1/6. classification and treatment of intercondyloid fractures of the humerus.The authors describe the satisfactory results obtained in sixteen intercondyloid fractures of the humerus, thirteen of which were treated surgically. The preference for surgical treatment in such fractures is based in the assumption that, as in all articular fractures, a good functional result can only be achieved if there is the most perfect possible reconstruction of the fragments and the joint surface. A classification is therefore suggested which is based not purely on anatomical criteria, but is also related to treatment and prognosis. The slendor nature of the distal end of the humerus and the danger of metal reaction call for the use of fixation devices that are efficient but slender, such as fine screws and crossed wires. The precise method of fixation is conditioned above all by the direction of the fracture lines. More solid fixation with early mobilisation can be achieved by compression screws, and less solid fixation with longer immobilisation is achieved by fixation with crossed Kirschner wires. Consequently, the more oblique types of fracture with fragments with long beaks that allow more stable fixation with compression screws have the more favourable prognosis. In the evaluation of results, the authors emphasize the importance of using parameters which take into account the functionally useful range of joint movement.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/6. Lateral condylar fracture and ipsilateral ulnar shaft fracture: Monteggia equivalent lesions?Displaced ulnar shaft fractures are frequently associated with radiohumeral dislocation, producing the Monteggia fracture-dislocation. Fractures not previously thought to coexist were seen in a young boy following a severe automobile-pedestrian accident. The displaced ulnar shaft fracture was associated with a displaced lateral condylar fracture with preservation of the radiocapitellar joint and capsule. This fracture was treated with rigid internal fixation in spite of the open nature of the ulnar shaft fracture. This treatment permitted early range of motion of the elbow with early use of ambulatory aids for other associated injuries and an excellent follow-up at 13 months with a normal range of motion of the elbow.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/6. Selection, evaluation and indications for electrical stimulation of ununited fractures.Management of nonunions requires careful and critical assessment of the true biologic status of the fracture. The mere radiographic persistence of a fracture line does not invariably indicate nonunion. Ten percent of fractures considered initially to be ununited in this series healed spontaneously without further treatment. The patient who has no pain with weight-bearing and no demonstrable motion on careful stress studies does not usually require further treatment, except for protection against reinjury. Intraosseous venography may be useful to distinguish the delayed from the nonunion in order to institute appropriate and early treatment. Percutaneous direct-current electrostimulation is proving to be a reliable and effective method of managing the most common nonunion of the tibia or distal femur. It appears less satisfactory for the more proximal femoral fractures and for fractures of the humerus. Electrical stimulation does not eliminate the need to stabilize the nonunion of either the femur or the upper limb. Electrical stimulation also does not eliminate the need for bone grafting in approximately 15% to 20% of nonunions. The fractures' biologic inability to respond may be identifiable by 99MTc diphosphonate bone scan. The implantable direct-current electrical stimulatory device proved ineffective in this series. Hopefully, further development of this technology may produce more consistent results in the future. The electromagnetic noninvasive stimulator appears to be a useful alternative method to the semi-invasive system. This, of course, should depend on the individual needs of the patient and the nature and location of the fracture. Continued technologic improvement in all electrical stimulatory methods should broaden their usefulness and applicability. However, the healing status of the fracture and the processes by which each fracture responds must be carefully assessed to appreciate what is being effected by electrical stimulation. Critical evaluation and clarification of indications are essential if the patient is to be offered the most effective therapy available.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/6. A contemporary approach to the management of complex fractures of the distal humerus and their sequelae.Improvements in both surgical implants and techniques for their application have enhanced the functional outcome after complex distal humeral fractures. Complication rates remain high, however, emphasizing the demanding nature of treatment of these injuries. This article focuses on the recognition and treatment of complex and previously poorly described distal humeral injuries and the prevention and treatment of complications commonly seen with these fractures.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/6. Unusual patterns of glenohumeral joint injuries in adolescent ski-jumpers.We report on two 16.5-year-old ski-jumpers who sustained unusual glenohumeral joint injuries. The first fell on landing, the other while running out. Neither could give any indications as to the pathomechanics of the injuries, thus illustrating the high speed nature of the trauma.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/6. Condylar fractures of the distal humerus in adults.Condylar fractures of the distal humerus are serious and in many instances pose a difficult treatment problem for the orthopedist. From 1969 to 1974, 24 condylar fractures of the distal humerus were treated at the University of alabama hospitals. Twenty of the fractures were closed and four were open. Eighteen fractures were treated open and fixed with a variety of K-wires and screws, and six fractures were treated closed. One postoperative wound infection occurred. Based on the 18 cases in which follow-up was sufficient to assess end result, we concluded that in comminuted fractures of the distal end of the humerus in adults, it may be technically very difficult to restore anatomic continuity. When secure fixation cannot be obtained or when the injury is of such a nature that internal fixation is contraindicated, such as a gunshot wound, traction may provide a functional range of motion. In fractures where good continuity and firm fixation can be obtained, open reduction and internal fixation give a superior functional range of motion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |