method is based on the multi- charge Keldysh action and is suitable for the treatment of interaction and fluctuation effects. As an application of the formalism, we study the subgap ...

  10. Goal-Proximity Decision-Making

    Science.gov (United States)

    Veksler, Vladislav D.; Gray, Wayne D.; Schoelles, Michael J.

    2013-01-01

    Reinforcement learning (RL) models of decision-making cannot account for human decisions in the absence of prior reward or punishment. We propose a mechanism for choosing among available options based on goal-option association strengths, where association strengths between objects represent previously experienced object proximity. The proposed…

  11. The shape of the hominoid proximal femur: a geometric morphometric analysis

    Science.gov (United States)

    Harmon, Elizabeth H

    2007-01-01

    As part of the hip joint, the proximal femur is an integral locomotor component. Although a link between locomotion and the morphology of some aspects of the proximal femur has been identified, inclusive shapes of this element have not been compared among behaviourally heterogeneous hominoids. Previous analyses have partitioned complex proximal femoral morphology into discrete features (e.g. head, neck, greater trochanter) to facilitate conventional linear measurements. In this study, three-dimensional geometric morphometrics are used to examine the shape of the proximal femur in hominoids to determine whether femoral shape co-varies with locomotor category. Fourteen landmarks are recorded on adult femora of Homo, Pan, Gorilla, Pongo and Hylobates. Generalized Procrustes analysis (GPA) is used to adjust for position, orientation and scale among landmark configurations. Principal components analysis is used to collapse and compare variation in residuals from GPA, and thin-plate spline analysis is used to visualize shape change among taxa. The results indicate that knucklewalking African apes are similar to one another in femoral shape, whereas the more suspensory Asian apes diverge from the African ape pattern. The shape of the human and orangutan proximal femur converge, a result that is best explained in terms of the distinct requirements for locomotion in each group. These findings suggest that the shape of the proximal femur is brought about primarily by locomotor behaviour. PMID:17310545

  12. A survey of Cr(VI) contamination of surface water in the proximity of ...

    African Journals Online (AJOL)

    In this study, Cr(VI) levels present in surface water within the vicinity of ferrochrome smelters located in the Bushveld Igneous Complex were monitored for a period of 1 year. The results indicated that surface water in the proximity of ferrochrome smelters was mostly unaffected by Cr(VI) pollution. Two surface water sampling ...

  13. Kidney-on-a-chip technology for renal proximal tubule tissue reconstruction

    NARCIS (Netherlands)

    Nieskens, T.T.G.; Wilmer, M.J.G.

    2016-01-01

    The renal proximal tubule epithelium is responsible for active secretion of endogenous and exogenous waste products from the body and simultaneous reabsorption of vital compounds from the glomerular filtrate. The complexity of this transport machinery makes investigation of processes such as tubular

  14. Proximal tubular hypertrophy and enlarged glomerular and proximal tubular urinary space in obese subjects with proteinuria.

    Directory of Open Access Journals (Sweden)

    Ana Tobar

    Full Text Available BACKGROUND: Obesity is associated with glomerular hyperfiltration, increased proximal tubular sodium reabsorption, glomerular enlargement and renal hypertrophy. A single experimental study reported an increased glomerular urinary space in obese dogs. Whether proximal tubular volume is increased in obese subjects and whether their glomerular and tubular urinary spaces are enlarged is unknown. OBJECTIVE: To determine whether proximal tubules and glomerular and tubular urinary space are enlarged in obese subjects with proteinuria and glomerular hyperfiltration. METHODS: Kidney biopsies from 11 non-diabetic obese with proteinuria and 14 non-diabetic lean patients with a creatinine clearance above 50 ml/min and with mild or no interstitial fibrosis were retrospectively analyzed using morphometric methods. The cross-sectional area of the proximal tubular epithelium and lumen, the volume of the glomerular tuft and of Bowman's space and the nuclei number per tubular profile were estimated. RESULTS: Creatinine clearance was higher in the obese than in the lean group (P=0.03. Proteinuria was similarly increased in both groups. Compared to the lean group, the obese group displayed a 104% higher glomerular tuft volume (P=0.001, a 94% higher Bowman's space volume (P=0.003, a 33% higher cross-sectional area of the proximal tubular epithelium (P=0.02 and a 54% higher cross-sectional area of the proximal tubular lumen (P=0.01. The nuclei number per proximal tubular profile was similar in both groups, suggesting that the increase in tubular volume is due to hypertrophy and not to hyperplasia. CONCLUSIONS: Obesity-related glomerular hyperfiltration is associated with proximal tubular epithelial hypertrophy and increased glomerular and tubular urinary space volume in subjects with proteinuria. The expanded glomerular and urinary space is probably a direct consequence of glomerular hyperfiltration. These effects may be involved in the pathogenesis of obesity

  15. Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

    Directory of Open Access Journals (Sweden)

    Hussain Shahid

    2014-06-01

    Full Text Available Objective:To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondylar fractures of the humerus in children. Methods: We prospectively followed 52 children who presented with Gartland type 3 displaced supracondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing (n=23, followed by fall from height (n=20, road traffic accidents (n=5 and fall from standing height (n=2. In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn’s criteria. Results:Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn’s criteria, 90.4% patients showed satisfactory results.Conclusion:Lateral approach for open reduction and internal fixation of the

  16. SINA: A test system for proximity fuses

    Science.gov (United States)

    Ruizenaar, M. G. A.

    1989-04-01

    SINA, a signal generator that can be used for testing proximity fuses, is described. The circuitry of proximity fuses is presented; the output signal of the RF circuit results from a mixing of the emitted signal and received signal that is Doppler shifted in frequency by the relative motion of the fuse with respect to the reflecting target of surface. With SINA, digitized and stored target and clutter signals (previously measured) can be transformed to Doppler signals, for example during a real flight. SINA can be used for testing fuse circuitry, for example in the verification of results of computer simulations of the low frequency Doppler signal processing. The software of SINA and its use are explained.

  17. Tunable Magnetic Proximity Effects in Graphene Junctions

    Science.gov (United States)

    Lazic, Predrag; Belashchenko, Kirill; Zutic, Igor

    2015-03-01

    The characteristic length of the magnetic proximity effects exceed the thickness of a graphene layer leading to an important, but typically overlooked, modifications of equilibrium and transport properties, as well as the implications for graphene spintronics. Using the first-principles studies that integrate a real space density functional theory (GPAW) with the state-of-the art boundary elements electrostatic code based on the Robin Hood method, we explore tunable electronic structure and magnetic proximity effects in the ferromagnet/insulator/graphene junctions. We show that the inclusion of a finite-size gate electrodes and van der Walls interaction lead to nontrivial effects that could also be important in other two-dimensional materials beyond graphene. Work supported by US ONR, NSF-DMR and Nebraska NSF MRSEC.

  18. Management of Proximal Third Arm Replantation

    Directory of Open Access Journals (Sweden)

    Süleyman Taş

    2017-12-01

    Full Text Available Notwithstanding the recent success in major limb replantation achieved through the advancements in microsurgical techniques, the viability of the extremity is still relatively low at the transhumeral level following a replantation. There are no exact guidelines for deciding whether to undertake a stump repair or a replantation in such amputations at the proximal level. However, a highly motivated patient with realistic expectations and protected shoulder function can be a candidate to undergo replantation. The replanted arm may help the uninjured arm in daily activities. In this report we present the case of a 47-year-old man whose arm was amputated at proximal third level by an asphalt machine and successfully replanted together with the encountered problems and their solutions. The roadmap followed in this rare case may be a guide for hand surgeons.

  19. Management of Acute Proximal Humeral Fractures.

    Science.gov (United States)

    Kancherla, Vamsi Krishna; Singh, Anshuman; Anakwenze, Oke A

    2017-01-01

    Proximal humeral fractures, which typically occur in elderly persons, are among the most common fractures. A myriad of nonsurgical and surgical treatment options exist for these injuries, including short-term immobilization and early physical therapy, percutaneous fixation, plate osteosynthesis, intramedullary nailing, hemiarthroplasty, and reverse shoulder arthroplasty. The choice of treatment depends on the fracture type and severity, surgeon expertise, patient age, and patient health status.

  20. Superconducting proximity effect in clean ferromagnetic layers

    OpenAIRE

    Zareyan, M.; Belzig, W.; Nazarov, Yu. V.

    2002-01-01

    We investigate the superconducting proximity effect in clean ferromagnetic layers with rough boundaries. The subgap density of states is formed by Andreev bound states at energies which depend on trajectory length and the ferromagnetic exchange field. At energies above the gap, the spectrum is governed by resonant scattering states. The resulting density of states, measurable by tunneling spectroscopy, exhibits a rich structure, which allows us to connect the theoretical parameters from exper...

  1. Alternating proximal algorithm for blind image recovery

    OpenAIRE

    Bolte, Jérôme; Combettes, Patrick Louis; Pesquet, Jean-Christophe

    2010-01-01

    International audience; We consider a variational formulation of blind image recovery problems. A novel iterative proximal algorithm is proposed to solve the associated nonconvex minimization problem. Under suitable assumptions, this algorithm is shown to have better convergence properties than standard alternating minimization techniques. The objective function includes a smooth convex data fidelity term and nonsmooth convex regularization terms modeling prior information on the data and on ...

  2. Transverse Stress Fracture of the Proximal Patella

    Science.gov (United States)

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-01-01

    Abstract Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete. A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity. Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws. PMID:26871789

  3. Isolated Proximal Tibiofibular Dislocation during Soccer

    Directory of Open Access Journals (Sweden)

    Casey Chiu

    2015-01-01

    Full Text Available Proximal tibiofibular dislocations are rarely encountered in the Emergency Department (ED. We present a case involving a man presenting to the ED with left knee pain after making a sharp left turn on the soccer field. His physical exam was only remarkable for tenderness over the lateral fibular head. His X-rays showed subtle abnormalities of the tibiofibular joint. The dislocation was reduced and the patient was discharged from the ED with orthopedic follow-up.

  4. Capacitive Proximity Sensor Has Longer Range

    Science.gov (United States)

    Vranish, John M.

    1992-01-01

    Capacitive proximity sensor on robot arm detects nearby object via capacitive effect of object on frequency of oscillator. Sensing element part of oscillator circuit operating at about 20 kHz. Total capacitance between sensing element and ground constitutes tuning capacitance of oscillator. Sensor circuit includes shield driven by replica of alternating voltage applied to sensing element. Driven shield concentrates sensing electrostatic field in exterior region to enhance sensitivity to object. Sensitivity and dynamic range has corresponding 12-to-1 improvement.

  5. THE PROXIMATE COMPOSITION OF AFRICAN BUSH MANGO ...

    African Journals Online (AJOL)

    BIG TIMMY

    The proximate analysis (moisture, crude protein, crude fat, mineral ash and total carbohydrates) in the kernels and flour of African Bush Mango (. ) were investigated. The results revealed that the kernels contained moisture (2.5 g/100 g), crude protein (8.9 g/100 g), crude fat (68.4 g/100 g), mineral ash (2.3 g/100 g) and total ...

  6. [Proximity and breastfeeding at the maternity hospital].

