Proximal fractures of the humerus in patients older than 75 years of age: should we consider operative treatment?

PubMed

de Kruijf, Marjolein; Vroemen, J P A M; de Leur, K; van der Voort, E A M; Vos, D I; Van der Laan, L

2014-06-01

Over 75 % of patients presenting with a proximal humerus fracture are 70 years or older. Very little is known about the outcome after operative treatment of these fractures in very old patients. This study was performed to gain more insight in safety and functional outcome of surgical treatment of proximal humerus fractures in the elderly. In this observational study, we analyzed all operatively treated patients, aged 75 or older, with a proximal humerus fracture between January 2003 and December 2008 in our center. Patient selection was on clinical grounds, based on physical, mental, and social criteria. Complications were evaluated. We used the DASH Questionnaire to investigate functional outcome, pain, and ADL limitations. Sixty-four patients were treated surgically for a displaced proximal fracture of the humerus: 15 two-part, 32 three-part, and 17 four-part fractures. Mean DASH scores were 37.5, 36.9, and 48.6, respectively. Regarding the operative methods, overall good results were obtained with the modern locked plate osteosynthesis (mean DASH 34.4). Prosthetic treatment, mostly used in highly comminuted fractures, often resulted in poor function (mean DASH 72.9). Persistent pain and ADL limitations were more present in more comminuted fractures (64 and 50 % in patients with 4-part fractures vs. 14 % in 2-part fractures). There were no postoperative deaths within 3 months of surgery, and fracture-related and non-fracture-related complication rates were low (non-union 3 %; 1 myocardial infarction). This study shows that it is safe and justifiable to consider surgical treatment of a severely dislocated proximal humerus fracture in selected patients aged 75 and older. According to OCEBM Working Group,Level IV.

A Preoperative Planning Tool: Aggregate Anterior Approach to the Humerus With Quantitative Comparisons.

PubMed

Phelps, Kevin D; Harmer, Luke S; Crickard, Colin V; Hamid, Nady; Sample, Katherine M; Andrews, Erica B; Seymour, Rachel B; Hsu, Joseph R

2018-06-01

Extensile approaches to the humerus are often needed when treating complex proximal or distal fractures that have extension into the humeral shaft or in those fractures that occur around implants. The 2 most commonly used approaches for more complex fractures include the modified lateral paratricipital approach and the deltopectoral approach with distal anterior extension. Although the former is well described and quantified, the latter is often associated with variable nomenclature with technical descriptions that can be confusing. Furthermore, a method to expose the entire humerus through an anterior extensile approach has not been described. Here, we illustrate and quantify a technique for connecting anterior humeral approaches in a stepwise fashion to form an aggregate anterior approach (AAA). We also describe a method for further distal extension to expose 100% of the length of the humerus and compare this approach with both the AAA and the lateral paratricipital in terms of access to critical bony landmarks, as well as the length and area of bone exposed.

Acromioclavicular Joint Dislocation with Ipsilateral Mid Third Clavicle, Mid Shaft Humerus and Coracoid Process Fracture - A Case Report.

PubMed

Sharma, Naveen; Mandloi, Avinash; Agrawal, Ashish; Singh, Shailendra

2016-01-01

The clavicle, humerus and acromioclavicular (AC) joint separately are very commonly involved in traumatic injuries around the shoulder. Acromioclavicular joint dislocation with distal clavicle fracture is a well recognized entity in clinical practice. AC joint dislocation with mid shaft clavicle fracture is uncommon and only few cases have been reported in literature. However, to the best of our knowledge, this is the first case report to describe an acromioclavicular dislocation with ipsilateral mid shaft clavicle, mid shaft humerus and coracoid process fracture. Fractures of the humerus and clavicle along with the acromioclavicular joint dislocation were fixed at the same setting. A 65-year-old male met with a high velocity road traffic accident. Plain radiographs showed displaced mid third clavicle fracture with acromioclavicular joint dislocation with mid shaft humerus fracture. Surgical fixation was planned for humerus with interlocking nail, clavicle with locking plate and acromioclavicular joint with reconstruction of coracoclavicular ligaments. Intraoperatively, coracoid process was found to have a comminuted fracture. The operative plan had to be changed on table as coracoclavicular fixation was not possible. So acromioclavicular joint fixation was done using tension band wiring and the coracoclavicular ligament was repaired using a 2-0 ethibond. The comminuted coracoid fracture was managed conservatively. K wires were removed at 6 weeks. Early mobilization was started. In acromioclavicular joint injuries, clavicle must be evaluated for any injury. Although it is more commonly associated with distal clavicle fractures, it can be associated with middle third clavicle fractures. As plain radiographs, AP view are most of the times insufficient for viewing integrity of coracoid process, either special views like Stryker notch or CT scan may help in diagnosing such concealed injuries. When associated with fractures of the humerus and clavicle, anatomical restoration of acromioclavicular joint along with anatomical reduction and a rigid fixation of associated fractures is essential. Proper rehabilitation protocol is a must for achieving promising results. In our case, we were able to achieve a stable surgical fixation of both the fractures as well as AC joint, which enabled us to start early joint mobilization and rehabilitation.

Treatment of the external epicondylitis of the humerus with a magnetic field

NASA Technical Reports Server (NTRS)

Degen, I. L.

1974-01-01

The therapeutic effect of a constant and varying magnetic field on epicondylitis of the humerus is studied on ninety patients. Good results are obtained from the treatment (recovery of 80%, considerable improvement in 14.5%). The method is recommended for clinical application.

Displaced Proximal Humerus Fractures: is a Sling as Good as a Plate?

PubMed

Steinhaus, Michael E; Dare, David M; Gulotta, Lawrence V

2016-10-01

The treatment of displaced proximal humerus fractures is challenging and complex, as its success is predicated on multiple factors. While it is clear that a majority of proximal humerus fractures may be treated nonoperatively, it is less clear which patients benefit from surgical management. The PROFHER trial, a randomized controlled study, used patient-reported outcomes to compare surgical to nonsurgical management of displaced proximal humerus fractures. The purpose of this review is to highlight the strengths and weaknesses of the PROFHER trial and to assess the validity of its conclusion in the context of existing literature. The authors found no difference in the Oxford Shoulder Score (OSS) between the surgical and nonsurgical groups. Additionally, no difference was found between groups in any of the secondary outcomes, which included the Short-Form 12 (SF-12) health survey, surgical and fracture-related complications, additional surgery or therapy, inpatient medical complications, and mortality. They concluded that the recent increase in surgical management of proximal humerus fractures is perhaps unwarranted. While the randomization was successful and the pragmatic design may enable greater generalizability, this study possesses numerous flaws inherent in such an ambitious endeavor, including an inability to identify specific factors which explain the lack of superiority of surgical management. Despite its weaknesses, this study is a valuable datapoint which encourages surgeons to reexamine their surgical indications for this injury.

Subchondral architecture in bones of the canine shoulder.

PubMed Central

Simkin, P A; Heston, T F; Downey, D J; Benedict, R S; Choi, H S

1991-01-01

The distal scapula and proximal humerus from each shoulder of nine adult dogs were slab-sectioned, cleaned of soft tissues, embedded in white plastic and stained black with a silver stain. These preparations were then photographed for automated, digital, morphometric analysis of subchondral bone structure. Comparison of transverse and coronal sections through the left and right shoulders demonstrated essential isometry of trabecular patterns within each bone. Comparison of the scapula and humerus revealed significant differences in bony architecture. The subchondral plate was an average of 5.6 times thicker under the glenoid fossa than in the opposing humeral head. Deeper trabecular structure also differed with the trabecular bone volume (density) in the humerus being greater than that in the scapula. This difference reflects a greater trabecular density in the humerus with comparable trabecular thickness in both bones. These structural differences are consistent with previous functional studies of the same two bones that revealed greater mechanical stiffness beneath the glenoid fossa and greater hydraulic resistance within the humeral head. Images Fig. 1 Fig. 2 (cont.) Fig. 2 Fig. 3 PMID:2050567

Multifocal humeral fractures.

PubMed

Maresca, A; Pascarella, R; Bettuzzi, C; Amendola, L; Politano, R; Fantasia, R; Del Torto, M

2014-02-01

Multifocal humeral fractures are extremely rare. These may affect the neck and the shaft, the shaft alone, or the diaphysis and the distal humerus. There is no classification of these fractures in the literature. From 2004 to 2010, 717 patients with humeral fracture were treated surgically at our department. Thirty-five patients presented with an associated fracture of the proximal and diaphyseal humerus: synthesis was performed with plate and screws in 34 patients, and the remaining patient had an open fracture that was treated with an external fixator. Mean follow-up was 3 years and 3 months. A classification is proposed in which type A fractures are those affecting the proximal and the humeral shaft, type B the diaphysis alone, and type C the diaphysis in association with the distal humerus. Type A fractures are then divided into three subgroups: A-I, undisplaced fracture of the proximal humerus and displaced shaft fracture; A-II: displaced fracture of the proximal and humeral shaft; and A-III: multifragmentary fracture affecting the proximal humerus and extending to the diaphysis. Multifocal humeral fractures are very rare and little described in the literature, both for classification and treatment. The AO classification describes bifocal fracture of the humeral diaphysis, type B and C. The classification suggested in this article mainly concerns fractures involving the proximal and humeral shaft. A simple classification of multifocal fractures is suggested to help the surgeon choose the most suitable type of synthesis for surgical treatment. Copyright © 2013 Elsevier Ltd. All rights reserved.

Do Treatment Policies for Proximal Humerus Fractures Differ among Three Nordic Countries and Estonia? Results of a Survey Study.

PubMed

Launonen, A P; Lepola, V; Laitinen, M; Mattila, V M

2016-09-01

Proximal humerus fractures are common fragility injuries. The incidence of these fractures has been estimated to be 82-105 per 105 person-years. Treatment of this fracture, especially in the elderly, is controversial. Our study group published a systematic review of the available literature and concluded that non-operative methods are favored over operative methods in three- and four-part fractures. The aim of this multinational study was to compare treatment policies for proximal humerus fractures among the Nordic countries and Estonia. The study was conducted as a questionnaire-based survey, using the Internet-based program, Webropol(®) (webropol.com). The questionnaire link was sent to the surgeons responsible for treating proximal humerus fractures in major public hospitals in Estonia, Finland, Norway, and Sweden. Questionnaire included questions regarding the responder's hospital, patient characteristics, and examinations taken before decision making. Clinical part included eight example patient cases with treatment options. Of the 77 recipients of the questionnaire, 59 responded; consequently, the response rate was 77%. Based on the eight presented displaced fracture examples, in both Estonia and Norway and in Finland, 41% and 38%, respectively, preferred surgical treatment with locking plate. In Sweden, the percentage was 28%. The pre- and post-operative protocols showed a similarity in all participant countries. Our survey revealed a remarkable uniformity in the current practice of operative treatments and rehabilitation for proximal humerus fractures in the participant countries. © The Finnish Surgical Society 2016.

Falling Down on the Job: Evaluation and Treatment of Fall Risk Among Older Adults With Upper Extremity Fragility Fractures.

PubMed

McDonough, Christine M; Colla, Carrie H; Carmichael, Donald; Tosteson, Anna N A; Tosteson, Tor D; Bell, John-Erik; Cantu, Robert V; Lurie, Jonathan D; Bynum, Julie P W

2017-03-01

Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline. The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk. Observational cohort. Participants were fee-for-service beneficiaries age 66 to 99 treated as outpatients for proximal humerus or distal radius/ulna ("wrist") fragility fractures. -Participants were studied using Carrier and Outpatient Hospital files. The proportion of patients evaluated or treated for fall risk up to 6 months after proximal humerus or wrist fracture from 2007-2009 was examined based on evaluation, treatment, and diagnosis codes. Time to evaluation and number of treatment sessions were calculated. Logistic regression was used to analyze patient characteristics that predicted receiving evaluation or treatment. Narrow (gait training) and broad (gait training or therapeutic exercise) definitions of service were used. There were 309,947 beneficiaries who sustained proximal humerus (32%) or wrist fracture (68%); 10.7% received evaluation or treatment for fall risk or gait issues (humerus: 14.2%; wrist: 9.0%). Using the broader definition, the percentage increased to 18.5% (humerus: 23.4%; wrist: 16.3%). Factors associated with higher likelihood of services after fracture were: evaluation or treatment for falls or gait prior to fracture, more comorbidities, prior nursing home stay, older age, humerus fracture (vs wrist), female sex, and white race. Claims analysis may underestimate physician and physical therapist fall assessments, but it is not likely to qualitatively change the results. A small proportion of older adults with upper extremity fracture received fall risk assessment and treatment. Providers and health systems must advance efforts to provide timely evidence-based management of fall risk in this population. © 2017 American Physical Therapy Association

Falling Down on the Job: Evaluation and Treatment of Fall Risk Among Older Adults With Upper Extremity Fragility Fractures

PubMed Central

Colla, Carrie H.; Carmichael, Donald; Tosteson, Anna N. A.; Tosteson, Tor D.; Bell, John-Erik; Cantu, Robert V.; Lurie, Jonathan D.; Bynum, Julie P. W.

2017-01-01

Abstract Background: Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline. Objective: The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk. Design: Observational cohort. Methods: Participants were fee-for-service beneficiaries age 66 to 99 treated as outpatients for proximal humerus or distal radius/ulna (“wrist”) fragility fractures. -Participants were studied using Carrier and Outpatient Hospital files. The proportion of patients evaluated or treated for fall risk up to 6 months after proximal humerus or wrist fracture from 2007–2009 was examined based on evaluation, treatment, and diagnosis codes. Time to evaluation and number of treatment sessions were calculated. Logistic regression was used to analyze patient characteristics that predicted receiving evaluation or treatment. Narrow (gait training) and broad (gait training or therapeutic exercise) definitions of service were used. Results: There were 309,947 beneficiaries who sustained proximal humerus (32%) or wrist fracture (68%); 10.7% received evaluation or treatment for fall risk or gait issues (humerus: 14.2%; wrist: 9.0%). Using the broader definition, the percentage increased to 18.5% (humerus: 23.4%; wrist: 16.3%). Factors associated with higher likelihood of services after fracture were: evaluation or treatment for falls or gait prior to fracture, more comorbidities, prior nursing home stay, older age, humerus fracture (vs wrist), female sex, and white race. Limitations: Claims analysis may underestimate physician and physical therapist fall assessments, but it is not likely to qualitatively change the results. Conclusions: A small proportion of older adults with upper extremity fracture received fall risk assessment and treatment. Providers and health systems must advance efforts to provide timely evidence-based management of fall risk in this population. PMID:28340130

The Distal Humerus Axial View: Assessment of Displacement in Medial Epicondyle Fractures.

PubMed

Souder, Christopher D; Farnsworth, Christine L; McNeil, Natalie P; Bomar, James D; Edmonds, Eric W

2015-01-01

The assessment and treatment of childhood medial epicondyle humerus fractures continues to be associated with significant debate. Several studies demonstrate that standard radiographic views are unable to accurately portray the true displacement. Without reliable ways to assess the amount of displacement, how can we debate treatment and outcomes? This study introduces a novel imaging technique for the evaluation of medial epicondyle fractures. An osteotomy of a cadaveric humerus was performed to simulate a medial epicondyle fracture. Plain radiographs were obtained with the fracture fragment displaced anteriorly in 2-mm increments between 0 and 18 mm. Anteroposterior (AP), internal oblique (IR), lateral (LAT), and distal humerus axial (AXIAL) views were performed. Axial images were obtained by positioning the central ray above the shoulder at 15 to 20 degrees from the long axis of the humerus, centered on the distal humerus. Displacement (mm) was measured by 7 orthopaedic surgeons on digital radiographs. At 10 mm displacement, AP views underestimated displacement by 5.5±0.6 mm and IR views underestimated by 3.8±2.1 mm. On LAT views, readers were not able to visualize fragments with <10 mm displacement. Displacement ≥10 mm from LAT views was overestimated by 1 reader by up to 4.6 mm and underestimated by others by up to 18.0 mm. AXIAL images more closely estimated the true amount of displacement, with a mean 1.5±1.1 mm error in measurement for <10 mm displacement and a mean 0.8±0.7 mm error for displacements of ≥10 mm. AXIAL measurements correlated strongly with the actual displacement (r=0.998, P<0.05); AP measurements did not (r=0.655, P=0.55). Intraclass correlation coefficient (ICC) was 0.257 for AP and IR measurements; ICC was 0.974 for AXIAL measurements. Standard imaging, consisting of AP, IR, and LAT radiographs, consistently underestimates the actual displacement of medial epicondyle humerus fractures. The newly described AXIAL projection more accurately and reliably demonstrated the true displacement while reducing the need for advanced imaging such as computed tomography. This simple view can be easily obtained at a clinic visit, enhancing the surgeon's ability to determine the true displacement.

External fixation for severe open fractures of the humerus caused by missiles.

PubMed

Zinman, C; Norman, D; Hamoud, K; Reis, N D

1997-10-01

To evaluate the use of external fixation of the humerus after missile injuries. Retrospective. University medical center. Twenty-six soldiers with twenty-six open Gustilo type III fractures. Immediate external fixation. Clinical, functional, social, and rehabilitation criteria were evaluated. Excellent in fourteen patients (61%), good in four (17%), fair in three (13%), and poor in two (9%). All fractures eventually healed. External fixation is the preferred initial treatment for stabilizing severe open missile fractures of the humerus. Its use, together with radical debridement of dead bone, has reduced the incidence of chronic infection and improved the prognosis of vascular repairs. As a result, the rate of morbidity and upper limb amputation has been reduced significantly, compared with our previous experience.

Elemental Analysis of Bone, Teeth, Horn and Antler in Different Animal Species Using Non-Invasive Handheld X-Ray Fluorescence.

PubMed

Buddhachat, Kittisak; Klinhom, Sarisa; Siengdee, Puntita; Brown, Janine L; Nomsiri, Raksiri; Kaewmong, Patcharaporn; Thitaram, Chatchote; Mahakkanukrauh, Pasuk; Nganvongpanit, Korakot

2016-01-01

Mineralized tissues accumulate elements that play crucial roles in animal health. Although elemental content of bone, blood and teeth of human and some animal species have been characterized, data for many others are lacking, as well as species comparisons. Here we describe the distribution of elements in horn (Bovidae), antler (Cervidae), teeth and bone (humerus) across a number of species determined by handheld X-ray fluorescence (XRF) to better understand differences and potential biological relevance. A difference in elemental profiles between horns and antlers was observed, possibly due to the outer layer of horns being comprised of keratin, whereas antlers are true bone. Species differences in tissue elemental content may be intrinsic, but also related to feeding habits that contribute to mineral accumulation, particularly for toxic heavy metals. One significant finding was a higher level of iron (Fe) in the humerus bone of elephants compared to other species. This may be an adaptation of the hematopoietic system by distributing Fe throughout the bone rather than the marrow, as elephant humerus lacks a marrow cavity. We also conducted discriminant analysis and found XRF was capable of distinguishing samples from different species, with humerus bone being the best source for species discrimination. For example, we found a 79.2% correct prediction and success rate of 80% for classification between human and non-human humerus bone. These findings show that handheld XRF can serve as an effective tool for the biological study of elemental composition in mineralized tissue samples and may have a forensic application.

Elemental Analysis of Bone, Teeth, Horn and Antler in Different Animal Species Using Non-Invasive Handheld X-Ray Fluorescence

PubMed Central

Buddhachat, Kittisak; Klinhom, Sarisa; Siengdee, Puntita; Brown, Janine L.; Nomsiri, Raksiri; Kaewmong, Patcharaporn; Thitaram, Chatchote; Mahakkanukrauh, Pasuk; Nganvongpanit, Korakot

2016-01-01

Mineralized tissues accumulate elements that play crucial roles in animal health. Although elemental content of bone, blood and teeth of human and some animal species have been characterized, data for many others are lacking, as well as species comparisons. Here we describe the distribution of elements in horn (Bovidae), antler (Cervidae), teeth and bone (humerus) across a number of species determined by handheld X-ray fluorescence (XRF) to better understand differences and potential biological relevance. A difference in elemental profiles between horns and antlers was observed, possibly due to the outer layer of horns being comprised of keratin, whereas antlers are true bone. Species differences in tissue elemental content may be intrinsic, but also related to feeding habits that contribute to mineral accumulation, particularly for toxic heavy metals. One significant finding was a higher level of iron (Fe) in the humerus bone of elephants compared to other species. This may be an adaptation of the hematopoietic system by distributing Fe throughout the bone rather than the marrow, as elephant humerus lacks a marrow cavity. We also conducted discriminant analysis and found XRF was capable of distinguishing samples from different species, with humerus bone being the best source for species discrimination. For example, we found a 79.2% correct prediction and success rate of 80% for classification between human and non-human humerus bone. These findings show that handheld XRF can serve as an effective tool for the biological study of elemental composition in mineralized tissue samples and may have a forensic application. PMID:27196603

3D geometric morphometric analysis of the proximal epiphysis of the hominoid humerus

PubMed Central

Arias-Martorell, Julia; Potau, Josep Maria; Bello-Hellegouarch, Gaëlle; Pastor, Juan Francisco; Pérez-Pérez, Alejandro

2012-01-01

In this study we perform a three-dimensional geometric morphometric (3D GM) analysis of the proximal epiphysis of the humerus in extant great apes, including humans, in order to accurately describe the functional anatomical differences between these taxa. In addition, a fossil hominin specimen of Australopithecus afarensis was included in a multivariate GM analysis in order to test the potential of this methodological approach for making locomotor inferences from fossil remains. The results obtained show significant differences in proximal humeral morphology among the taxa studied, which had thus far largely remained unnoticed. Based on morphofunctional considerations, these anatomical differences can be correlated to differences in the locomotor repertoires of the taxa, thus confirming that the proximal humerus is suitable for constructing paleobiological inferences about locomotion. Modern humans display markedly divergent features, which set them apart from both the extant great apes and the fossil hominin A. afarensis. The morphology of the proximal epiphysis of the humerus of the latter more closely resembles that of the orangutans, thus suggesting that despite hindlimb adaptations to bipedalism, the forelimb of this taxon was still functionally involved in arboreal behaviors, such as climbing or suspension. PMID:22946496

The anterolateral acromial approach for fractures of the proximal humerus.

PubMed

Gardner, Michael J; Boraiah, Sreevathsa; Helfet, David L; Lorich, Dean G

2008-02-01

Displaced and unstable fractures of the proximal humerus are notoriously difficult to manage. Successful surgical treatment requires finding the appropriate balance between adequate exposure for reduction and rigid fixation and minimizing soft tissue dissection. The anterolateral acromial approach was developed to allow less invasive treatment of proximal humerus fractures. The plane of the avascular anterior deltoid raphe is utilized, and the axillary nerve is identified and protected. Anterior dissection near the critical blood supply is avoided, substantial muscle retraction is minimized, and the lateral plating zone is directly accessed. Over a 4-year period, 52 patients with acute displaced fractures of the proximal humerus were treated with the anterolateral acromial approach and either a locking plate or an intramedullary nail. Twenty-three patients were evaluated clinically at a minimum follow-up of 1 year (average, 28 months) by clinical examination for range of motion and nerve function and a QuickDASH score. There were no axillary nerve deficits postoperatively related to the approach, and the average QuickDASH score was 25.2 (0, best; 100, worst). This approach allowed direct access to the lateral fracture planes for fracture reduction and plate placement or safe nail and interlocking screw placement.

Proximal humerus fractures: a comparative biomechanical analysis of intra and extramedullary implants.

PubMed

Füchtmeier, B; May, R; Hente, R; Maghsudi, M; Völk, M; Hammer, J; Nerlich, M; Prantl, L

2007-08-01

The biomechanical stability of a newly developed humerus nail (Sirustrade mark) for the treatment of fractures of the proximal humerus was analyzed in comparison to established systems. In total, three randomized groups were formed (n = 4 pairs) from 12 matched pairs of human cadaver humeri. All intact bones were mechanically characterized by five subsequent load cycles under bending and torsional loading. The bending moment at the osteotomy was 7.5 N m the torsional moment was 8.3 N m over the hole specimen length. Loading was consistently initiated at the distal epiphysis and the deformation at the distal epiphysis was continuously recorded. Prior to implant reinforcement, a defect of 5 mm was created to simulate an unstable subcapital humerus fracture. For paired comparison, one humerus of each pair was stabilized with the Sirus proximal humerus nail while the counterpart was stabilized by a reference implant. In detail, the following groups were created: Sirus versus Proximal humerus nail (PHN) with spiral blade (group I); Sirus versus PHILOS plate (group II); Sirus versus 4.5 mm AO T-plate (group III). The Sirus nail demonstrated significantly higher stiffness values compared to the reference implants for both bending and torsional loading. The following distal epiphyseal displacements were recorded for a bending moment of 7.5 N m at the osteotomy: Sirus I: 8.8 mm, II: 8.4 mm, III: 7.7 mm (range 6.9-10.9), PHN 21.1 mm (range 15.7-25.2) (P = 0.005), PHILOS plate 27.5 mm (range 21.6-35.8) (P < 0.001), 4.5 AO T-plate 26.3 mm (range 24.3-33.9) (P = 0.01). The rotations corresponding to 8.3 N m torsional moment were: Sirus I: 9.1 degrees , II: 9.3 degrees , III: 10.6 degrees (range 7.5-12.2), PHN 13.5 degrees (range 10.3-15.6) (P = 0.158), PHILOS plate 15.6 degrees (range 13.7-20.8) (P = 0.007), 4.5 AO T-Platte 14.1 degrees (range 11.5-19.7) (P = 0.158). The intramedullary load carriers were biomechanically superior when compared to the plating systems in the fracture model presented here. Supplementary, the Sirus Nail showed higher stiffness values than the PHN. However, the latter are gaining in importance due to the possibility of minimal invasive implantation. Whether this will be associated with functional advantages requires further clinical investigation.

Melorheostosis of the humerus: a rare differential diagnosis of carpal tunnel syndrome.

PubMed

De Vos, J; Mulliez, A; De Loore, G

2010-04-01

Melorheostosis is an uncommon and rare linear hyperostosis, which can be complicated by soft tissue changes. We present a case of this disorder in the humerus, clinically referred because of carpal tunnel syndrome. Although treatment is usually conservative, in this case, a neurolysis and resection of the sclerotic bone were done with good clinical result. Copyright 2010 Elsevier Masson SAS. All rights reserved.

Biomechanical in vitro assessment of screw augmentation in locked plating of proximal humerus fractures.

PubMed

Röderer, Götz; Scola, Alexander; Schmölz, Werner; Gebhard, Florian; Windolf, Markus; Hofmann-Fliri, Ladina

2013-10-01

Proximal humerus fracture fixation can be difficult because of osteoporosis making it difficult to achieve stable implant anchorage in the weak bone stock even when using locking plates. This may cause implant failure requiring revision surgery. Cement augmentation has, in principle, been shown to improve stability. The aim of this study was to investigate whether augmentation of particular screws of a locking plate aimed at a region of low bone quality is effective in improving stability in a proximal humerus fracture model. Twelve paired human humerus specimens were included. Quantitative computed tomography was performed to determine bone mineral density (BMD). Local bone quality in the direction of the six proximal screws of a standard locking plate (PHILOS, Synthes) was assessed using mechanical means (DensiProbe™). A three-part fracture model with a metaphyseal defect was simulated and fixed with the plate. Within each pair of humeri the two screws aimed at the region of the lowest bone quality according to the DensiProbe™ were augmented in a randomised manner. For augmentation, 0.5 ml of bone cement was injected in a screw with multiple outlets at its tip under fluoroscopic control. A cyclic varus-bending test with increasing upper load magnitude was performed until failure of the screw-bone fixation. The augmented group withstood significantly more load cycles. The correlation of BMD with load cycles until failure and BMD with paired difference in load cycles to failure showed that augmentation could compensate for a low BMD. The results demonstrate that augmentation of screws in locked plating in a proximal humerus fracture model is effective in improving primary stability in a cyclic varus-bending test. The augmentation of two particular screws aimed at a region of low bone quality within the humeral head was almost as effective as four screws with twice the amount of bone cement. Screw augmentation combined with a knowledge of the local bone quality could be more effective in enhancing the primary stability of a proximal humerus locking plate because the effect of augmentation can be exploited more effectively limiting it to the degree required. Copyright © 2013 Elsevier Ltd. All rights reserved.

Comparative limb bone loading in the humerus and femur of the tiger salamander: testing the 'mixed-chain' hypothesis for skeletal safety factors.

PubMed

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.

Left-handed skeletally mature baseball players have smaller humeral retroversion in the throwing arm than right-handed players.

PubMed

Takenaga, Tetsuya; Goto, Hideyuki; Sugimoto, Katsumasa; Tsuchiya, Atsushi; Fukuyoshi, Masaki; Nakagawa, Hiroki; Nozaki, Masahiro; Takeuchi, Satoshi; Otsuka, Takanobu

2017-12-01

It is known that the humeral retroversion of baseball players is greater in the throwing arm than in the nonthrowing arm. An investigation measuring dry bone specimens also showed that the right humerus had greater retroversion than the left. Considering these facts, it was hypothesized that humeral retroversion would differ between right- and left-handed players. This study aimed to compare the bilateral humeral retroversion between right- and left-handed skeletally mature baseball players. We investigated 260 (196 right-handed and 64 left-handed) male baseball players who belonged to a college or amateur team. Bilateral humeral retroversion was assessed using an ultrasound-assisted technique (humeral torsion angle [HTA]) as described by previous studies. Analysis of covariance, adjusted for handedness and baseball position, assessed the effect of throwing arm dominance on HTA. In comparison of the throwing arm, HTA was significantly smaller in left-handed (left humerus) than in right-handed (right humerus) players (77° vs. 81°; P < .001). In comparison of the nonthrowing arm, HTA was significantly greater in left-handed (right humerus) than in right-handed (left humerus) players (73° vs. 69°; P < .001). The mean side-to-side difference of HTA was significantly smaller in left-handed than in right-handed players (3° vs. 12°; P < .001). Humeral retroversion of left-handed skeletally mature baseball players was significantly smaller in the throwing arm, greater in the nonthrowing arm, and smaller in side-to-side differences than that of right-handed players. These findings may be key to understanding some of the biomechanical differences between right- and left-handed baseball players. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A comparison between orthogonal and parallel plating methods for distal humerus fractures: a prospective randomized trial.

PubMed

Lee, Sang Ki; Kim, Kap Jung; Park, Kyung Hoon; Choy, Won Sik

2014-10-01

With the continuing improvements in implants for distal humerus fractures, it is expected that newer types of plates, which are anatomically precontoured, thinner and less irritating to soft tissue, would have comparable outcomes when used in a clinical study. The purpose of this study was to compare the clinical and radiographic outcomes in patients with distal humerus fractures who were treated with orthogonal and parallel plating methods using precontoured distal humerus plates. Sixty-seven patients with a mean age of 55.4 years (range 22-90 years) were included in this prospective study. The subjects were randomly assigned to receive 1 of 2 treatments: orthogonal or parallel plating. The following results were assessed: operating time, time to fracture union, presence of a step or gap at the articular margin, varus-valgus angulation, functional recovery, and complications. No intergroup differences were observed based on radiological and clinical results between the groups. In our practice, no significant differences were found between the orthogonal and parallel plating methods in terms of clinical outcomes, mean operation time, union time, or complication rates. There were no cases of fracture nonunion in either group; heterotrophic ossification was found 3 patients in orthogonal plating group and 2 patients in parallel plating group. In our practice, no significant differences were found between the orthogonal and parallel plating methods in terms of clinical outcomes or complication rates. However, orthogonal plating method may be preferred in cases of coronal shear fractures, where posterior to anterior fixation may provide additional stability to the intraarticular fractures. Additionally, parallel plating method may be the preferred technique used for fractures that occur at the most distal end of the humerus.

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

PubMed

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.

Proceedings of the 2010 AFMS Medical Research Symposium. Volume 3. Enroute Track: Abstracts and Presentations

DTIC Science & Technology

2011-03-15

comparison of proximal tibia, proximal humerus and distal femur infusion rates under high pressure using the EZ-IO Intraosseous device on an adult...contaminated complex musculoskeletal wounds. METHODS: We adapted a previously characterized caprine model. Under anesthesia , complex musculoskeletal...of proximal tibia, proximal humerus and distal femur infusion rates under high pressure using the EZ-IO Intraosseous device on an adult swine model

Fracture of supracondylar process of the humerus.

PubMed

Suresh, S S

2008-07-01

The supracondylar process of the humerus is a rare skeletal anomaly, which is usually an incidental finding while an X-ray is done for some other purpose. The process can fracture resulting in pain and tender mobile swelling over the medial aspect of the arm, and consequent neurovascular symptoms, or entrapment neuropathies. The anomaly, which fractured in a clinical situation, is described, followed by a review of the literature.

Review of literature of radial nerve injuries associated with humeral fractures-an integrated management strategy.

PubMed

Li, YuLin; Ning, GuangZhi; Wu, Qiang; Wu, QiuLi; Li, Yan; Feng, ShiQing

2013-01-01

Radial nerve palsy associated with fractures of the shaft of the humerus is the most common nerve lesion complicating fractures of long bones. However, the management of radial nerve injuries associated with humeral fractures is debatable. There was no consensus between observation and early exploration. The PubMed, Embase, Cochrane Central Register of Controlled Trials, Google Scholar, CINAHL, International Bibliography of the Social Sciences, and Social Sciences Citation Index were searched. Two authors independently searched for relevant studies in any language from 1966 to Jan 2013. Thirty studies with 2952 humeral fractures participants were identified. Thirteen studies favored conservative strategy. No significant difference between early exploration and no exploration groups (OR, 1.03, 95% CI 0.61, 1.72; I(2) = 0.0%, p = 0.918 n.s.). Three studies recommend early radial nerve exploration in patients with open fractures of humerus with radial nerve injury. Five studies proposed early exploration was performed in high-energy humeral shaft fractures with radial nerve injury. The conservative strategy was a good choice for patients with low-energy closed fractures of humerus with radial nerve injury. We recommend early radial nerve exploration (within the first 2 weeks) in patients with open fractures or high-energy closed fractures of humerus with radial nerve injury.

