1/47. Salvage of contaminated fractures of the distal humerus with thin wire external fixation.Fractures and osteotomies of the distal humerus that are contaminated or infected represent a difficult management problem. Stable anatomic fixation with plates and screws, the acknowledged key to a good result in the treatment of bicondylar fractures, may be unwise. A thin wire circular (Ilizarov) external fixator was used as salvage treatment in such complex situations in five patients. The fixator allowed functional mobilization of the elbow while allowing achievement of the primary goal of eradicating the infection or colonization. Two patients required a second operation for fixation of a fibrous union of the lateral condyle. One patient with a vascularized fibular graft later required triple plate fixation for malalignment at the distal host and graft junction. Four of five patients ultimately achieved complete union. The fracture remained ununited in one patient who has declined additional intervention. All five patients achieved at least 85 degrees ulnohumeral motion, two after a secondary elbow capsulectomy performed after healing was achieved. This experience suggested that the Ilizarov construct, although not a panacea, represents a reliable method of skeletal stabilization that allows functional mobilization while elimination of infection or colonization is ensured. If necessary, stiffness and incomplete healing can be addressed with an increased margin of safety at subsequent operations.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/47. Use of a hinged external fixator for elbow instability after severe distal humeral fracture.The authors report the case of a forty-year-old man who developed acute elbow instability after fixation of an open, comminuted distal humeral fracture. Treatment with a hinged, external elbow fixator was successful in reestablishing elbow stability and a functional range of elbow motion. To the best of the authors' knowledge, the use of this device for acute elbow instability after distal humeral fracture fixation has not been previously reported.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/47. Fishtail deformity following fracture of the distal humerus in children: historical review, case presentations, discussion of etiology, and thoughts on treatment.Fishtail deformity is an uncommon complication of distal humeral fractures in children. This article reports four cases accompanied by premature closure of a portion of the distal humeral physis with resultant deformity, length retardation, decreased elbow motion, and functional impairment. The ages of the patients at time of injury ranged from 4 years 2 months to 6 years 1 month (average 5 years 4 months). The average length of follow-up was 9 years 9 months (range, 3 years 5 months to 18 years 10 months). The cause of the arrest is multifactorial and may be due to a gap in reduction of an intracondylar fracture, avascular necrosis of the epiphysis, or central premature physeal arrest (bar formation) without a fracture gap or avascular necrosis. If identified in a young child, surgical closure of the medial and lateral portion of the physis may prevent the deformity from progressing and would not cause significant additional humeral length discrepancy.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/47. Antegrade intramedullary nailing of the humerus complicated by heterotopic ossification of the deltoid: a case report.A case of antegrade nailing of the humeral shaft in a polytrauma patient was complicated by heterotopic ossification of the lateral deltoid muscle and severe loss of shoulder motion. The patient did not respond to physiotherapy alone and was successfully managed by excision of the heterotopic bone and adjunctive radiation therapy.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/47. myositis ossificans after a supracondylar fracture of the humerus in a child.myositis ossificans After a Supracondylar Fracture of the humerus in a child. In addition to the better known complications of supracondylar humerus fractures, myositis ossificans is often listed as a less common complication. This complication is extremely rare in children and historically has been attributed to high-energy trauma, manipulation, surgical intervention, aggressive passive range-of-motion exercises, or associated head injury. We present a case report of a 3-year-old girl who developed myositis ossificans after a low-energy supracondylar fracture of the humerus despite having been treated without manipulation, surgery, or physical therapy. This report illustrates that supracondylar humerus fractures can be complicated by myositis ossificans despite the best attempts at prevention.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/47. Marchetti nailing with decortication and bone graft in non-unions of the two upper thirds of the humerus.METHOD: Twelve patients with humeral shaft non-unions were treated using a Marchetti-Vicenzi nailing. The fractures site was decorticated and bone graft added. RESULTS: fracture healing was obtained in all cases. The mean healing time was 4.7 months. The range of motion of the shoulder was excellent in nine patients, moderate in two and poor in one. The elbow had an excellent range of motion in ten patients, moderate in one and poor in one. The functional result was excellent in nine patients, good in two, and fair in one. CONCLUSION: Marchetti-Vicenzi nailing with bone grafting appears to be a good method for the treatment of humeral shaft non-unions. It is technically easy and its results are satisfactory.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
7/47. Intramedullary plate fixation of a distal humerus fracture: a case report.A case of a complex distal humeral fracture is presented. The patient lacked sufficient bony architecture to allow for conventional reconstruction. A technique is described using an intramedullary plate to obtain bony stabilization and permit early range of motion exercises.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/47. Articular impingement in malunited fracture of the humeral head.We report on the case of a fracture of the humeral metaepiphysis, surgical neck, and greater tuberosity treated conservatively. Malunion of a fracture of the greater tuberosity developed an impingement on the glenoid surface, causing an articular locking in internal rotation that resolved with slight pressure and a painful "click." The impinging bone was removed arthroscopically. Its extreme posterior position required opening a second, novel portal close to the posterior edge of the acromion for instrument access. Complete removal of the impinging bone restored free internal rotation without signs of impingement on the glenoid surface. Passive motion was initiated immediately postoperatively, and active motion in a water pool was initiated after 2 weeks. After 1 year, the patient has no pain, has maintained complete range of motion, and experiences no limitations in daily or sports activities. The peculiar features of this case are the absence of soft tissue scar stiffness and deficiency of the rotator cuff, because malunion of the bone fragment to the posterior edge of the humeral head produced a mechanical block of internal rotation, and the arthroscopic treatment of the impingement through an atypical superoposterior portal, which has not been described in the literature before.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
9/47. Intra-articular corrective osteotomy for the malunited intercondylar humeral fracture: a case report.A 35-year-old patient sustained comminuted intercondylar fracture of the distal humerus. At six months post-open reduction and internal fixation, the malunion was corrected with an intra-articular osteotomy. The patient obtained a painless, functional elbow joint with increased grip strength after corrective osteotomy, although she had complained of severe elbow pain, limited range of motion, and loss of grip strength before osteotomy. A 15 degrees cubitus varus deformity was also corrected . Radiographs of the elbow joint did not show accelerated degenerative changes at over three years follow-up post-corrective osteotomy. Intra-articular corrective osteotomy should be considered as a salvage procedure for the treatment of a malunited intercondylar humeral fracture, especially in patients who are thought to be too young for elbow arthroplasty.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/47. Functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion in replantation or revascularisation of above-elbow amputations.Two total and one subtotal above-elbow amputations had replantation or revascularization for their severely damaged upper extremities followed by functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion. The mean follow-up was 68 months (range: 14 to 121 months). At final follow-up examinations, the patients had sufficient range-of-motion of their elbows with good strength. Restoring elbow function eliminates one of the most important limiting factors for above-elbow replantations. Functional latissimus dorsi island pedicle musculocutaneous flap is very reliable, has minimal donor-site morbidity and offers a wider choice when deciding about arm replantation in the upper arm region by providing a chance of restoring functions.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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