    Science.gov (United States)

    Fradin-Charrier, Anne-Claire

    2015-01-01

    The establishment of breastfeeding, as well as its duration, are facilitated through the proximity of the mother with her new baby. However, in maternity hospitals, breastfeeding mothers very often leave their baby in the nursery at night time. A study carried out in 2014 in several maternity hospitals put forward suggestions and highlighted areas to improve in everyday practice. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  7. Features of Three- and Four-Part Proximal Humeral Fractures and Outcome of Internal Fixation Using the Philos® Locking Plate

    Directory of Open Access Journals (Sweden)

    Ali Sadighi

    2017-03-01

    Full Text Available Background: Proximal humeral fractures are among common types of fractures and remain a challenging issue for surgical management. This study aimed to assess the clinical outcomes and complication rates of three- vs. four-part proximal humeral fractures, treated with internal fixation using the Philos® plate. Material and Methods: In this cohort study, a total of 30 consecutive patients with three-part or four-part proximal humeral fractures based on the Neer classification were included. Surgical treatment was performed with open reduction and internal fixation using the Philos® plate. The constant score was evaluated 6 months later in follow-up. The P<0.05 was considered significant. Results: Four-part fractures were mainly caused by trauma from above, while insults of opposite direction were responsible for more than half of 3 part fractures (P=0.01. Open fractures were only observed in patients with a four-part fracture (P=0.018. No significant differences were noticed regarding gender, cause, and side of the fracture. The presence of other fractures, fracture of the implant, reduction loss, avascular necrosis (AVN of humerus head, rotator cuff injury, and revision surgery were significantly higher in patients with four-part fractures. The mean constant score was 81.40±11.61 and 65.09±16.09 for three-part and four-part fractures, respectively (P=0.006. Conclusion: Open reduction and internal fixation with Philos® plate yield acceptable results in both types of fractures, however, the prognosis of this intervention is poorer four-part fractures.

  8. Proximal Gastrojejunal Reconstruction after Pancreaticoduodenal Resection

    Directory of Open Access Journals (Sweden)

    M. Wayne

    2012-01-01

    Full Text Available Introduction. Reconstruction by proximal gastrojejunostomy, and distal biliary and pancreatic anastomoses is infrequently used after resection of the head of the pancreas because of fear of fistulas and cholangitis. Pancreaticoduodenectomy is being performed more frequently for cystic malignant and premalignant lesions. Because of this there is a need for endoscopic visualization and biopsy of the residual pancreatic duct, since multi-centricity is characteristic of some of these malignancies. Since endoscopic access of the bile duct and pancreatic duct is difficult and unsuccessful in 50–70% after B II or Roux Y reconstruction, we prospectively studied the merit and complications (early and late of proximal gastrojejunal (PGJ reconstruction after pancreaticoduodenal resection. Material and Methods. Thirty nine consecutive, non-radomized patients underwent pancreaticoduodenectomy and PGJ reconstruction over 14 mos. There were 21 males and 18 females. Results. 7 patients with IPMN have undergone repeat CT scanning for surveillance, with 3 requiring repeat EUS and ERCP. There were no technical difficulties accessing the pancreas or the pancreatic duct, supporting the PGJ reconstruction. Conclusion. Proximal gastrojejunal reconstruction following pancreaticoduodenal resection may be safely done with similar morbidity to traditional pancreaticojejunal reconstructions. PGJ reconstruction may be of greater value when direct visual access to the bile duct or pancreatic duct is necessary, and should be considered when doing resection for mucinous cysts or IPMN of the head of the pancreas.

  9. Bilateral, atraumatic, proximal tibiofibular joint instability.

    Science.gov (United States)

    Morrison, Troy D; Shaer, James A; Little, Jill E

    2011-01-01

    Dislocation of the tibiofibular joint is rare and usually results from a traumatic event. Only 1 case of atraumatic proximal tibiofibular joint instability in a 14-year-old girl has been reported in the literature, however this condition might occur more frequently than once thought. A wide range of treatment options exist for tibiofibular dislocations. Currently, the first choice is a conservative approach, and when this fails, surgical means such as resection of the fibula head, arthrodesis, and reconstruction are considered. However, no consensus exists on the most effective treatment. This article reports a unique case of bilateral, atraumatic, proximal tibia and fibular joint instability involving a 30-year-old man with a 20-year history of pain and laxity in the right knee. The patient had no trauma to his knees; he reported 2 immediate family members with similar complaints, which suggests that this case is likely congenital. After conservative approaches proved to be ineffective, the patient underwent capsular reconstruction using free autologous gracilis tendon. At 6-month postoperative follow-up, the patient was pain free with no locking and instability. He then underwent surgery on the left knee. At 1-year follow-up after the second surgery, the patient had no symptoms or restrictions in mobility. We provide an alternative surgical approach to arthrodesis and resection for the treatment of chronic proximal tibiofibular instability. In the treatment of chronic tibiofibular instability, we believe that reconstruction of the tibiofibular joint is a safe and effective choice. Copyright 2011, SLACK Incorporated.

  10. Three-dimensional in vivo displacements of the shoulder complex from biplanar radiography.

    Science.gov (United States)

    Berthonnaud, E; Herzberg, G; Zhao, K D; An, K N; Dimnet, J

    2005-08-01

    The goal of this study was to adapt roentgen photogrammetry to in vivo studies of shoulder skeletal motion during arm elevation in the scapular plane. Numerous in vitro and in vivo studies have been published describing shoulder bone movements. They involve plain radiographic measurements and utilize a three-dimensional (3D) approach. Measurements are either direct using pins implanted in bones, or indirect recording points on medical images. Roentgen photogrammetry locates points in space from two projections obtained from two different radiographic incidences. The technique has been applied in vivo by implanting metallic balls in bones. However, to be used as a standard clinical procedure, the technique must be adapted to be less invasive. In vivo photogrammetric reconstruction of known points in 3D space requires that the subject is strictly motionless between the successive radiographic exposures or that the exposures are obtained simultaneously. Methods used in this study were developed to allow subsequent exposures to be used for analysis. Numerical tools have been developed to align the two projections of a point in 3D space which have moved slightly between two successive exposures. The standard photogrammetric technique is completed by geometric modeling of the shoulder complex and humerus, and by the control of their mutual proximity at the level of joints. Bones are modeled as a set of simple volumes linked together using geometric shapes described by shape parameters. The coincidence between real bone contours and radiographic projections of the modeled bone gives the values of the shape parameters and the accurate location in space. Results focus on two different topics: errors related to the use of roentgen photogrammetry with successive exposures, and results obtained by applying roentgen photogrammetry to the in vivo shoulder complex. Results describing shoulder bone and joint displacements are presented for comparison with previously published

  11. Proximity Utilizing Biotinylation of Nuclear Proteins in vivo

    Directory of Open Access Journals (Sweden)