First-line management of distal humerus fracture by total elbow arthroplasty in geriatric traumatology: Results in a 21-patient series at a minimum 2years' follow-up.

PubMed

Lami, D; Chivot, M; Caubere, A; Galland, A; Argenson, J N

2017-10-01

Total elbow arthroplasty (TEA) is one option in distal humerus fracture in elderly osteoporotic patients. The study hypothesis was that, in patients aged 70years or more, TEA provides functional results and ranges of motion compatible with everyday activity, with a complications rate equal to or lower than with internal fixation, and no loss of autonomy or cognitive impairment. In this retrospective study, 21 patients receiving TEA for distal humerus fracture were included. Mean follow-up was 3.2years, with functional (Quick DASH and MEPS), cognitive (MMSE), autonomy-related (ADL) and radiological assessment (Morrey). Mean MEPS was 84 and QuickDASH 32.4. Mean extension deficit was 22°, and mean flexion 125°. There was no loss of autonomy or cognitive impairment. The complications rate was 9.5%. There were no revision surgeries. TEA proved reliable in comminuted distal humerus fracture in elderly patients. Functional results were comparable to those in the literature, and the complications rate was lower. Long-term implant survival needs confirmation to validate this option as a treatment of choice in these indications in geriatric traumatology. Retrospective non-comparative, single-center. 4. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

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

PubMed

Brorson, Stig

2011-04-01

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. I reviewed nineteenth-century principles of (1) diagnosis, (2) classification, (3) reduction, (4) bandaging, and (5) concepts of displacement in fractures of the proximal humerus. A narrative review of nineteenth-century surgical texts is presented. Sources were identified by searching bibliographic databases, orthopaedic sourcebooks, textbooks in medical history, and a subsequent hand search. Substantial progress in understanding fractures of the proximal humerus is found in nineteenth-century textbooks. A rational approach to understanding fractures of the proximal humerus was made possible by an appreciation of the underlying functional anatomy and subsequent pathoanatomy. Thus, new principles of diagnosis, pathoanatomic classifications, modified methods of reduction, functional bandaging, and advanced concepts of displacement were proposed, challenging the classic management adhered to for more than 2000 years. The principles for modern pathoanatomic and pathophysiologic understanding of proximal humeral fractures and the principles for classification, nonsurgical treatment, and bandaging were established in the preradiographic era.

[Measurement of screw length through drilling technique in osteosynthesis of the proximal humerus fractures].

PubMed

Avcı, Cem Coşkun; Gülabi, Deniz; Sağlam, Necdet; Kurtulmuş, Tuhan; Saka, Gürsel

2013-01-01

This study aims to investigate the efficacy of screw length measurement through drilling technique on the reduction of intraarticular screw penetration and fluoroscopy time in osteosynthesis of proximal humerus fractures. Between January 2008 and June 2012, 98 patients (34 males, 64 females; mean age 64.4 years; range 35 to 81 years) who underwent osteosynthesis using locking anatomical proximal humerus plates (PHILOS) in our clinic with the diagnosis of Neer type 2, 3 or 4 were included. Two different surgical techniques were used to measure proximal screw length in the plate and patients were divided into two groups based on the technique used. In group 1, screw length was determined by a 3 mm blunt tipped Kirschner wire without fluoroscopic control. In group 2, bilateral fluoroscopic images for each screw at least were obtained. Intraarticular screw penetration was detected in five patients (10.6%) in group 1, and in 19 patients (37.3%) in group 2. The mean fluoroscopic imaging time was 10.6 seconds in group 1 and 24.8 seconds in group 2, indicating a statistically significant difference. Screw length measurement through the drilling technique significantly reduces the intraarticular screw penetration and fluoroscopy time in osteosynthesis of proximal humerus fractures using PHILOS plates.

Fat embolism syndrome: Case report of a clinical conundrum

PubMed Central

Nandi, Roneeta; Venkategowda, Pradeep Marur; Mutkule, Dnyaneshwar; Rao, Surath Manimala

2014-01-01

Fat embolism syndrome is a rare clinical condition associated with trauma, particularly of long bones. FES after fracture of neck of femur or head of humerus is uncommon. We report a case of FES following fracture in neck of femur and head of humerus in a man with history of mitral valve replacement, on long-term oral anticoagulant therapy, with an alleged history of convulsions. Our dilemma in clinical diagnosis is discussed. PMID:25190956

The Rubber Stopper: A Simple and Inexpensive Technique to Prevent Pin Tract Infection following Kirschner Wiring of Supracondylar Fractures of Humerus in Children.

PubMed

Santy, J E; Kamal, J; Abdul-Rashid, A H; Ibrahim, S

2015-07-01

Percutaneous pinning after closed reduction is commonly used to treat supracondylar fractures of the humerus in children. Minor pin tract infections frequently occur. The aim of this study was to prevent pin tract infections using a rubber stopper to reduce irritation of the skin against the Kirschner (K) wire following percutaneous pinning. Between July 2011 and June 2012, seventeen children with closed supracondylar fracture of the humerus of Gartland types 2 and 3 were treated with this technique. All patients were treated with closed reduction and percutaneous pinning and followed up prospectively. Only one patient, who was a hyperactive child, developed pin tract infection due to softening of the plaster slab. We found using the rubber stopper to be a simple and inexpensive method to reduce pin tract infections following percutaneous pinning.

The Rubber Stopper: A Simple and Inexpensive Technique to Prevent Pin Tract Infection following Kirschner Wiring of Supracondylar Fractures of Humerus in Children

PubMed Central

Santy, JE; Abdul-Rashid, AH; Ibrahim, S

2015-01-01

Percutaneous pinning after closed reduction is commonly used to treat supracondylar fractures of the humerus in children. Minor pin tract infections frequently occur. The aim of this study was to prevent pin tract infections using a rubber stopper to reduce irritation of the skin against the Kirschner (K) wire following percutaneous pinning. Between July 2011 and June 2012, seventeen children with closed supracondylar fracture of the humerus of Gartland types 2 and 3 were treated with this technique. All patients were treated with closed reduction and percutaneous pinning and followed up prospectively. Only one patient, who was a hyperactive child, developed pin tract infection due to softening of the plaster slab. We found using the rubber stopper to be a simple and inexpensive method to reduce pin tract infections following percutaneous pinning. PMID:28435603

Supraintercondylar fractures of the humerus--treatment by the Vigliani osteosynthesis.

PubMed

Fama, G

1987-03-01

Nineteen cases of supraintercondylar fractures of the humerus treated by the Vigliani osteosynthesis technique are described. This consists of wide transolecranon exposure of the fracture, stabilisation of the epiphyseal fragments with a transcondylar screw, and of the metaphyseo-epiphyseal junction with two condylo-diaphyseal "Eiffel Tower" Kirschner wires. The ulnar nerve is transposed anteriorly and the operation is carried out early in order to prevent neural disturbances and intra and/or periarticular ossification. The results confirm the validity of this method, which respects the delicate structure of this part of the humerus. Postoperative plaster is necessary as an indispensable complement to "minimum" osteosynthesis but this is quite free from risk. The importance of careful and gradual mobilisation of the elbow is also confirmed. Finally, this method combines the advantages of stable osteosynthesis in compression (screw and nut) at the epiphyseal site, with those of elastic osteosynthesis (Kirschner wires) at the metaphyseo-epiphyseal junction.

Humerus fracture bending risk function for the 50th percentile male.

PubMed

Santago, Anthony C; Cormier, Joseph M; Duma, Stefan M

2008-01-01

The increase in upper extremity injuries in automobile collisions, because of the widespread implantation of airbags, has lead to an increased focus in humerus injury criteria. Risk functions for upper extremity injury that can be used in instrumented upper extremities would be useful. This paper presents a risk function for humerus injury for the 50th percentile male based on bending fracture moment data gathered from previous studies. The data was scaled using two scaling factors, one for mass and one for rate, and the Weibull survival analysis model was then used to develop the risk function. It was determined that a 25% risk of injury corresponds to a 214 Nm bending load, a 50% risk of injury corresponds to a 257 Nm bending load, and a 75% risk of injury corresponds to a 296 Nm bending load. It is believed the risk function can be used with an instrumented upper extremity during vehicle testing.

(Un)importance of physical therapy in treatment of displaced supracondylar humerus fractures in children.

PubMed

Ducic, Sinisa; Bumbasirevic, Marko; Radlovic, Vladimir; Bukumiric, Zoran; Bukva, Bojan; Abramovic, Dusan

2015-09-01

Elbow joint stiffness is a common complication following supracondylar humerus fractures. In prospective study, dynamics of establishing a full range of motion in the elbow joint following the treatment of supracondylar humerus fractures were assessed, together with the effects of physical therapy on improvement in the range of motion. Two groups of patients were observed. Physical therapy was administered to the first group, comprised of 25 patients. The second group, comprised of 28 patients, underwent no physical therapy. In the first few months following treatment, the range of motion was significantly greater in the patients who had undergone physical therapy, but after 12 months, the range of motion was almost equal in the two groups. This study has shown that it takes about 12 months to establish a full range of motion after the injury, and that it is not necessary to apply physical therapy in patients with elbow fractures.

Site and Severity of the Increased Humeral Retroversion in Symptomatic Baseball Players: A 3-dimensional Computed Tomographic Analysis.

PubMed

Itami, Yasuo; Mihata, Teruhisa; Shibano, Koji; Sugamoto, Kazuomi; Neo, Masashi

2016-07-01

Humeral retroversion in baseball players is greater in the dominant shoulder than in the nondominant shoulder. However, the site and severity of the humeral rotational deformity remain unclear. To evaluate the site of side-to-side differences in humeral retroversion in baseball players and the severity of these changes through 3-dimensional computed tomographic (3D CT) bone models. Cross-sectional study; Level of evidence, 3. From 2008 to 2014, we studied 25 baseball players (12 pitchers, 13 fielders) who underwent surgery for throwing-related injuries (shoulder injury, 15 players; elbow injury, 10 players). The mean age (±SD) at the time of surgery was 20.0 ± 5.9 years. A reconstructed 3D CT model of the entire humerus was divided into 15 segments of equal height (overall mean, 21.4 ± 1.0 mm). The side-to-side difference in humeral retroversion in each segment was calculated by superimposing the model of the dominant side over the mirror-image model of the nondominant side. The overall mean increase in humeral retroversion was 13.0° ± 6.2° on the dominant side. Significant side-to-side differences in retroversion were present throughout the humerus. The largest side-to-side difference in humeral retroversion was seen at the insertions of the internal rotator muscles (2.5° ± 4.3°) and around the proximal physis (2.5° ± 1.4°). At the insertions of shoulder capsule and rotator cuff tendons, the superior half of the humeral head was more retroverted than the inferior half (P < .0001). The side-to-side difference in humeral retroversion was significantly greater in the pitchers (16.2° ± 5.1°) than in the fielders (10.0° ± 5.7°) (P = .009), particularly at the proximal physis. Baseball players exhibited significant side-to-side differences in humeral retroversion at multiple sites throughout the humerus, including the proximal humerus near the epiphyseal plate and at the insertions of the internal rotator muscles, the middle of the humeral shaft, and the distal third of the humerus. Therefore, the increased humeral retroversion at multiple sites throughout the humerus needs to be considered when we perform physical examinations, provide treatment, or undertake biomechanical studies for any throwing-related injuries. © 2016 The Author(s).

Biomechanical Analysis of a Novel Intercalary Prosthesis for Humeral Diaphyseal Segmental Defect Reconstruction.

PubMed

Zhao, Li-Ming; Tian, Dong-Mu; Wei, Yue; Zhang, Jun-Hui; Di, Zheng-Lin; He, Zhi-Yong; Hu, Yong-Cheng

2018-02-01

To study the biomechanical properties of a novel modular intercalary prosthesis for humeral diaphyseal segmental defect reconstruction, to establish valid finite element humerus and prosthesis models, and to analyze the biomechanical differences in modular intercalary prostheses with or without plate fixation. Three groups were set up to compare the performance of the prosthesis: intact humerus, humerus-prosthesis and humerus-prosthesis-plate. The models of the three groups were transferred to finite element software. Boundary conditions, material properties, and mesh generation were set up for both the prosthesis and the humerus. In addition, 100 N or 2 N.m torsion was loaded to the elbow joint surface with the glenohumeral joint surface fixed. Humeral finite element models were established according to CT scans of the cadaveric bone; reverse engineering software Geomagic was used in this procedure. Components of prosthetic models were established using 3-D modeling software Solidworks. To verify the finite element models, the in vitro tests were simulated using a mechanical testing machine (Bionix; MTS Systems Corporation, USA). Starting with a 50 N preload, the specimen was subjected to 5 times tensile (300 N) and torsional (5 N.m) strength; interval time was 30 min to allow full recovery for the next specimen load. Axial tensile and torsional loads were applied to the elbow joint surface to simulate lifting heavy objects or twisting something, with the glenohumeral joint surface fixed. Stress distribution on the humerus did not change its tendency notably after reconstruction by intercalary prosthesis whether with or without a plate. The special design which included a plate and prosthesis effectively diminished stress on the stem where aseptic loosening often takes place. Stress distribution major concentrate upon two stems without plate addition, maximum stress on proximal and distal stem respectively diminish 27.37% and 13.23% under tension, 10.66% and 11.16% under torsion after plate allied. The novel intercalary prosthesis has excellent ability to reconstruct humeral diaphyseal defects. The accessory fixation system, which included a plate and prosthesis, improved the rigidity of anti-tension and anti-torsion, and diminished the risk of prosthetic loosening and dislocation. A finite element analysis is a kind of convenient and practicable method to be used as the confirmation of experimental biomechanics study. © 2018 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Increased severity of type III supracondylar humerus fractures in the preteen population.

PubMed

Fletcher, Nicholas D; Schiller, Jonathan R; Garg, Sumeet; Weller, Amanda; Larson, A Noelle; Kwon, Michael; Browne, Richard; Copley, Lawson; Ho, Christine

2012-09-01

Supracondylar humerus fractures are the most common operative fractures in children; however, no studies describe the older child with this injury. The purpose of this study was to compare Gartland type III supracondylar humerus fractures in children older than 8 years of age with those in younger children than age 8. We hypothesized that there would be more complications in older children, reflecting a higher-energy injury mechanism. A retrospective chart review of supracondylar humerus fractures managed at a single level I pediatric trauma institution from 2004 to 2007 was performed. Patients with type III fractures were divided into groups based on age at presentation greater or less than 8. Baseline demographics, fracture characteristics, mechanism of injury, operative technique, and complications were analyzed. A consecutive series of 1297 pediatric patients with surgically treated supracondylar humerus fractures was retrospectively reviewed including 873 (67.3%) type III fractures. Of those, 160 (18.3%) patients were older than age 8 at time of injury. Older children were more likely to have fractures from high-energy mechanisms (45.1% vs. 28.7%, P<0.001) and more open fracture (3.8% vs. 1.3%, P=0.0097). There was no difference in preoperative or iatrogenic neuropraxias between groups. There was a shorter delay between presentation and surgery in older children (mean, 217 vs. 451 min, P<0.0001). Three or more pins were used more often in older patients (61.8% in older children vs. 43.6% in younger children, P<0.0001). Major complications including reoperation, loss of fixation, or compartment syndrome were rare in both groups (1.1% in younger group vs. 0.6% in older group, P=1.000). There was a trend toward more pin site infections in older children (3.75% vs. 1.56%, P=0.071). Physical therapy was required nearly 4 times more frequently in older children for management of residual stiffness (20.0% vs. 5.7%, P<0.0001). Children older than 8 years of age have a higher rate of open supracondylar humerus fractures, although nerve injury rates are similar. Surgeons placed more pins for fixation of fractures in older patients and elbow stiffness requiring physical therapy occurred more commonly after surgical intervention. III Retrospective cohort.

OSTEOCHONDROMA OF THE PROXIMAL HUMERUS WITH FRICTIONAL BURSITIS AND SECONDARY SYNOVIAL OSTEOCHONDROMATOSIS.

PubMed

De Groote, J; Geerts, B; Mermuys, K; Verstraete, K

2015-01-01

We report a case of multiple hereditary exostosis in a 33-year old patient with clinical symptoms of pain and impression of a growing mass of the left shoulder alerting potential risk of malignant transformation of an osteochondroma. Imaging studies illustrated perilesional bursitis surrounding an osteochondroma of the proximal humerus. Malignant transformation was excluded with MRI. Fragments of the osteochondroma were dislocated in the inflammatory synovial bursa illustrating a case of secondary synovial osteochondromatosis.

Experiment K-6-02. Biomedical, biochemical and morphological alterations of muscle and dense, fibrous connective tissues during 14 days of spaceflight

NASA Technical Reports Server (NTRS)

Vailas, A.; Zernicke, R.; Grindeland, R.; Kaplanski, A.

1990-01-01

Findings on the connective tissue response to short-term space flight (12 days) are discussed. Specifically, data regarding the biochemical, biomechanical and morphological characteristics of selected connective tissues (humerus, vertebral body, tendon and skeletal muscle) of growing rats is given. Results are given concerning the humerus cortical bone, the vertebral bone, nutritional effects on bone biomechanical properties, and soft tense fiber connective tissue response.

Do race-specific definitions of short long bones improve the detection of down syndrome on second-trimester genetic sonograms?

PubMed

Harper, Lorie M; Gray, Diana; Dicke, Jeffrey; Stamilio, David M; Macones, George A; Odibo, Anthony O

2010-02-01

The purpose of this study was to determine whether the use of race-specific definitions of short femur and humerus lengths improves Down syndrome detection. This was a retrospective cohort study over 16 years. For each self-reported maternal race (white, African American, Hispanic, and Asian), we evaluated the efficiency of Down syndrome detection using published race-specific formulas compared with a standard formula for short femur and humerus lengths (observed versus expected lengths < or =0.91 and < or =0.89, respectively). The sensitivity, specificity, and 95% confidence intervals for each parameter were compared. Screening performance was compared by areas under the receiver operating characteristic curves. Of 58,710 women, 209 (0.3%) had a diagnosis of a fetus with Down syndrome. Although the race-based formula increased sensitivity in each population, the increase was statistically significant only in the white population, whereas a decrease in specificity was statistically significant in all 4 populations, as denoted by nonoverlapping confidence intervals. The area under the receiver operating characteristic curve for the model using the race-specific definition of short femur length was 0.67 versus 0.65 compared with the standard definition, and for humerus length it was 0.70 versus 0.71. The use of race-based formulas for the determination of short femur and humerus lengths did not significantly improve the detection rates for Down syndrome.

Intercondylar humerus fracture- parallel plating and its results.

PubMed

Kumar, Sanjiv; Singh, Sudhir; Kumar, Dharmender; Kumar, Neeraj; Verma, Reetu

2015-01-01

Intercondylar fracture of humerus is one of the commonest fractures of young adult and counts for about 30% of all elbow fractures. The treatment of these fractures continues to present challenges despite advances in internal fixation. Although orthogonal plating use to provid adequate functional results in these fractures, parallel plating is said to be mechanically more stable construct thus allowing early mobilization and better range of motion. AIM of the study is to assess the clinical as well functional results of these fractures treated with parallel plating. Prospective study in a tertiary care hospital. A total of 23 fresh patients of intercondylar fracture of humerus from Jan 2013 to May 2014 were included in the study and were treated with parallel plating. These patients were followed at 3, 6, 12, 24 weeks and at 1year of follow up and assessed in terms of time for union, range of motion, MAYO score, DASH score and complication rate. At final follow up Mayo score was 96.32±04.96 from 5.00±01.26 and DASH SCORE was 31.42±2.04 which dropped from 150±05.34, Range of motion improved from 21.38±05.70 to 116.1±07.92 with 100% union rate and complications less than 19%. Parallel plating for intercondylar fracture of humerus is excellent method of fixation and results are similar to those treated with orthogonal plating.

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

PubMed Central

Grawe, Brian

2018-01-01

Introduction: Proximal humerus fractures are common in the elderly. The evaluation and management of these injuries is often controversial. The purpose of this study is to review recent evidence and provide updated recommendations for treating proximal humerus fractures in the elderly. Methods: A literature review of peer-reviewed publications related to the evaluation and management of proximal humerus fractures in the elderly was performed. There was a focus on randomized controlled trials and systematic reviews published within the last 5 years. Results: The incidence of proximal humerus fractures is increasing. It is a common osteoporotic fracture. Bone density is a predictor of reduction quality and can be readily assessed with anteroposterior views of the shoulder. Social independence is a predictor of outcome, whereas age is not. Many fractures are minimally displaced and respond acceptably to nonoperative management. Displaced and severe fractures are most frequently treated operatively with intramedullary nails, locking plates, percutaneous techniques, or arthroplasty. Discussion: Evidence from randomized controlled trials and systematic reviews is insufficient to recommend a treatment; however, most techniques have acceptable or good outcomes. Evaluation should include an assessment of the patient’s bone quality, social independence, and surgical risk factors. With internal fixation, special attention should be paid to medial comminution, varus angulation, and restoration of the calcar. With arthroplasty, attention should be paid to anatomic restoration of the tuberosities and proper placement of the prosthesis. Conclusion: A majority of minimally displaced fractures can be treated conservatively with early physical therapy. Treatment for displaced fractures should consider the patient’s level of independence, bone quality, and surgical risk factors. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all acceptable treatment options. There is no clear evidence-based treatment of choice, and the surgeon should consider their comfort level with various procedures during the decision-making process. PMID:29399372

[A study of proximal humerus fractures using close reduction and percutaneous minimally invasive fixation].

PubMed

Liu, Yin-wen; Kuang, Yong; Gu, Xin-feng; Zheng, Yu-xin; Li, Zhi-qiang; Wei, Xiao-en; Lu, Wei-da; Zhan, Hong-sheng; Shi, Yin-yu

2011-11-01

To investigate the clinical effects of close reduction and percutaneous minimally invasive fixation in the treatment of proximal humerus fractures. From April 2008 to March 2010, 28 patients with proximal humerus fracture were treated with close reduction and percutaneous minimally invasive fixation. There were 21 males and 7 females, ranging in age from 22 to 78 years,with an average of 42.6 years. The mean time from suffering injuries to the operation was 1.7 d. Nineteen cases caused by falling down, 9 cases by traffic accident. The main clinical manifestation was swelling, pain and limited mobility of shoulders. According to Neer classification, two part fractures were in 17 cases and three part fractures in 11 cases. The locking proximal humerus plate was used to minimally fixation through deltoid muscle under acromion. The operating time,volume of blood loss, the length of incision and Constant-Murley assessment were applied to evaluate the therapeutic effects. The mean operating time was 40 min, the mean blood loss was 110 ml, and the mean length of incision was about 5.6 cm. The postoperative X-ray showed excellent reduction and the plate and screws were successfully place. Twenty-eight patients were followed up for 6 to 24 months (averaged 14.2 months). The healing time ranged from 6 to 8 weeks and all incision was primarily healed. There were no cases with necrosis head humerus, 24 cases without omalgia, and 4 cases with o-malgia occasionally. All the patients can complete the daily life. The mean score of Constant-Murley assessment was 91.0 +/- 5.8, 24 cases got an excellent result, 3 good and 1 fair. Close reduction and percutaneous minimally invasive fixation, not only can reduce surgical invasive, but also guarantee the early function activities. It has the advantages of less invasive, fixed well and less damage of blood circulation.

The surgical manegement of metastases to humerus-clinical evaluation.

PubMed

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 found after intramedullary nailing compared to common plate technique.

Epidemiology of fragility fractures in Sakaiminato, Japan: incidence, secular trends, and prognosis.

PubMed

Tsukutani, Y; Hagino, H; Ito, Y; Nagashima, H

2015-09-01

We investigated the incidence of fragility fractures from 2010 to 2012 in Sakaiminato, Japan. The incidence rates of limb fractures in Sakaiminato were lower than in Caucasian populations but had increased relative to data obtained in Japan in the 1990s. Clinical vertebral fractures occurred at higher rates in Sakaiminato than in Caucasian populations. To elucidate the incidence and prognosis of fragility fractures in Sakaiminato, Japan. A survey of all hip, distal radius, proximal humerus, and clinical vertebral fractures was performed from 2010 to 2012 in patients aged 50 or older in Sakaiminato city, Tottori prefecture, Japan. The age- and gender-specific incidence rates (per 100,000 person-years) were calculated based on the population of Sakaiminato city each year. The incidence rates of hip, distal radius, and proximal humerus fractures were compared with previous reports. We conducted a follow-up study assessing patients within 1 year following their initial treatment at two Sakaiminato hospitals. The age-adjusted incidence rates in population aged 50 years or older (per 100,000 person-years) of hip, distal radius, proximal humerus, and clinical vertebral fractures were, respectively, 217, 82, 26, and 412 in males and 567, 432, 96, and 1229 in females. Age-specific incidence rates of hip, distal radius, and proximal humerus fractures all increased since the 1990s. Our study also revealed that anti-osteoporotic pharmacotherapy was prescribed 1 year post-fracture at rates of 29, 20, 30, and 50 % for patients with hip, distal radius, proximal humerus, and clinical vertebral fractures, respectively. The incidence rates of limb fractures in Sakaiminato were substantially lower than Caucasian populations in northern Europe but had increased relative to data obtained in Japan in the 1990s. Unlike upper and lower limb fractures, clinical vertebral fractures occurred at higher rates in our study population than in other Asian and North European countries.

Anterior transposition of the radial nerve--a cadaveric study.

PubMed

Yakkanti, Madhusudhan R; Roberts, Craig S; Murphy, Joshua; Acland, Robert D

2008-01-01

The radial nerve is at risk during the posterior plating of the humerus. The purpose of this anatomic study was to assess the extent of radial nerve dissection required for anterior transposition through the fracture site (transfracture anterior transposition). A cadaver study was conducted approaching the humerus by a posterior midline incision. The extent of dissection of the nerve necessary for plate fixation of the humerus fracture was measured. An osteotomy was created to model a humeral shaft fracture at the spiral groove (OTA classification 12-A2, 12-A3). The radial nerve was then transposed anterior to the humeral shaft through the fracture site. The additional dissection of the radial nerve and the extent of release of soft tissue from the humerus shaft to achieve the transposition were measured. Plating required a dissection of the radial nerve 1.78 cm proximal and 2.13 cm distal to the spiral groove. Transfracture anterior transposition of the radial nerve required an average dissection of 2.24 cm proximal and 2.68 cm distal to the spiral groove. The lateral intermuscular septum had to be released for 2.21 cm on the distal fragment to maintain laxity of the transposed nerve. Transfracture anterior transposition of the radial nerve before plating is feasible with dissection proximal and distal to the spiral groove and elevation of the lateral intermuscular septum. Potential clinical advantages of this technique include enhanced fracture site visualization, application of broader plates, and protection of the radial nerve during the internal fixation.

Performance and Longevity of a Novel Intraosseous Device in a Goat (Capra hircus) Model

PubMed Central

Jackson, Erin E; Ashley, T Clay; Snowden, Karen F; Gresham, Vincent C; Budke, Christine M; Eichelberger, Bunita M; Taylor, Destiny A

2011-01-01

We performed 2 studies to assess the function and longevity of a novel intraosseous catheter device. For study 1, 9 goats were assigned to 3 groups (intraosseous catheter in the proximal humerus, intraosseous catheter in the proximal tibia, or standard jugular catheter). Devices in the tibia remained in place for less time than did those in the humerus, and no goats exhibited radiographic evidence of resulting damage or structural change in surrounding bone. Positive bacterial cultures were found in all 9 goats at various time points. In study 2, 18 goats were assigned to 2 groups (intraosseous catheter in the wing of the ilium or proximal humerus). Samples for serial aerobic and anaerobic blood cultures and CBC were collected while devices remained in use. Clinical monitoring and removal criteria were identical those for study 1. Catheters in the ilium remained in place for less than 24 h on average, and those in the humerus remained in place for an average of 2.5 d. Several goats with proximal humeral catheters demonstrated moderate lameness after removal, and radiographic evidence of periosteal bone growth was noted in another goat. Bloodwork indicated mild elevations of WBC counts from baseline in some cases. Bacterial growth was found in samples from 4 of 18 goats at various time points. Our study indicated that intraosseous catheters may remain safely in place for more than 24 h, but animals should be monitored closely for negative side effects for several days after removal. PMID:21640033

Evaluation of regression-based 3-D shoulder rhythms.

PubMed

Xu, Xu; Dickerson, Clark R; Lin, Jia-Hua; McGorry, Raymond W

2016-08-01

The movements of the humerus, the clavicle, and the scapula are not completely independent. The coupled pattern of movement of these bones is called the shoulder rhythm. To date, multiple studies have focused on providing regression-based 3-D shoulder rhythms, in which the orientations of the clavicle and the scapula are estimated by the orientation of the humerus. In this study, six existing regression-based shoulder rhythms were evaluated by an independent dataset in terms of their predictability. The datasets include the measured orientations of the humerus, the clavicle, and the scapula of 14 participants over 118 different upper arm postures. The predicted orientations of the clavicle and the scapula were derived from applying those regression-based shoulder rhythms to the humerus orientation. The results indicated that none of those regression-based shoulder rhythms provides consistently more accurate results than the others. For all the joint angles and all the shoulder rhythms, the RMSE are all greater than 5°. Among those shoulder rhythms, the scapula lateral/medial rotation has the strongest correlation between the predicted and the measured angles, while the other thoracoclavicular and thoracoscapular bone orientation angles only showed a weak to moderate correlation. Since the regression-based shoulder rhythm has been adopted for shoulder biomechanical models to estimate shoulder muscle activities and structure loads, there needs to be further investigation on how the predicted error from the shoulder rhythm affects the output of the biomechanical model. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

[Augmentation technique on the proximal humerus].

PubMed

Scola, A; Gebhard, F; Röderer, G

2015-09-01

The treatment of osteoporotic fractures is still a challenge. The advantages of augmentation with respect to primary in vitro stability and the clinical use for the proximal humerus are presented in this article. In this study six paired human humeri were randomized into an augmented and a non-augmented group. Osteosynthesis was performed with a PHILOS plate (Synthes®). In the augmented group the two screws finding purchase in the weakest cancellous bone were augmented. The specimens were tested in a 3-part fracture model in a varus bending test. The augmented PHILOS plates withstood significantly more load cycles until failure. The correlation to bone mineral density (BMD) showed that augmentation could partially compensate for low BMD. The augmentation of the screws in locked plating in a proximal humerus fracture model is effective in improving the primary stability in a cyclic varus bending test. The targeted augmentation of two particular screws in a region of low bone quality within the humeral head was almost as effective as four screws with twice the amount of bone cement. Screw augmentation combined with a knowledge of the local bone quality could be more effective in enhancing the primary stability of a proximal humerus locking plate because the effect of augmentation can be exploited more effectively limiting it to the degree required. The technique of augmentation is simple and can be applied in open and minimally invasive procedures. When the correct procedure is used, complications (cement leakage into the joint) can be avoided.

Sex determination in skeletal remains from the medieval Eastern Adriatic coast – discriminant function analysis of humeri

PubMed Central

Bašić, Željana; Anterić, Ivana; Vilović, Katarina; Petaros, Anja; Bosnar, Alan; Madžar, Tomislav; Polašek, Ozren; Anđelinović, Šimun

2013-01-01

Aim To investigate the usefulness of humerus measurement for sex determination in a sample of medieval skeletons from the Eastern Adriatic Coast. Additional aim was to compare the results with contemporary female population. Methods Five humerus measurements (maximum length, epicondylar width, maximum vertical diameter of the head, maximum and minimum diameter of the humerus at midshaft) for 80 male and 35 female medieval and 19 female contemporary humeri were recorded. Only sufficiently preserved skeletons and those with no obvious pathological or traumatic changes that could affect the measurements were included. For ten samples, analysis of DNA was performed in order to determine sex using amelogenin. Results The initial comparison of men and women indicated significant differences in all five measures (P < 0.001). Discriminant function for sex determination indicated that as much as 85% of cases could be properly categorized, with better results in men (86%) than women (80%). Furthermore, the comparison of the medieval and contemporary women did not show significant difference in any of the measured features. Sex results obtained by anthropological and DNA analysis matched in all 10 cases. Conclusion The results indicate that humerus measurement in Croatian medieval population may be sufficient to determine the sex of the skeleton. Furthermore, it seems that secular changes have not substantially affected contemporary population, suggesting that the results of this study are transferable to contemporary population as well. PMID:23771758

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

PubMed

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, p<0.0001), the 4.5-FAP construct (123.8 vs. 33.3, p<0.0001) and the IMN construct (123.8 vs. 60.1, p=0.005). The IMN-FAB construct reported a significantly higher load to failure than the 3.5-FAB construct (4667.3 N vs. 1756.9 N, p<0.0001), and the 4.5-FAP construct (4667.3 N vs. 2829.4 N, p=0.019, Table 2). The IMN construct had a significantly higher load to failure than the 3.5-FAP construct (3946.8 vs. 1756.9, p=0.001, Table 2). Biomechanical testing of modern fixation options for two-part proximal 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.

The effect of the remplissage procedure on shoulder range of motion: a cadaveric study.

PubMed

Omi, Rei; Hooke, Alexander W; Zhao, Kristin D; Matsuhashi, Tomoya; Goto, Akira; Yamamoto, Nobuyuki; Sperling, John W; Steinmann, Scott P; Itoi, Eiji; An, Kai-Nan

2014-02-01

The purpose of this in vitro biomechanical study was to assess the effects of the remplissage procedure for small- and large-sized Hill-Sachs lesions (HSLs) on shoulder range of motion (ROM) with a special interest in the apprehension position. HSLs of 50% and 100% of the glenoid width were simulated in 7 cadaveric shoulders as small and large lesions, respectively, and the postoperative condition was reproduced by placing suture anchors on the articular surface and tying down the infraspinatus at the medial edge of the would-be lesion site. ROMs were measured in abduction, internal rotation, and external rotation with the humerus in the adducted and abducted position. In addition, the ROM was measured in the anterior apprehension position, in which 2 torques of external rotation and extension were applied simultaneously, and external rotation and horizontal extension ROMs were measured with the humerus in different abduction angles (20°, 40°, and 60°). For standard ROMs, the procedure for the 50% HSL maintained complete ROMs, whereas the procedure for the 100% HSL significantly decreased external rotation ROM with the humerus in both the adducted and abducted positions, as well as abduction ROM. In the apprehension position, remplissage for the 50% HSL decreased extension ROM with the humerus abducted to 40° and 60°. Remplissage for the 100% HSL significantly decreased both external and extension ROMs regardless of the humeral abduction angle. In the cadaveric model with an intact humeral head and the simulated postoperative condition, the remplissage procedure for a large HSL caused significant restrictions in ROM of abduction in the scapular plane and external rotation with the humerus in both adduction and abduction. It also caused significant restrictions in both external rotation and extension ROMs in the apprehension position. The indication for the remplissage procedure for the larger HSL should be considered carefully, especially for the competitive throwing athlete who needs exceptional external rotation ROM for optimal overhead throwing performance. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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®.

PubMed

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.

Studying Upper-Limb Kinematics Using Inertial Sensors Embedded in Mobile Phones

PubMed Central

Bennett, Paul

2015-01-01

Background In recent years, there has been a great interest in analyzing upper-limb kinematics. Inertial measurement with mobile phones is a convenient and portable analysis method for studying humerus kinematics in terms of angular mobility and linear acceleration. Objective The aim of this analysis was to study upper-limb kinematics via mobile phones through six physical properties that correspond to angular mobility and acceleration in the three axes of space. Methods This cross-sectional study recruited healthy young adult subjects. Humerus kinematics was studied in 10 young adults with the iPhone4. They performed flexion and abduction analytical tasks. Mobility angle and lineal acceleration in each of its axes (yaw, pitch, and roll) were obtained with the iPhone4. This device was placed on the right half of the body of each subject, in the middle third of the humerus, slightly posterior. Descriptive statistics were calculated. Results Descriptive graphics of analytical tasks performed were obtained. The biggest range of motion was found in pitch angle, and the biggest acceleration was found in the y-axis in both analytical tasks. Focusing on tridimensional kinematics, bigger range of motion and acceleration was found in abduction (209.69 degrees and 23.31 degrees per second respectively). Also, very strong correlation was found between angular mobility and linear acceleration in abduction (r=.845) and flexion (r=.860). Conclusions The use of an iPhone for humerus tridimensional kinematics is feasible. This supports use of the mobile phone as a device to analyze upper-limb kinematics and to facilitate the evaluation of the patient. PMID:28582241

Morphological integration in the forelimb of musteloid carnivorans

PubMed Central

Fabre, Anne-Claire; Goswami, Anjali; Peigné, Stéphane; Cornette, Raphaël

2014-01-01

The forelimb forms a functional unit that allows a variety of behaviours and needs to be mobile, yet at the same time stable. Both mobility and stability are controlled, amongst others, at the level of the elbow joint. This joint is composed of the humero-ulnar articulation, mainly involved during parasagittal movements; and the radio-ulnar articulation, mainly allowing rotation. In contrast, the humero-radial articulation allows both movements of flexion–extension and rotation. Here, we study the morphological integration between each bone of the forelimb at the level of the entire arm, as well as at the elbow joint, in musteloid carnivorans. To do so, we quantitatively test shape co-variation using surface 3D geometric morphometric data. Our results show that morphological integration is stronger for bones that form functional units. Different results are obtained depending on the level of investigation: for the entire arm, results show a greater degree of shape co-variation between long bones of the lower arm than between the humerus and either bone of the lower arm. Thus, at this level the functional unit of the lower arm is comprised of the radius and ulna, permitting rotational movements of the lower arm. At the level of the elbow, results display a stronger shape co-variation between bones allowing flexion and stability (humerus and ulna) than between bones allowing mobility (ulna and radius and humerus and radius). Thus, the critical functional unit appears to be the articulation between the humerus and ulna providing the stability of the joint. PMID:24836555

[Meta analysis of parallel versus perpendicular double plating for distal humerus fracture of type C in adults].

PubMed

Li, B B; Lin, F; Cai, L H; Chen, Y; Lin, Z J

2017-08-01

Objective: To evaluate the effects of parallel versus perpendicular double plating for distal humerus fracture of type C. Methods: A standardized comprehensive literature search was performed by PubMed, Embase, Cochrane library, CMB, CNKI and Medline datebase.Randomized controlled studies on comparison between parallel versus perpendicular double plating for distal humerus fracture of type C before December 2015 were enrolled in the study.All date were analyzed by the RevMan 5.2 software. Results: Six studies, including 284 patients, met the inclusion criteria.There were 155 patients in perpendicular double plating group, 129 patients in parallel double plating group.The results of Meta-analysis indicated that there were statistically significant difference between the two groups in complications ( OR =2.59, 95% CI : 1.03 to 6.53, P =0.04). There was no significant difference between the two groups in surgical duration ( MD =-1.84, 95% CI : -9.06 to 5.39, P =0.62), bone union time ( MD =0.09, 95% CI : -0.06 to 0.24, P =0.22), Mayo Elbow Performance Score ( MD =0.09, 95% CI : -0.06 to 0.24, P =0.22), Range of Motions ( MD =-0.92, 95% CI : -4.65 to 2.81, P =0.63) and the rate of excellent and good results ( OR =0.64, 95% CI : 0.27 to 1.52, P =0.31). Conclusion: Both perpendicular and parallel double plating are effective in distal humerus fracture of type C, parallel double plating has less complications.

Occlusion of an Intraosseous Arteriovenous Malformation With Percutaneous Injection of Polymethylmethacrylate

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ierardi, Anna Maria, E-mail: amierardi@yahoo.it; Mangini, Monica, E-mail: monica.mangini@tin.it; Vaghi, Massimo, E-mail: vaghim@yahoo.it

Primary intraosseous arteriovenous malformations are rare. Many minimally invasive procedures can be considered preoperative steps and/or definitive treatment. The case reported regards a young woman with a voluminous arteriovenous extratroncular infiltrating malformation of the humerus. She underwent several treatments, but none of them was completely occlusive. The last treatment consisted of direct percutaneous puncture of the intraosseous alteration and injection of polymethylmethacrylate (PMMA), which is normally used in percutaneous vertebroplasty. We obtained complete occlusion of the humerus lytic lesion. To the best of our knowledge, this represents the first case of intraosseous AVM treated by percutaneous injection of PMMA.

Studying Upper-Limb Kinematics Using Inertial Sensors Embedded in Mobile Phones.

PubMed

Roldan-Jimenez, Cristina; Cuesta-Vargas, Antonio; Bennett, Paul

2015-05-20

In recent years, there has been a great interest in analyzing upper-limb kinematics. Inertial measurement with mobile phones is a convenient and portable analysis method for studying humerus kinematics in terms of angular mobility and linear acceleration. The aim of this analysis was to study upper-limb kinematics via mobile phones through six physical properties that correspond to angular mobility and acceleration in the three axes of space. This cross-sectional study recruited healthy young adult subjects. Humerus kinematics was studied in 10 young adults with the iPhone4. They performed flexion and abduction analytical tasks. Mobility angle and lineal acceleration in each of its axes (yaw, pitch, and roll) were obtained with the iPhone4. This device was placed on the right half of the body of each subject, in the middle third of the humerus, slightly posterior. Descriptive statistics were calculated. Descriptive graphics of analytical tasks performed were obtained. The biggest range of motion was found in pitch angle, and the biggest acceleration was found in the y-axis in both analytical tasks. Focusing on tridimensional kinematics, bigger range of motion and acceleration was found in abduction (209.69 degrees and 23.31 degrees per second respectively). Also, very strong correlation was found between angular mobility and linear acceleration in abduction (r=.845) and flexion (r=.860). The use of an iPhone for humerus tridimensional kinematics is feasible. This supports use of the mobile phone as a device to analyze upper-limb kinematics and to facilitate the evaluation of the patient. ©Cristina Roldan-Jimenez, Antonio Cuesta-Vargas, Paul Bennett. Originally published in JMIR Rehabilitation and Assistive Technology (http://rehab.jmir.org), 20.05.2015.

Utility of Postoperative Antibiotics After Percutaneous Pinning of Pediatric Supracondylar Humerus Fractures.

PubMed

Schroeder, Nicholas O; Seeley, Mark A; Hariharan, Arun; Farley, Frances A; Caird, Michelle S; Li, Ying

2017-09-01

Pediatric supracondylar humerus fractures are common injuries that are often treated surgically with closed reduction and percutaneous pinning. Although surgical-site infections are rare, postoperative antibiotics are frequently administered without evidence or guidelines for their use. With the increasing prevalence of antibiotic-resistant organisms and heightened focus on health care costs, appropriate and evidence-based use of antibiotics is needed. We hypothesized that postoperative antibiotic administration would not decrease the rate of surgical-site infection. A billing query identified 951 patients with operatively treated supracondylar humerus fractures at our institution over a 15-year period. Records were reviewed for demographic data, perioperative antibiotic use, and the presence of surgical-site infection. Exclusion criteria were open fractures, open reduction, pathologic fractures, metabolic bone disease, the presence of other injuries that required operative treatment, and follow-up <2 weeks after pin removal. χ and Fisher exact test were used to compare antibiotic use to the incidence of surgical-site infection. Six hundred eighteen patients met our inclusion criteria. Two hundred thirty-eight patients (38.5%) received postoperative antibiotics. Eleven surgical-site infections were identified for an overall rate of 1.8%. The use of postoperative antibiotics was not associated with a lower rate of surgical-site infection (P=0.883). Patients with a type III fracture (P<0.001), diminished preoperative vascular (P=0.001) and neurological status (P=0.019), and postoperative hospital admission (P<0.001) were significantly more likely to receive postoperative antibiotics. Administration of postoperative antibiotics after closed reduction and percutaneous pinning of pediatric supracondylar humerus fractures does not decrease the rate of surgical-site infection. Level III-therapeutic.

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

PubMed

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

2018-02-01

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.

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

PubMed

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 <16 years of age during the extended summer time period with the absence of snow cover. All children <16 years of age with an outdoor supracondylar humerus fracture between May 1 and September 30 in a defined geographical area during the decade of 2000-2009 were included. Daily meteorological recordings for altogether 1526 study days were reviewed from the national 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 < 0.001). The 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 < 0.001), compared with cool (<15 °C) days. The fracture incidence did not 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.

[Modified osteotomy of olecranon for the management of inter-condylar fracture of the humerus].

PubMed

Mei, Zheng-Feng; Lei, Wen-Tao; Huang, Dong-Hui; Zhao, Qi-Hui; Qu, Hang-Bo; Ni, Lian-Zhi

2017-01-25

To explore the surgical method and clinical outcome of modified osteotomy of olecranon for the treatment of inter-condylar fracture of humerus. From May 2007 to December 2012, 32 patients of intercondylar fracture of humerus were treated surgically through the approach of modified osteotomy of olecranon. The patients were 21 males and 11 females with a mean age of 46.3 years (ranged 18 to 65 years). Nineteen fractures occurred on the right extremity and 13 on the left extremity. According to the AO classification, type C1 fracture was found in 7, C2 in 11 and C3 in 14. Five patients suffered from open fracture (Gustilo type Iin 3, type II in 2). Other fractures occurred in 6 patients and the primary injury of nerve occurred 6. The healing of the osteotomy was evaluated with physical examination and plain X-ray film, and the function of elbow was assessed according to Cassebaum scale. All the patients were followed from 9 months to 5 years(average, 1.9 years). All the osteotomies healed at 7.4 weeks averagely after operation, and no nonunion, delayed union, fracture of ulna olecranon were found. Two cases had little pain on the elbow, heterotopic ossification occurred in 2 cases and cutting bone block loosed in 1 case. The function of the elbow showed excellent in 19 cases, good in 8, fair in 4 and poor in 1. The use of the approach of modified olecranon osteotomy for surgical management of intercondylar fracture of humerus has some advantages, it provides satisfactory stability with simple technical procedures avoiding inter-articular invasion, and it facilitates rehabilitation exercises and providing good results with low complication rates.

Reliability and validity in measurement of true humeral retroversion by a three-dimensional cylinder fitting method.

PubMed

Saka, Masayuki; Yamauchi, Hiroki; Hoshi, Kenji; Yoshioka, Toru; Hamada, Hidetoshi; Gamada, Kazuyoshi

2015-05-01

Humeral retroversion is defined as the orientation of the humeral head relative to the distal humerus. Because none of the previous methods used to measure humeral retroversion strictly follow this definition, values obtained by these techniques vary and may be biased by morphologic variations of the humerus. The purpose of this study was 2-fold: to validate a method to define the axis of the distal humerus with a virtual cylinder and to establish the reliability of 3-dimensional (3D) measurement of humeral retroversion by this cylinder fitting method. Humeral retroversion in 14 baseball players (28 humeri) was measured by the 3D cylinder fitting method. The root mean square error was calculated to compare values obtained by a single tester and by 2 different testers using the embedded coordinate system. To establish the reliability, intraclass correlation coefficient (ICC) and precision (standard error of measurement [SEM]) were calculated. The root mean square errors for the humeral coordinate system were <1.0 mm/1.0° for comparison of all translations/rotations obtained by a single tester and <1.0 mm/2.0° for comparison obtained by 2 different testers. Assessment of reliability and precision of the 3D measurement of retroversion yielded an intratester ICC of 0.99 (SEM, 1.0°) and intertester ICC of 0.96 (SEM, 2.8°). The error in measurements obtained by a distal humerus cylinder fitting method was small enough not to affect retroversion measurement. The 3D measurement of retroversion by this method provides excellent intratester and intertester reliability. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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

PubMed

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. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Outcome of Surgical Fixation of Lateral Column Distal Humerus Fractures.

PubMed

Von Keudell, Arvind; Kachooei, Amir R; Moradi, Ali; Jupiter, Jesse B

2016-05-01

The purpose of this study was to report the long-term outcome and complications of surgically fixated lateral unicondylar distal humerus fractures. Retrospective Review. Two level 1 Trauma Centers, Massachusetts General Hospital and Brigham and Women's Hospital. Between 2002 and 2014, 24 patients treated with open reduction and internal fixation for lateral unicondylar distal humerus fractures (OTA/AO type B1 fractures) were retrospectively reviewed. Open reduction and internal fixation. Union rates, early complications, functional outcome, and the range of elbow motion were evaluated. Disabilities of the arm, shoulder, and hand, Mayo elbow Performance Index, satisfaction, pain scale, and American Shoulder and Elbow Surgeons. The mean age of patients was 46 ± 23 years at the time of surgery. The average final flexion/extension arc of motion was 108°. Reoperations were performed in 9 of 24 elbows after an average 21 ± 31 months. Twenty of the 24 patients were available for the clinical follow-up at an average of 70 months (range: 16-144 months). Disabilities of the arm, shoulder, and hand averaged at 10.8 ± 11.7 points, satisfaction at 9.5 ± 1.2, American Shoulder and Elbow Surgeons score at 88.5 ± 13.3 points at final follow-up. Based on the functional classification proposed by Jupiter, 16 demonstrated good to excellent results, 2 fair and 2 poor result. Outcome of open reduction and internal fixation of isolated lateral column distal humerus fractures can result in high union rates with acceptable outcome scores and high patient satisfaction despite a high reoperation rate. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Kinematic constraints associated with the acquisition of overarm throwing part II: upper extremity actions.

PubMed

Stodden, David F; Langendorfer, Stephen J; Fleisig, Glenn S; Andrews, James R

2006-12-01

The purposes of this study were to: (a) examine the differences within 11 specific kinematic variables and an outcome measure (ball velocity) associated with component developmental levels of humerus and forearm action (Roberton & Halverson, 1984), and (b) if the differences in kinematic variables were significantly associated with the differences in component levels, determine potential kinematic constraints associated with skilled throwing acquisition. Significant differences among component levels in five of six humerus kinematic variables (p <.01) and all five forearm kinematic variables (p < .01) were identified using multivariate analysis of variance. These kinematic variables represent potential control parameters and, therefore, constraints on overarm throwing acquisition.

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

PubMed

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.

An integer programming model for distal humerus fracture fixation planning.

PubMed

Maratt, Joseph D; Peaks, Ya-Sin A; Doro, Lisa Case; Karunakar, Madhav A; Hughes, Richard E

2008-05-01

To demonstrate the feasibility of an integer programming model to assist in pre-operative planning for open reduction and internal fixation of a distal humerus fracture. We describe an integer programming model based on the objective of maximizing the reward for screws placed while satisfying the requirements for sound internal fixation. The model maximizes the number of bicortical screws placed while avoiding screw collision and favoring screws of greater length that cross multiple fracture planes. The model was tested on three types of total articular fractures of the distal humerus. Solutions were generated using 5, 9, 21 and 33 possible screw orientations per hole. Solutions generated using 33 possible screw orientations per hole and five screw lengths resulted in the most clinically relevant fixation plan and required the calculation of 1,191,975 pairs of screws that resulted in collision. At this level of complexity, the pre-processor took 104 seconds to generate the constraints for the solver, and a solution was generated in under one minute in all three cases. Despite the large size of this problem, it can be solved in a reasonable amount of time, making use of the model practical in pre-surgical planning.

Nonunion of the humerus following intramedullary nailing treated by Ilizarov hybrid fixation.

PubMed

Raschke, M; Khodadadyan, C; Maitino, P D; Hoffmann, R; Südkamp, N P

1998-02-01

A case of a posttraumatic humeral shaft nonunion, after intramedullary stabilization with a Seidel nail, is presented. Severe osteoporosis, an oligotrophic nonunion, subclinical infection, and adhesive capsulitis of the glenohumeral joint were present. Due to the subclinical infection and severe osteoporosis, other major invasive therapeutic options such as intramedullary nailing or compression plating and bone grafting were not applicable. Nonoperative treatment was also not indicated secondary to the pain and disability present. External fixation with the Ilizarov hybrid fixator seemed to offer a minimally invasive treatment modality without the need of additional bone grafting. After fourteen weeks of "callus massage," consisting of closed alternating compression and distraction with an Ilizarov hybrid fixator, osseous consolidation was achieved. Eight months after Ilizarov treatment the patient had returned to work as a mechanic. At the one-year follow-up examination, the patient presented pain free and with near normal shoulder and elbow motion, with stable osseous consolidation of the humerus. In some cases of nonunion of the humerus shaft, when standard treatment options are not recommended, external fixation with an Ilizarov hybrid fixator may offer a salvage procedure with a successful clinical outcome.

Management of Pediatric Supracondylar Humerus Fractures With Vascular Injury.

PubMed

Sanders, James O; Heggeness, Michael H; Murray, Jayson N; Pezold, Ryan C; Sevarino, Kaitlyn S

2016-02-01

The American Academy of Orthopaedic Surgeons has developed the Appropriate Use Criteria (AUC) document Management of Pediatric Supracondylar Humerus Fractures With Vascular Injury. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The AUC clinical patient scenarios were derived from patient indications that generally accompany a pediatric supracondylar humerus fracture with vascular injury, as well as from current evidence-based clinical practice guidelines and supporting literature. The 6 patient scenarios and 18 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Next, the Review Panel, a separate group of volunteer physicians, independently reviewed these materials to ensure that they were representative of patient scenarios that clinicians are likely to encounter in daily practice. Finally, the multidisciplinary Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

The molecular response of bone to growth hormone during skeletal unloading: regional differences

NASA Technical Reports Server (NTRS)

Bikle, D. D.; Harris, J.; Halloran, B. P.; Currier, P. A.; Tanner, S.; Morey-Holton, E.

1995-01-01

Hind limb elevation of the growing rat provides a good model for the skeletal changes that occur during space flight. In this model the bones of the forelimbs (normally loaded) are used as an internal control for the changes that occur in the unloaded bones of the hind limbs. Previous studies have shown that skeletal unloading of the hind limbs results in a transient reduction of bone formation in the tibia and femur, with no change in the humerus. This fall in bone formation is accompanied by a fall in serum osteocalcin (bone Gla protein, BGP) and bone BGP messenger RNA (mRNA) levels, but a rise in bone insulin-like growth factor-I (IGF-I) protein and mRNA levels and resistance to the skeletal growth-promoting actions of IGF-I. To determine whether skeletal unloading also induced resistance to GH, we evaluated the response of the femur and humerus of sham and hypophysectomized rats, control and hind limb elevated, to GH (two doses), measuring mRNA levels of IGF-I, BGP, rat bone alkaline phosphatase (RAP), and alpha 1(1)-procollagen (coll). Hypophysectomy (HPX) decreased the mRNA levels of IGF-I, BGP, and coll in the femur, but was either less effective or had the opposite effect in the humerus. GH at the higher dose (500 micrograms/day) restored these mRNA levels to or above the sham control values in the femur, but generally had little or no effect on the humerus. RAP mRNA levels were increased by HPX, especially in the femur. The lower dose of GH (50 micrograms/day) inhibited this rise in RAP, whereas the higher dose raised the mRNA levels and resulted in the appearance of additional transcripts not seen in controls. As for the other mRNAs, RAP mRNA in the humerus was less affected by HPX or GH than that in the femur. Hind limb elevation led to an increase in IGF-I, coll, and RAP mRNAs and a reduction in BGP mRNA in the femur and either had no effect or potentiated the response of these mRNAs to GH. We conclude that GH stimulates a number of markers of bone formation by raising their mRNA levels, and that skeletal unloading does not block this response, but the response varies substantially from bone to bone.

Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002-2012.

PubMed

Papaioannou, A; Kennedy, C C; Ioannidis, G; Cameron, C; Croxford, R; Adachi, J D; Mursleen, S; Jaglal, S

2016-03-01

In this population-based study, we compared incident fracture rates in long-term care (LTC) versus community seniors between 2002 and 2012. Hip fracture rates declined more rapidly in LTC than in the community. An excess burden of fractures occurred in LTC for hip, pelvis, and humerus fractures in men and hip fractures only in women. This study compares trends in incident fracture rates between long-term care (LTC) and community-dwelling seniors ≥65 years, 2002-2012. This is a population-based cohort study using administrative data. Measurements were age/sex-adjusted incident fracture rates and rate ratios (RR) and annual percent change (APC). Over 11 years, hip fracture rates had a marked decline occurring more rapidly in LTC (APC, -3.49 (95% confidence interval (CI), -3.97, -3.01)) compared with the community (APC, -2.93 (95% CI, -3.28, -2.57); p < 0.05 for difference in slopes). Humerus and wrist fracture rates decreased; however, an opposite trend occurred for pelvis and spine fractures with rates increasing over time in both cohorts (all APCs, p < 0.05). In 2012, incident hip fracture rates were higher in LTC than the community (RRs: women, 1.55 (95% CI, 1.45, 1.67); men, 2.18 (95% CI, 1.93, 2.47)). Higher rates of pelvis (RR, 1.48 (95% CI, 1.22, 1.80)) and humerus (RR, 1.40 (95% CI, 1.07, 1.84)) fractures were observed in LTC men, not women. In women, wrist (RR, 0.76 (95% CI, 0.71, 0.81)) and spine (RR, 0.52 (95% CI, 0.45, 0.61)) fracture rates were lower in LTC than the community; in men, spine (RR, 0.75 (95% CI, 0.57, 0.98) but not wrist fracture (RR, 0.91 (95% CI, 0.67, 1.23)) rates were significantly lower in LTC than the community. Previous studies in the community have shown declining hip fracture rates over time, also demonstrated in our study but at a more rapid rate in LTC. Rates of humerus and wrist fractures also declined. An excess burden of fractures in LTC occurred for hip fractures in women and for hip, pelvis, and humerus fractures in men.

Forelimb bone curvature in terrestrial and arboreal mammals

PubMed Central

Henderson, Keith; Pantinople, Jess; McCabe, Kyle; Milne, Nick

2017-01-01

It has recently been proposed that the caudal curvature (concave caudal side) observed in the radioulna of terrestrial quadrupeds is an adaptation to the habitual action of the triceps muscle which causes cranial bending strains (compression on cranial side). The caudal curvature is proposed to be adaptive because longitudinal loading induces caudal bending strains (increased compression on the caudal side), and these opposing bending strains counteract each other leaving the radioulna less strained. If this is true for terrestrial quadrupeds, where triceps is required for habitual elbow extension, then we might expect that in arboreal species, where brachialis is habitually required to maintain elbow flexion, the radioulna should instead be cranially curved. This study measures sagittal curvature of the ulna in a range of terrestrial and arboreal primates and marsupials, and finds that their ulnae are curved in opposite directions in these two locomotor categories. This study also examines sagittal curvature in the humerus in the same species, and finds differences that can be attributed to similar adaptations: the bone is curved to counter the habitual muscle action required by the animal’s lifestyle, the difference being mainly in the distal part of the humerus, where arboreal animals tend have a cranial concavity, thought to be in response the carpal and digital muscles that pull cranially on the distal humerus. PMID:28462036

Injection of Unicameral Bone Cysts with Bone Marrow Aspirate and Demineralized Bone Matrix Avoids Open Curettage and Bone Grafting in a Retrospective Cohort.

PubMed

Gundle, Kenneth R; Bhatt, Etasha M; Punt, Stephanie E; Bompadre, Viviana; Conrad, Ernest U

2017-01-01

Many treatment options exist for unicameral bone cysts (UBC), without clear evidence of superiority. Meta-analyses have been limited by small numbers of patients in specific anatomic and treatment subgroups. The purpose of this study was to report the outcomes of injecting bone marrow aspirate and demineralized bone matrix (BMA/DBM) for the treatment of proximal humerus UBC. Fifty-one patients with proximal humerus lesions treated by BMA/DBM injection were retrospectively reviewed from a single academic medical center. The mean number of injections performed per patient was 2.14 (range 1-5). Eleven patients underwent only one injection (22%), an additional 19 patients completed treatment after two injections (37%), four patients healed after three injections (8%), and one patient healed after four injections (2%). The cumulative success rate of serial BMA/DBM injections was 22% (11/51), 58% (30/51), 67% (34/51), and 69% (35/51). Eleven patients (22%) ultimately underwent open curettage and bone grafting, and five patients (10%) were treated with injection of calcium phosphate bone substitute. A BMA/DBM injection strategy avoided an open procedure in 78% of patients with a proximal humerus UBC. The majority of patients underwent at least 2 injection treatments. Level IV retrospective cohort study.

Reverse total shoulder replacement for nonunion of a fracture of the proximal humerus.

PubMed

Zafra, M; Uceda, P; Flores, M; Carpintero, P

2014-09-01

Patients with pain and loss of shoulder function due to nonunion of a fracture of the proximal third of the humerus may benefit from reverse total shoulder replacement. This paper reports a prospective, multicentre study, involving three hospitals and three surgeons, of 35 patients (28 women, seven men) with a mean age of 69 years (46 to 83) who underwent a reverse total shoulder replacement for the treatment of nonunion of a fracture of the proximal humerus. Using Checchia's classification, nine nonunions were type I, eight as type II, 12 as type III and six as type IV. The mean follow-up was 51 months (24 to 99). Post-operatively, the patients had a significant decrease in pain (p < 0.001), and a significant improvement in flexion, abduction, external rotation and Constant score (p < 0.001), but not in internal rotation. A total of nine complications were recorded in seven patients: six dislocations, one glenoid loosening in a patient who had previously suffered dislocation, one transitory paresis of the axillary nerve and one infection. Reverse total shoulder replacement may lead to a significant reduction in pain, improvement in function and a high degree of satisfaction. However, the rate of complications, particularly dislocation, was high. ©2014 The British Editorial Society of Bone & Joint Surgery.

Percutaneous insertion of a proximal humeral locking plate: an anatomic study.

PubMed

Smith, Jason; Berry, Greg; Laflamme, Yves; Blain-Pare, Etienne; Reindl, Rudy; Harvey, Edward

2007-02-01

This cadaveric study sought to evaluate the feasibility of applying a locking proximal humerus plate with a novel minimally invasive technique. A unique pre-contoured locking plate was placed on cadaveric proximal humeri through a described minimally invasive approach. Proximity of the plate and screws to the axillary nerve and their respective surgical tracks were quantified. Safe screw hole placement with respect to the axillary nerve was determined. Risk of entrapment of the nerve beneath the plate was evaluated. Three of the holes near the middle of the locking plate consistently intersected the course of the axillary nerve and were unsafe for percutaneous placement of the screws. The axillary nerve could be palpated during the course of surgery and easily protected from injury. No entrapment of the axillary nerve occurred using this minimally invasive technique. The screw-in locking guide cannot be used with this technique as it caused tenting of the axillary nerve. Placement of a locking proximal humerus plate via a minimally invasive lateral trans-deltoid approach is safe if the locking screws are limited to superior and inferior holes. This can be done safely without entrapment of the axillary beneath the plate. Plate fixation of proximal humerus fractures may now be more desirable with the use of this approach.

Development of a model osseo-magnetic link for intuitive rotational control of upper-limb prostheses.

PubMed

Rouse, Elliott J; Nahlik, David C; Peshkin, Michael A; Kuiken, Todd A

2011-04-01

The lack of proprioceptive feedback is a serious deficiency of current prosthetic control systems. The Osseo-Magnetic Link (OML) is a novel humeral or wrist rotation control system that could preserve proprioception. It utilizes a magnet implanted within the residual bone and sensors mounted in the prosthetic socket to detect magnetic field vectors and determine the bone's orientation. This allows the use of volitional bone rotation to control a prosthetic rotator. We evaluated the performance of the OML using a physical model of a transhumeral residual limb. A small Neodymium-Iron-Boron magnet was placed in a model humerus, inside a model upper arm. Four three-axis Hall-effect sensors were mounted on a ring 3 cm distal to the magnet. An optimization algorithm based on Newton's method determined the position and orientation of the magnet within the model humerus under various conditions, including bone translations, interference, and magnet misalignment. The orientation of the model humerus was determined within 3° for rotations centered in the arm; an additional 6° error was found for translations 20 mm from center. Adjustments in sensor placement may reduce these errors. The results demonstrate that the OML is a feasible solution for providing prosthesis rotation control while preserving rotational proprioception.

Effect of strain of layer and age at photostimulation on egg production, egg quality, and bone strength.

PubMed

Silversides, F G; Korver, D R; Budgell, K L

2006-07-01

Bone strength in layers is a concern for economic reasons and animal welfare concerns. Bone characteristics were investigated in 3 strains of hens: Babcock B-300, a small-bodied commercial white-egg layer; ISA-Brown, a commercial brown-egg layer; and an unselected Brown Leghorn line (BL). After being reared together in a single pen with 8 h of light per day, hens were caged with 14 h of light per day. Half of the hens were caged at 18 wk of age and the other half at 20 wk of age, resulting in a 2-wk difference in the age at photostimulation. Body weights, egg production, feed efficiency, and egg quality were measured throughout production. At 15, 25, 50, and 74 wk of age, hens were euthanized for sampling of the radius and the humerus. Breaking strength of the radius and humerus was measured, and the area and density of trabecular (largely medullary bone) and cortical bone were measured using quantitative computed tomography. Egg production and feed conversion of ISA-Brown hens was as good as or better than that of Babcock B-300 hens, and both commercial strains had higher production than the BL. Photostimulation late delayed sexual maturity and improved albumen and shell characteristics but had only minor effects on egg production and did not affect the yolk weight. The delayed photostimulation resulting from caging 2 wk later affected the radius by increasing the area of the trabecular space at 50 wk of age and the density of the bone in the trabecular space at 74 wk of age. Breaking strength of the humerus at 25 wk of age was greater for the birds that were photostimulated late but was not different later in the trial. The humerus, but not the radius, of the BL had a greater breaking strength than that of the commercial strains, suggesting that selection has decreased humeral breaking strength.

Accuracy in identifying the elbow rotation axis on simulated fluoroscopic images using a new anatomical landmark.

PubMed

Wiggers, J K; Snijders, R M; Dobbe, J G G; Streekstra, G J; den Hartog, D; Schep, N W L

2017-11-01

External fixation of the elbow requires identification of the elbow rotation axis, but the accuracy of traditional landmarks (capitellum and trochlea) on fluoroscopy is limited. The relative distance (RD) of the humerus may be helpful as additional landmark. The first aim of this study was to determine the optimal RD that corresponds to an on-axis lateral image of the elbow. The second aim was to assess whether the use of the optimal RD improves the surgical accuracy to identify the elbow rotation axis on fluoroscopy. CT scans of elbows from five volunteers were used to simulate fluoroscopy; the actual rotation axis was calculated with CT-based flexion-extension analysis. First, three observers measured the optimal RD on simulated fluoroscopy. The RD is defined as the distance between the dorsal part of the humerus and the projection of the posteromedial cortex of the distal humerus, divided by the anteroposterior diameter of the humerus. Second, eight trauma surgeons assessed the elbow rotation axis on simulated fluoroscopy. In a preteaching session, surgeons used traditional landmarks. The surgeons were then instructed how to use the optimal RD as additional landmark in a postteaching session. The deviation from the actual rotation axis was expressed as rotational and translational error (±SD). Measurement of the RD was robust and easily reproducible; the optimal RD was 45%. The surgeons identified the elbow rotation axis with a mean rotational error decreasing from 7.6° ± 3.4° to 6.7° ± 3.3° after teaching how to use the RD. The mean translational error decreased from 4.2 ± 2.0 to 3.7 ± 2.0 mm after teaching. The humeral RD as additional landmark yielded small but relevant improvements. Although fluoroscopy-based external fixator alignment to the elbow remains prone to error, it is recommended to use the RD as additional landmark.

Mid-humerus adaptation in fast pitch softballers and the impact of throwing mechanics

PubMed Central

Bogenschutz, Elizabeth D.; Smith, Heather D.; Warden, Stuart J.

2011-01-01

Purpose Throwing is a vigorous activity that generates large internal loads. There is limited evidence of the effect of these loads on bone adaptation. The aim of this study was to investigate the: 1) magnitude of bone adaptation within the midshaft humerus of female fast-pitch softball players and 2) influence of throwing mechanics (windmill vs. overhand throwing) on the magnitude of adaptation. Methods Midshaft humeral bone mass, structure and estimated strength were assessed via peripheral quantitative computed tomography in fast-pitch softball players (throwers; n=15) and matched controls (controls; n=15). The effect of throwing was examined by comparing dominant-to-nondominant differences in throwers to controls, while the influence of mechanics was determined by comparing dominant-to-nondominant differences in throwers who primarily play as pitcher (windmill thrower), catcher (overhand thrower) or fielder (overhand thrower). Results Throwers had greater dominant-to-nondominant difference in midshaft humeral bone mass, structure and estimated strength relative to controls (all P<0.05). The largest effect was for estimated torsional strength with throwers having a mean dominant-to-nondominant difference of 22.5% (range, 6.7% to 43.9%) compared to 4.4% (range, -8.3% to 17.5%) in controls (P<0.001). Throwing mechanics appeared to influence the magnitude of skeletal adaptation, with overhand throwers having more than double dominant-to-nondominant difference in midshaft humeral bone mass, structure and estimated strength than windmill throwers (all P<0.05). Conclusion Throwing induces substantial skeletal adaptation at the midshaft humerus of the dominant upper extremity. Throwing mechanics appears to the influence the magnitude of adaptation as catchers and fielders (overhand throwers) had twice as much adaptation as pitchers (windmill throwers). The latter finding may have implications for skeletal injury risk at the midshaft humerus in throwing athletes. PMID:21311354

Biomechanical measurements of stiffness and strength for five types of whole human and artificial humeri.

PubMed

Aziz, Mina S R; Nicayenzi, Bruce; Crookshank, Meghan C; Bougherara, Habiba; Schemitsch, Emil H; Zdero, Radovan

2014-05-01

The human humerus is the third largest longbone and experiences 2-3% of all fractures. Yet, almost no data exist on its intact biomechanical properties, thus preventing researchers from obtaining a full understanding of humerus behavior during injury and after being repaired with fracture plates and nails. The aim of this experimental study was to compare the biomechanical stiffness and strength of "gold standard" fresh-frozen humeri to a variety of humerus models. A series of five types of intact whole humeri were obtained: human fresh-frozen (n = 19); human embalmed (n = 18); human dried (n = 15); artificial "normal" (n = 12); and artificial "osteoporotic" (n = 12). Humeri were tested under "real world" clinical loading modes for shear stiffness, torsional stiffness, cantilever bending stiffness, and cantilever bending strength. After removing geometric effects, fresh-frozen results were 585.8 ± 181.5 N/mm2 (normalized shear stiffness); 3.1 ± 1.1 N/(mm2 deg) (normalized torsional stiffness); 850.8 ± 347.9 N/mm2 (normalized cantilever stiffness); and 8.3 ± 2.7 N/mm2 (normalized cantilever strength). Compared to fresh-frozen values, statistical equivalence (p ≥ 0.05) was obtained for all four test modes (embalmed humeri), 1 of 4 test modes (dried humeri), 1 of 4 test modes (artificial "normal" humeri), and 1 of 4 test modes (artificial "osteoporotic" humeri). Age and bone mineral density versus experimental results had Pearson linear correlations ranging from R = -0.57 to 0.80. About 77% of human humeri failed via a transverse or oblique distal shaft fracture, whilst 88% of artificial humeri failed with a mixed transverse + oblique fracture. To date, this is the most comprehensive study on the biomechanics of intact human and artificial humeri and can assist researchers to choose an alternate humerus model that can substitute for fresh-frozen humeri.

Is it safe to preserve the deltoid when resecting the proximal humerus for a primary malignant bone tumour? A comparative study.

PubMed

Cladière-Nassif, V; Bourdet, C; Audard, V; Babinet, A; Anract, P; Biau, D

2017-09-01

Resection of the proximal humerus for the primary malignant bone tumour sometimes requires en bloc resection of the deltoid. However, there is no information in the literature which helps a surgeon decide whether to preserve the deltoid or not. The aim of this study was to determine whether retaining the deltoid at the time of resection would increase the rate of local recurrence. We also sought to identify the variables that persuade expert surgeons to choose a deltoid sparing rather than deltoid resecting procedure. We reviewed 45 patients who had undergone resection of a primary malignant tumour of the proximal humerus. There were 29 in the deltoid sparing group and 16 in the deltoid resecting group. Imaging studies were reviewed to assess tumour extension and soft-tissue involvement. The presence of a fat rim separating the tumour from the deltoid on MRI was particularly noted. The cumulative probability of local recurrence was calculated in a competing risk scenario. There was no significant difference (adjusted p = 0.89) in the cumulative probability of local recurrence between the deltoid sparing (7%, 95% confidence interval (CI) 1 to 20) and the deltoid resecting group (26%, 95% CI 8 to 50). Patients were more likely to be selected for a deltoid sparing procedure if they presented with a small tumour (p = 0.0064) with less bone involvement (p = 0.032) and a continuous fat rim on MRI (p = 0.002) and if the axillary nerve could be identified (p = 0.037). A deltoid sparing procedure can provide good local control after resection of the proximal humerus for a primary malignant bone tumour. A smaller tumour, the presence of a continuous fat rim and the identification of the axillary nerve on pre-operative MRI will persuade surgeons to opt for a deltoid resecting procedure. Cite this article: Bone Joint J 2017;99-B:1244-9. ©2017 The British Editorial Society of Bone & Joint Surgery.

Treatment of pediatric supracondylar humerus fractures in the community hospital.

PubMed

Payvandi, Soheil A; Fugle, Michael J

2007-06-01

Supracondylar fractures of the humerus are among the most common elbow injuries in the pediatric population. Because of the significant morbidity associated with treating displaced pediatric supracondylar humerus fractures, most community-based orthopedic surgeons prefer to transfer these injuries to specialty children's hospitals. Our intention in writing this article was to document and evaluate the results we obtained using the lateral diverging pin technique to treat patients at our community hospital. In doing so, we set out to determine if our results were comparable to those of specialty hospitals, allowing us in the future to eliminate the inconvenience placed on patients and their families when being transferred to a specialty facility. We retrospectively reviewed the patients treated surgically at our institution for a closed Gartland type II or type III supracondylar distal humerus fracture during the months of September and October of 2005. The medical records and radiographs of all children who had been treated for a displaced extension-type supracondylar humerus fractures were evaluated. The data recorded from the chart review included the age and sex of the patients, preoperative and postoperative neurovascular status, operative techniques (2 vs 3 lateral entry point Kirschner wires), and the operative time (start to close). The radiographs were reviewed to determine the Gartland type of fracture and the Baumann angle on the anteroposterior film immediately postoperative and at the time of fracture union. Four Gartland type II and 3 Gartland type III fractures were identified during the study period. There were 3 boys and 4 girls with a mean age of 6.29 years (range, 3.92-8.58 years). The mean immediate postoperative Baumann angle was 18.29 degrees (range, 10-25 degrees). At the time of fracture union, the mean Baumann angle was 19.0 degrees (range, 14-22 degrees). The mean range-of-motion loss as compared with the extension loss (range, 10-2 degrees) and 4.57 degrees of flexion loss (range, 10-2 degrees). The mean operative time was 20.43 minutes (range, 7-37 minutes). Our results show the change in Baumann angle and loss of range of motion compare favorably with results of studies done at specialty hospitals. We believe that the divergent lateral pinning technique, in combination with postoperative splinting and a sling can provide excellent results while eliminating the risk of injury to the ulnar nerve. With this knowledge, we feel that the advantage to treating these fractures at a community hospital is the elimination of the anxiety, stress, and time spent waiting in the emergency department of multiple hospitals.

Computed tomography analysis of guinea pig bone: architecture, bone thickness and dimensions throughout development

PubMed Central

Witkowska, Agata; Alibhai, Aziza; Hughes, Chloe; Price, Jennifer; Klisch, Karl; Sturrock, Craig J.

2014-01-01

The domestic guinea pig, Cavia aperea f. porcellus, belongs to the Caviidae family of rodents. It is an important species as a pet, a source of food and in medical research. Adult weight is achieved at 8–12 months and life expectancy is ∼5–6 years. Our aim was to map bone local thickness, structure and dimensions across developmental stages in the normal animal. Guinea pigs (n = 23) that had died of natural causes were collected and the bones manually extracted and cleaned. Institutional ethical permission was given under the UK Home Office guidelines and the Veterinary Surgeons Act. X-ray Micro Computed Tomography (microCT) was undertaken on the left and right scapula, humerus and femur from each animal to ascertain bone local thickness. Images were also used to undertake manual and automated bone measurements, volumes and surface areas, identify and describe nutrient, supratrochlear and supracondylar foramina. Statistical analysis between groups was carried out using ANOVA with post-hoc testing. Our data mapped a number of dimensions, and mean and maximum bone thickness of the scapula, humerus and femur in guinea pigs aged 0–1 month, 1–3 months, 3–6 months, 6 months–1 year and 1–4 years. Bone dimensions, growth rates and local bone thicknesses differed between ages and between the scapula, humerus and femur. The microCT and imaging software technology showed very distinct differences between the relative local bone thickness across the structure of the bones. Only one bone showed a singular nutrient foramen, every other bone had between 2 and 5, and every nutrient canal ran in an oblique direction. In contrast to other species, a supratrochlear foramen was observed in every humerus whereas the supracondylar foramen was always absent. Our data showed the bone local thickness, bone structure and measurements of guinea pig bones from birth to 4 years old. Importantly it showed that bone development continued after 1 year, the point at which most guinea pigs have reached full weight. This study is the first to show the high abundance (100% in this study) of the supratrochlear foramen within the guinea pig humerus and the complete absence of a supracondylar foramen, which is different to many other species and may also affect potential fracture points and frequencies. Understanding bone morphology and growth is essential in not only understanding the requirements of the healthy guinea pig, but also necessary in order to investigate disease states. PMID:25289194

Computed tomography analysis of guinea pig bone: architecture, bone thickness and dimensions throughout development.

PubMed

Witkowska, Agata; Alibhai, Aziza; Hughes, Chloe; Price, Jennifer; Klisch, Karl; Sturrock, Craig J; Rutland, Catrin S

2014-01-01

The domestic guinea pig, Cavia aperea f. porcellus, belongs to the Caviidae family of rodents. It is an important species as a pet, a source of food and in medical research. Adult weight is achieved at 8-12 months and life expectancy is ∼5-6 years. Our aim was to map bone local thickness, structure and dimensions across developmental stages in the normal animal. Guinea pigs (n = 23) that had died of natural causes were collected and the bones manually extracted and cleaned. Institutional ethical permission was given under the UK Home Office guidelines and the Veterinary Surgeons Act. X-ray Micro Computed Tomography (microCT) was undertaken on the left and right scapula, humerus and femur from each animal to ascertain bone local thickness. Images were also used to undertake manual and automated bone measurements, volumes and surface areas, identify and describe nutrient, supratrochlear and supracondylar foramina. Statistical analysis between groups was carried out using ANOVA with post-hoc testing. Our data mapped a number of dimensions, and mean and maximum bone thickness of the scapula, humerus and femur in guinea pigs aged 0-1 month, 1-3 months, 3-6 months, 6 months-1 year and 1-4 years. Bone dimensions, growth rates and local bone thicknesses differed between ages and between the scapula, humerus and femur. The microCT and imaging software technology showed very distinct differences between the relative local bone thickness across the structure of the bones. Only one bone showed a singular nutrient foramen, every other bone had between 2 and 5, and every nutrient canal ran in an oblique direction. In contrast to other species, a supratrochlear foramen was observed in every humerus whereas the supracondylar foramen was always absent. Our data showed the bone local thickness, bone structure and measurements of guinea pig bones from birth to 4 years old. Importantly it showed that bone development continued after 1 year, the point at which most guinea pigs have reached full weight. This study is the first to show the high abundance (100% in this study) of the supratrochlear foramen within the guinea pig humerus and the complete absence of a supracondylar foramen, which is different to many other species and may also affect potential fracture points and frequencies. Understanding bone morphology and growth is essential in not only understanding the requirements of the healthy guinea pig, but also necessary in order to investigate disease states.

Feeding strategies as revealed by the section moduli of the humerus bones in bipedal theropod dinosaurs

NASA Astrophysics Data System (ADS)

Lee, Scott; Richards, Zachary

2015-03-01

The section modulus of a bone is a measure of its ability to resist bending torques. Carnivorous dinosaurs presumably had strong arm bones to hold struggling prey during hunting. Some theropods are believed to have become herbivorous and such animals would not have needed such strong arms. In this work, the section moduli of the humerus bones of bipedal theropod dinosaurs (from Microvenator celer to Tyrannosaurus rex) are studied to determine the maximum bending loads their arms could withstand. The results show that bending strength is not of uniform importance to these magnificent animals. The predatory theropods had strong arms for use in hunting. In contrast, the herbivorous dinosaurs had weaker arms.

Anatomy, histology and elemental profile of long bones and ribs of the Asian elephant (Elephas maximus).

PubMed

Nganvongpanit, Korakot; Siengdee, Puntita; Buddhachat, Kittisak; Brown, Janine L; Klinhom, Sarisa; Pitakarnnop, Tanita; Angkawanish, Taweepoke; Thitaram, Chatchote

2017-09-01

This study evaluated the morphology and elemental composition of Asian elephant (Elephas maximus) bones (humerus, radius, ulna, femur, tibia, fibula and rib). Computerized tomography was used to image the intraosseous structure, compact bones were processed using histological techniques, and elemental profiling of compact bone was conducted using X-ray fluorescence. There was no clear evidence of an open marrow cavity in any of the bones; rather, dense trabecular bone was found in the bone interior. Compact bone contained double osteons in the radius, tibia and fibula. The osteon structure was comparatively large and similar in all bones, although the lacuna area was greater (P < 0.05) in the femur and ulna. Another finding was that nutrient foramina were clearly present in the humerus, ulna, femur, tibia and rib. Twenty elements were identified in elephant compact bone. Of these, ten differed significantly across the seven bones: Ca, Ti, V, Mn, Fe, Zr, Ag, Cd, Sn and Sb. Of particular interest was the finding of a significantly larger proportion of Fe in the humerus, radius, fibula and ribs, all bones without an open medullary cavity, which is traditionally associated with bone marrow for blood cell production. In conclusion, elephant bones present special characteristics, some of which may be important to hematopoiesis and bone strength for supporting a heavy body weight.

Fishtail deformity--a delayed complication of distal humeral fractures in children.

PubMed

Narayanan, Srikala; Shailam, Randheer; Grottkau, Brian E; Nimkin, Katherine

2015-06-01

Concavity in the central portion of the distal humerus is referred to as fishtail deformity. This entity is a rare complication of distal humeral fractures in children. The purpose of this study is to describe imaging features of post-traumatic fishtail deformity and discuss the pathophysiology. We conducted a retrospective analysis of seven cases of fishtail deformity after distal humeral fractures. Seven children ages 7-14 years (five boys, two girls) presented with elbow pain and history of distal humeral fracture. Four of the seven children had limited range of motion. Five children had prior grade 3 supracondylar fracture treated with closed reduction and percutaneous pinning. One child had a medial condylar fracture and another had a lateral condylar fracture; both had been treated with conservative casting. All children had radiographs, five had CT and three had MRI. All children had a concave central defect in the distal humerus. Other imaging features included joint space narrowing with osteophytes and subchondral cystic changes in four children, synovitis in one, hypertrophy or subluxation of the radial head in three and proximal migration of the ulna in two. Fishtail deformity of the distal humerus is a rare complication of distal humeral fractures in children. This entity is infrequently reported in the radiology literature. Awareness of the classic imaging features can result in earlier diagnosis and appropriate treatment.

Injection of Unicameral Bone Cysts with Bone Marrow Aspirate and Demineralized Bone Matrix Avoids Open Curettage and Bone Grafting in a Retrospective Cohort

PubMed Central

Gundle, Kenneth R.; Bhatt, Etasha M.; Punt, Stephanie E.; Bompadre, Viviana; Conrad, Ernest U.

2017-01-01

Background: Many treatment options exist for unicameral bone cysts (UBC), without clear evidence of superiority. Meta-analyses have been limited by small numbers of patients in specific anatomic and treatment subgroups. The purpose of this study was to report the outcomes of injecting bone marrow aspirate and demineralized bone matrix (BMA/DBM) for the treatment of proximal humerus UBC. Methods: Fifty-one patients with proximal humerus lesions treated by BMA/DBM injection were retrospectively reviewed from a single academic medical center. Results: The mean number of injections performed per patient was 2.14 (range 1-5). Eleven patients underwent only one injection (22%), an additional 19 patients completed treatment after two injections (37%), four patients healed after three injections (8%), and one patient healed after four injections (2%). The cumulative success rate of serial BMA/DBM injections was 22% (11/51), 58% (30/51), 67% (34/51), and 69% (35/51). Eleven patients (22%) ultimately underwent open curettage and bone grafting, and five patients (10%) were treated with injection of calcium phosphate bone substitute. Conclusion: A BMA/DBM injection strategy avoided an open procedure in 78% of patients with a proximal humerus UBC. The majority of patients underwent at least 2 injection treatments. Level of Evidence: Level IV retrospective cohort study. PMID:28694887

PROMIS Physical Function Computer Adaptive Test Compared With Other Upper Extremity Outcome Measures in the Evaluation of Proximal Humerus Fractures in Patients Older Than 60 Years.

PubMed

Morgan, Jordan H; Kallen, Michael A; Okike, Kanu; Lee, Olivia C; Vrahas, Mark S

2015-06-01

To compare the PROMIS Physical Function Computer Adaptive Test (PROMIS PF CAT) to commonly used traditional PF measures for the evaluation of patients with proximal humerus fractures. Prospective. Two Level I trauma centers. Forty-seven patients older than 60 years with displaced proximal humerus fractures treated between 2006 and 2009. Evaluation included completion of the PROMIS PF CAT, the Constant Shoulder Score, the Disabilities of the Arm, Shoulder, and Hand (DASH) and the Short Musculoskeletal Functional Assessment (SMFA). Observed correlations among the administered PF outcome measures. On average, patients responded to 86 outcome-related items for this study: 4 for the PROMIS PF CAT (range: 4-8 items), 6 for the Constant Shoulder Score, 30 for the DASH, and 46 for the SMFA. Time to complete the PROMIS PF CAT (median completion time = 98 seconds) was significantly less than that for the DASH (median completion time = 336 seconds, P < 0.001) and for the SMFA (median completion time = 482 seconds, P < 0.001). PROMIS PF CAT scores correlated statistically significantly and were of moderate-to-high magnitude with all other PF outcome measure scores administered. This study suggests using the PROMIS PF CAT as a sole PF outcome measure can yield an assessment of upper extremity function similar to those provided by traditional PF measures, while substantially reducing patient assessment time.

Pullout strength of monocortical and bicortical screws in metaphyseal and diaphyseal regions of the canine humerus.

PubMed

Vaughn, Denty Paul; Syrcle, Jason Alan; Ball, John E; Elder, Steven H; Gambino, Jennifer Michele; Griffin, Russell L; McLaughlin, Ronald M

2016-11-23

Monocortical screws are commonly employed in locking plate fixation, but specific recommendations for their placement are lacking and use of short monocortical screws in metaphyseal bone may be contraindicated. Objectives of this study were to evaluate axial pullout strength of two different lengths of monocortical screws placed in various regions of the canine humerus compared to bicortical screws, and to derive cortical thickness and bone density values for those regions using quantitative computed tomography analysis (QCT). The QCT analysis was performed on 36 cadaveric canine humeri for six regions of interest (ROI). A bicortical, short monocortical, or 50% transcortical 3.5 mm screw was implanted in each ROI and axial pullout testing was performed. Bicortical screws were stronger than monocortical screws in all ROI except the lateral epicondylar crest. Short monocortical metaphyseal screws were weaker than those placed in other regions. The 50% transcortical screws were stronger than the short monocortical screws in the condyle. A linear relationship between screw length and pullout strength was observed. Cortical thickness and bone density measurements were obtained from multiple regions of the canine humerus using QCT. Use of short monocortical screws may contribute to failure of locking plate fixation of humeral fractures, especially when placed in the condyle. When bicortical screw placement is not possible, maximizing monocortical screw length may optimize fixation stability for distal humeral fractures.

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

PubMed

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.

Interactive effects of nutrition, environment, and rat-strain on cortical and vertebral bone geometry and biomechanics

NASA Technical Reports Server (NTRS)

Zernicke, R. F.; Li, K.-C.; Salem, G. J.; Vailas, A. C.; Grindeland, R. E.

1990-01-01

An investigation was conducted to generate comparative data on the sensitivity of cortical- and vertebral-bone adaptations in two different rat strains maintained at conditions typical for spaceborne experiments conducted by U.S.A. and USSR. The effects of cage environment, diet, and rat-strain on the cortical (humerus) and vertebral (T7) bones of male Taconic-Sprague-Dawley and Czechoslovakian-Wistar rats were investigated using different flight-simulation cages (one rat/cage for U.S.A.; ten rats/cage for USSR conditions) and fed either U.S.A. or USSR diet. The results showed significant effects of these factors on the humeral and vertebral geometry and mechanical properties, as well as significant interactive effects on the mechanical properties of the humerus.

Interpreting the three-dimensional orientation of vascular canals and cross-sectional geometry of cortical bone in birds and bats.

PubMed

Pratt, Isaac V; Johnston, James D; Walker, Ernie; Cooper, David M L

2018-06-01

Cortical bone porosity and specifically the orientation of vascular canals is an area of growing interest in biomedical research and comparative/paleontological anatomy. The potential to explain microstructural adaptation is of great interest. However, the determinants of the development of canal orientation remain unclear. Previous studies of birds have shown higher proportions of circumferential canals (called laminarity) in flight bones than in hindlimb bones, and interpreted this as a sign that circumferential canals are a feature for resistance to the torsional loading created by flight. We defined the laminarity index as the percentage of circumferential canal length out of the total canal length. In this study we examined the vascular canal network in the humerus and femur of a sample of 31 bird and 24 bat species using synchrotron micro-computed tomography (micro-CT) to look for a connection between canal orientation and functional loading. The use of micro-CT provides a full three-dimensional (3D) map of the vascular canal network and provides measurements of the 3D orientation of each canal in the whole cross-section of the bone cortex. We measured several cross-sectional geometric parameters and strength indices including principal and polar area moments of inertia, principal and polar section moduli, circularity, buckling ratio, and a weighted cortical thickness index. We found that bat cortices are relatively thicker and poorly vascularized, whereas those of birds are thinner and more highly vascularized, and that according to our cross-sectional geometric parameters, bird bones have a greater resistance to torsional stress than the bats; in particular, the humerus in birds is more adapted to resist torsional stresses than the femur. Our results show that birds have a significantly (P = 0.031) higher laminarity index than bats, with birds having a mean laminarity index of 0.183 in the humerus and 0.232 in the femur, and bats having a mean laminarity index of 0.118 in the humerus and 0.119 in the femur. Counter to our expectation, the birds had a significantly higher laminarity index in the femur than in the humerus (P = 0.035). To evaluate whether this discrepancy was a consequence of methodology we conducted a comparison between our 3D method and an analogue to two-dimensional (2D) histological measurements. This comparison revealed that 2D methods significantly underestimate (P < 0.001) the amount of longitudinal canals by an average of 20% and significantly overestimate (P < 0.001) the laminarity index by an average of 7.7%, systematically mis-estimating indices of vascular canal orientations. In comparison with our 3D results, our approximated 2D measurement had the same results for comparisons between the birds and bats but found significant differences only in the longitudinal index between the humerus and the femur for both groups. The differences between our 3D and pseudo-2D results indicate that differences between our findings and the literature may be partially based in methodology. Overall, our results do not support the hypothesis that the bones of flight are more laminar, suggesting a complex relation between functional loading and microstructural adaptation. © 2018 The Authors. Journal of Anatomy published by John Wiley & Sons Ltd on behalf of Anatomical Society.

Osteonecrosis

MedlinePlus

... humerus). Knees. Shoulders. Ankles. It is also called: Avascular necrosis. Aseptic necrosis. Ischemic necrosis. Who gets it? Anyone ... Fast Facts Oral Health and Bone Disease Osteonecrosis (Avascular Necrosis), Questions and Answers about Last Reviewed: 10/30/ ...

Comparison of the Fluid Resuscitation Rate with and without External Pressure Using Two Intraosseous Infusion Systems for Adult Emergencies, the CITRIN (Comparison of InTRaosseous infusion systems in emergency medicINe)-Study

PubMed Central

Gries, André; Hossfeld, Björn; Bechmann, Ingo; Bernhard, Michael

2015-01-01

Introduction Intraosseous infusion is recommended if peripheral venous access fails for cardiopulmonary resuscitation or other medical emergencies. The aim of this study, using body donors, was to compare a semi-automatic (EZ-IO®) device at two insertion sites and a sternal intraosseous infusion device (FASTR™). Methods Twenty-seven medical students being inexperienced first-time users were randomized into three groups using EZ-IO and FASTR. The following data were evaluated: attempts required for successful placement, insertion time and flow rates with and without external pressure to the infusion. Results The first-pass insertion success of the EZ-IO tibia, EZ-IO humerus and FASTR was 91%, 77%, and 95%, respectively. Insertion times (MW±SD) did not show significant differences with 17±7 (EZ-IO tibia) vs. 29±42 (EZ-IO humerus) vs. 33±21 (FASTR), respectively. One-minute flow rates using external pressures between 0 mmHg and 300 mmHg ranged between 27±5 to 69±54 ml/min (EZ-IO tibia), 16±3 to 60±44 ml/min (EZ-IO humerus) and 53±2 to 112±47 ml/min (FASTR), respectively. Concerning pressure-related increases in flow rates, negligible correlations were found for the EZ-IO tibia in all time frames (c = 0.107–0.366; p≤0.013), moderate positive correlations were found for the EZ-IO humerus after 5 minutes (c = 0.489; p = 0.021) and strong positive correlations were found for the FASTR in all time frames (c = 0.63–0.80; p≤0.007). Post-hoc statistical power was 0.62 with the given sample size. Conclusions The experiments with first-time users applying EZ-IO and FASTR in body donors indicate that both devices may be effective intraosseous infusion devices, likely suitable for fluid resuscitation using a pressure bag. Variations in flow rate may limit their reliability. Larger sample sizes will prospectively be required to substantiate our findings. PMID:26630579

Developing bones are differentially affected by compromised skeletal muscle formation

PubMed Central

Nowlan, Niamh C.; Bourdon, Céline; Dumas, Gérard; Tajbakhsh, Shahragim; Prendergast, Patrick J.; Murphy, Paula

2010-01-01

Mechanical forces are essential for normal adult bone function and repair, but the impact of prenatal muscle contractions on bone development remains to be explored in depth in mammalian model systems. In this study, we analyze skeletogenesis in two ‘muscleless’ mouse mutant models in which the formation of skeletal muscle development is disrupted; Myf5nlacZ/nlacZ:MyoD−/− and Pax3Sp/Sp (Splotch). Ossification centers were found to be differentially affected in the muscleless limbs, with significant decreases in bone formation in the scapula, humerus, ulna and femur, but not in the tibia. In the scapula and humerus, the morphologies of ossification centers were abnormal in muscleless limbs. Histology of the humerus revealed a decreased extent of the hypertrophic zone in mutant limbs but no change in the shape of this region. The elbow joint was also found to be clearly affected with a dramatic reduction in the joint line, while no abnormalities were evident in the knee. The humeral deltoid tuberosity was significantly reduced in size in the Myf5nlacZ/nlacZ:MyoD−/− mutants while a change in shape but not in size was found in the humeral tuberosities of the Pax3Sp/Sp mutants. We also examined skeletal development in a ‘reduced muscle’ model, the Myf5nlacZ/+:MyoD−/− mutant, in which skeletal muscle forms but with reduced muscle mass. The reduced muscle phenotype appeared to have an intermediate effect on skeletal development, with reduced bone formation in the scapula and humerus compared to controls, but not in other rudiments. In summary, we have demonstrated that skeletal development is differentially affected by the lack of skeletal muscle, with certain rudiments and joints being more severely affected than others. These findings indicate that the response of skeletal progenitor cells to biophysical stimuli may depend upon their location in the embryonic limb, implying a complex interaction between mechanical forces and location-specific regulatory factors affecting bone and joint development. PMID:19948261

[A case control study of perpendicular or parallel double plate for the treatment of young and middle-aged patients with type C fractures of distal humerus].

PubMed

Yu, Ye-Feng; Dai, Jia-Ping; Sheng, Jian-Ming; Zhou, Xiao

2017-06-25

To compare clinical outcomes of perpendicular or parallel double plate in treating type C fractures of distal humerus in adults. From March 2009 and March 2013, 40 adult patients with type C distal humerus fractures were treated. The patients were divided into two groups according to fixed form. In perpendicular group(group A), there were 13 males and 9 females with a mean age of (37.56±9.24) years old(ranged 18 to 56);while in parallel plating group(group B), including 11 males and 7 females, with a mean age of (41.35±9.03) year old(ranged 20 to 53). All fractures were fresh and closed without blood vessels or nerve damaged. Incision length, operating time, blood loss, hospital stay, preoperative and postoperative radiological change, range of activity of elbow joint, Mayo score, flexor and extensor elbow strength, and postoperative complications were observed and compared. All incisions were healed well. One patient occurred myositis ossificans between two groups. Two patients in group A and 1 patient in group B occurred elbow joint stiffness. All fractures were obtained bone union. Group A were followed up from 20 to 36 months with an average of (25.2±7.1) months, while group B were followed up from 18 to 35 months with an average of(24.3±6.0) months. There were significant differences in blood loss and operative time, while there was no obvious meaning in incision length, hospital stay, muscle strength, fracture healing time, range of activity of elbow joint. Mayo score of group A was 82.27±10.43, 6 cases obtained excellent results, 12 good, 3 moderate and 1 poor;in group B was 81.94±12.02, 5 cases obtained excellent results, 9 good, 3 moderate and 1 poor;and there were no statistical significance between two groups. There was no significant differences in clinical effects between perpendicular and parallel double plate for adult patients with type C distal humerus fractures, while the operation should choose according to facture and proficiency of operator.

Comparison of the Fluid Resuscitation Rate with and without External Pressure Using Two Intraosseous Infusion Systems for Adult Emergencies, the CITRIN (Comparison of InTRaosseous infusion systems in emergency medicINe)-Study.

PubMed

Hammer, Niels; Möbius, Robert; Gries, André; Hossfeld, Björn; Bechmann, Ingo; Bernhard, Michael

2015-01-01

Intraosseous infusion is recommended if peripheral venous access fails for cardiopulmonary resuscitation or other medical emergencies. The aim of this study, using body donors, was to compare a semi-automatic (EZ-IO®) device at two insertion sites and a sternal intraosseous infusion device (FASTR™). Twenty-seven medical students being inexperienced first-time users were randomized into three groups using EZ-IO and FASTR. The following data were evaluated: attempts required for successful placement, insertion time and flow rates with and without external pressure to the infusion. The first-pass insertion success of the EZ-IO tibia, EZ-IO humerus and FASTR was 91%, 77%, and 95%, respectively. Insertion times (MW ± SD) did not show significant differences with 17 ± 7 (EZ-IO tibia) vs. 29 ± 42 (EZ-IO humerus) vs. 33 ± 21 (FASTR), respectively. One-minute flow rates using external pressures between 0 mmHg and 300 mmHg ranged between 27 ± 5 to 69 ± 54 ml/min (EZ-IO tibia), 16 ± 3 to 60 ± 44 ml/min (EZ-IO humerus) and 53 ± 2 to 112 ± 47 ml/min (FASTR), respectively. Concerning pressure-related increases in flow rates, negligible correlations were found for the EZ-IO tibia in all time frames (c = 0.107-0.366; p ≤ 0.013), moderate positive correlations were found for the EZ-IO humerus after 5 minutes (c = 0.489; p = 0.021) and strong positive correlations were found for the FASTR in all time frames (c = 0.63-0.80; p ≤ 0.007). Post-hoc statistical power was 0.62 with the given sample size. The experiments with first-time users applying EZ-IO and FASTR in body donors indicate that both devices may be effective intraosseous infusion devices, likely suitable for fluid resuscitation using a pressure bag. Variations in flow rate may limit their reliability. Larger sample sizes will prospectively be required to substantiate our findings.

Sex determination using discriminant analysis of upper and lower extremity bones: New approach using the volume and surface area of digital model.

PubMed

Lee, U-Young; Kim, In-Beom; Kwak, Dai-Soon

2015-08-01

This study used 110 CT images taken from donated Korean cadavers to create 3-D models of the following upper and lower limb bones: the clavicle, scapula, humerus, radius, ulna, hip bone (os coxa), femur, patella (knee cap), tibia, talus, and calcaneus. In addition, the bone volume and surface area were calculated to determine sex differences using discriminant analysis. Significant sex differences were found in all bones with respect to volume and surface area (p<0.01). The order of volume was the same in females and males (femur>hip bone>tibia>humerus>scapula), although the order of surface area was different. The largest surface area in men was the femur and in women was the hip bone (p<0.01). An interesting finding of this study was that the ulna is the bone with the highest accuracy for sex determination (94%). When using the surface area of multiple bones, the maximum accuracy (99.4%) was achieved. The equation was as follows: (discriminant equation of surface area; female<0

Melorheostosis in the upper extremity.

PubMed

Yildirim, Cengiz; Ozyürek, Selahattin; Ciçek, Engin Ilker; Kuskucu, Mesih

2009-04-01

Melorheostosis is a rare mesodermal disease affecting the skeleton and adjacent soft tissues. Often it is incidentally detected on radiographs. In the standard radiology and orthopedics literature, melorheostosis is described as a "flowing hyperostosis, resembling dripping candle wax as an incidental radiographic finding." A 22-year-old man presented with a 2-year history of right-hand pain. Radiologic evaluation of the hand showed massive sclerotic changes in the first and second metacarpal and phalangeal bones on the right side. Further radiographic evaluation of the right upper extremity revealed the same sclerotic changes in the right scapula, humerus, radius, and scaphoid. Computed tomography (CT) scans showed a high attenuation undulating cortical hyperostosis with a "dripping candle wax appearance" involving the radial and/or dorsal aspects of humerus, radius, scaphoid, and first and second ray bones of the hand. Radionuclide triphasic bone scintigraphy showed diffuse homogenous radiotracer uptake within the entire right upper extremity involving the scapula, humerus, radius, scaphoid, and first and second metacarpals and phalangeal bones of the hand. The patient was followed conservatively, and 1-year follow-up revealed no change in the clinical, laboratory, or radiological findings. The diagnosis of melorheostosis was made on the basis of the characteristic distribution, location, and combined radiographic, CT, and radionuclide imaging features of the abnormalities. Conservative treatment was recommended for the patient. After 26 months of follow-up, despite the persistence of the radiologic findings, the patient is currently well, with no painful symptoms unless he performs forceful exercise.

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

PubMed

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.

Preliminary Study to Test the Feasibility of Sex Identification of Human (Homo sapiens) Bones Based on Differences in Elemental Profiles Determined by Handheld X-ray Fluorescence.

PubMed

Nganvongpanit, Korakot; Buddhachat, Kittisak; Brown, Janine L; Klinhom, Sarisa; Pitakarnnop, Tanita; Mahakkanukrauh, Pasuk

2016-09-01

Sex assignment of human remains is a crucial step in forensic anthropological studies. The aim of this study was to examine elemental differences between male and female bones using X-ray fluorescence (XRF) and determine if elemental profiling could be used for sex discrimination. Cranium, humerus, and os coxae of 60 skeletons (30 male, 30 female) from the Chiang Mai University Skeletal Collection were scanned by XRF and differences in elemental profiles between male and female bones determined using discriminant analysis. In the cranium, three elements (S, Ca, Pb) were significantly higher in males and five elements (Si, Mn, Fe, Zn, Ag) plus light elements (atomic number lower than 12) were higher in females. In humerus and os coxae, nine elements were significantly higher in male and one element was higher in female samples. The accuracy rate for sex estimation was 60, 63, and 61 % for cranium, humerus, and os coxae, respectively, and 67 % when data for all three bones were combined. We conclude that there are sex differences in bone elemental profiles; however, the accuracy of XRF analyses for discriminating between male and female samples was low compared to standard morphometric and molecular methods. XRF could be used on small samples that cannot be sexed by traditional morphological methods, but more work is needed to increase the power of this technique for gender assignment.

Giant distal humeral geode.

PubMed

Maher, M M; Kennedy, J; Hynes, D; Murray, J G; O'Connell, D

2000-03-01

We describe the imaging features of a giant geode of the distal humerus in a patient with rheumatoid arthritis, which presented initially as a pathological fracture. The value of magnetic resonance imaging in establishing this diagnosis is emphasized.

Arm Injuries and Disorders

MedlinePlus

... your body, three of them are in your arm: the humerus, radius, and ulna. Your arms are also made up of muscles, joints, tendons, ... Injuries to any of these parts of the arm can occur during sports, a fall, or an ...

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

PubMed

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

2018-06-01

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.

FE analysis of SMA-based bio-inspired bone-joint system

NASA Astrophysics Data System (ADS)

Yang, S.; Seelecke, S.

2009-10-01

This paper presents the finite element (FE) analysis of a bio-inspired bone-joint system. Motivated by the BATMAV project, which aims at the development of a micro-air-vehicle platform that implements bat-like flapping flight capabilities, we study the actuation of a typical elbow joint, using shape memory alloy (SMA) in a dual manner. Micro-scale martensitic SMA wires are used as 'metal muscles' to actuate a system of humerus, elbow joint and radius, in concert with austenitic wires, which operate as flexible joints due to their superelastic character. For the FE analysis, the humerus and radius are modeled as standard elastic beams, while the elbow joint and muscle wires use the Achenbach-Muller-Seelecke SMA model as beams and cable elements, respectively. The particular focus of the paper is on the implementation of the above SMA model in COMSOL.

Bone Lengthening in the Pediatric Upper Extremity.

PubMed

Farr, Sebastian; Mindler, Gabriel; Ganger, Rudolf; Girsch, Werner

2016-09-07

➤Bone lengthening has been used successfully for several congenital and acquired conditions in the pediatric clavicle, humerus, radius, ulna, and phalanges.➤Common indications for bone lengthening include achondroplasia, radial longitudinal deficiency, multiple hereditary exostosis, brachymetacarpia, symbrachydactyly, and posttraumatic and postinfectious growth arrest.➤Most authors prefer distraction rates of <1 mm/day for each bone in the upper extremity except the humerus, which can safely be lengthened by 1 mm/day.➤Most authors define success by the amount of radiographic bone lengthening, joint motion after lengthening, and subjective patient satisfaction rather than validated patient-related outcome measures.➤Bone lengthening of the upper extremity is associated with a high complication rate, with complications including pin-track infections, fixation device failure, nerve lesions, nonunion, fracture of regenerate bone, and joint dislocations. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Automated trabecular bone histomorphometry

NASA Technical Reports Server (NTRS)

Polig, E.; Jee, W. S. S.

1985-01-01

The toxicity of alpha-emitting bone-seeking radionuclides and the relationship between bone tumor incidence and the local dosimetry of radionuclides in bone are investigated. The microdistributions of alpha-emitting radionuclides in the trabecular bone from the proximal humerus, distal humerus, proximal ulna, proximal femur, and distal femur of six young adult beagles injected with Am-241 (three with 2.8 micro-Ci/kg and three with 0.9 micro-Ci/kg) are estimated using a computer-controlled microscope photometer system; the components of the University of Utah Optical Track Scanner are described. The morphometric parameters for the beagles are calculated and analyzed. It is observed that the beagles injected with 0.9 micro-Ci of Am-241/kg showed an increase in the percentage of bone and trabecular bone thickness, and a reduction in the width of the bone marrow space and surface/volume ratio. The data reveal that radiation damage causes abnormal bone structure.

Pulmonary carcinoma in a great horned owl (Bubo virginianus).

PubMed

Rettenmund, Christy; Sladky, Kurt K; Rodriguez, Daniel; Petersen, Michael; Pinkerton, Marie E; Rao, Deepa

2010-03-01

Pulmonary carcinoma was diagnosed in an 18+-year-old captive female great horned owl (Bubo virginianus). The owl presented with a history of progressive weakness and sudden onset of frank blood in the droppings. On physical examination, the owl had multiple white to yellow plaques in the oral cavity, decreased air sac sounds on the right side, dyspnea (during manual restraint), and reduced pectoral musculature. Whole-body radiographs revealed obliteration of the right-sided air sacs, a soft tissue plaque/density in the left caudal thoracic air sac, soft tissue opacity over the coelomic organs, and increased medullary opacity in the distal right humerus. The owl died during anesthetic recovery, and the body was submitted for necropsy. Although the clinical signs, physical examination results, radiographic signs, and gross pathology supported a diagnosis of mycotic infection, such as aspergillosis, histopathology confirmed pulmonary carcinoma with metastases to the air sacs and humerus.

[Reconstruction and balance of soft tissue in hemi-shoulder replacement for patients with four-part fracture of the proximal humerus].

PubMed

Wu, Xing; Lou, Lie-ming; Chen, Zheng-rong; Zhang, Guang-jian

2008-10-01

To explore the effective skills of reconstruction and balance of soft tissue in hemi-shoulder replacement for patients with four-part fracture of the proximal humerus in order to avoid postoperative complications of joint instability and great tubercle displacement. From June 2002 to June 2006, 25 patients with Neer four-part fracture of the proximal humerus were adopted in the study which included 15 females and 10 males, with the mean age of 66 years (ranged from 56 years to 80 years). They were treated with humeral head replacement and should joint reparation simultaneously by modified operation approach and reconstruction and balance skills of soft tissue. The mean duration of follow-up was 2.3 years (ranged from 1 to 4.5 years). No infection, nerve damage and prosthesis loosing were found in all cases. Two cases of infra-forward dislocation or subluxation occurred due to affected limb placed on abduction splint postoperatively. One case occurred prosthesis upward displacement due to early active abduction exercise but no complains. Neither joint instability nor displacement and malunion of great tubercle were found in other patients. According to Neer scoring system, 6 cases were rated as excellent, 15 as good and 5 as fair. The good and excellent rate was 84%. In hemi-shoulder replacement for patients with Neer four-part fracture the modified operation approach and reconstruction and balance of soft tissue skills combined with rational rehabilitation exercise can prevent postoperative shoulder joint instability and displacement and malunion of great tubercle.

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly.

PubMed

Grubhofer, Florian; Wieser, Karl; Meyer, Dominik C; Catanzaro, Sabrina; Beeler, Silvan; Riede, Ulf; Gerber, Christian

2016-10-01

Anatomic reduction and stable internal fixation of complex proximal humeral fractures in the elderly is challenging. Secondary displacement, screw perforation, and humeral head necrosis are common complications. The outcome of hemiarthroplasty is unpredictable and strongly dependent on the uncertain healing of the greater tuberosity. This multicenter study retrospectively analyzes the midterm results of primary reverse total shoulder arthroplasty for the treatment of acute, complex fractures of the humerus in an elderly population. Fifty-two shoulders in 51 patients with a mean age of 77 years treated with reverse total shoulder arthroplasty for an acute, complex fracture of the proximal humerus were clinically and radiographically analyzed after a mean follow-up period of 35 months (range, 12-90 months). There were no intraoperative complications. Revision surgery was performed in 4 shoulders. At final follow-up, the absolute and relative Constant scores averaged 62 points (range, 21-83 points) and 86% (range, 30%-100%), respectively, with a mean Subjective Shoulder Value of 83% (range, 30%-100%). Of the patients, 92% rated the treatment outcome as excellent or good. Patients with a resected or secondarily displaced greater tuberosity had an inferior clinical outcome to those with a healed greater tuberosity. The midterm clinical results are predictably good, with low complication rates and a rapid postoperative recovery of painfree everyday function. If secondary displacement of the greater tuberosity occurs, revision surgery may warrant consideration in view of potential improvement of ultimate outcome. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Survey study suggests that reverse total shoulder arthroplasty is becoming the treatment of choice for four-part fractures of the humeral head in the elderly.

PubMed

Savin, David D; Zamfirova, Ina; Iannotti, Joseph; Goldberg, Benjamin A; Youderian, Ari R

2016-09-01

The role of reverse total shoulder arthroplasty (RTSA) for three and four-part proximal humerus fractures is evolving. However, there does not appear to be a clear consensus amongst surgeons. The purpose of this study is to further define the standard of care, assessing surgeon preference and treatment considerations for management of such fractures. Orthopaedic surgeons were surveyed on their training, practice setting, and experience regarding management of four-part proximal humerus fractures. The survey also presented five representative cases to assess treatment preferences. Two hundred five surgeons responded to the survey with fellowship training in shoulder and elbow surgery (114), orthopaedic trauma (35) or sports medicine/other training (56). There was no difference between respondents with years in practice and confidence with performing RTSA, however, surgeons in the academic setting were more confident in performing the surgery. Surgeons preferred RTSA for management of four-part fractures in patients over age 65. However, they also trended to favour hemiarthroplasty with higher co-morbidities. Physicians with more than 11 years of experience were more likely to choose hemiarthroplasty for older and high comorbidity patients. RTSA was not the preferred treatment method for younger, active patients. Patient age and fracture pattern had a greater influence on the surgeon's decision. There is a consensus in our study population that RTSA is the preferred treatment for four-part proximal humerus fractures for elderly patients with patient age and fracture pattern being the most important factors in making management decisions. Level III - Case controlled study.

Cadaveric Study of the Articular Branches of the Shoulder Joint.

PubMed

Eckmann, Maxim S; Bickelhaupt, Brittany; Fehl, Jacob; Benfield, Jonathan A; Curley, Jonathan; Rahimi, Ohmid; Nagpal, Ameet S

This cadaveric study investigated the anatomic relationships of the articular branches of the suprascapular (SN), axillary (AN), and lateral pectoral nerves (LPN), which are potential targets for shoulder analgesia. Sixteen embalmed cadavers and 1 unembalmed cadaver, including 33 shoulders total, were dissected. Following dissections, fluoroscopic images were taken to propose an anatomical landmark to be used in shoulder articular branch blockade. Thirty-three shoulders from 17 total cadavers were studied. In a series of 16 shoulders, 16 (100%) of 16 had an intact SN branch innervating the posterior head of the humerus and shoulder capsule. Suprascapular sensory branches coursed laterally from the spinoglenoid notch then toward the glenohumeral joint capsule posteriorly. Axillary nerve articular branches innervated the posterolateral head of the humerus and shoulder capsule in the same 16 (100%) of 16 shoulders. The AN gave branches ascending circumferentially from the quadrangular space to the posterolateral humerus, deep to the deltoid, and inserting at the inferior portion of the posterior joint capsule. In 4 previously dissected and 17 distinct shoulders, intact LPNs could be identified in 14 (67%) of 21 specimens. Of these, 12 (86%) of 14 had articular branches innervating the anterior shoulder joint, and 14 (100%) of 14 LPN articular branches were adjacent to acromial branches of the thoracoacromial blood vessels over the superior aspect of the coracoid process. Articular branches from the SN, AN, and LPN were identified. Articular branches of the SN and AN insert into the capsule overlying the glenohumeral joint posteriorly. Articular branches of the LPN exist and innervate a portion of the anterior shoulder joint.

Spatial mapping of humeral head bone density.

PubMed

Alidousti, Hamidreza; Giles, Joshua W; Emery, Roger J H; Jeffers, Jonathan

2017-09-01

Short-stem humeral replacements achieve fixation by anchoring to the metaphyseal trabecular bone. Fixing the implant in high-density bone can provide strong fixation and reduce the risk of loosening. However, there is a lack of data mapping the bone density distribution in the proximal humerus. The aim of the study was to investigate the bone density in proximal humerus. Eight computed tomography scans of healthy cadaveric humeri were used to map bone density distribution in the humeral head. The proximal humeral head was divided into 12 slices parallel to the humeral anatomic neck. Each slice was then divided into 4 concentric circles. The slices below the anatomic neck, where short-stem implants have their fixation features, were further divided into radial sectors. The average bone density for each of these regions was calculated, and regions of interest were compared using a repeated-measures analysis of variance with significance set at P < .05. Average apparent bone density was found to decrease from proximal to distal regions, with the majority of higher bone density proximal to the anatomic neck of the humerus (P < .05). Below the anatomic neck, bone density increases from central to peripheral regions, where cortical bone eventually occupies the space (P < .05). In distal slices below the anatomic neck, a higher bone density distribution in the medial calcar region was also observed. This study indicates that it is advantageous with respect to implant fixation to preserve some bone above the anatomic neck and epiphyseal plate and to use the denser bone at the periphery. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

In vitro assessment of the contact mechanics of reverse-engineered distal humeral hemiarthroplasty prostheses.

PubMed

Willing, Ryan; Lapner, Michael; King, Graham J W; Johnson, James A

2014-11-01

Distal humeral hemiarthroplasty alters cartilage contact mechanics, which may predispose to osteoarthritis. Current prostheses do not replicate the native anatomy, and therefore contribute to these changes. We hypothesized that prostheses reverse-engineered from the native bone shape would provide similar contact patterns as the native articulation. Reverse-engineered hemiarthroplasty prostheses were manufactured for five cadaveric elbows based on CT images of the distal humerus. Passive flexion trials with constant muscle forces were performed with the native articulation intact while bone motions were recorded using a motion tracking system. Motion trials were then repeated after the distal humerus was replaced with a corresponding reverse-engineered prosthesis. Contact areas and patterns were reconstructed using computer models created from CT scan images combined with the motion tracker data. The total contact areas, as well as the contact area within smaller sub-regions of the ulna and radius, were analyzed for changes resulting from hemiarthroplasty using repeated-measures ANOVAs. Contact area at the ulna and radius decreased on average 42% (SD 19%, P=.008) and 41% (SD 42%, P=.096), respectively. Contact area decreases were not uniform throughout the different sub-regions, suggesting that contact patterns were also altered. Reverse-engineered prostheses did not reproduce the same contact pattern as the native joints, possibly because the thickness of the distal humerus cartilage layer was neglected when generating the prosthesis shapes or as a consequence of the increased stiffness of the metallic implants. Alternative design strategies and materials for hemiarthroplasty should be considered in future work. Copyright © 2014 Elsevier Ltd. All rights reserved.

Biomechanical Comparison of 3 Inferiorly Directed Versus 3 Superiorly Directed Locking Screws on Stability in a 3-Part Proximal Humerus Fracture Model.

PubMed

Donohue, David M; Santoni, Brandon G; Stoops, T Kyle; Tanner, Gregory; Diaz, Miguel A; Mighell, Mark

2018-06-01

To quantify the stability of 3 points of inferiorly directed versus 3 points of superiorly directed locking screw fixation compared with the full contingent of 6 points of locked screw fixation in the treatment of a 3-part proximal humerus fracture. A standardized 3-part fracture was created in 10 matched pairs (experimental groups) and 10 nonmatched humeri (control group). Osteosynthesis was performed using 3 locking screws in the superior hemisphere of the humeral head (suspension), 3 locking screws in the inferior hemisphere (buttress), or the full complement of 6 locking screws (control). Specimens were tested in varus cantilever bending (7.5 Nm) to 10,000 cycles or failure. Construct survival (%) and the cycles to failure were compared. Seven of 10 controls survived the 10,000-cycle runout (70%: 8193 average cycles to failure). No experimental constructs survived the 10,000-cycle runout. Suspension and buttress screw groups failed an average of 331 and 516 cycles, respectively (P = 1.00). The average number of cycles to failure and the number of humeri surviving the 10,000-cycle runout were greater in the control group than in the experimental groups (P ≤ 0.006). Data support the use of a full contingent of 6 points of locking screw fixation over 3 superior or 3 inferior points of fixation in the treatment of a 3-part proximal humerus fracture with a locking construct. No biomechanical advantage to the 3 buttress or 3 suspension screws used in isolation was observed.

The humeroscapular bone of the great horned owl (Bubo virginianus) and other raptors.

PubMed

Smith, B J; Smith, S A

1992-03-01

A small, separate, bony density dorsal to the shoulder joint is radiographically visible in several species of large hawks and owls. Gross dissection and histological examination show the bone to lie on the deep surface of the major deltoid muscle in intimate association with the dorsal coracohumeral ligament of the shoulder joint. The tendon of the supracoracoideus muscle passes immediately cranial to the humeroscapular bone. Two ligaments distinct from the shoulder joint capsule attach the humeroscapular bone to the proximal humerus: one passes to the proximal edge of the pectoral crest of the humerus, and the other passes to the ventral tubercle of the humerus. The bone was described as the humeroscapular bone in reference to a similar fibrocartilaginous structure possessed by some birds. The humeroscapular bone is present in the great horned owl (Bubo virginianus), the screech owl (Otus asio), the barred owl (Strix varia), the red-tailed hawk (Buteo jamaicencis), the Cooper's hawk (Accipiter cooperii), and the sharp-shinned hawk (Accipiter striatus). The bone is absent in the barn owl (Tyto alba), the osprey (Pandion haliaetus), the golden eagle (Aquila chysaetos), and the turkey vulture (Cathartes aura), though some of these species possessed a similar fibrocartilaginous structure. Whether the humeroscapular structure develops as bone or cartilage in a given species may be related to other morphological features of the wing, and/or to characteristics of the predatory behavior of the species. Clinicians and anatomists dealing with birds of prey must be aware of the presence of the humeroscapular bone to avoid misinterpreting it as a fracture fragment.

Initial varus displacement of proximal humerus fractures results in similar function but higher complication rates.

PubMed

Capriccioso, Christina E; Zuckerman, Joseph D; Egol, Kenneth A

2016-04-01

To investigate the effect of initial varus or valgus surgical neck alignment on outcomes of patients who sustained proximal humerus fractures treated with open reduction and internal fixation (ORIF). An institutional review board approved database of proximal humerus fractures treated with locked plates was reviewed. Of 185 fractures in the database, 101 fractures were identified and met inclusion criteria. Initial varus displacement was seen in 47 fractures (OTA types 11.A2.2, A3.1, A3.3, B1.2, B2.2, C1.2, C2.2, or C2.3) and initial valgus displacement was observed in 54 fractures (OTA types 11.A2.3, B1.1, C1.1, or C2.1). All patients were treated in a similar manner and examined by the treating physician at standard intervals. Functional outcomes were quantified via the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and physical examination data at 12 months. Radiographs were reviewed for complications of healing. Additionally, complication rate and reoperation rate were investigated. Patients who presented with initial varus displacement had an average age of 59.3 years, while patients in the valgus group had an average age of 62.4 years. Overall, there was no statistically significant difference in age, sex distribution, BMI, fracture parts, screws used, or implant plate type between the two groups. At a minimum 12 months follow up, there was no significant difference in DASH scores between those presenting with varus versus valgus fracture patterns. In addition, no significant differences were seen in final shoulder range of motion in any plane. Overall, 30 patients included in this study developed a complication. A significantly greater number of patients in the initial varus cohort developed complications (40.4%), as compared to 20.3% of patients in the initial valgus cohort (P=0.03). Fourteen patients in this study underwent reoperation. Nine of these patients were in the varus cohort, while 5 were in the valgus cohort (P=0.15). In this study, initial surgical neck displacement in varus or valgus was found to not significantly affect functional outcome. Based upon our findings, patients with varus displaced proximal humerus fractures are at a greater risk of developing postoperative complications than those who present with initial valgus displaced fracture patterns. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Effects of Age, Adiposity, and Physical Activity on the Risk of Seven Site‐Specific Fractures in Postmenopausal Women

PubMed Central

Lacombe, Jason; Cairns, Benjamin J; Green, Jane; Reeves, Gillian K; Beral, Valerie

2016-01-01

ABSTRACT Risk factors for fracture of the neck of the femur are relatively well established, but those for fracture at other sites are little studied. In this large population study we explore the role of age, body mass index (BMI), and physical activity on the risk of fracture at seven sites in postmenopausal women. As part of the Million Women Study, 1,154,821 postmenopausal UK women with a mean age of 56.0 (SD 4.8) years provided health and lifestyle data at recruitment in 1996 to 2001. All participants were linked to National Health Service (NHS) hospital records for day‐case or overnight admissions with a mean follow‐up of 11 years per woman. Adjusted absolute and relative risks for seven site‐specific incident fractures were calculated using Cox regression models. During follow‐up, 4931 women had a fracture of the humerus; 2926 of the forearm; 15,883 of the wrist; 9887 of the neck of the femur; 1166 of the femur (not neck); 3199 a lower leg fracture; and 10,092 an ankle fracture. Age‐specific incidence rates increased gradually with age for fractures of forearm, lower leg, ankle, and femur (not neck), and steeply with age for fractures of neck of femur, wrist, and humerus. When compared to women with desirable BMI (20.0 to 24.9 kg/m2), higher BMI was associated with a reduced risk of fracture of the neck of femur, forearm, and wrist, but an increased risk of humerus, femur (not neck), lower leg, and ankle fractures (p < 0.001 for all). Strenuous activity was significantly associated with a decreased risk of fracture of the humerus and femur (both neck and remainder of femur) (p < 0.001), but was not significantly associated with lower leg, ankle, wrist, and forearm fractures. Postmenopausal women are at a high lifetime risk of fracture. BMI and physical activity are modifiable risk factors for fracture, but their associations with fracture risk differ substantially across fracture sites. © 2016 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research (ASBMR) PMID:26950269

Is the Clavicula Pro Humero Technique of Value for Reconstruction After Resection of the Proximal Humerus in Children?

PubMed

Barbier, Dominique; De Billy, Benoît; Gicquel, Philippe; Bourelle, Sophie; Journeau, Pierre

2017-10-01

There are several options for reconstruction of proximal humerus resections after wide resection for malignant tumors in children. The clavicula pro humero technique is a biologic option that has been used in the past, but there are only scant case reports and small series that comment on the results of the procedure. Because the longevity of children mandates a reconstruction with potential longevity not likely to be achieved by other techniques, the clavicula pro humero technique may be a potential option in selected patients. (1) How successful is the clavicula pro humero procedure in achieving local tumor control? (2) What is the frequency of nonunion? (3) What are the complications of the procedure? (4) What scores do patients achieve (on the Musculoskeletal Tumor Society (MSTS) and the Toronto Extremity Salvage Score (TESS) after this procedure? Four university hospitals performed the clavicula pro humero technique in eight children aged 8 to 18 years between June 2006 and February 2014. During that period, general indications for this approach included all reconstructions of the proximal humerus for malignant tumors in children older than 8 years. All patients were followed for a mean of 40 months (range, 25-86 months); one patient was lost to followup before 2 years. The tumor resections removed the rotator cuff muscles in all patients, glenohumeral joint in five, and deltoid muscle in three. The median length of the bone defect after resection was 20 cm (range, 7-25 cm). It was reduced to 9 cm (range, 0-17 cm) or 27% (range, 0%-64%) of the total humerus length after clavicular rotation. Direct osteosynthesis (one patient), induced membrane technique (one patient), or vascularized fibular autograft (six patients) was used to complete the defect after rotation of the clavicle if necessary. Presence of union (defined as bone healing before 10 months, as assessed by disappearance of the osteotomy on AP and lateral view radiographs), and complications were determined by chart review performed by a surgeon not involved in patient care. Function assessed by the MSTS and the TESS scores were determined by the patients with their families. None of the patients had tumor recurrence. One patient died of pulmonary metastases before the 2-year followup. Proximal and distal bone unions were achieved before 10 months without an additional surgical procedure in two and six of seven patients, respectively. Fourteen local complications occurred resulting in nine revision operations. The main complication was aseptic proximal pseudarthrosis (five patients); other complications included one proximal junction fracture, one clavicle fracture complicated by clavicle osteolysis, one distal junction fracture, one necrosis of the skin paddle of the fibular autograft, one glenoclavicular ossification, and one distal pseudarthrosis complicated by a fracture of this distal junction. Function, as assessed by the MSTS score, was a median of 23 of 30 (range, 11-27). The median TESS score was 82% (range, 75%-92%). Shoulder ROM (median; range) in abduction, front elevation, and external and internal rotations were 70°(30°-90°), 75°(30°-85°), 10°(0°-20°), and 80°(80°-100°), respectively. Three of the seven patients reported dissatisfaction with the cosmetic appearance. The clavicula pro humero technique achieved oncologic local control after resection and reconstruction of proximal humerus tumors in children. Although union times are approximately 2 years and some patients underwent augmentation with other grafts, it eventually provides a solid, painless, biologic, and stable reconstruction and creates a mobile acromioclavicular joint and generally good function. Nonunion of the proximal junction is the main complication of this technique. We cannot directly compare this technique with other reconstruction options, and longer followup is needed, but this may be a useful reconstruction option to consider in select pediatric patients with sarcomas of the proximal humerus. Level IV, therapeutic study.

Evidence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon.

PubMed

Tosounidis, Theodoros; Hadjileontis, Constantine; Triantafyllou, Christos; Sidiropoulou, Varvara; Kafanas, Antonios; Kontakis, George

2013-03-01

The primary purpose of this study was to investigate the sympathetic innervation of the long head of the biceps brachii tendon LHB via immunohistochemical staining for protein S-100 and neuropeptide Y (NPY) in patients with complex proximal humerus fractures, in individuals with chronic biceps tendinosis in the setting of large rotator cuff tears (RC), and in cadaveric samples with no previously reported shoulder pathology. We investigated the presence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon (LHB) in patients with complex proximal humerus fractures and individuals with chronic biceps tendinosis in the setting of large rotator cuff tears (RC). The correlation of morphological features with immunohistochemical evidence of neural element presence was also investigated. Forty-one LHB tendon specimens were examined. Seventeen were harvested from patients who underwent hemiarthroplasty for proximal humerus fractures, 14 were from individuals with biceps tendinosis in the context of a large RC tear, and ten were from cadaveric controls with no previous shoulder pathology. Histologic examination was performed using hematoxylin and eosin. Immunohistochemistry was used to detect the expression of the protein S-100, neuropeptide Y, and α1-adrenergic receptors, as well as to characterize the potential neural differentiation of tendon cells. A strong correlation between the expression of NPY/S-100, α1-adrenergic/S-100, and α1-adrenergic/NPY was found. The LHB tendon has sympathetic innervation and α1-adrenergic receptors in acute and chronic pathological conditions. Our results provide useful guidance on the management of tendinosis and the handling of the LHB in hemiarthroplasties for fractures.

A closer look at the "Protopithecus" fossil assemblages: new genus and species from Bahia, Brazil.

PubMed

Halenar, Lauren B; Rosenberger, Alfred L

2013-10-01

The recently extinct large-bodied New World monkey Protopithecus brasiliensis Lund 1836 was named based on a distal humerus and proximal femur found in the Lagoa Santa cave system in the southeastern Brazilian state of Minas Gerais. These bones are from an animal about twice the size of the largest extant platyrrhines. One hundred and seventy-five years later, a nearly complete skeleton was discovered in the Toca da Boa Vista caves in the neighboring state of Bahia and was allocated to the same taxon as it was the first platyrrhine fossil of comparable size found since the originals. Our detailed study of the equivalent elements, however, reveals important morphological differences that do not correspond to intraspecific variation as we know it in related platyrrhine taxa. The presence of both an expanded brachioradialis flange on the humerus and gluteal tuberosity on the femur of the Bahian skeleton distinguishes it from the Lagoa Santa fossil as well as from all other platyrrhines. Further cranial and postcranial evidence suggests a closer relationship of the former with the alouattine Alouatta, while the limited Lund material fits more comfortably with the ateline clade. Therefore, we propose to limit P. brasiliensis Lund to the distal humerus and proximal femur from Lagoa Santa and erect a new genus and species for the skeleton from Toca da Boa Vista. Cartelles coimbrafilhoi was a large-bodied frugivore with a relatively small brain and diverse locomotor repertoire including both suspension and climbing that expands the range of platyrrhine biodiversity beyond the dimensions of the living neotropical primates. Copyright © 2013 Elsevier Ltd. All rights reserved.

Surgical anatomy of the radial nerve at the elbow.

PubMed

Artico, M; Telera, S; Tiengo, C; Stecco, C; Macchi, V; Porzionato, A; Vigato, E; Parenti, A; De Caro, R

2009-02-01

An anatomical study of the brachial portion of the radial nerve with surgical implications is proposed. Thirty specimens of arm from 20 fresh cadavers (11 male, 9 female) were used to examine the topographical relations of the radial nerve with reference to the following anatomical landmarks: acromion angle, medial and lateral epicondyles, point of division between the lateral and long heads of the triceps brachii, lateral intermuscular septum, site of division of the radial nerve into its superficial and posterior interosseous branches and entry and exit point of the posterior interosseous branch into the supinator muscle. The mean distances between the acromion angle and the medial and lateral levels of crossing the posterior aspect of the humerus were 109 (+/-11) and 157 (+/-11) mm, respectively. The mean length and calibre of the nerve in the groove were 59 (+/-4) and 6 (+/-1) mm, respectively. The division of the lateral and long heads of the triceps was found at a mean distance of 126 (+/-13) mm from the acromion angle. The mean distances between the lateral point of crossing the posterior aspect of the humerus and the medial and lateral epicondyles were 125 (+/-13) and 121 (+/-13) mm, respectively. The mean distance between the lateral point of crossing the posterior aspect of the humerus and the entry point in the lateral intermuscular septum (LIS) was 29 (+/-6) mm. The mean distances between the entry point of the nerve in the LIS and the medial and lateral epicondyles were 133 (+/-14) and 110 (+/-23) mm, respectively. Our study provides reliable and objective data of surgical anatomy of the radial nerve which should be always kept in mind by surgeons approaching to the surgery of the arm, in order to avoid iatrogenic injuries.

Effects of humerus intraosseous versus intravenous amiodarone administration in a hypovolemic porcine model.

PubMed

Holloway, Cpt Monica M; Jurina, Cpt Shannan L; Orszag, Cpt Joshua D; Bragdon, Lt George R; Green, Lt Rustin D; Garcia-Blanco, Jose C; Benham, Brian E; Adams, Ltc Timothy S; Johnson, Don

2016-01-01

To compare the effects of amiodarone administration by humerus intraosseous (HIO) and intravenous (IV) routes on return of spontaneous circulation (ROSC), time to maximum concentration (Tmax), maximum plasma drug concentration (Cmax), time to ROSC, and mean concentrations over time in a hypovolemic cardiac arrest model. Prospective, between subjects, randomized experimental design. TriService Research Facility. Yorkshire-cross swine (n = 28). Swine were anesthetized and placed into cardiac arrest. After 2 minutes, cardiopulmonary resuscitation was initiated. After an additional 2 minutes, amiodarone 300 mg was administered via the HIO or the IV route. Blood samples were collected over 5 minutes. The samples were analyzed using high-performance liquid chromatography tandem mass spectrometry. ROSC, Tmax, Cmax, time to ROSC, and mean concentrations over time. There was no difference in ROSC between the HIO and IV groups; each had five achieve ROSC and two that did not (p = 1). There was no difference in Tmax (p = 0.501) or in Cmax between HIO and IV groups (p = 0.232). Means ± standard deviations in seconds were 94.3 ± 78.3 compared to 115.7 ± 87.3 in the IV versus HIO groups, respectively. The mean ± standard deviation in nanograms per milliliter for the HIO was 49,041 ± 21,107 and 74,258 ± 33,176 for the IV group. There were no significant differences between the HIO and IV groups relative to time to ROSC (p = 0.220). A repeated analysis of variance indicated that there were no significant differences between the groups relative to concentrations over time (p > 0.05). The humerus intraosseous provides rapid and reliable access to administer life-saving medications during cardiac arrest.

Radiographic changes differ between two different short press-fit humeral stem designs in total shoulder arthroplasty.

PubMed

Denard, Patrick J; Noyes, Matthew P; Walker, J Brock; Shishani, Yousef; Gobezie, Reuben; Romeo, Anthony A; Lederman, Evan

2018-02-01

The purpose of this study was to compare the radiographic changes of the humerus in the short term after total shoulder arthroplasty with two different short-stem humeral components. The hypothesis was that there would be no difference in radiographic changes or functional outcome based on component type. A retrospective review was conducted of primary total shoulder arthroplasties performed with a short press-fit humeral component. Group A included a collarless humeral stem with an oval geometry and curved stem (Ascend or Ascend Flex; Wright Medical, Memphis, TN, USA). Group B included a humeral stem with a metaphyseal collar, rectangular geometry, and straight stem (Apex; Arthrex, Inc., Naples, FL, USA). Radiographic changes and functional outcome were evaluated at a minimum of 2 years postoperatively. There were 42 patients in group A and 35 patients in group B available for analysis. There was no difference in functional outcome between the groups. In group A, the mean total radiographic change score of the humerus was 3.9, with changes classified as low in 38% and high in 62%. In group B, the mean total radiographic change score of the humerus was 2.5, with changes classified as low in 77% and high in 23% (P < .001). Medial calcar osteolysis was present in 71% of group A compared with 28.5% of group B (P < .001). At short-term follow-up, there is no difference in functional outcome or revision between 2 different humeral stem designs. However, bone adaptive changes and the rate of medial calcar osteolysis are significantly different. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A geometric morphometrics comparative analysis of Neandertal humeri (epiphyses-fused) from the El Sidrón cave site (Asturias, Spain).

PubMed

Rosas, Antonio; Pérez-Criado, Laura; Bastir, Markus; Estalrrich, Almudena; Huguet, Rosa; García-Tabernero, Antonio; Pastor, Juan Francisco; de la Rasilla, Marco

2015-05-01

A new collection of 49,000 year old Neandertal fossil humeri from the El Sidrón cave site (Asturias, Spain) is presented. A total of 49 humeral remains were recovered, representing 10 left and 8 right humeri from adults, adolescents, and a juvenile (not included in the analyses). 3D geometric morphometric (GM) methods as well as classic anthropological variables were employed to conduct a broad comparative analysis by means of mean centroid size and shape comparisons, principal components analysis, and cluster studies. Due to the fragmentary nature of the fossils, comparisons were organized in independent analyses according to different humeral portions: distal epiphysis, diaphysis, proximal epiphysis, and the complete humerus. From a multivariate viewpoint, 3D-GM analyses revealed major differences among taxonomic groups, supporting the value of the humerus in systematic classification. Notably, the Australopithecus anamensis (KP-271) and Homo ergaster Nariokotome (KNM-WT 15000) distal humerus consistently clusters close to those of modern humans, which may imply a primitive condition for Homo sapiens morphology. Australopithecus specimens show a high degree of dispersion in the morphospace. The El Sidrón sample perfectly fits into the classic Neandertal pattern, previously described as having a relatively wide olecranon fossa, as well as thin lateral and medial distodorsal pillars. These characteristics were also typical of the Sima de los Huesos (Atapuerca) sample, African mid-Pleistocene Bodo specimen, and Lower Pleistocene TD6-Atapuerca remains and may be considered as a derived state. Finally, we hypothesize that most of the features thought to be different between Neandertals and modern humans might be associated with structural differences in the pectoral girdle and shoulder joint. Copyright © 2015 Elsevier Ltd. All rights reserved.

Comparison of three surgical treatment options for unicameral bone cysts in humerus.

PubMed

Mavčič, Blaž; Saraph, Vinay; Gilg, Magdalena M; Bergovec, Marko; Brecelj, Janez; Leithner, Andreas

2018-04-23

Treatment of unicameral bone cysts (UBC) in the humerus with drainage screws is scarcely reported in the literature. The aim of this retrospective study was to compare drainage screws and alternative treatment methods with respect to the number of required surgical procedures to achieve sufficient UBC healing, postoperative fractures/recurrences/complications, and radiological outcome. Medical archives of two tertiary orthopedic referral centers were screened for all patients who were treated surgically for humeral UBC in the period 1991-2015 with a histologically/cytologically confirmed diagnosis. Sex, age, all surgical procedures, fractures, complications, recurrences, and the final radiological outcome were compared between patients treated with drainage screws, elastic intramedullary nails, or curettage with optional grafting. The study included 106 operated patients with a mean age of 10.3 years, with a mean follow-up of 5.7 years. The average number of UBC-related surgical procedures in sex-matched and age-matched treatment groups was 2.7 with drainage screws, 2.8 with intramedullary nails, and 3.5 with curettage/grafting (P=0.54). Intramedullary nails (odds ratio 0.20) and older age (odds ratio for each year 0.83) predicted a lower risk of postoperative UBC recurrence. Patients with drainage screws had the highest UBC recurrence rates and the lowest rates of changed initial treatment method. There was no difference between the treatment groups in the postoperative fracture rate, complications, or the final radiological outcome. UBC treatment in the humerus therefore requires approximately three surgical procedures, irrespective of the treatment modality chosen. Adding an elastic intramedullary nail to a humeral UBC cyst may reduce recurrence risk and prevent further fractures. Level III - therapeutic retrospective comparative study.

Cost analysis of the surgical treatment of fractures of the proximal humerus: an evaluation of the determinants of cost and comparison of the institutional cost of treatment with the national tariff.

PubMed

Sabharwal, S; Carter, A W; Rashid, A; Darzi, A; Reilly, P; Gupte, C M

2016-02-01

The aims of this study were to estimate the cost of surgical treatment of fractures of the proximal humerus using a micro-costing methodology, contrast this cost with the national reimbursement tariff and establish the major determinants of cost. A detailed inpatient treatment pathway was constructed using semi-structured interviews with 32 members of hospital staff. Its content validity was established through a Delphi panel evaluation. Costs were calculated using time-driven activity-based costing (TDABC) and sensitivity analysis was performed to evaluate the determinants of cost The mean cost of the different surgical treatments was estimated to be £3282. Although this represented a profit of £1138 against the national tariff, hemiarthroplasty as a treatment choice resulted in a net loss of £952. Choice of implant and theatre staffing were the largest cost drivers. Operating theatre delays of more than one hour resulted in a loss of income Our findings indicate that the national tariff does not accurately represent the cost of treatment for this condition. Effective use of the operating theatre and implant discounting are likely to be more effective cost containment approaches than control of bed-day costs. This cost analysis of fractures of the proximal humerus reinforces the limitations of the national tariff within the English National Health Service, and underlines the importance of effective use of the operating theatre, as well as appropriate implant procurement where controlling costs of treatment is concerned. ©2016 The British Editorial Society of Bone & Joint Surgery.

A regression-based 3-D shoulder rhythm.

PubMed

Xu, Xu; Lin, Jia-hua; McGorry, Raymond W

2014-03-21

In biomechanical modeling of the shoulder, it is important to know the orientation of each bone in the shoulder girdle when estimating the loads on each musculoskeletal element. However, because of the soft tissue overlying the bones, it is difficult to accurately derive the orientation of the clavicle and scapula using surface markers during dynamic movement. The purpose of this study is to develop two regression models which predict the orientation of the clavicle and the scapula. The first regression model uses humerus orientation and individual factors such as age, gender, and anthropometry data as the predictors. The second regression model includes only the humerus orientation as the predictor. Thirty-eight participants performed 118 static postures covering the volume of the right hand reach. The orientation of the thorax, clavicle, scapula and humerus were measured with a motion tracking system. Regression analysis was performed on the Euler angles decomposed from the orientation of each bone from 26 randomly selected participants. The regression models were then validated with the remaining 12 participants. The results indicate that for the first model, the r(2) of the predicted orientation of the clavicle and the scapula ranged between 0.31 and 0.65, and the RMSE obtained from the validation dataset ranged from 6.92° to 10.39°. For the second model, the r(2) ranged between 0.19 and 0.57, and the RMSE obtained from the validation dataset ranged from 6.62° and 11.13°. The derived regression-based shoulder rhythm could be useful in future biomechanical modeling of the shoulder. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

The massive fossil humerus from the Oldowan horizon of Gombore I, Melka Kunture (Ethiopia, >1.39 Ma)

NASA Astrophysics Data System (ADS)

Di Vincenzo, Fabio; Rodriguez, Laura; Carretero, José Miguel; Collina, Carmine; Geraads, Denis; Piperno, Marcello; Manzi, Giorgio

2015-08-01

A well-preserved distal portion of a left humerus was discovered in 1976 during excavations directed by J. Chavaillon at the Gombore I site, in the Melka Kunture area (Ethiopia). The specimen, labelled Gombore IB-7594 (formally Melka Kunture 3, or MK3), was found in situ within unit 2 of level B, which is dated to >1.39 Ma and includes a rich Oldowan Paleolithic assemblage. Although MK3 has never been described in detail, it appeared in the literature several times and, from a taxonomic point of view, has been alternatively regarded as Homo, Australopithecus or Paranthropus. According to our analysis, MK3 exhibits a suite of features that fit the variability of the genus Homo and does not display any clear Australopithecus/Paranthropus affinity. Nevertheless, MK3 adds a great deal of variability to the genus Homo, at least as far as the Early Pleistocene fossil record is concerned. In particular, our quantitative approach, which combines traditional morphometric analyses and geometric morphometrics, highlights traits that are uncommon among the Plio-Pleistocene fossil record, while affinities with Mid-to-Late Pleistocene representatives of Homo are observed. In addition, the large size of MK3 suggests that this humerus belonged to an individual whose body weight approached 90 kg, far from the range of body size known for Homo representatives in the Early Pleistocene and as big as those of extant humans or even gorillas. We suggest that such peculiar features are of interest when regarded from an ecological perspective; thus, dimension and morphology of MK3 may be considered as an exaptation that became useful when early humans dispersed to high altitudes such as those of the upper Awash basin on the Ethiopian plateau, at heights above 2000 m.

The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF).

PubMed

Joeris, Alexander; Lutz, Nicolas; Blumenthal, Andrea; Slongo, Theddy; Audigé, Laurent

2017-04-01

Background and purpose - To achieve a common understanding when dealing with long bone fractures in children, the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO PCCF) was introduced in 2007. As part of its final validation, we present the most relevant fracture patterns in the upper extremities of a representative population of children classified according to the PCCF. Patients and methods - We included children and adolescents (0-17 years old) diagnosed with 1 or more long bone fractures between January 2009 and December 2011 at the university hospitals in Bern and Lausanne (Switzerland). Patient charts were retrospectively reviewed and fractures were classified from standard radiographs. Results - Of 2,292 upper extremity fractures in 2,203 children and adolescents, 26% involved the humerus and 74% involved the forearm. In the humerus, 61%, and in the forearm, 80% of single distal fractures involved the metaphysis. In adolescents, single humerus fractures were more often epiphyseal and diaphyseal fractures, and among adolescents radius fractures were more often epiphyseal fractures than in other age groups. 47% of combined forearm fractures were distal metaphyseal fractures. Only 0.7% of fractures could not be classified within 1 of the child-specific fracture patterns. Of the single epiphyseal fractures, 49% were Salter-Harris type-II (SH II) fractures; of these, 94% occurred in schoolchildren and adolescents. Of the metaphyseal fractures, 58% showed an incomplete fracture pattern. 89% of incomplete fractures affected the distal radius. Of the diaphyseal fractures, 32% were greenstick fractures. 24 Monteggia fractures occurred in pre-school children and schoolchildren, and 2 occurred in adolescents. Interpretation - The pattern of pediatric fractures in the upper extremity can be comprehensively described according to the PCCF. Prospective clinical studies are needed to determine its clinical relevance for treatment decisions and prognostication of outcome.

Diversity and evolution of the Confuciusornithidae: Evidence from a new 131-million-year-old specimen from the Huajiying Formation in NE China

NASA Astrophysics Data System (ADS)

Navalón, Guillermo; Meng, Qingjin; Marugán-Lobón, Jesús; Zhang, Yuguang; Wang, Baopeng; Xing, Hai; Liu, Di; Chiappe, Luis M.

2018-02-01

The Huajiying Formation contains the earliest deposits of the Jehol Biota, representing the world's second oldest avifauna. This avifauna includes the early confuciusornithid Eoconfuciusornis zhengi, the oldest occurrence of this clade and one of the earliest divergences of pygostylian birds. Although E. zhengi shows unique traits, the holotype's immature age makes comparisons with the better known Confuciusornis sanctus problematic. As a result, the taxonomic validity of E. zhengi is controversial. We describe a small, osteologically adult confuciusornithid from the same deposits as E. zhengi. The new fossil is most similar to E. zhengi but also shares traits with the stratigraphically younger Confuciusornis. The humerus of the new fossil is straighter and more slender, and bears a less dorsally-developed deltopectoral crest compared with similarly-sized and smaller specimens of Confuciusornis. The morphology of the humerus is intermediate between E. zhengi and Confuciusornis and its proximal portion is pierced by a small deltopectoral foramen, absent in the holotype of E. zhengi. However, this foramen is much smaller than in any other confuciusornithid. Shape analyses (geometric morphometrics) of the humerus of confuciusornithids of different ages and representatives of other basal avians and closely-related non-avian theropods supports our observations and indicate that the humeral differences between the holotype of E. zhengi and the new specimen are not easily explained as ontogenetic variation within a single species. However, the limited number of early confuciursornithids does not allow us to confidently interpret such differences as interspecific. Nonetheless, these analyses support the morphological distinctiveness of the early confuciusornithids from the Huajiying Formation and suggest a stepwise acquisition of the unique humeral morphology of Confuciusornithidae.

Limb lengthening in achondroplasia.

PubMed

Chilbule, Sanjay K; Dutt, Vivek; Madhuri, Vrisha

2016-01-01

Stature lengthening in skeletal dysplasia is a contentious issue. Specific guidelines regarding the age and sequence of surgery, methods and extent of lengthening at each stage are not uniform around the world. Despite the need for multiple surgeries, with their attendant complications, parents demanding stature lengthening are not rare, due to the social bias and psychological effects experienced by these patients. This study describes the outcome and complications of extensive stature lengthening performed at our center. Eight achondroplasic and one hypochondroplasic patient underwent bilateral transverse lengthening for tibiae, humeri and femora. Tibia lengthening was carried out using a ring fixator and bifocal corticotomy, while a monolateral pediatric limb reconstruction system with unifocal corticotomy was used for the femur and humerus. Lengthening of each bone segment, height gain, healing index and complications were assessed. Subgroup analysis was carried out to assess the effect of age and bone segment on the healing index. Nine patients aged five to 25 years (mean age 10.2 years) underwent limb lengthening procedures for 18 tibiae, 10 femora and 8 humeri. Four patients underwent bilateral lengthening of all three segments. The mean length gain for the tibia, femur and humerus was 15.4 cm (100.7%), 9.9 cm (52.8%) and 9.6 cm (77.9%), respectively. Healing index was 25.7, 25.6 and 20.6 days/cm, respectively, for the tibia, femur and humerus. An average of 33.3% height gain was attained. Lengthening of both tibia and femur added to projected height achieved as the 3(rd) percentile of standard height in three out of four patients. In all, 33 complications were encountered (0.9 complications per segment). Healing index was not affected by age or bone segment. Extensive limb lengthening (more than 50% over initial length) carries significant risk and should be undertaken only after due consideration.

The size of the supraspinatus outlet during elevation of the arm in the frontal and sagittal plane: a 3-D model study.

PubMed

Meskers, Carel G M; van der Helm, Frans C T; Rozing, Piet M

2002-05-01

To quantify the size of the supraspinatus outlet as it is dictated by both the three-dimensional geometry of the shoulder and the relative orientation of the humerus with respect to the scapula during motions of the arm. Previously obtained data of shoulder kinematics were brought into a geometrical model of the shoulder, derived from a cadaver study. Knowledge of the parameters dictating the size of the supraspinatus outlet is essential for a better understanding of the impingement syndrome of the shoulder. A geometrical model, based on fitting spheres to various anatomical items of the shoulder was derived from three-dimensional position data of the gleno-humeral joint and coraco-acromial arch of 32 cadaver shoulders. Kinematical data were collected from 10 healthy volunteers. The geometrical and kinematical data were combined to study the supraspinatus outlet during elevation of the humerus in the frontal and sagittal plane. No single geometry parameter correlated significantly with the initial size of the outlet. During arm elevation, the greater tuberosity was moved away from the coraco-acromial arch quite effectively resulting in narrowing of the outlet during elevation in the frontal plane from 60 degrees to 120 degrees only. Deviations from the average were quite substantial. This was caused by kinematical and especially geometrical variability. The size of the outlet is dictated by both the geometry and kinematics of the gleno-humeral joint. Assessment of the individual susceptibility to impingement requires three-dimensional viewing techniques including three-dimensional movements of both the scapula and humerus. Little is known about etiology and pathogenesis of various shoulder disorders such as the impingement syndrome. The supraspinatus outlet plays probably a key role. More knowledge on the architecture of the outlet is required for a better understanding.

Quantitative determination of selenium and mercury, and an ICP-MS semi-quantitative scan of other elements in samples of eagle tissues collected from the Pacific Northwest--Summer 2011

USGS Publications Warehouse

May, Thomas; Walther, Mike; Brumbaugh, William

2013-01-01

Eagle tissues from dead eagle carcasses were collected by U.S. Fish and Wildlife Service personnel at various locations in the Pacific Northwest as part of a study to document the occurrence of metal and metalloid contaminants. A group of 182 eagle tissue samples, consisting of liver, kidney, brain, talon, feather, femur, humerus, and stomach contents, were quantitatively analyzed for concentrations of selenium and mercury by atomic absorption techniques, and for other elements by semi-quantitative scan with an inductively coupled plasma-mass spectrometer. For the various tissue matrices analyzed by an ICP-MS semiquantitative scan, some elemental concentrations (micrograms per gram dry weight) were quite variable within a particular matrix; notable observations were as follows: lead concentrations ranged from 0.2 to 31 in femurs, 0.1 to 29 in humeri, 0.1 to 54 in talons, less than (<) 0.05 to 120 in livers, <0.05 to 34 in kidneys, and 0.05 to 8 in brains; copper concentrations ranged from 5 to 9 in feathers, 8 to 47 in livers, 7 to 43 in kidneys, and 7 to 28 in brains; cadmium concentrations ranged from 0.1 to 10 in kidneys. In stomach contents, concentrations of vanadium ranged from 0.08 to 5, chromium 2 to 34, manganese 1 to 57, copper 2 to 69, arsenic <0.05 to 6, rubidium 1 to 13, and barium <0.5 to 18. Selenium concentrations from highest to lowest based on the matrix mean were as follows: kidney, liver, feather, brain, stomach content, talon, femur, and humerus. For mercury, the highest to lowest concentrations were feather, liver, talon, brain, stomach content, femur, and humerus.

The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF)

PubMed Central

Joeris, Alexander; Lutz, Nicolas; Blumenthal, Andrea; Slongo, Theddy; Audigé, Laurent

2017-01-01

Background and purpose To achieve a common understanding when dealing with long bone fractures in children, the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO PCCF) was introduced in 2007. As part of its final validation, we present the most relevant fracture patterns in the upper extremities of a representative population of children classified according to the PCCF. Patients and methods We included children and adolescents (0–17 years old) diagnosed with 1 or more long bone fractures between January 2009 and December 2011 at the university hospitals in Bern and Lausanne (Switzerland). Patient charts were retrospectively reviewed and fractures were classified from standard radiographs. Results Of 2,292 upper extremity fractures in 2,203 children and adolescents, 26% involved the humerus and 74% involved the forearm. In the humerus, 61%, and in the forearm, 80% of single distal fractures involved the metaphysis. In adolescents, single humerus fractures were more often epiphyseal and diaphyseal fractures, and among adolescents radius fractures were more often epiphyseal fractures than in other age groups. 47% of combined forearm fractures were distal metaphyseal fractures. Only 0.7% of fractures could not be classified within 1 of the child-specific fracture patterns. Of the single epiphyseal fractures, 49% were Salter-Harris type-II (SH II) fractures; of these, 94% occurred in schoolchildren and adolescents. Of the metaphyseal fractures, 58% showed an incomplete fracture pattern. 89% of incomplete fractures affected the distal radius. Of the diaphyseal fractures, 32% were greenstick fractures. 24 Monteggia fractures occurred in pre-school children and schoolchildren, and 2 occurred in adolescents. Interpretation The pattern of pediatric fractures in the upper extremity can be comprehensively described according to the PCCF. Prospective clinical studies are needed to determine its clinical relevance for treatment decisions and prognostication of outcome. PMID:27882802

Morphology of the limbs in the semi-fossorial desert rodent species of Tympanoctomys (Octodontidae, Rodentia)

PubMed Central

Perez, M. Julieta; Barquez, Ruben M.; Diaz, M. Monica

2017-01-01

Abstract Here, a detailed description of the forelimbs and hindlimbs of all living species of the genus Tympanoctomys are presented. These rodents, highly adapted to desert environments, are semi-fossorial with capacity to move on the surface as well as to build burrows. The shape, structure, and size of the limbs are described. Contrary to what was expected for scratch digging semi-fossorial species, Tympanoctomys have slender humerus, radius and ulna; with narrow epicondyles of the humerus and short olecranon of the ulna with poorly developed processes. Following our descriptions, no intrageneric morphological variation regarding to the configuration of the limbs was detected, probably due to phylogenetic proximity, and not related to specific variations in response to different use of substrates or habits. The obtained results constitute a source of previously unpublished information as well as an important base for future analysis in different studies, such as morphometric, morpho-functional, or phylogenetic researches. PMID:29118644

Unusual localizations of unicameral bone cysts and aneurysmal bone cysts: A retrospective review of 451 cases.

PubMed

Aycan, Osman Emre; Çamurcu, İsmet Yalkın; Özer, Devrim; Arıkan, Yavuz; Kabukçuoğlu, Yavuz Selim

2015-06-01

Unicameral bone cysts (UBC) and aneurysmal bone cysts (ABC) are benign cystic lesions of bone which are easily diagnosed. However, unusual locations may lead to a false diagnosis. Therefore the aim of this retrospective study was to determine the frequency of unusual localizations. The authors studied 451 cases with histopathologically confirmed diagnosis of UBC or ABC, seen between 1981 and 2012. In the UBC group (352 cases) humerus, femur and calcaneus were found to be the most common sites, while acetabulum, scapula, scaphoid, lunatum, metacarpals, metatarsals, toe phalanges and ulna each accounted for less than 1%. In the ABC group (99 cases) the most common sites of involvement were femur, humerus and tibia, while finger phalanges, ilium, acetabulum, pubis, calcaneus, cuboid, and toe phalanges each accounted for only 1%. The differential diagnosis of cystic bone lesions should include both UBC and ABC. Pain complaints plead for the latter, except in case of fracture.

The role of total elbow arthroplasty in traumatology.

PubMed

Mansat, P; Bonnevialle, N; Rongières, M; Bonnevialle, P

2014-10-01

Fractures of the distal humerus account for 5% of osteoporotic fractures in subjects older than 60 years. A history of osteoporosis, co-morbidities, and joint comminution make their management difficult. The therapeutic options are limited to functional treatments, osteosynthesis, or either partial or total arthroplasty. Functional treatment of distal humerus fractures in the elderly subject provide inconsistent results, often with persistence of pain with a stiff or unstable elbow. Osteosynthesis remains the reference treatment for these fractures, following the principle of stable and rigid osteosynthesis allowing early mobilization. However, joint comminution and a history of osteoporosis occasionally make it impossible to meet this objective, with a considerable rate of complications and surgical revisions. Total elbow arthroplasty remains an alternative to osteosynthesis with very satisfactory immediate results restoring a painless, stable, and functional elbow. These results seem reproducible and sustainable over time. The complication rate is not uncommon with an approximately 10% surgical revision rate. Elbow hemiarthroplasty remains to be validated in this indication. V. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Surgical anatomy of latissimus dorsi muscle in transfers about the shoulder.

PubMed

Goldberg, Benjamin A; Elhassan, Bassem; Marciniak, Steven; Dunn, Jonathan H

2009-03-01

Transfer of the latissimus dorsi to the greater tuberosity has been used successfully in the treatment of massive rotator-cuff deficiency. For safe release and transfer of the tendon, the variations in the tendinous insertions of the latissimus dorsi and teres major onto the humerus need to be understood. In anatomical dissection of 12 cadavers, mean width of the latissimus tendon was 3.3 cm at its insertion, and mean length was 7.3 cm. In all specimens, there were fascial connections between the latissimus and teres major and between the latissimus and the long head of the triceps. There were 3 insertion patterns of the latissimus dorsi tendon onto the humerus with respect to the tendon of the teres major: completely separate (8 cadavers), loosely bound (3 cadavers), and completely joined (1 cadaver). If the latissimus dorsi were being transferred in the last type, the teres major would need to be transferred with the latissimus dorsi as a common musculotendinous unit.

[Treatment of posttraumatic cubitus varus in children and adolescents. Supracondylar humeral osteotomy using radial external fixation].

PubMed

Slongo, T

2015-06-01

Precise adaptable fixation of a supracondylar humerus osteotomy with a radial/lateral external fixator to correct posttraumatic cubitus varus. Acquired, posttraumatic cubitus varus as a result of a malhealed and unsatisfactorily treated supracondylar humerus fracture. Idiopathic, congenital cubitus varus (very seldom) if the child (independent of age and after complete healing) is cosmetically impaired; stability of the elbow is reduced due to malalignment (hyperextension); secondary problems and pain (e. g., irritation of the ulnar nerve) are expected or already exist; or there is an explicit wish of the child/parents (relative indication). In principle there are no contraindications provided that the indication criteria are filled. The common argument of age does not represent a contraindication in our opinion, since angular remodeling at the distal end of the humerus is practically nonexistent. Basically, the surgical technique of the radial external fixator is used as previously described for stabilization of complex supracondylar humeral fractures. With the patient in supine position, the arm is placed freely on an arm table. Using a 4-5 cm long skin incision along the radial, supracondylar, the extracapsular part of the distal humerus is prepared, whereby great caution regarding the radial nerve is advised. In contrast to the procedure used in radial external fixation for supracondylar humeral fracture treatment, two Schanz screws are always fixed in each fragment at a distance of 1.5-2 cm. The osteotomy must allow the fragment to freely move in all directions. The proximal and distal two Schanz screws are then connected with short 4 mm carbon or stainless steel rods. These two rods are connected with each other over another rod using the tub-to-tub technique. Now the preliminary correction according the clinical situation can be performed and the clamps are tightened. Anatomical axis and function are checked. If these are radiologically and clinically perfect, all clamps are definitively tightened; if the alignment or the function is not perfect, then further adjustments can be made. Due to the excellent stability, further immobilization not necessary. Immediate functional follow-up treatment performed according to pain. Adequate healing is usually expected within 6 weeks. At this time the external fixator can be removed in the fracture clinic. Because the whole operation is performed in an extraarticular manner and the mobility of the elbow is not affected, deterioration of function has never been observed. Also regarding the cosmetic/anatomical situation, good results are expected because they were already achieved intraoperatively.

Genome sequencing of the extinct Eurasian wild aurochs illuminates the phylogeography and evolution of cattle

USDA-ARS?s Scientific Manuscript database

Interrogation of modern and ancient bovine genome sequences provides a valuable model to study the evolution of cattle. Here, we analyse the first complete wild aurochs (Bos primigenius) genome sequence using DNA extracted from a ~ 6,750 year-old humerus bone retrieved from a cave site in Derbyshire...

Epicondylitis in the athlete's elbow.

PubMed

Van Hofwegen, Christopher; Baker, Champ L; Baker, Champ L

2010-10-01

Epicondylitis is a diagnostic term that describes a pattern of pain and tenderness localized to the medial or lateral epicondyles of the distal humerus. The pathoanatomy, clinical presentation, and treatment of these disorders is described. Nonoperative treatment, operative techniques, postoperative care, and the results of treatment are discussed. Copyright © 2010 Elsevier Inc. All rights reserved.

Kinematic Constraints Associated with the Acquisition of Overarm Throwing Part II: Upper Extremity Actions

ERIC Educational Resources Information Center

Stodden, David F.; Langendorfer, Stephen J.; Fleisig, Glenn S.; Andrews, James R.

2006-01-01

The purposes of this study were to: (a) examine the differences within 11 specific kinematic variables and an outcome measure (ball velocity) associated with component developmental levels of humerus and forearm action (Roberton & Halverson, 1984), and (b) if the differences in kinematic variables were significantly associated with the differences…

Polycaprolactone/glass bioabsorbable implant in a rabbit humerus fracture model.

PubMed

Lowry, K J; Hamson, K R; Bear, L; Peng, Y B; Calaluce, R; Evans, M L; Anglen, J O; Allen, W C

1997-09-15

Research in improved materials and methods for internal fixation has centered on internal fixators made of bioabsorbable materials such as polylactic acid, polyglycolic acid, and polyparadioxanone. These materials have two problems: the first is a postoperative complication related to a delayed inflammatory response; and the second is low strength characteristics. An alternative material developed to alleviate these problems is a composite of phosphate glass fibers embedded in the polymer polycaprolactone, referred to as PCL. In this study, intramedullary pins made of PCL were compared to stainless steel pins in a rabbit humerus osteotomy model. Specimens were harvested at 0, 6, and 12 weeks postoperatively, radiographs and mechanical testing to failure were performed at each time interval, and tissue was examined microscopically at 6 and 12 weeks. Histologic results showed PCL pins to be well tolerated with minimal inflammation around the pin. Mechanical testing revealed the PCL fixation to be weaker initially than the stainless steel fixation. There was significant stress shielding of stainless-steel-healed rabbit humeri when compared to the PCL/bone humeri. All osteotomies immobilized with PCL healed with abundant periosteal callus production.

Continuous decompression with intramedullary nailing for the treatment of unicameral bone cysts.

PubMed

Masquijo, Julio Javier; Baroni, Eduardo; Miscione, Horacio

2008-08-01

To evaluate the efficacy of decompression of unicameral bone cysts (UBCs) of the long bones with intramedullary nailing and to compare responses to treatment according to location. We evaluated 48 consecutive patients treated between January 1988 and June 2000. Mean age was 10.3 years. Mean follow-up was 9.8 years. Evaluation was performed according to the radiographic criteria of Capanna. UBCs were located in the proximal humerus (n = 24), humeral shaft (n = 2), proximal femur (n = 19), distal tibia (n = 2) and fibula (n = 1). A total of 62.5% presented a pathological fracture. Successful results were observed in 89.5% (26 total healing, 17 healing with residual radiolucent areas), and there were four recurrences and, in one case, no response to treatment. There was more healing in the humerus than in the femur (92.3% versus 84.2%), and more tendency to restitution ad integrum, although the difference was not statistically significant (P = 0.1499). Intramedullary nailing is a minimally invasive method, which permits early stability and decompresses the cyst allowing healing. Significant differences were not observed among results from different locations.

Emerging Indications for Reverse Shoulder Arthroplasty.

PubMed

Urch, Ekaterina; Dines, Joshua S; Dines, David M

2016-01-01

Historically, reverse shoulder arthroplasty was reserved for older, low-demand patients in whom rotator cuff arthropathy was diagnosed. Other common indications included sequelae of previously treated proximal humerus fractures, failed anatomic total shoulder arthroplasty, tumor resection, and rheumatoid arthritis in the elderly population. Unpredictable implant durability and high complication rates have limited the use of reverse shoulder arthroplasty to a narrow group of patients. Over the past decade, however, research has led to an improved understanding of the biomechanics behind reverse shoulder prostheses, which has improved implant design and surgical techniques. Consequently, orthopaedic surgeons have slowly begun to expand the indications for reverse shoulder arthroplasty to include a wider spectrum of shoulder pathologies. Recent studies have shown promising results for patients who undergo reverse shoulder arthroplasty for the treatment of acute proximal humerus fractures, massive rotator cuff tears without arthropathy, primary osteoarthritis, and chronic anterior dislocation, as well as for younger patients who have rheumatoid arthritis. These data suggest that, with judicious patient selection, reverse shoulder arthroplasty can be an excellent treatment option for a growing patient cohort.

Anaplastic transformation of metastatic papillary thyroid carcinoma at shoulder mimicking soft tissue sarcoma.

PubMed

Kaushal, Seema; Sharma, Mehar Chand; Mathur, Sandeep R; Rastogi, Shishir; Bal, Chander Shekhar; Chumber, Sunil

2011-01-01

A 52-year-old woman presented with fracture upper end of the left humerus after trivial trauma and aspiration cytology from the lytic lesion in the upper humerus seen on X-ray revealed a metastatic papillary carcinoma from the thyroid. Total thyroidectomy confirmed the papillary carcinoma thyroid. Post-operatively, she was given radioactive iodine (I-131) ablation therapy for 8 years and was asymptomatic during this period; however, for the last 1 year, she has been complaining of swelling in the shoulder, which did not respond to palliative radiotherapy and rapidly increased in size. Disarticulation of the shoulder joint was performed, which showed anaplastic carcinoma on histopathological examination. Anaplastic transformation of papillary carcinoma at the metastatic sites is well documented in the literature and is rare. However, the same has not been reported at the shoulder and from India before. Although soft tissue sarcomas are most common at this site, however, the possibility of anaplastic transformation should be kept in the differential diagnosis of rapidly enlarging painful mass in a known case of metastatic thyroid carcinoma to prevent misdiagnosis.

