1/10. Pathologic fracture of the humerus due to metastatic cholangiocarcinoma.cholangiocarcinoma is a rare tumor of the bile duct system known to frequently metastasize to the axial skeleton, lungs, adrenal glands, brain, and lymphatic system. Spread to the long bones has not previously been reported in the literature partly because of the short life expectancies of patients with this disease. We discuss a case of a pathologic humerus fracture due to metastatic cholangiocarcinoma.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
2/10. Another sports fatigue fracture. Stress fracture of the coracoid process of the scapula.An example of stress fracture of the coracoid process of the scapula in a trapshooter is presented. The value of the axillary view of tbe shoulder is emphasized.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
3/10. Long-standing nonunion of fractures of the lateral humeral condyle.BACKGROUND: patients with nonunion of a fracture of the lateral humeral condyle often have pain, instability, or progressive cubitus valgus deformity with tardy ulnar nerve palsy. However, some patients have minimal or no symptoms or disabilities. We evaluated patients with long-standing established nonunion of the lateral humeral condyle to correlate the clinical long-term outcome of this condition with the original fracture type. methods: Nineteen elbows in eighteen patients who were at least twenty years of age were evaluated. Fourteen patients were male, and four were female. The average age at presentation was 42.5 years. The average interval from the injury to the presentation of the symptoms of the nonunion was thirty-seven years. patients were divided into two groups on the basis of the size of the fragment and the location of the fracture line. Group 1 included nine elbows with nonunion resulting from a Milch Type-I injury, and Group 2 included ten elbows with a nonunion resulting from a Milch Type-II injury. Evaluations were performed with use of radiographic examination, clinical assessment, and calculation of the Broberg and Morrey score. RESULTS: Symptoms were seen more frequently in Group 1 than in Group 2. The range of flexion in Group 1 (range, 60 degrees to 145 degrees; average, 99 degrees) was more restricted than that in Group 2 (range, 100 degrees to 150 degrees; average, 129 degrees) (p = 0.0078). The functional score in Group 2 was significantly higher than that in Group 1 (p = 0.03). CONCLUSION: Disabling symptoms only rarely developed in Group-2 patients. Occasionally, however, these patients do present with clinically detectable dysfunction of the ulnar nerve. In contrast, pain, instability, and loss of range of motion as well as ulnar nerve dysfunction developed in Group 1. For this reason we think that a nonunion of a Milch Type-I fracture should be treated as soon as possible after injury, preferably before the patient reaches skeletal maturity.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
4/10. Use of allograft for large Hill-Sachs lesion associated with anterior glenohumeral dislocation. A case report.Though Hill-Sachs lesion is a common injury associated with anterior glenohumeral dislocation, there have been only few articles describing specific treatments for the humeral head defects. This paper described the case of an alternative treatment for large defect of the posterior-superior aspect of the humeral head using allograft. The patient was a 69-year-old male and the diagnosis was a chronic anterior dislocation of the right glenohumeral joint with a large impaction fracture of the posterior-superior aspect of the humeral head. The size of this defect was 4 cm by 2.5 cm in diameter with a 2 cm depth. To reduce the impaction fracture of the humeral head, a preserved frozen allograft of the femoral head was selected and configured to fit the defect. The graft was then impacted firmly down into the defect, and appeared to offer excellent stability even without adjuvant internal fixation. Two years after surgery, the patient was doing quite well with no complaints. Radiographs showed humeral head with incorporation of the graft and no evidence of collapse.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
5/10. Brachial-plexus injury after clavicular fracture: case report and literature review.brachial plexus injury is a rare complication of the fractured clavicle. The authors describe the second reported case of brachial plexus injury due to secondary fracture displacement. This case emphasizes the following points: the neurologic status of the arm after a fracture of the clavicle must be documented; fractures of the middle one-third of the clavicle are prone to displacement; patients should be advised to report immediately any new symptoms in the arm; when fracture displacement is the cause of brachial-plexus compression then a trial of conservative therapy is indicated; the prognosis for neurologic recovery after this injury is good.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
6/10. Reconstruction of shoulder and arm defects using the latissimus dorsi myocutaneous flap. A report of five cases.Five patients with extensive traumatic shoulder and arm defects in whom successful repair with the latissimus dorsi island myocutaneous flap are presented. The ease and speed of elevation of the flap, its wide skin surface, large size, and long pedicle make it an ideal flap for reconstruction of such defects.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
7/10. Fractures of the proximal end of the humerus caused by convulsive seizures.Fractures due to convulsions are known to occur. The purpose of this study was to find the frequency of convulsive seizures as the cause of fractures of the proximal end of the humerus, which are the most common of these fractures. Of 278 cases admitted to the department, 2 per cent occurred after a seizure without other contributory causes. The manner of injury is discussed, and it is demonstrated that the diagnosis is often delayed. The importance of early reduction in cases with dislocation or displacement of the fracture is emphasized.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
8/10. Isolated avulsion fracture of the lesser tuberosity of the humerus.Six cases of isolated avulsions of the lesser tuberosity of the humerus were encountered within a short period of time. Although it seldom has been described in the literature, it might be a more common fracture than suspected. physical examination revealed a painful shoulder with limited function in all six patients. In retrospect, all diagnoses could have been made on the primary plain roentgenograms. However, the fragment of the lesser tuberosity was easily misdiagnosed. An axillary view showed the fragment clearly in all cases. Computed tomography is useful for making an accurate diagnosis because it establishes the size and displacement of the fragment and determines additional injuries, such as a ruptured biceps tendon. Five patients with displacement of the lesser tuberosity were operated on after several weeks or months. The lesser tuberosity was reattached in all cases. After 6 months three patients had slight impairment of elevation and external rotation, and one of them suffered from pain during movements of the arm. The patient with no fracture displacement was treated conservatively with a good result. In conclusion, we recommended an axillary roentgenogram as part of the posttrauma radiologic series of the shoulder. A nondisplaced avulsion fracture of the lesser tuberosity of the humerus can be treated conservatively. We recommend reattachment of displaced fractures.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
9/10. Percutaneous intramedullary pinning of proximal humeral fractures.Proximal humeral fractures can usually be treated closed. However, even with an adequate closed reduction, these fractures are occasionally unstable, fail to remain reduced, and require operative intervention. A percutaneous intramedullary pinning technique is effective in stabilizing these fractures. Two cases that illustrate the adult and pediatric techniques for pin placement/application are presented. In the pediatric population, however, large multiple pins often cannot be used due to the size of the intramedullary canal, and fewer or smaller diameter pins are used.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
10/10. Late vascular complication after fracture of the proximal humerus.A case of late vascular complication after a fracture of the proximal humerus is presented. The main clinical feature was neurological loss of the brachial plexus, while angiography showed no rupture or false aneurysm. The long delay before surgical intervention caused irreversible damage to the nerves. early diagnosis and surgical intervention are emphasized.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
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