    Arman Kulyyassov

    2015-06-01

    Full Text Available Introduction. The human genome consists of roughly 30,000 genes coding for over 500,000 different proteins, of which more than 10,000 proteins can be produced by the cell at any given time (the cellular “proteome”. It has been estimated that over 80% of proteins do not operate alone, but in complexes. These protein-protein interactions (PPI are regulated by several mechanisms. For example, post-translational modifications (methylation, acetylation, phosphorylation, or ubiquitination or metal-binding can lead to conformational changes that alter the affinity and kinetic parameters of the interaction. Many PPIs are part of larger cellular networks of interactions or interactomes. Indeed, these interactions are at the core of the entire interactomics system of any living cell, and so, aberrant PPIs are the basis of multiple diseases, such as neurodegenerative diseases and cancer. The objective of this study was to develop a method of monitoring protein-protein interactions and proximity dependence in vivo.Methods. The biotin ligase BirA was fused to the protein of interest, and the Biotin Acceptor Peptide (BAP was fused to an interacting partner to make the detection of its biotinylation possible by western blot or mass spectrometry.Results. Using several experimental systems (BirA.A + BAP.B, we showed that the biotinylation is interaction/proximity dependent. Here, A and B are the next nuclear proteins used in the experiments – 3 paralogues of heterochromatin protein HP1a (CBX5, HP1b (CBX1, HP1g (CBX3, wild type and transcription mutant factor Kap1, translesion DNA polymerase PolH and E3, ubiquitin ligase RAD18, Proliferative Cell Nuclear Antigen (PCNA, ubiquitin Ub, SUMO-2/3, different types and isoforms of histones H2A, H2Az, H3.1, H3.3, CenpA, H2A.BBD, and macroH2A. The variant of this approach is termed PUB-NChIP (Proximity Utilizing Biotinylation with Native Chromatin Immuno-precipitation and is designed to purify and study the protein

  12. Proximate chemical composition and fatty acid profiles of ...

    African Journals Online (AJOL)

    Proximate chemical composition and fatty acid profiles of Longissimus Proximate chemical composition and fatty acid profiles of Longissimus thoracis from pasture fed LHRH immunocastrated, castrated and intact Bos indicus bulls.

  13. Proximate Analysis and Total Lycopene Content of Some Tomato ...

    African Journals Online (AJOL)

    MBI

    2017-06-05

    Jun 5, 2017 ... Standard analytical techniques were employed to determine the proximate composition and lycopene content of three tomato cultivars namely: ... Keywords: Antioxidant, lycopene content, proximate composition, tomato cultivars. INTRODUCTION ..... from oranges, tomatoes and carrots. African. Journal of ...

  14. A Regularized Algorithm for the Proximal Split Feasibility Problem

    Directory of Open Access Journals (Sweden)

    Zhangsong Yao

    2014-01-01

    Full Text Available The proximal split feasibility problem has been studied. A regularized method has been presented for solving the proximal split feasibility problem. Strong convergence theorem is given.

  15. Gross anatomical and dimensional characteristics of the proximal hamstring origin.

    Science.gov (United States)

    Feucht, Matthias J; Plath, Johannes E; Seppel, Gernot; Hinterwimmer, Stefan; Imhoff, Andreas B; Brucker, Peter U

    2015-09-01

    The current study was undertaken to better define the gross anatomical and dimensional characteristics of the proximal hamstring origin. Twelve paired whole-lower extremities from six embalmed cadavers were dissected. The gross anatomy of the proximal hamstrings was studied. With the tendons attached to the ischial tuberosity, the width and thickness of each tendon was measured 1 cm distally to their origin, and the distance from the most proximal border of the common origin of the semitendinosus (ST) and long head of the biceps (LB) to their distal junction was assessed. After removal of the hamstring group, the shape, orientation, and dimension of the tendon footprints were determined. One cadaver demonstrated unique anatomy, which was considered as an anatomic variant and was therefore excluded from the study group. The ST and LB had a common origin on the posterolateral aspect of the ischial tuberosity (ST/LB), whereas the semimembranosus (SM) had a separated origin at the anterolateral aspect. The mean distance from the most proximal border of the ST/LB origin to the distal junction was 10.0 ± 1.3 cm. The shape of both footprints was longitudinal-oval, with the longitudinal axes of the SM and ST/LB footprints parallel aligned. Mean tendon width was 3.4 ± 0.5 cm for the common ST/LB complex and 4.2 ± 0.9 cm for the SM (p = 0.009). The corresponding values for tendon thickness were 1.0 ± 0.3 cm (ST/LB) and 0.8 ± 0.2 cm (SM), respectively (n.s.). Mean footprint length was 3.9 ± 0.4 cm for ST/LB and 4.5 ± 0.5 cm for SM (p = 0.002). The corresponding values for footprint height were 1.4 ± 0.5 cm (ST/LB) and 1.2 ± 0.3 cm (SM), respectively (n.s.). The ST and LB had a common origin, whereas the SM originated separately. The site of origin of both tendons was the lateral aspect of the ischial tuberosity, with the SM footprint lying directly anterior to the footprint of the ST/LB complex. The footprint of the SM was significantly wider than the footprint of

  16. A new anchor augmentation technique with a cancellous screw in osteoporotic rotator cuff repair: an in vitro biomechanical study on sheep humerus specimens.

    Science.gov (United States)

    Uruc, Vedat; Ozden, Raif; Dogramacı, Yunus; Kalacı, Aydıner; Hallaceli, Hasan; Küçükdurmaz, Fatih

    2014-01-01

    The aim of this study was to test a simple technique to augment the pullout resistance of an anchor in an over-drilled sheep humerus model. Sixty-four paired sheep humeri were harvested from 32 male sheep aged 18 months. Specimens were divided into an augmented group and non-augmented group. FASTIN RC 5-mm titanium screw anchors (DePuy Mitek, Raynham, MA) double loaded with suture material (braided polyester, nonabsorbable USP No. 2) were used in both groups. Osteoporosis was simulated by over-drilling with a 4.5-mm drill. Augmentation was performed by fixing 1 of the sutures 1.5 cm inferior to the anchor insertion site with a washer screw. This was followed by a pull-to-failure test at 50 mm/min. The ultimate load (the highest value of strength before anchor pullout) was recorded. A paired t test was used to compare the biomechanical properties of the augmented and non-augmented groups. In all specimens the failure mode was pullout of the anchor. The ultimate failure loads were statistically significantly higher in the augmented group (P anchor to a fully threaded 6.5-mm cancellous screw with a washer, significantly increases the ultimate failure loads in the over-drilled sheep humerus model. Our technique is simple, safe, and inexpensive. It can be easily used in all osteoporotic patients and will contribute to the reduction of anchor failure. This technique might be difficult to apply arthroscopically. Cannulated smaller screws would probably be more practical for arthroscopic use. Further clinical studies are needed. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. Proximity Operations Nano-Satellite Flight Demonstration (PONSFD) Rendezvous Proximity Operations Design and Trade Studies

    Science.gov (United States)

    Griesbach, J.; Westphal, J. J.; Roscoe, C.; Hawes, D. R.; Carrico, J. P.

    2013-09-01

    The Proximity Operations Nano-Satellite Flight Demonstration (PONSFD) program is to demonstrate rendezvous proximity operations (RPO), formation flying, and docking with a pair of 3U CubeSats. The program is sponsored by NASA Ames via the Office of the Chief Technologist (OCT) in support of its Small Spacecraft Technology Program (SSTP). The goal of the mission is to demonstrate complex RPO and docking operations with a pair of low-cost 3U CubeSat satellites using passive navigation sensors. The program encompasses the entire system evolution including system design, acquisition, satellite construction, launch, mission operations, and final disposal. The satellite is scheduled for launch in Fall 2015 with a 1-year mission lifetime. This paper provides a brief mission overview but will then focus on the current design and driving trade study results for the RPO mission specific processor and relevant ground software. The current design involves multiple on-board processors, each specifically tasked with providing mission critical capabilities. These capabilities range from attitude determination and control to image processing. The RPO system processor is responsible for absolute and relative navigation, maneuver planning, attitude commanding, and abort monitoring for mission safety. A low power processor running a Linux operating system has been selected for implementation. Navigation is one of the RPO processor's key tasks. This entails processing data obtained from the on-board GPS unit as well as the on-board imaging sensors. To do this, Kalman filters will be hosted on the processor to ingest and process measurements for maintenance of position and velocity estimates with associated uncertainties. While each satellite carries a GPS unit, it will be used sparsely to conserve power. As such, absolute navigation will mainly consist of propagating past known states, and relative navigation will be considered to be of greater importance. For relative observations

  18. Proksimal humerus kırıklarında PHILOS plağı ile tespitin fonksiyonel sonuçları ve komplikasyonları

    OpenAIRE

    Geiger, Emanuel; Maier, Marcus; Kelm, Arne; Wutzler, Sebastian; Seebach, Caroline; MARZI, INGO

    2004-01-01

    Objectives: Proximal humeral fractures account for approximately 5% of all fractures. New plating techniques have been developed to improve stability. The purpose of this study was to evaluate functional outcome following plate fixation with the Proximal Humeral Internal Locking System (PHILOS) and to analyze potential implant-related complications. Methods: The PHILOS plate was used for internal fixation of displaced proximal humeral fractures in 28 patients (20 females, 8 males; mean age...

  19. Phase holograms in PMMA with proximity effect correction

    Science.gov (United States)

    Maker, Paul D.; Muller, R. E.

    1993-01-01

    Complex computer generated phase holograms (CGPH's) have been fabricated in PMMA by partial e-beam exposure and subsequent partial development. The CGPH was encoded as a sequence of phase delay pixels and written by the JEOL JBX-5D2 E-beam lithography system, a different dose being assigned to each value of phase delay. Following carefully controlled partial development, the pattern appeared rendered in relief in the PMMA, which then acts as the phase-delay medium. The exposure dose was in the range 20-200 micro-C/sq cm, and very aggressive development in pure acetone led to low contrast. This enabled etch depth control to better than plus or minus lambda(sub vis)/60. That result was obtained by exposing isolated 50 micron square patches and measuring resist removal over the central area where the proximity effect dose was uniform and related only to the local exposure. For complex CGPH's with pixel size of the order of the e-beam proximity effect radius, the patterns must be corrected for the extra exposure caused by electrons scattered back up out of the substrate. This has been accomplished by deconvolving the two-dimensional dose deposition function with the desired dose pattern. The deposition function, which plays much the same role as an instrument response function, was carefully measured under the exact conditions used to expose the samples. The devices fabricated were designed with 16 equal phase steps per retardation cycle, were up to 1 cm square, and consisted of up to 100 million 0.3-2.0 micron square pixels. Data files were up to 500 MB long and exposure times ranged to tens of hours. A Fresnel phase lens was fabricated that had diffraction limited optical performance with better than 85 percent efficiency.

  20. Ex situ elaborated proximity mesoscopic structures for ultrahigh vacuum scanning tunneling spectroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Stolyarov, V. S. [UMR 7588, Institut des Nanosciences de Paris, UPMC Univ Paris 06, Sorbonne Universités, F-75005 Paris (France); CNRS, UMR 7588, Institut des Nanosciences de Paris, F-75005 Paris (France); Institute of Solid State Physics RAS, 142432 Chernogolovka (Russian Federation); Moscow Institute of Physics and Technology, 141700 Dolgoprudny (Russian Federation); Kazan Federal University, 420008 Kazan (Russian Federation); Moscow State University, 119991 Moscow (Russian Federation); Cren, T., E-mail: tristan.cren@upmc.fr; Debontridder, F.; Brun, C. [UMR 7588, Institut des Nanosciences de Paris, UPMC Univ Paris 06, Sorbonne Universités, F-75005 Paris (France); CNRS, UMR 7588, Institut des Nanosciences de Paris, F-75005 Paris (France); Veshchunov, I. S. [Université de Bordeaux, LP2N, 351 cours de la Libération, F-33405 Talence (France); Institute of Solid State Physics RAS, 142432 Chernogolovka (Russian Federation); Skryabina, O. V. [Institute of Solid State Physics RAS, 142432 Chernogolovka (Russian Federation); Rusanov, A. Yu. [LLC “Applied radiophysics” 142432 Chernogolovka (Russian Federation); Roditchev, D. [UMR 7588, Institut des Nanosciences de Paris, UPMC Univ Paris 06, Sorbonne Universités, F-75005 Paris (France); CNRS, UMR 7588, Institut des Nanosciences de Paris, F-75005 Paris (France); LPEM-UMR 8213, CNRS, ESPCI-ParisTech, UPMC, 10 rue Vauquelin, F-75005 Paris (France)