On the importance of considering disease subtypes: Earliest detection of a parosteal osteosarcoma? Differential diagnosis of an osteosarcoma in an Anglo-Saxon female.

PubMed

Ferrante di Ruffano, Lavinia; Waldron, Tony

2016-12-30

A case of potentially dedifferentiated parosteal osteosarcoma was found in the proximal humerus of an adult female buried in the late Anglo-Saxon cemetery of Cherry Hinton, Cambridgeshire, UK. Key features include a large, dense, lobulated mass attached to the medial metaphysis of the proximal humerus by a broad-based attachment, accompanied by cortical destruction and widespread spiculated periosteal reaction. Radiographic images confirm medullary involvement, lack of continuity between the cortex and external mass, a radiolucent cleavage plane and possible radiolucent zones within the bony masses. Differential diagnoses considered include osteochondroma, myositis ossificans, fracture callus, as well as the primary malignancies of osteosarcoma and chondrosarcoma, and their various subtypes. The macroscopic and radiographic analysis of the tumor is described and discussed within clinical and paleopathological contexts. One of only 19 uncontested examples of osteosarcoma from past human populations, most of which remain unconfirmed, this case represents what we believe to be the earliest, and probably singular, bioarcheological example of parosteal osteosarcoma in human history. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Basic principles of fracture treatment in children.

PubMed

Ömeroğlu, Hakan

2018-04-01

This review aims to summarize the basic treatment principles of fractures according to their types and general management principles of special conditions including physeal fractures, multiple fractures, open fractures, and pathologic fractures in children. Definition of the fracture is needed for better understanding the injury mechanism, planning a proper treatment strategy, and estimating the prognosis. As the healing process is less complicated, remodeling capacity is higher and non-union is rare, the fractures in children are commonly treated by non-surgical methods. Surgical treatment is preferred in children with multiple injuries, in open fractures, in some pathologic fractures, in fractures with coexisting vascular injuries, in fractures which have a history of failed initial conservative treatment and in fractures in which the conservative treatment has no/little value such as femur neck fractures, some physeal fractures, displaced extension and flexion type humerus supracondylar fractures, displaced humerus lateral condyle fractures, femur, tibia and forearm shaft fractures in older children and adolescents and unstable pelvis and acetabulum fractures. Most of the fractures in children can successfully be treated by non-surgical methods.

Articular scaling and body mass estimation in platyrrhines and catarrhines: Modern variation and application to fossil anthropoids.

PubMed

Perry, Jonathan M G; Cooke, Siobhán B; Runestad Connour, Jacqueline A; Burgess, M Loring; Ruff, Christopher B

2018-02-01

Body mass is an important component of any paleobiological reconstruction. Reliable skeletal dimensions for making estimates are desirable but extant primate reference samples with known body masses are rare. We estimated body mass in a sample of extinct platyrrhines and Fayum anthropoids based on four measurements of the articular surfaces of the humerus and femur. Estimates were based on a large extant reference sample of wild-collected individuals with associated body masses, including previously published and new data from extant platyrrhines, cercopithecoids, and hominoids. In general, scaling of joint dimensions is positively allometric relative to expectations of geometric isometry, but negatively allometric relative to expectations of maintaining equivalent joint surface areas. Body mass prediction equations based on articular breadths are reasonably precise, with %SEEs of 17-25%. The breadth of the distal femoral articulation yields the most reliable estimates of body mass because it scales similarly in all major anthropoid taxa. Other joints scale differently in different taxa; therefore, locomotor style and phylogenetic affinity must be considered when calculating body mass estimates from the proximal femur, proximal humerus, and distal humerus. The body mass prediction equations were applied to 36 Old World and New World fossil anthropoid specimens representing 11 taxa, plus two Haitian specimens of uncertain taxonomic affinity. Among the extinct platyrrhines studied, only Cebupithecia is similar to large, extant platyrrhines in having large humeral (especially distal) joints. Our body mass estimates differ from each other and from published estimates based on teeth in ways that reflect known differences in relative sizes of the joints and teeth. We prefer body mass estimators that are biomechanically linked to weight-bearing, and especially those that are relatively insensitive to differences in locomotor style and phylogenetic history. Whenever possible, extant reference samples should be chosen to match target fossils in joint proportionality. Copyright © 2017 Elsevier Ltd. All rights reserved.

Treatment of a Simple Bone Cyst Using a Cannulated Hydroxyapatite Pin

PubMed Central

Shirai, Toshiharu; Tsuchiya, Hiroyuki; Terauchi, Ryu; Tsuchida, Shinji; Mizoshiri, Naoki; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Miwa, Shinji; Kimura, Hiroaki; Takeuchi, Akihiko; Hayashi, Katsuhiro; Yamamoto, Norio; Kubo, Toshikazu

2015-01-01

Abstract Simple bone cysts (SBCs) are benign bone tumors. However, the treatment of SBCs remains controversial because of their healing rate and the invasiveness of surgery. The purpose of the present study was to evaluate the treatment of SBCs using a cannulated hydroxyapatite (HA) pin. A total of 43 patients (35 males, 8 females; mean age 12.1 years; age range, 5–22 years) with SBCs were treated with continuous decompression by inserting ceramic HA pins between 1989 and 2014. The SBCs were located in the calcaneus in 23, the humerus in 15, the femur in 3, and the pelvis in 2 cases. In all patients, minimal fenestration of the cyst wall and curettage and multiple drilling in the cyst wall were performed, followed by insertion of the HA pin. The mean follow-up period was 26.6 months. Operating time, healing period, risk factors for recurrence, and the cure rate were evaluated. Healing was achieved without intervention in 38 patients after a mean of 6.4 months. Two patients had persistent small residual cysts, which had no changes after 1 year at the latest follow-up. There were 5 patients with recurrences (humerus 4, femur 1), who were cured by curettage and artificial bone grafting. The final healing rate by cannulation only using an HA pin was 88.2%. On Fisher exact test, age, site of SBCs, and distance from the physis were found to be significantly associated with SBC recurrence (P < 0.05). In the present study, cannulation using an HA pin for SBCs was found to be a useful technique, particularly for calcaneal cysts, because it is a minimally invasive procedure with a high cure rate. In patients <10 years, involvement of the humerus and contact with the growth plate were significant risk factors for SBC recurrence. PMID:26107670

Functional outcomes of "floating elbow" injuries in adult patients.

PubMed

Yokoyama, K; Itoman, M; Kobayashi, A; Shindo, M; Futami, T

1998-05-01

To assess elbow function, complications, and problems of floating elbow fractures in adults receiving surgical treatment. Retrospective clinical review. Level I trauma center in Kanagawa, Japan. Fourteen patients with fifteen floating elbow injuries, excluding one immediate amputation, seen at the Kitasato University Hospital from January 1, 1984, to April 30, 1995. All fractures were managed surgically by various methods. In ten cases, the humeral and forearm fractures were treated simultaneously with immediate fixation. In three cases, both the humeral and forearm fractures were treated with delayed fixation on Day 1, 4, or 7. In the remaining two cases, the open forearm fracture was managed with immediate fixation and the humerus fracture with delayed fixation on Day 10 or 25. All subjects underwent standardized elbow evaluations, and results were compared with an elbow score based on a 100-point scale. The parameters evaluated were pain, motion, elbow and grip strength, and function during daily activities. Complications such as infections, nonunions, malunions, and refractures were investigated. Mean follow-up was forty-three months (range 13 to 112 months). At final follow-up, the mean elbow function score was 79 points, with 67 percent (ten of fifteen) of the subjects having good or excellent results. The functional outcome did not correlate with the Injury Severity Score of the individual patients, the existence of open injuries or neurovascular injuries, or the timing of surgery. There were one deep infection, two nonunions of the humerus, two nonunions of the forearm, one varus deformity of the humerus, and one forearm refracture. Based on the present data, we could not clarify the factors influencing the final functional outcome after floating elbow injury. These injuries, however, potentially have many complications, such as infection or nonunion, especially when there is associated brachial plexus injury. We consider that floating elbow injuries are severe injuries and that surgical stabilization is needed; beyond that, there are no specific forms of surgical treatment to reliably guarantee excellent results.

Limb lengthening in achondroplasia

PubMed Central

Chilbule, Sanjay K; Dutt, Vivek; Madhuri, Vrisha

2016-01-01

Background: Stature lengthening in skeletal dysplasia is a contentious issue. Specific guidelines regarding the age and sequence of surgery, methods and extent of lengthening at each stage are not uniform around the world. Despite the need for multiple surgeries, with their attendant complications, parents demanding stature lengthening are not rare, due to the social bias and psychological effects experienced by these patients. This study describes the outcome and complications of extensive stature lengthening performed at our center. Materials and Methods: Eight achondroplasic and one hypochondroplasic patient underwent bilateral transverse lengthening for tibiae, humeri and femora. Tibia lengthening was carried out using a ring fixator and bifocal corticotomy, while a monolateral pediatric limb reconstruction system with unifocal corticotomy was used for the femur and humerus. Lengthening of each bone segment, height gain, healing index and complications were assessed. Subgroup analysis was carried out to assess the effect of age and bone segment on the healing index. Results: Nine patients aged five to 25 years (mean age 10.2 years) underwent limb lengthening procedures for 18 tibiae, 10 femora and 8 humeri. Four patients underwent bilateral lengthening of all three segments. The mean length gain for the tibia, femur and humerus was 15.4 cm (100.7%), 9.9 cm (52.8%) and 9.6 cm (77.9%), respectively. Healing index was 25.7, 25.6 and 20.6 days/cm, respectively, for the tibia, femur and humerus. An average of 33.3% height gain was attained. Lengthening of both tibia and femur added to projected height achieved as the 3rd percentile of standard height in three out of four patients. In all, 33 complications were encountered (0.9 complications per segment). Healing index was not affected by age or bone segment. Conclusion: Extensive limb lengthening (more than 50% over initial length) carries significant risk and should be undertaken only after due consideration. PMID:27512222

A new anchor augmentation technique with a cancellous screw in osteoporotic rotator cuff repair: an in vitro biomechanical study on sheep humerus specimens.

PubMed

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 < .0001). The mean pullout strength was 121.1 ± 10.17 N in the non-augmented group and 176.1 ± 10.34 N in the augmented group. The described augmentation technique, which is achieved by inferior-lateral fixation of 1 of the sutures of the double-loaded 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.

Expected lifetime numbers, risks, and burden of osteoporotic fractures for 50-year old Chinese women: a discrete event simulation incorporating FRAX.

PubMed

Jiang, Yawen; Ni, Weiyi

2016-11-01

This work was undertaken to provide an estimation of expected lifetime numbers, risks, and burden of fractures for 50-year-old Chinese women. A discrete event simulation model was developed to simulate the lifetime fractures of 50-year-old Chinese women at average risk of osteoporotic fracture. Main events in the model included hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, and other fracture. Fracture risks were calculated using the FRAX ® tool. Simulations of 50-year-old Chinese women without fracture risks were also carried out as a comparison to determine the burden of fractures. A 50-year-old Chinese woman at average risk of fracture is expected to experience 0.135 (95 % CI: 0.134-0.137) hip fractures, 0.120 (95 % CI: 0.119-0.122) clinical vertebral fractures, 0.095 (95 % CI: 0.094-0.096) wrist fractures, 0.079 (95 % CI: 0.078-0.080) humerus fractures, and 0.407 (95 % CI: 0.404-0.410) other fractures over the remainder of her life. The residual lifetime risk of any fracture, hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, and other fracture for a 50-year-old Chinese woman is 37.36, 11.77, 10.47, 8.61, 7.30, and 27.80 %, respectively. The fracture-attributable excess quality-adjusted life year (QALY) loss and lifetime costs are estimated at 0.11 QALYs (95 % CI: 0.00-0.22 QALYs) and US $714.61 (95 % CI: US $709.20-720.02), totaling a net monetary benefit loss of US $1,104.43 (95 % CI: US $904.09-1,304.78). Chinese women 50 years of age are at high risk of osteoporotic fracture, and the expected economic and quality-of-life burden attributable to osteoporotic fractures among Chinese women is substantial.

A quantitative method for evaluating inferior glenohumeral joint stiffness using ultrasonography.

PubMed

Tsai, Wen-Wei; Lee, Ming-Yih; Yeh, Wen-Lin; Cheng, Shih-Chung; Soon, Kok-Soon; Lei, Kin Fong; Lin, Wen-Yen

2013-02-01

Subluxation of the affected shoulder in post-stroke patients is associated with nerve disorders and muscle fatigue. Clinicians must be able to accurately and reliably measure inferior glenohumeral subluxation in patients to provide appropriate treatment. However, quantitative methods for evaluating the laxity and stiffness of the glenohumeral joint (GHJ) are still being developed. The aim of this study was to develop a new protocol for evaluating the laxity and stiffness of the inferior GHJ using ultrasonography under optimal testing conditions and to investigate changes in the GHJ from a commercially available humerus brace and shoulder brace. Multistage inferior displacement forces were applied to create a glide between the most cephalad point on the visible anterosuperior surface of the humeral head and coracoid process in seven healthy volunteers. GHJ stiffness was defined as the slope of the linear regression line between the glides and different testing loads. The testing conditions were defined by different test loading mechanisms (n=2), shoulder constraining conditions (n=2), and loading modes (n=4). The optimal testing condition was defined as the condition with the least residual variance of measured laxity to the calculated stiffness under different testing loads. A paired t-test was used to compare the laxity and stiffness of the inferior GHJ using different braces. No significant difference was identified between the two test loading mechanisms (t=0.218, p=0.831) and two shoulder constraining conditions (t=-0.235, p=0.818). We concluded that ultrasonographic laxity measurements performed using a pulley set loading mechanism was as reliable as direct loading. Additionally, constraining the unloaded shoulder was proposed due to the lower mean residual variance value. Moreover, pulling the elbow downward with loading on the upper arm was suggested, as pulling the elbow downward with the elbow flexed and loading on the forearm may overestimate stiffness and pain in the inferior GHJ at the loading point due to friction between the wide belt and skin. Furthermore, subjects wearing a humerus brace with a belt, which creates the effect of lifting the humerus toward the acromion, had greater GHJ stiffness compared to subjects wearing a shoulder brace without a belt to lift the humerus under the proposed testing conditions. This study provides experimental evidence that shoulder braces may reduce GHJ laxity under an external load, implying that the use of a humeral brace can prevent subluxation in post-stroke patients. The resulting optimal testing conditions for measuring the laxity and stiffness of the GHJ is to constrain the unloaded shoulder and bend the loaded arm at the elbow with loading on the upper arm using a pulley system. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.

21 CFR 888.3000 - Bone cap.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Bone cap. 888.3000 Section 888.3000 Food and Drugs... ORTHOPEDIC DEVICES Prosthetic Devices § 888.3000 Bone cap. (a) Identification. A bone cap is a mushroom... polyethylene. It is used to cover the severed end of a long bone, such as the humerus or tibia, to control bone...

21 CFR 888.3000 - Bone cap.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bone cap. 888.3000 Section 888.3000 Food and Drugs... ORTHOPEDIC DEVICES Prosthetic Devices § 888.3000 Bone cap. (a) Identification. A bone cap is a mushroom... polyethylene. It is used to cover the severed end of a long bone, such as the humerus or tibia, to control bone...

21 CFR 888.3000 - Bone cap.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Bone cap. 888.3000 Section 888.3000 Food and Drugs... ORTHOPEDIC DEVICES Prosthetic Devices § 888.3000 Bone cap. (a) Identification. A bone cap is a mushroom... polyethylene. It is used to cover the severed end of a long bone, such as the humerus or tibia, to control bone...

21 CFR 888.3000 - Bone cap.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Bone cap. 888.3000 Section 888.3000 Food and Drugs... ORTHOPEDIC DEVICES Prosthetic Devices § 888.3000 Bone cap. (a) Identification. A bone cap is a mushroom... polyethylene. It is used to cover the severed end of a long bone, such as the humerus or tibia, to control bone...

21 CFR 888.3000 - Bone cap.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Bone cap. 888.3000 Section 888.3000 Food and Drugs... ORTHOPEDIC DEVICES Prosthetic Devices § 888.3000 Bone cap. (a) Identification. A bone cap is a mushroom... polyethylene. It is used to cover the severed end of a long bone, such as the humerus or tibia, to control bone...

Malignant transformation of a unicameral bone cyst in a cat.

PubMed

Berger, Björn; Brühschwein, Andreas; Eddicks, Lina; Meyer-Lindenberg, Andrea

2016-04-01

A unicameral bone cyst in the proximal humerus of a 3-year-old Norwegian forest cat was diagnosed by dynamic contrast-enhanced magnetic resonance imaging, surgical exploration, and histopathology. Surgical curettage and incorporation of bone cement led to full recovery. An osteosarcoma developed at the surgical site 17 months later. Thoracic radiographs showed pulmonary lesions consistent with metastasis.

Malignant transformation of a unicameral bone cyst in a cat

PubMed Central

Berger, Björn; Brühschwein, Andreas; Eddicks, Lina; Meyer-Lindenberg, Andrea

2016-01-01

A unicameral bone cyst in the proximal humerus of a 3-year-old Norwegian forest cat was diagnosed by dynamic contrast-enhanced magnetic resonance imaging, surgical exploration, and histopathology. Surgical curettage and incorporation of bone cement led to full recovery. An osteosarcoma developed at the surgical site 17 months later. Thoracic radiographs showed pulmonary lesions consistent with metastasis. PMID:27041754

Humeral windows in revision total elbow arthroplasty.

PubMed

Peach, Chris A; Salama, Amir; Stanley, David

2016-04-01

The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery.

Assessment of modified gold surfaced titanium implants on skeletal fixation

PubMed Central

Zainali, Kasra; Danscher, Gorm; Jakobsen, Thomas; Baas, Jorgen; Møller, Per; Bechtold, Joan E.; Soballe, Kjeld

2013-01-01

Noncemented implants are the primary choice for younger patients undergoing total hip replacements. However, the major concern in this group of patients regarding revision is the concern from wear particles, periimplant inflammation, and subsequently aseptic implant loosening. Macrophages have been shown to liberate gold ions through the process termed dissolucytosis. Furthermore, gold ions are known to act in an anti-inflammatory manner by inhibiting cellular NF-κB-DNA binding. The present study investigated whether partial coating of titanium implants could augment early osseointegration and increase mechanical fixation. Cylindrical porous coated Ti-6Al-4V implants partially coated with metallic gold were inserted in the proximal region of the humerus in ten canines and control implants without gold were inserted in contralateral humerus. Observation time was 4 weeks. Biomechanical push out tests and stereological histomorphometrical analyses showed no statistically significant differences in the two groups. The unchanged parameters are considered an improvement of the coating properties, as a previous complete gold-coated implant showed inferior mechanical fixation and reduced osseointegration compared to control titanium implants in a similar model. Since sufficient early mechanical fixation is achieved with this new coating, it is reasonable to investigate the implant further in long-term studies. PMID:22847873

Effects of spaceflight on rat humerus geometry, biomechanics, and biochemistry.

PubMed

Vailas, A C; Zernicke, R F; Grindeland, R E; Kaplansky, A; Durnova, G N; Li, K C; Martinez, D A

1990-01-01

The effects of a 12.5-day spaceflight (Cosmos 1887 biosatellite) on the geometric, biomechanical, and biochemical characteristics of humeri of male specific pathogen-free rats were examined. Humeri of age-matched basal control, synchronous control, and vivarium control rats were contrasted with the flight bones to examine the influence of growth and space environment on bone development. Lack of humerus longitudinal growth occurred during the 12.5 days in spaceflight. In addition, the normal mid-diaphysial periosteal appositional growth was affected; compared with their controls, the spaceflight humeri had less cortical cross-sectional area, smaller periosteal circumferences, smaller anterior-posterior periosteal diameters, and smaller second moments of area with respect to the bending and nonbending axes. The flexural rigidity of the flight humeri was comparable to that of the younger basal control rats and significantly less than that of the synchronous and vivarium controls; the elastic moduli of all four groups, nonetheless, were not significantly different. Generally, the matrix biochemistry of the mid-diaphysial cross sections showed no differences among groups. Thus, the spaceflight differences in humeral mechanical strength and flexural rigidity were probably a result of the differences in humeral geometry rather than material properties.

A small azhdarchoid pterosaur from the latest Cretaceous, the age of flying giants.

PubMed

Martin-Silverstone, Elizabeth; Witton, Mark P; Arbour, Victoria M; Currie, Philip J

2016-08-01

Pterosaur fossils from the Campanian-Maastrichtian of North America have been reported from the continental interior, but few have been described from the west coast. The first pterosaur from the Campanian Northumberland Formation (Nanaimo Group) of Hornby Island, British Columbia, is represented here by a humerus, dorsal vertebrae (including three fused notarial vertebrae), and other fragments. The elements have features typical of Azhdarchoidea, an identification consistent with dominance of this group in the latest Cretaceous. The new material is significant for its size and ontogenetic stage: the humerus and vertebrae indicate a wingspan of ca 1.5 m, but histological sections and bone fusions indicate the individual was approaching maturity at time of death. Pterosaurs of this size are exceedingly rare in Upper Cretaceous strata, a phenomenon commonly attributed to smaller pterosaurs becoming extinct in the Late Cretaceous as part of a reduction in pterosaur diversity and disparity. The absence of small juveniles of large species-which must have existed-in the fossil record is evidence of a preservational bias against small pterosaurs in the Late Cretaceous, and caution should be applied to any interpretation of latest Cretaceous pterosaur diversity and success.

Effects of spaceflight on rat humerus geometry, biomechanics, and biochemistry

NASA Technical Reports Server (NTRS)

Vailas, A. C.; Zernicke, R. F.; Grindeland, R. E.; Kaplansky, A.; Durnova, G. N.; Li, K. C.; Martinez, D. A.

1990-01-01

The effects of a 12.5-day spaceflight (Cosmos 1887 biosatellite) on the geometric, biomechanical, and biochemical characteristics of humeri of male specific pathogen-free rats were examined. Humeri of age-matched basal control, synchronous control, and vivarium control rats were contrasted with the flight bones to examine the influence of growth and space environment on bone development. Lack of humerus longitudinal growth occurred during the 12.5 days in spaceflight. In addition, the normal mid-diaphysial periosteal appositional growth was affected; compared with their controls, the spaceflight humeri had less cortical cross-sectional area, smaller periosteal circumferences, smaller anterior-posterior periosteal diameters, and smaller second moments of area with respect to the bending and nonbending axes. The flexural rigidity of the flight humeri was comparable to that of the younger basal control rats and significantly less than that of the synchronous and vivarium controls; the elastic moduli of all four groups, nonetheless, were not significantly different. Generally, the matrix biochemistry of the mid-diaphysial cross sections showed no differences among groups. Thus, the spaceflight differences in humeral mechanical strength and flexural rigidity were probably a result of the differences in humeral geometry rather than material properties.

Allograft-prosthetic composite reverse total shoulder arthroplasty for reconstruction of proximal humerus tumor resections.

PubMed

King, Joseph J; Nystrom, Lukas M; Reimer, Nickolas B; Gibbs, C Parker; Scarborough, Mark T; Wright, Thomas W

2016-01-01

Proximal humerus reconstructions after resection of tumors are challenging. Early success of the reverse shoulder arthroplasty for reconstructions has recently been reported. The reverse allograft-prosthetic composite offers the advantage of improved glenohumeral stability compared with hemiarthroplasty for proximal humeral reconstructions as it uses the deltoid for stability. This article describes the technique for treating proximal humeral tumors, including preoperative planning, biopsy principles, resection pearls, soft tissue tensioning, and specifics about reconstruction using the reverse allograft-prosthetic composite. Two cases are presented along with the functional outcomes with use of this technique. Biomechanical considerations during reconstruction are reviewed, including techniques to improve the deltoid compression force. Reported instability rates are less with reverse shoulder arthroplasty reconstruction as opposed to hemiarthroplasty or total shoulder arthroplasty reconstructions of tumor resections. Reported functional outcomes are promising for the reverse allograft-prosthetic composite reconstructions, although complications are reported. Reverse allograft-prosthetic composites are a promising option for proximal humeral reconstructions, although nonunion of the allograft-host bone junction continues to be a challenge for this technique. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Massive subacromial-subdeltoid bursitis with rice bodies secondary to an orthopedic implant.

PubMed

Urruela, Adriana M; Rapp, Timothy B; Egol, Kenneth A

2012-09-01

Both early and late complications following open reduction and internal fixation of proximal humerus fractures have been reported extensively in the literature. Although orthopedic implants are known to cause irritation and inflammation, to our knowledge, this is the first case report to describe a patient with rice bodies secondary to an orthopedic implant. Although the etiology of rice bodies is unclear, histological studies reveal that they are composed of an inner amorphous core surrounded by collagen and fibrin. The differential diagnosis in this case included synovial chondromatosis, infection, and the formation of a malignant tumor. Additional imaging studies, such as magnetic resonance imaging, and more specific tests were necessary to differentiate the rice bodies due to bursitis versus neoplasm, prior to excision. The patient presented 5 years following open reduction and internal fixation of a displaced proximal humerus fracture, with swelling in the area of the previous surgical site. Examination revealed a large, painless tumor-like mass on the anterior aspect of the shoulder. The patient's chief concern was the unpleasant aesthetic of the mass; no pain was reported. Upon excision of the mass, the patient's full, painless range of motion returned.

Testing convergent and parallel adaptations in talpids humeral mechanical performance by means of geometric morphometrics and finite element analysis.

PubMed

Piras, P; Sansalone, G; Teresi, L; Kotsakis, T; Colangelo, P; Loy, A

2012-07-01

The shape and mechanical performance in Talpidae humeri were studied by means of Geometric Morphometrics and Finite Element Analysis, including both extinct and extant taxa. The aim of this study was to test whether the ability to dig, quantified by humerus mechanical performance, was characterized by convergent or parallel adaptations in different clades of complex tunnel digger within Talpidae, that is, Talpinae+Condylura (monophyletic) and some complex tunnel diggers not belonging to this clade. Our results suggest that the pattern underlying Talpidae humerus evolution is evolutionary parallelism. However, this insight changed to true convergence when we tested an alternative phylogeny based on molecular data, with Condylura moved to a more basal phylogenetic position. Shape and performance analyses, as well as specific comparative methods, provided strong evidence that the ability to dig complex tunnels reached a functional optimum in distantly related taxa. This was also confirmed by the lower phenotypic variance in complex tunnel digger taxa, compared to non-complex tunnel diggers. Evolutionary rates of phenotypic change showed a smooth deceleration in correspondence with the most recent common ancestor of the Talpinae+Condylura clade. Copyright © 2012 Wiley Periodicals, Inc.

Unicameral Bone Cyst of the Medial Cuneiform.

PubMed

Schick, Faith A; Daniel, Joseph N; Miller, Juliane S

2016-09-02

A unicameral bone cyst is a relatively uncommon, benign bone tumor found in the metaphysis of long bones, such as the humerus and the femur, in skeletally immature persons. In the foot, these benign, fluid-filled cavities are most commonly found within the os calcis. We present a case report of a 10-year-old female with a unicameral bone cyst of the medial cuneiform.

Unicameral Bone Cyst of the Medial Cuneiform: A Case Report.

PubMed

Schick, Faith A; Daniel, Joseph N; Miller, Juliane S

2016-02-17

A unicameral bone cyst is a relatively uncommon, benign bone tumor found in the metaphysis of long bones, such as the humerus and the femur, in skeletally immature persons. In the foot, these benign, fluid-filled cavities are most commonly found within the os calcis. We present a case report of a 10-year-old female with a unicameral bone cyst of the medial cuneiform.

Differentiating Stress Fracture From Periostitis.

PubMed

Martire, J R

1994-10-01

In brief Even in the age of high-technology MRI and CT, the triple-phase bone scan (TPBS) remains an exceptionally useful and accurate tool in evaluating athletic injuries. This is perhaps best seen in active people with overuse injuries of the tibia, femur, or humerus when plain films are negative but bone pain persists. Differentiating periostitis from stress fracture requires analyzing distinctive TPBS appearances and patterns.

Biomechanical effect of the configuration of screw hole style on locking plate fixation in proximal humerus fracture with a simulated gap: A finite element analysis.

PubMed

Zhang, Ya-Kui; Wei, Hung-Wen; Lin, Kang-Ping; Chen, Wen-Chuan; Tsai, Cheng-Lun; Lin, Kun-Jhih

2016-06-01

Locking plate fixation for proximal humeral fractures is a commonly used device. Recently, plate breakages were continuously reported that the implants all have a mixture of holes allowing placement of both locking and non-locking screws (so-called combi plates). In commercialized proximal humeral plates, there still are two screw hole styles included "locking and dynamic holes separated" and "locking hole only" configurations. It is important to understand the biomechanical effect of different screw hole style on the stress distribution in bone plate. Finite element method was employed to conduct a computational investigation. Three proximal humeral plate models with different screw hole configurations were reconstructed depended upon an identical commercialized implant. A three-dimensional model of a humerus was created using process of thresholding based on the grayscale values of the CT scanning of an intact humerus. A "virtual" subcapital osteotomy was performed. Simulations were performed under an increasing axial load. The von Mises stresses around the screw holes of the plate shaft, the construct stiffness and the directional displacement within the fracture gap were calculated for comparison. The mean value of the peak von Mises stresses around the screw holes in the plate shaft was the highest for combi hole design while it was smallest for the locking and dynamic holes separated design. The stiffness of the plate-bone construct was 15% higher in the locking screw only design (132.6N/mm) compared with the combi design (115.0N/mm), and it was 4% higher than the combi design for the locking and dynamic holes separated design (119.5N/mm). The displacement within the fracture gap was greatest in the combi hole design, whereas it was smallest for the locking hole only design. The computed results provide a possible explanation for the breakages of combi plates revealed in clinical reports. The locking and dynamic holes separated design may be a better configuration to reduce the risk of plate fracture. Copyright © 2016 Elsevier Ltd. All rights reserved.

Management of Cubitus Varus Deformity in Children by Closed Dome Osteotomy

PubMed Central

Kejariwal, Ujjwal; Singh, Bijendra

2017-01-01

Introduction Supracondylar fractures are the most common elbow injuries in skeletally immature children between 5-10 years of age and cubitus varus deformity is the most common late complication. Cubitus varus or bow elbow or gunstock deformity is the result of malunion occurring as a complication of supracondylar fracture of the humerus. Various type of corrective osteotomies are used of which lateral closed wedge French osteotomy is commomly used which has its own complications like lateral condylar prominence, unsightful scar and limitation of movement. Closed dome osteotomy is a technique which overcomes these complications. This surgery is done with simple readily available instruments in the orthopaedic operation theatre with no special requirements for instrumentation. Aim This study was done to study the results of closed dome osteotomy for correction of cubitus varus deformity, after malunited supracondylar fracture of humerus in children. Materials and Methods This study included 25 children of either sex with malunited supracondylar fracture of distal humerus having cubitus varus deformity admitted in orthopaedics department. After appropriate pre operative assessment, closed dome osteotomy was done and post operatively X-ray of patients was taken and carrying angle and Lateral Condylar Prominence Index (LCPI) were calculated. Patients were re-assessed at complete union and results were calculated as per Mitchell and Adams criteria. Results In our study of 25 patients, 68% were males, 32% were females. Majority (84%) of patients were in the age group of 5-10 years. Carrying angle post operatively was 0-10° valgus in 64% of patients while 36% had 10-20° valgus. LCPI changed post operatively ranging from +5.0% to -10.7%, average -2.75%. Decrease in LCPI had better cosmetic appearance. Range of motion post operatively increased or remained same as previous full motion in 84% of the patients. Union occurred in all patients by eight weeks. Few complications were seen. Results according to Mitchell and Adams criteria were excellent in 88% and good in 12%; while no poor results were recorded. Conclusion The results obtained in our study concluded that closed dome osteotomy is safe and effective treatment for the correction of cubitus varus deformity with few minor complications. PMID:28511466

Dynamic injury tolerances for long bones of the female upper extremity

PubMed Central

DUMA, STEFAN M.; SCHREIBER, PHIL H.; McMASTER, JOHN D.; CRANDALL, JEFF R.; BASS, CAMERON R.; PILKEY, WALTER D.

1999-01-01

This paper presents the dynamic injury tolerances for the female humerus and forearm derived from dynamic 3-point bending tests using 22 female cadaver upper extremities. Twelve female humeri were tested at an average strain rate of 3.7±1.3%/s. The strain rates were chosen to be representative of those observed during upper extremity interaction with frontal and side airbags. The average moment to failure when mass scaled for the 5th centile female was 128±19 Nm. Using data from the in situ strain gauges during the drop tests and geometric properties obtained from pretest CT scans, an average dynamic elastic modulus for the female humerus was found to be 24.4±3.9 GPa. The injury tolerance for the forearm was determined from 10 female forearms tested at an average strain rate of 3.94±2.0%/s. Using 3 matched forearm pairs, it was determined that the forearm is 21% stronger in the supinated position (92±5 Nm) versus the pronated position (75±7 Nm). Two distinct fracture patterns were seen for the pronated and supinated groups. In the supinated position the average difference in fracture time between the radius and ulna was a negligible 0.4±0.3 ms. However, the pronated tests yielded an average difference in fracture time of 3.6±1.2 ms, with the ulna breaking before the radius in every test. This trend implies that in the pronated position, the ulna and radius are loaded independently, while in the supinated position the ulna and radius are loaded together as a combined structure. To produce a conservative injury criterion, a total of 7 female forearms were tested in the pronated position, which resulted in the forearm injury criterion of 58±12 Nm when scaled for the 5th centile female. It is anticipated that these data will provide injury reference values for the female forearm during driver air bag loading, and the female humerus during side air bag loading. PMID:10386782

Radiographic pattern of skeletal trauma in children seen in a tertiary hospital in Sagamu, South West Nigeria.