    2014-04-28

    We apply ultrahigh vacuum Scanning Tunneling Spectroscopy (STS) at ultra-low temperature to study proximity phenomena in metallic Cu in contact with superconducting Nb. In order to solve the problem of Cu-surface contamination, Cu(50 nm)/Nb(100 nm) structures are grown by respecting the inverted order of layers on SiO{sub 2}/Si substrate. Once transferred into vacuum, the samples are cleaved at the structure-substrate interface. As a result, a contamination-free Cu-surface is exposed in vacuum. It enables high-resolution STS of superconducting correlations induced by proximity from the underlying superconducting Nb layer. By applying magnetic field, we generate unusual proximity-induced superconducting vortices and map them with a high spatial and energy resolution. The suggested method opens a way to access local electronic properties of complex electronic mesoscopic devices by performing ex situ STS under ultrahigh vacuum.

  1. Defining the fracture population in a pragmatic multicentre randomised controlled trial: PROFHER and the Neer classification of proximal humeral fractures.

    Science.gov (United States)

    Handoll, H H G; Brealey, S D; Jefferson, L; Keding, A; Brooksbank, A J; Johnstone, A J; Candal-Couto, J J; Rangan, A

    2016-10-01

    Accurate characterisation of fractures is essential in fracture management trials. However, this is often hampered by poor inter-observer agreement. This article describes the practicalities of defining the fracture population, based on the Neer classification, within a pragmatic multicentre randomised controlled trial in which surgical treatment was compared with non-surgical treatment in adults with displaced fractures of the proximal humerus involving the surgical neck. The trial manual illustrated the Neer classification of proximal humeral fractures. However, in addition to surgical neck displacement, surgeons assessing patient eligibility reported on whether either or both of the tuberosities were involved. Anonymised electronic versions of baseline radiographs were sought for all 250 trial participants. A protocol, data collection tool and training presentation were developed and tested in a pilot study. These were then used in a formal assessment and classification of the trial fractures by two independent senior orthopaedic shoulder trauma surgeons. Two or more baseline radiographic views were obtained for each participant. The independent raters confirmed that all fractures would have been considered for surgery in contemporaneous practice. A full description of the fracture population based on the Neer classification was obtained. The agreement between the categorisation at baseline (tuberosity involvement) and Neer classification as assessed by the two raters was only fair (kappa 0.29). However, this disparity did not appear to affect trial findings, specifically in terms of influencing the effect of treatment on the primary outcome of the trial. A key reporting requirement, namely the description of the fracture population, was achieved within the context of a pragmatic multicentre randomised clinical trial. This article provides important guidance for researchers designing similar trials on fracture management.Cite this article: H. H. G. Handoll, S. D

  2. Complex regional pain syndrome-like symptoms during herpes zoster.

    Science.gov (United States)

    Berry, James D; Rowbotham, Michael C; Petersen, Karin Lottrup

    2004-07-01

    Complex Regional Pain Syndrome (CRPS) associated with herpes zoster (HZ) was first reported by Sudeck in 1901 (Sudeck, 1901) and is recognized clinically. However, only 13 cases have been published in the literature, and nothing is known about the incidence, prevalence, or natural history (Chester, 1992; Foster et al., 1989; Grosslight et al., 1986; Ketz and Schliack,1968; Kishimoto et al., 1995; Querol and Cisneros, 2001; Sudeck, 1901; Visitsunthorn and Prete, 1981). The aim of the present study was to determine the prevalence of CRPS-like symptoms in a prospectively gathered cohort of subjects with HZ and to follow the natural history of their pain and sensory disturbance during the first 6 months after onset of HZ. Subjects were evaluated at four time points after HZ: 2-6 weeks, 6-8 weeks, 3 months, and 6 months. Only subjects aged 50 or older with pain VAS ratings of >/=20/100 at 2-6 weeks were eligible. The first (screening) visit included a neurological and physical examination that was updated at each subsequent visit. Assessments included ratings of pain intensity, allodynia severity, and rash severity. The neurological exam included determination of presence or absence of the following CRPS-like symptoms: (1) increased sweating, (2) color changes, (3) skin temperature changes, (4) weakness of the affected area based on physical exam, (5) edema, and (6) extension of CRPS-like symptoms outside the affected dermatome. For subjects with HZ in dermatomes that can include the limbs (C4-T2 and L1-S2), extremity involvement was considered present if allodynia or rash extended beyond the neck of the humerus (upper extremity), the inguinal ligament (anterior lower extremity), or gluteal sulcus (posterior lower extremity). Involvement of the extremity was considered proximal if neither HZ rash nor allodynia extended past the elbow (upper extremity) or knee (lower extremity). Of the first 75 subjects recruited, 25 had HZ outbreaks in dermatomes that extended into the

  3. The regional dimension of intergenerational proximity in the Netherlands

    NARCIS (Netherlands)

    van der Pers, Marieke; Mulder, Clara H.

    Previous research has shown the impact of individual characteristics on intergenerational proximity but has largely ignored the regional dimension of such proximity. In this paper, we examine the regional variation in intergenerational proximity in the Netherlands. We address this issue by

  4. Quality Assessment and Proximate Analysis of Amaranthus hybridus ...

    African Journals Online (AJOL)

    The aim of this research is to determine the quality and proximate composition of Amaranthus hybridus, Celosia argentea, and Talinum triangulare obtained from open markets in Benin City, Nigeria. Microbiological and proximate analysis were carried out using standard methods. Results of the proximate analysis revealed ...

  5. Proximal femur geometry in the adult Kenyan femur and its ...

    African Journals Online (AJOL)

    Background: Numerous orthopaedic procedures are carried out on the proximal femur. For optimal hip function, these procedures must restore the anatomy of the proximal femur to as near normal as possible. There are currently no local studies that have described in detail the normal anatomy of the proximal femur and its ...

  6. Minimally Invasive Fixation for Proximal Humeral Fracture: A Review on the use of T2 Proximal Humeral Nail

    Directory of Open Access Journals (Sweden)

    Sze-Ling Iris Ngai

    2013-12-01

    Discussion and conclusion: With the proper surgical technique high union rate, good functional recovery, and low complication rate can be achieved by using T2 Proximal Humeral Nail in managing traumatic proximal humeral fracture.

  7. Uptake of leptin and albumin via separate pathways in proximal tubule cells.

    Science.gov (United States)

    Briffa, Jessica F; Grinfeld, Esther; Poronnik, Philip; McAinch, Andrew J; Hryciw, Deanne H

    2016-10-01

    The adipokine leptin and oncotic protein albumin are endocytosed in the proximal tubule via the scavenger receptor megalin. Leptin reduces megalin expression and activates cell signalling pathways that upregulate fibrotic protein expression. The aim of this study was to investigate if leptin uptake in proximal tubule cells was via the albumin-megalin endocytic complex. In immortalised proximal tubule Opossum kidney cells (OK) fluorescent leptin and albumin co-localised following 5min exposure, however there was no co-localisation at 10, 20 and 30min exposure. In OK cells, acute exposure to leptin for 2h did not alter NHE3, ClC-5, NHERF1 and NHERF2 mRNA. However, acute leptin exposure increased NHERF2 protein expression in proximal tubule cells. In OK cells, immunoprecipitation experimentation indicated leptin did not bind to ClC-5. Leptin uptake in OK cells was enhanced by bafilomycin and ammonium chloride treatment, demonstrating that uptake was not dependent on lysosomal pH. Thus, it is likely that two pools of megalin exist in proximal tubule cells to facilitate separate uptake of leptin and albumin by endocytosis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Delayed homicides and the proximate cause.

    Science.gov (United States)

    Lin, Peter; Gill, James R

    2009-12-01

    Delayed homicides result from complications of remote injuries inflicted by "the hands of another." The investigation of delayed homicides may be a challenge due to a number of factors including: failure to report the death to the proper authorities, lack of ready and adequate documentation of the original injury and circumstances, and jurisdictional differences between the places of injury and death. The certification of these deaths also requires the demonstration of a pathophysiologic link between the remote injury and death. In sorting through these issues, it is helpful to rely upon the definition of the proximate cause of death. Over a 2-year period in New York City, there were 1211 deaths certified as homicide of which 42 were due to injuries sustained greater than 1 year before death. The survival interval ranged from 1.3 to 43.2 years. The most common immediate causes of death were: infections (22), seizures (7), and intestinal obstructions/hernias (6). Common patterns of complications included infection following a gunshot wound of the spinal cord, seizure disorder due to blunt head trauma, and intestinal obstruction/hernia due to adhesions from an abdominal stab wound. Spinal cord injuries resulted in paraplegia in 14 instances and quadriplegia in 8. The mean survival interval for paraplegics was 20.3 years and 14.8 years for quadriplegics; infections were a frequent immediate cause of death in both groups, particularly infections due to chronic bladder catheterization. The definition of proximate cause originated with civil law cases and was later applied to death certification as the proximate cause of death. The gradual extinction of the "year and a day rule" for the limitation of bringing homicide charges in delayed deaths may result in more of these deaths going to trial. Medical examiners/coroners must be able to explain the reasoning behind these death certifications and maintain consistent standards for the certification of all delayed deaths due

  9. Laparoscopic proximal gastrectomy with oblique jejunogastrostomy.

    Science.gov (United States)

    Tanaka, Kimitaka; Ebihara, Yuma; Kurashima, Yo; Nakanishi, Yoshitsugu; Asano, Toshimichi; Noji, Takehiro; Murakami, Soichi; Nakamura, Toru; Tsuchikawa, Takahiro; Okamura, Keisuke; Shichinohe, Toshiaki; Hirano, Satoshi

    2017-05-10

    Proximal early gastric cancer is a good indication for totally laparoscopic proximal gastrectomy (TLPG) with double-tract reconstruction (DTR). However, when most of the dietary intake passes through the escape route of the jejunum, the functional benefits of proximal gastrectomy might be similar to those after total gastrectomy. Our DTR procedure was improved for easy passage through the remnant stomach. The purposes of this study were to present a novel technique for intracorporeal DTR using linear staplers after TLPG and to investigate surgical outcomes. DTR was performed using linear staplers only. A side-to-side jejunogastrostomy with twisting of both the remnant stomach and the anal jejunum was performed for the purpose of passing meals through the remnant stomach (an oblique jejunogastrostomy technique). The ten patients who underwent TLPG with DTR from January 2011 to August 2016 in Hokkaido University Hospital were retrospectively reviewed. Their clinicopathological characteristics and surgical and postoperative outcomes were collected and analyzed. The median duration of operation was 285 (range 146-440) min. No patients required blood transfusions. The number of dissected lymph nodes was 32 (range 22-56). There were no intraoperative complications, and no cases were converted to open surgery. All the patients were pT1N0M0 stage IA. No anastomotic leakage or complications were detected. Postoperative gastrography after reconstruction showed that contrast medium flowed mainly to the remnant stomach. The average percentage body weight loss was 14.0 ± 7.1% at 10 months. The average percentage decrease in serum hemoglobin was 5.4 ± 10.4% at 12 months. This novel technique for intracorporeal DTR provided a considerable advantage by the passage of dietary intake to the remnant stomach after LPG.

  10. Bicarbonate secretion by rabbit proximal colon.

    Science.gov (United States)

    Sullivan, S K; Smith, P L

    1986-10-01

    Stripped segments of proximal colon (1-6 cm distal to the ampulla caecalis coli) were studied in vitro in Ussing chambers under short-circuit conditions using the pH-stat technique. With glucose and HCO3-CO2 present in the serosal bathing solution only, proximal colon alkalinizes the luminal bathing solution at a rate of 2.1 +/- 0.2 mu eq X h-1 X cm-2 (n = 36). With HCO3-CO2 present in the luminal bathing solution alone, proximal colon does not significantly acidify or alkalinize the serosal bathing solution. Addition of glucose (10 mM) to the luminal bathing solution abolished luminal alkalinization. Removal of HCO3 and CO2 from the serosal bathing solution or replacement of O2 with N2 also abolished luminal alkalinization. Acetazolamide (0.1 mM) added to both bathing solutions did not alter the rate of luminal alkalinization. Ion-replacement studies revealed that the alkalinization process was highly dependent on the presence of Na in the bathing solutions and much less dependent on the presence of Cl. Furthermore, ouabain (0.1 mM) significantly reduced luminal alkalinization. As in rabbit ileum, serosal epinephrine (0.1 mM) did not alter luminal alkalinization but increased serosal alkalinization by a Na-dependent mechanism. These results suggest that luminal alkalinization results from a Na-dependent, active transcellular HCO3 transport process and that a Na-dependent HCO3 absorptive process is activated by adrenergic stimuli.

  11. Temporal Proximity Promotes Integration of Overlapping Events.

    Science.gov (United States)

    Zeithamova, Dagmar; Preston, Alison R

    2017-08-01

    Events with overlapping elements can be encoded as two separate representations or linked into an integrated representation, yet we know little about the conditions that promote one form of representation over the other. Here, we tested the hypothesis that the proximity of overlapping events would increase the probability of integration. Participants first established memories for house-object and face-object pairs; half of the pairs were learned 24 hr before an fMRI session, and the other half 30 min before the session. During scanning, participants encoded object-object pairs that overlapped with the initial pairs acquired on the same or prior day. Participants were also scanned as they made inference judgments about the relationships among overlapping pairs learned on the same or different day. Participants were more accurate and faster when inferring relationships among memories learned on the same day relative to those acquired across days, suggesting that temporal proximity promotes integration. Evidence for reactivation of existing memories-as measured by a visual content classifier-was equivalent during encoding of overlapping pairs from the two temporal conditions. In contrast, evidence for integration-as measured by a mnemonic strategy classifier from an independent study [Richter, F. R., Chanales, A. J. H., & Kuhl, B. A. Predicting the integration of overlapping memories by decoding mnemonic processing states during learning. Neuroimage, 124, 323-335, 2016]-was greater for same-day overlapping events, paralleling the behavioral results. During inference itself, activation patterns further differentiated when participants were making inferences about events acquired on the same day versus across days. These findings indicate that temporal proximity of events promotes integration and further influences the neural mechanisms engaged during inference.

  12. Management of posttraumatic proximal interphalangeal joint contracture.

    Science.gov (United States)

    Houshian, Shirzad; Jing, Shan Shan; Chikkamuniyappa, Chandrasekar; Kazemian, Gholam Hussein; Emami-Moghaddam-Tehrani, Mohammad

    2013-08-01

    Chronic flexion contracture of the proximal interphalangeal (PIP) joint presents a common yet challenging problem to hand surgeons. Over the years, multiple treatment modalities have been described for this problem, producing limited results. Nonoperative treatment using serial casting and splints should be tried before attempting open surgical release, which should be done in selected patients. The use of external fixation for treating PIP contracture has been encouraging and can be a useful alterative. This review provides an update on the current management of PIP joint contractures and presents a flowchart of treatment to aid decision making. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  13. Proximal iliotibial band syndrome: case report

    Directory of Open Access Journals (Sweden)

    Guilherme Guadagnini Falotico

    2013-08-01

    Full Text Available OBJECTIVE: The overuse injuries in the hip joint occur commonly in sports practitioners and currently due to technical advances in diagnostic imaging, especially magnetic resonance imaging (MRI, are often misdiagnosed. Recently, a group of people were reported, all female, with pain and swelling in the pelvic region.T2-weighted MRI showed increased signal in the enthesis of the iliotibial band (ITB along the lower border of the iliac tubercle. We report a case of a 34 year old woman, non-professional runner, with pain at the iliac crest with no history of trauma and whose MRI was compatible with the proximal iliotibial band syndrome.

  14. Ontogeny of rabbit proximal tubule urea permeability

    Science.gov (United States)

    QUIGLEY, RAYMOND; LISEC, AMBER; BAUM, MICHEL

    2014-01-01

    Urea transport in the proximal tubule is passive and is dependent on the epithelial permeability. The present study examined the maturation of urea permeability (Purea) in in vitro perfused proximal convoluted tubules (PCT) and basolateral membrane vesicles (BLMV) from rabbit renal cortex. Urea transport was lower in neonatal than adult PCT at both 37 and 25°C. The PCT Purea was also lower in the neonates than the adults (37°C: 45.4 ± 10.8 vs. 88.5 ± 15.2 × 10−6 cm/s, P 0.05). The activation energy for PCT Purea was not different between the neonatal and adult groups. BLMV Purea was determined by measuring vesicle shrinkage, due to efflux of urea, using a stop-flow instrument. Neonatal BLMV Purea was not different from adult BLMV Purea at 37°C [1.14 ± 0.05 × 10−6 vs. 1.25 ± 0.05 × 10−6 cm/s; P = not significant (NS)] or 25°C (0.94 ± 0.06 vs. 1.05 ± 0.10 × 10−6 cm/s; P = NS). There was no effect of 250 μM phloretin, an inhibitor of the urea transporter, on Purea in either adult or neonatal BLMV. The activation energy for urea diffusion was also identical in the neonatal and adult BLMV. These findings in the BLMV are in contrast to the brush-border membrane vesicles (BBMV) where we have previously demonstrated that urea transport is lower in the neonate than the adult. Urea transport is lower in the neonatal proximal tubule than the adult. This is due to a lower rate of apical membrane urea transport, whereas basolateral urea transport is the same in neonates and adults. The lower Purea in neonatal proximal tubules may play a role in overall urea excretion and in developing and maintaining a high medullary urea concentration and thus in the ability to concentrate the urine during renal maturation. PMID:11353675