PubMed

Olatunji, A A; Thanni, L O A

2013-03-01

The study was aimed at identifying the pattern of skeletal trauma in the paediatric age group as it relates to the causes. A retrospective analysis of the records on the request cards, case notes, radiographs and reports (where available) of all children aged one day to 15 years who were referred to the radiology department of Olabisi Onabanjo University Teaching Hospital, Sagamu was carried out. Fractures were analysed with respect to sex, age, causes, type and location of fracture. The analysis spanned a period of twenty-eight months during which a total of three hundred and twenty eight radiographs were analysed. The mean ages of male and female patients were 5.4±4.6 and 5.1±4.6 years, respectively, with a range of 0.2-15 years. Normal radiographs were found in 124 (37.80%) patients,53.1 (16.1%) had 55 fractures, and 39 (11.9%) had soft tissue swelling. Fractures were found most commonly in male children and in the age range 4-6 years. Fractures occur three times more in the upper limbs, and the bones most frequently affected are the humerus, radius, and the ulna in descending order. Most of the fractures were due to Road Traffic Injury (RTI) seen in 18.9%, falls seen in 18.9%, and birth trauma, which was responsible for 7.5%. The most frequently involved bone in fractures is the humerus followed by the femur bone. Skull fractures occur mostly in the parietal bone. Fractures are still mostly investigated with plain radiographs. Fractures are more frequent in male children and in the 4-6 year age range; it is seen more in the upper limb bones especially in the humerus. Skull fractures are relatively rare. Half of the fractures occur in the distal and mid portions of long bones. This study has also high lighted the importance of road traffic injury and falls as aetiological factors in fracture occurring in children. Effort should be made to ease deliveries in order to reduce the incidence of birth trauma.

Bone histology in extant and fossil penguins (Aves: Sphenisciformes).

PubMed

Ksepka, Daniel T; Werning, Sarah; Sclafani, Michelle; Boles, Zachary M

2015-11-01

Substantial changes in bone histology accompany the secondary adaptation to life in the water. This transition is well documented in several lineages of mammals and non-avian reptiles, but has received relatively little attention in birds. This study presents new observations on the long bone microstructure of penguins, based on histological sections from two extant taxa (Spheniscus and Aptenodytes) and eight fossil specimens belonging to stem lineages (†Palaeospheniscus and several indeterminate Eocene taxa). High bone density in penguins results from compaction of the internal cortical tissues, and thus penguin bones are best considered osteosclerotic rather than pachyostotic. Although the oldest specimens sampled in this study represent stages of penguin evolution that occurred at least 25 million years after the loss of flight, major differences in humeral structure were observed between these Eocene stem taxa and extant taxa. This indicates that the modification of flipper bone microstructure continued long after the initial loss of flight in penguins. It is proposed that two key transitions occurred during the shift from the typical hollow avian humerus to the dense osteosclerotic humerus in penguins. First, a reduction of the medullary cavity occurred due to a decrease in the amount of perimedullary osteoclastic activity. Second, a more solid cortex was achieved by compaction. In extant penguins and †Palaeospheniscus, most of the inner cortex is formed by rapid osteogenesis, resulting an initial latticework of woven-fibered bone. Subsequently, open spaces are filled by slower, centripetal deposition of parallel-fibered bone. Eocene stem penguins formed the initial latticework, but the subsequent round of compaction was less complete, and thus open spaces remained in the adult bone. In contrast to the humerus, hindlimb bones from Eocene stem penguins had smaller medullary cavities and thus higher compactness values compared with extant taxa. Although cortical lines of arrested growth have been observed in extant penguins, none was observed in any of the current sampled specimens. Therefore, it is likely that even these 'giant' penguin taxa completed their growth cycle without a major pause in bone deposition, implying that they did not undergo a prolonged fasting interval before reaching adult size. © 2015 Anatomical Society.

Glenohumeral Function of the Long Head of the Biceps Muscle

PubMed Central

Chalmers, Peter N.; Cip, Johannes; Trombley, Robert; Cole, Brian J.; Wimmer, Markus A.; Romeo, Anthony A.; Verma, Nikhil N.

2014-01-01

Background: Optimal treatment of superior labral anterior-posterior (SLAP) tears is controversial, in part because the dynamic role of the long head of the biceps muscle (LHBM) in the glenohumeral joint is unclear. The aim of this study was to determine dynamic LHBM behavior during shoulder activity by studying (1) the electromyographic activity of the LHBM during shoulder motion, (2) the effect of elbow immobilization on this activity, and (3) the effect of a load applied to the distal humerus on this activity. Hypothesis: The LHBM would not play a significant role in active glenohumeral range of motion. Study Design: Controlled laboratory study. Methods: Thirteen normal volunteers underwent surface electromyography (EMG) measurement of the LHBM, short head biceps muscle (SHBM), deltoid, infraspinatus, and brachioradialis during shoulder motion from the neutral position (0° of rotation, flexion, and abduction) to 45° of flexion, 90° of flexion, 45° of abduction, and 90° of abduction. These motions were repeated both with and without splint immobilization of the forearm and elbow at 100° of flexion and neutral rotation and with and without a 1-kg weight placed on the lateral distal humerus. Results: Mean EMG activity within the LHBM and the SHBM was low (≤11.6% ± 9.1%). LHBM activity was significant increased by flexion and abduction (P < .049 in all cases), while SHBM activity was not. EMG activity from the middle head of the deltoid was significantly increased by loading with the shoulder positioned away from the body (ie, in abduction or flexion). When compared with the unloaded state, the addition of a distal humeral load significantly increased LHBM activity in 45° of abduction (P = .028) and 90° of flexion (P = .033) despite forearm and elbow immobilization. The SHBM showed similar trends. Conclusion: In normal volunteers with forearm and elbow immobilization and application of a load to the distal humerus, LHBM EMG activity is increased by both glenohumeral flexion and abduction, suggesting that this muscle plays a dynamic role in glenohumeral motion with higher demand activities. Clinical Relevance: Biceps tenodesis may result in dynamic change within the glenohumeral joint with higher demand activities. PMID:26535304

Bone histology in extant and fossil penguins (Aves: Sphenisciformes)

PubMed Central

Ksepka, Daniel T; Werning, Sarah; Sclafani, Michelle; Boles, Zachary M

2015-01-01

Substantial changes in bone histology accompany the secondary adaptation to life in the water. This transition is well documented in several lineages of mammals and non-avian reptiles, but has received relatively little attention in birds. This study presents new observations on the long bone microstructure of penguins, based on histological sections from two extant taxa (Spheniscus and Aptenodytes) and eight fossil specimens belonging to stem lineages (†Palaeospheniscus and several indeterminate Eocene taxa). High bone density in penguins results from compaction of the internal cortical tissues, and thus penguin bones are best considered osteosclerotic rather than pachyostotic. Although the oldest specimens sampled in this study represent stages of penguin evolution that occurred at least 25 million years after the loss of flight, major differences in humeral structure were observed between these Eocene stem taxa and extant taxa. This indicates that the modification of flipper bone microstructure continued long after the initial loss of flight in penguins. It is proposed that two key transitions occurred during the shift from the typical hollow avian humerus to the dense osteosclerotic humerus in penguins. First, a reduction of the medullary cavity occurred due to a decrease in the amount of perimedullary osteoclastic activity. Second, a more solid cortex was achieved by compaction. In extant penguins and †Palaeospheniscus, most of the inner cortex is formed by rapid osteogenesis, resulting an initial latticework of woven-fibered bone. Subsequently, open spaces are filled by slower, centripetal deposition of parallel-fibered bone. Eocene stem penguins formed the initial latticework, but the subsequent round of compaction was less complete, and thus open spaces remained in the adult bone. In contrast to the humerus, hindlimb bones from Eocene stem penguins had smaller medullary cavities and thus higher compactness values compared with extant taxa. Although cortical lines of arrested growth have been observed in extant penguins, none was observed in any of the current sampled specimens. Therefore, it is likely that even these ‘giant’ penguin taxa completed their growth cycle without a major pause in bone deposition, implying that they did not undergo a prolonged fasting interval before reaching adult size. PMID:26360700

Progressive skeletal benefits of physical activity when young as assessed at the midshaft humerus in male baseball players.

PubMed

Warden, S J; Weatherholt, A M; Gudeman, A S; Mitchell, D C; Thompson, W R; Fuchs, R K

2017-07-01

Physical activity benefits the skeleton, but there is contrasting evidence regarding whether benefits differ at different stages of growth. The current study demonstrates that physical activity should be encouraged at the earliest age possible and be continued into early adulthood to gain most skeletal benefits. The current study explored physical activity-induced bone adaptation at different stages of somatic maturity by comparing side-to-side differences in midshaft humerus properties between male throwing athletes and controls. Throwers present an internally controlled model, while inclusion of control subjects removes normal arm dominance influences. Throwing athletes (n = 90) and controls (n = 51) were categorized into maturity groups (pre, peri, post-early, post-mid, and post-late) based on estimated years from peak height velocity (<-2, -2 to 2, 2 to 4, 4 to 10, and >10 years). Side-to-side percent differences in midshaft humerus cortical volumetric bone mineral density (Ct.vBMD) and bone mineral content (Ct.BMC); total (Tt.Ar), medullary (Me.Ar), and cortical (Ct.Ar) areas; average cortical thickness (Ct.Th); and polar Strength Strain Index (SSI P ) were assessed. Significant interactions between physical activity and maturity on side-to-side differences in Ct.BMC, Tt.Ar, Ct.Ar, Me.Ar, Ct.Th, and SSI P resulted from the following: (1) greater throwing-to-nonthrowing arm differences than dominant-to-nondominant arm differences in controls (all p < 0.05) and (2) throwing-to-nonthrowing arm differences in throwers being progressively greater across maturity groups (all p < 0.05). Regional analyses revealed greatest adaptation in medial and lateral sectors, particularly in the three post-maturity groups. Years throwing predicted 59% of the variance of the variance in throwing-to-nonthrowing arm difference in SSI P (p < 0.001). These data suggest that physical activity has skeletal benefits beginning prior to and continuing beyond somatic maturation and that a longer duration of exposure to physical activity has cumulative skeletal benefits. Thus, physical activity should be encouraged at the earliest age possible and be continued into early adulthood to optimize skeletal benefits.

Quality of life after antegrade intramedullary nail fixation of humeral fractures: a survey in a selected cohort of Brazilian patients.

PubMed

Cocco, Luiz Fernando; Ejnisman, Benno; Belangero, Paulo Santoro; Cohen, Moises; Dos Reis, Fernando Baldy

2018-01-01

The treatment of humeral fractures remains controversial. Systematic reviews demonstrate similar results between dynamic compression plating and locked intramedullary nailing in the surgical treatment of these fractures. However, it appears that antegrade intramedullary nailing causes higher residual pain in the shoulder. The proposal of this work is to evaluate through the WORC protocol (Western Ontario Rotator Cuff Index) the consequences in the quality of life of patients submitted to osteosynthesis of the humerus with antegrade locked intramedullary nailing. This work is a cohort retrospective study in addition to the application of a questionnaire for self-rated quality of life with its 05 domains (WORC - Western Ontario Rotator Cuff Index) for patients ( N  = 26) classified in the Trauma Sector of the Department of Orthopedics and Traumatology of the Federal University of São Paulo (DOT/UNIFESP) submitted to Humerus Osteosynthesis with Antegrade Locked Intramedullary Nailing. There was also the inclusion of data related to the time since surgery, age, sex, surgical laterality, dominance among members and work leave, which were not considered in the original protocol. After, the data were statistically assessed to evaluate the association between numerical and categorical variables. The overall WORC score was 82.75 ± 17.00 (Mean ± SD) and was not different considering sex, age and postoperative period. Among the WORC domains, both Work and Sport / Recreation Protocols were the most unfavorable factors in the evaluation of patients. Although not statistically significant, those who had the procedure on the dominant side presented a lower quality of life score than those who had the surgery on the non-dominant side. Although non-significant again, those who were away from work had an overall lower quality of life score than those who were not. The WORC Quality of Life Protocol shows good results for evaluating patients submitted to humerus osteosynthesis with antegrade locked intramedullary nailing. The data stratified by domains were good, however, Work and Sport/Recreation domains showed the lowest means compared to the other domains. Research Ethics Commitee (CEP 0676/2016) and Plataforma Brasil 56381216.3.0000.550. CAAE: 56381216.3.0000.5505.

Relationship between humeral geometry and shoulder muscle power among suspensory, knuckle-walking, and digitigrade/palmigrade quadrupedal primates.

PubMed

Kikuchi, Yasuhiro; Takemoto, Hironori; Kuraoka, Akio

2012-01-01

Shoulder morphology is functionally related to different patterns of locomotion in primates. To investigate this we performed a quantitative analysis of the relationship between cortical bone thickness (Cbt) of the muscle/tendon attachment site on the humerus and physiological cross-sectional area (PCSA) of the shoulder muscle in primates with different locomotory habits. The deltoid, subscapularis, supraspinatus, and infraspinatus were investigated. A chimpanzee, a gibbon, a baboon, two species of macaque, a lutong, a capuchin, and a squirrel monkey were included in the study. The total length of the humerus was measured and the values were converted into three-dimensional reconstructed data on a computer by computed tomography. The Cbt values were obtained from the volumes divided by the areas of the muscle/tendon attachment sites of the humerus by computer analysis. Muscle mass, muscle fascicle length, and muscle pennation angle were measured and PCSA was calculated using these parameters. A relatively high Cbt and small PCSA were characteristic of the gibbon. The gibbon's high Cbt suggests that passive tension in the muscle/tendon attachment site of suspensory primates (brachiators) may be greater than that of quadrupedal primates, whereas the relatively small PCSA indicates an association with a large amount of internal muscle fascia to endure the passive stress of brachiation. Although chimpanzees undertake some suspensory locomotion, the results for this species resemble those of the digitigrade/palmigrade quadrupedal primates rather than those of the suspensory primate. However, the deltoid and subscapularis in chimpanzee differ from those of the other primates and appear to be affected by the peculiar locomotion of knuckle-walking, i.e. the moment arm of forelimb in chimpanzees is relatively longer than that of digitigrade/palmigrade quadrupedal primates. Hence, a large PCSA in the deltoid and subscapularis may contribute to sustaining the body weight during locomotion. On the other hand, a thin cortical bone relative to a large PCSA was a feature of the cercopithecids, indicating that digitigrade/palmigrade quadrupedal locomotion produces less tension at the muscle/tendon attachment sites compared with that produced by brachiators. © 2011 The Authors. Journal of Anatomy © 2011 Anatomical Society of Great Britain and Ireland.

Does the Modified Gartland Classification Clarify Decision Making?

PubMed

Leung, Sophia; Paryavi, Ebrahim; Herman, Martin J; Sponseller, Paul D; Abzug, Joshua M

2018-01-01

The modified Gartland classification system for pediatric supracondylar fractures is often utilized as a communication tool to aid in determining whether or not a fracture warrants operative intervention. This study sought to determine the interobserver and intraobserver reliability of the Gartland classification system, as well as to determine whether there was agreement that a fracture warranted operative intervention regardless of the classification system. A total of 200 anteroposterior and lateral radiographs of pediatric supracondylar humerus fractures were retrospectively reviewed by 3 fellowship-trained pediatric orthopaedic surgeons and 2 orthopaedic residents and then classified as type I, IIa, IIb, or III. The surgeons then recorded whether they would treat the fracture nonoperatively or operatively. The κ coefficients were calculated to determine interobserver and intraobserver reliability. Overall, the Wilkins-modified Gartland classification has low-moderate interobserver reliability (κ=0.475) and high intraobserver reliability (κ=0.777). A low interobserver reliability was found when differentiating between type IIa and IIb (κ=0.240) among attendings. There was moderate-high interobserver reliability for the decision to operate (κ=0.691) and high intraobserver reliability (κ=0.760). Decreased interobserver reliability was present for decision to operate among residents. For fractures classified as type I, the decision to operate was made 3% of the time and 27% for type IIa. The decision was made to operate 99% of the time for type IIb and 100% for type III. There is almost full agreement for the nonoperative treatment of Type I fractures and operative treatment for type III fractures. There is agreement that type IIb fractures should be treated operatively and that the majority of type IIa fractures should be treated nonoperatively. However, the interobserver reliability for differentiating between type IIa and IIb fractures is low. Our results validate the Gartland classfication system as a method to help direct treatment of pediatric supracondylar humerus fractures, although the modification of the system, IIa versus IIb, seems to have limited reliability and utility. Terminology based on decision to treat may lead to a more clinically useful classification system in the evaluation and treatment of pediatric supracondylar humerus fractures. Level III-diagnostic studies.

Decreased Hip, Lower Leg, and Humeral Fractures but Increased Forearm Fractures in Highly Active Individuals.

PubMed

Stattin, Karl; Hållmarker, Ulf; Ärnlöv, Johan; James, Stefan; Michaëlsson, Karl; Byberg, Liisa

2018-06-22

It is not known how physical exercise affects the risk of different types of fractures, especially in highly active individuals. To investigate this association, we studied a cohort of 118,204 men and 71,757 women who from 1991 to 2009 participated in Vasaloppet, a long-distance cross-country skiing race in Sweden, and 505,194 nonparticipants frequency-matched on sex, age, and county of residence from the Swedish population. Participants ranged from recreational exercisers to world-class skiers. Race participation, distance of race run, number of races participated in, and finishing time were used as proxies for physical exercise. Incident fractures from 1991 to 2010 were obtained from national Swedish registers. Over a median follow-up of 8.9 years, 53,175 fractures of any type, 2929 hip, 3107 proximal humerus, 11,875 lower leg, 11,733 forearm, and 2391 vertebral fractures occurred. In a Cox proportional hazard regression analysis using time-updated exposure and covariate information, participation in the race was associated with an increased risk of any type of fracture (hazard ratio [HR], 1.02; 95% CI, 1.00 to 1.05); forearm fractures had an HR, 1.11 with a 95% CI, 1.06 to 1.15. There was a lower risk of hip (HR, 0.75; 95% CI, 0.67 to 0.83), proximal humerus (HR, 0.90; 95% CI, 0.82 to 0.98), and lower leg fractures (HR, 0.93; 95% CI, 0.89 to 0.97), whereas the HR of vertebral fracture was 0.97 with a 95% CI, 0.88 to 1.07. Among participants, the risk of fracture was similar irrespective of race distance and number of races run. Participants close to the median finishing time had a lower risk of fracture compared with faster and slower participants. In summary, high levels of physical exercise were associated with a slightly higher risk of fractures of any type, including forearm fractures, but a lower risk of hip, proximal humerus, and lower leg fractures. © 2018 American Society for Bone and Mineral Research. © 2018 American Society for Bone and Mineral Research.

Post-surgical rehabilitative approach to fragility fractures.

PubMed

Gimigliano, F; Iolascon, G; Riccio, I; Frizzi, L; Gimigliano, R

2013-10-01

Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. The most frequent sites of fragility fractures are the hip, the distal radius, the spine, the proximal humerus, and the ankle. In most cases, a surgical approach with subsequent rehabilitative treatment is required. The general aims of rehabilitation are to increase functioning and improve patients' activities, participation level, and quality of life.

Chondrosarcoma third metacarpal: Diagnosis and management options.

PubMed

Sharma, Vipin; Verma, Lucky; Chander, Bal; Sharma, Seema

2018-01-01

Chondrosarcoma is a rare malignant tumor of cartilage commonly arising in the pelvis, proximal femur, and humerus, but quite uncommon in the small bones of the hand. Although limited surgical procedures such as curettage are mentioned as a management option in low-grade chondrosarcomas, they tend to have a high rate of recurrences. Hence, wide excision is recommended as a treatment option even in low-grade chondrosarcomas of the hand.

Developmental toxicity of diphenyl ether herbicides in nestling American kestrels

USGS Publications Warehouse

Hoffman, D.J.; Spann, J.W.; LeCaptain, L.J.; Bunck, C.M.; Rattner, B.A.

1991-01-01

Beginning the day after hatching, American kestrel (Falco sparverius) nestlings were orally dosed for 10 consecutive days with 5 microliters/g of corn oil (controls) or one of the diphenyl ether herbicides (nitrofen, bifenox, or oxyfluorfen) at concentrations of 10, 50, 250, or 500 mg/kg in corn oil. At 500 mg/kg, nitrofen resulted in complete nestling mortality, bifenox in high (66%) mortality, and oxyfluorfen in no mortality. Nitrofen at 250 mg/kg reduced nestling growth as reflected by decreased body weight, crownrump length, and bone lengths including humerus, radiusulna, femur, and tibiotarsus. Bifenox at 250 mg/kg had less effect on growth than nitrofen, but crownrump, humerus, radiusulna, and femur were significantly shorter than controls. Liver weight as a percent of body weight increased with 50 and 250 mg/kg nitrofen. Other manifestations of impending hepatotoxicity following nitrofen ingestion included increased hepatic GSH peroxidase activity in all nitrofentreated groups, and increased plasma enzyme activities for ALT, AST, and LDHL in the 250mg/kg group. Bifenox ingestion resulted in increased hepatic GSH peroxidase activity in the 50and 250mg/kg groups. Nitrofen exposure also resulted in an increase in total plasma thyroxine (T4) concentration. These findings suggest that altricial nestlings are more sensitive to diphenyl ether herbicides than young or adult birds of precocial species.

Skeletal unloading and dietary copper depletion are detrimental to bone quality of mature rats

NASA Technical Reports Server (NTRS)

Smith, Brenda J.; King, Jarrod B.; Lucas, Edralin A.; Akhter, Mohammed P.; Arjmandi, Bahram H.; Stoecker, Barbara J.

2002-01-01

This study was designed to examine the skeletal response to copper depletion and mechanical unloading in mature animals. In a 2 x 2 experimental design, 5.5-mo-old male Sprague-Dawley rats (n = 36) consumed either the control (AIN-93M) or Cu-depletion ((-)Cu) diet beginning 21 d before suspension and throughout the remainder of the study. Half of the rats in each dietary treatment group were either tail-suspended (TS) or kept ambulatory (AMB) for 28 d. Lower bone mineral densities (BMD) of 5th lumbar vertebra (L5) (P < 0.05) and femur were observed with (-)Cu and TS, but no differences were noted in the BMD of the humerus. Mechanical strength in the femur and vertebra decreased in response to TS, but were unaffected by copper depletion. Urinary deoxypyridinoline, an index of bone resorption, was significantly greater in TS rats, but unaltered by (-)Cu. No changes in serum or bone alkaline phosphatase activity, an indicator of bone formation, were observed. Our findings suggest that TS and (-)Cu decreased BMD in unloaded femur and vertebra but had no effect on normally loaded humerus. Bone loss with TS appeared to be related to accelerated bone resorption. Alterations in bone metabolism and bone mechanical properties in the mature skeleton resulting from (-)Cu warrant further investigation.

Assessment of modified gold surfaced titanium implants on skeletal fixation.

PubMed

Zainali, Kasra; Danscher, Gorm; Jakobsen, Thomas; Baas, Jorgen; Møller, Per; Bechtold, Joan E; Soballe, Kjeld

2013-01-01

Noncemented implants are the primary choice for younger patients undergoing total hip replacements. However, the major concern in this group of patients regarding revision is the concern from wear particles, periimplant inflammation, and subsequently aseptic implant loosening. Macrophages have been shown to liberate gold ions through the process termed dissolucytosis. Furthermore, gold ions are known to act in an anti-inflammatory manner by inhibiting cellular NF-κB-DNA binding. The present study investigated whether partial coating of titanium implants could augment early osseointegration and increase mechanical fixation. Cylindrical porous coated Ti-6Al-4V implants partially coated with metallic gold were inserted in the proximal region of the humerus in ten canines and control implants without gold were inserted in contralateral humerus. Observation time was 4 weeks. Biomechanical push out tests and stereological histomorphometrical analyses showed no statistically significant differences in the two groups. The unchanged parameters are considered an improvement of the coating properties, as a previous complete gold-coated implant showed inferior mechanical fixation and reduced osseointegration compared to control titanium implants in a similar model. Since sufficient early mechanical fixation is achieved with this new coating, it is reasonable to investigate the implant further in long-term studies. Copyright © 2012 Wiley Periodicals, Inc.

Potential ecotoxic effects of polychlorinated biphenyls on Xenopus laevis.

PubMed

Qin, Zhan-Fen; Zhou, Jing-Ming; Cong, Lin; Xu, Xiao-Bai

2005-10-01

We examined potential ecotoxic effects of polychlorinated biphenyl (PCB)3, PCB5, Aroclor 1254, and Aroclor 1242 on Xenopus laevis. Tadpoles were exposed to PCBs from stage 46/47 (system of Nieuwkoop and Faber) to the completion of metamorphosis. We demonstrated, to our knowledge for the first time, forelimb malformations caused by PCBs (malformation rate, > 70%). The malformed forelimbs were fixed in the adduction-backward rotation position and could not move. Therefore, malformed male frogs were destined to have no offspring, because they could not grasp the females with their forelimbs to mate. Alcian blue-alizarin red double-staining indicated that the forelimb malformation resulted from the shoulder abnormality. Compared with the normal shoulder joint, the proximal humerus with the humerus inter-rotated 90 degrees in the abnormal shoulder joint. Moreover, testes from more than a third of male frogs with exposed to PCBs exhibited feminization to different degrees at gross morphology and histology, with fewer or abnormal spermatogonia and oocytes. Gonadal abnormalities would lead directly to reproductive dysfunction and population decline. These results suggest that PCBs have potentially ecotoxic effects on amphibian populations. We infer that PCBs could play roles in amphibian malformations and population declines, at least at sites that are polluted heavily with PCBs.

Rate of displacement for Jakob Type 1 lateral condyle fractures treated with a cast.

PubMed

Zale, C; Winthrop, Z A; Hennrikus, W

2018-04-01

The aim of this retrospective study is to report the rate of displacement of Jakob Type 1 lateral condyle fractures that were initially treated in a cast. We performed a retrospective review of all patients that were treated for a non-displaced (Jakob Type 1 < 2 mm) lateral condyle fracture of the humerus at our institution between 2002 and 2015. A total of 59 patients were initially treated with casting. Five fractures displaced and were converted to a closed pinning treatment plan with a conversion rate of 8.5%. There was a mean of 13.2 days (4 to 21) between treatment by initial casting and closed pinning. This study demonstrates an 8.5% displacement and conversion rate from cast treatment to closed pinning for initially non-displaced Jakob Type 1 lateral condyle fractures of the humerus. The internal oblique radiograph is most accurate to determine displacement. We recommend obtaining an internal oblique view at initial evaluation and at follow-up in the cast for lateral condyle fractures. To minimize movement at the fracture site, we recommend treating Jakob Type 1 lateral condyle fractures with a long arm cast with the elbow at 90° and the forearm in the supine position with a sling-loop design. IV - retrospective therapeutic study.

Shoulder joint abduction motion test bench: a new shoulder test bench for in vitro experiments with active muscle force simulation.

PubMed

Onder, Ursula; Blauth, Michael; Kralinger, Franz; Schmoelz, Werner

2012-05-30

In our society the average age is increasing, as are the number of proximal humeral head fractures. For fixation of these fractures, an increasing number of implants are available. New fixation devices should be compared biomechanically with established methods in a standardized fashion. The test bench that was designed was intended to simulate abduction motion of the humerus actively induced by muscle forces. We used three pneumatic muscles to apply forces to the tendons of the musculus supraspinatus and the bifid musculus deltoideus. Thus, it was possible to create an active abduction in the scapular plane. Two different fracture models (with and without medial support) were stabilised with an angular stable plate in sawbone models to reproduce a known clinical outcome with the newly designed test setup. The resultant force acting on the proximal humerus reached approximately 47% BW (per cent body weight), which amounted to 329.0 N (SD: 21.76). The supraspinatus reached maximum forces of 254.7 N (SD: 20.1) and the deltoid muscle 258.9 N (SD: 16.5). Fracture gap instrumentation with medial support resulted in a significantly reduced per-cycle fracture gap motion. The performance evaluation showed that the simulator produced predicable, reproducible movements with physiological muscle force magnitudes.

Horizontal flight of a swallow (Hirundo rustica) observed in a wind tunnel, with a new method for directly measuring mechanical power.

PubMed

Pennycuick, C J; Hedenström, A; Rosén, M

2000-06-01

A swallow flying in the Lund wind tunnel was observed from the side and from behind, by two synchronised high-speed video cameras. The side-view camera provided a record of the vertical position of a white mark, applied to the feathers behind and below the eye, from which the vertical acceleration was obtained. The rear-view camera provided measurements of the mean angle of the left and right humeri above horizontal. From these data, the force acting on the body, the moment applied by each pectoralis muscle to the humerus and the rotation of the humerus were estimated and used to analyse the time course of a number of variables, including the work done by the muscles in each wing beat. The average mechanical power turned out to be more than that predicted on the basis of current estimates of body drag coefficient and profile power ratio, possibly because the bird was not flying steadily in a minimum-drag configuration. We hope to develop the method further by correlating the mechanical measurements with observations of the vortex wake and to apply it to birds that have been conditioned to hold a constant position in the test section.

Development of a novel method for surgical implant design optimization through noninvasive assessment of local bone properties.

PubMed

Schiuma, D; Brianza, S; Tami, A E

2011-03-01

A method was developed to improve the design of locking implants by finding the optimal paths for the anchoring elements, based on a high resolution pQCT assessment of local bone mineral density (BMD) distribution and bone micro-architecture (BMA). The method consists of three steps: (1) partial fixation of the implant to the bone and creation of a reference system, (2) implant removal and pQCT scan of the bone, and (3) determination of BMD and BMA of all implant-anchoring locations along the actual and alternative directions. Using a PHILOS plate, the method uncertainty was tested on an artificial humerus bone model. A cadaveric humerus was used to quantify how the uncertainty of the method affects the assessment of bone parameters. BMD and BMA were determined along four possible alternative screw paths as possible criteria for implant optimization. The method is biased by a 0.87 ± 0.12 mm systematic uncertainty and by a 0.44 ± 0.09 mm random uncertainty in locating the virtual screw position. This study shows that this method can be used to find alternative directions for the anchoring elements, which may possess better bone properties. This modification will thus produce an optimized implant design. Copyright © 2010 IPEM. Published by Elsevier Ltd. All rights reserved.

The European saber-toothed cat (Homotherium latidens) found in the "Spear Horizon" at Schöningen (Germany).

PubMed

Serangeli, Jordi; Van Kolfschoten, Thijs; Starkovich, Britt M; Verheijen, Ivo

2015-12-01

The 300,000 year old Lower Paleolithic site Schöningen 13 II-4 became world famous with the discovery of the oldest well-preserved and complete wooden spears. Through ongoing excavations, new archaeological discoveries of scientific importance are still being made from the same archaeological layer where the spears were found. In this context, remains of a rare carnivore species, the European saber-toothed cat (Homotherium latidens), were recovered. Here we present five teeth and one humerus fragment that are unambiguously from two individual saber-toothed cats. The humerus is a unique specimen; it shows evidence of hominin impacts and use as a percussor. The Homotherium remains from Schöningen are the best documented finds of this species in an archaeological setting and they are amongst the youngest specimens of Homotherium in Europe. The presence of this species as a carnivore competitor would certainly have impacted the lives of late Middle Pleistocene hominins. The discovery illustrates the possible day-to-day challenges that the Schöningen hominins would have faced and suggests that the wooden spears were not necessarily only used for hunting, but possibly also as a weapon for self-defense. Copyright © 2015 Elsevier Ltd. All rights reserved.

Sex determination using humeral dimensions in a sample from KwaZulu-Natal: an osteometric study

PubMed Central

Ogedengbe, Oluwatosin Olalekan; Ajayi, Sunday Adelaja; Komolafe, Omobola Aderibigbe; Zaw, Aung Khaing; Naidu, Edwin Coleridge Stephen

2017-01-01

The morphological characteristics of the humeral bone has been investigated in recent times with studies showing varying degrees of sexual dimorphism. Osteologists and forensic scientists have shown that sex determination methods based on skeletal measurements are population specific, and these population-specific variations are present in many body dimensions. The present study aims to establish sex identification using osteometric standards for the humerus in a contemporary KwaZulu-Natal population. A total of 11 parameters were measured in a sample of n=211 humeri (males, 113; females, 98) from the osteological collection in the Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. The difference in means for nearly all variables were found to be significantly higher in males compared to females (P<0.01) with the most effective single parameter for predicting sex being the vertical head diameter having an accuracy of 82.5%. Stepwise discriminant analysis increased the overall accuracy rate to 87.7% when all measurements were jointly applied. We conclude that the humerus is an important bone which can be reliably used for sex determination based on standard metric methods despite minor tribal or ancestral differences amongst an otherwise homogenous population. PMID:29043096

Sex determination using humeral dimensions in a sample from KwaZulu-Natal: an osteometric study.

PubMed

Ogedengbe, Oluwatosin Olalekan; Ajayi, Sunday Adelaja; Komolafe, Omobola Aderibigbe; Zaw, Aung Khaing; Naidu, Edwin Coleridge Stephen; Okpara Azu, Onyemaechi

2017-09-01

The morphological characteristics of the humeral bone has been investigated in recent times with studies showing varying degrees of sexual dimorphism. Osteologists and forensic scientists have shown that sex determination methods based on skeletal measurements are population specific, and these population-specific variations are present in many body dimensions. The present study aims to establish sex identification using osteometric standards for the humerus in a contemporary KwaZulu-Natal population. A total of 11 parameters were measured in a sample of n=211 humeri (males, 113; females, 98) from the osteological collection in the Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. The difference in means for nearly all variables were found to be significantly higher in males compared to females ( P <0.01) with the most effective single parameter for predicting sex being the vertical head diameter having an accuracy of 82.5%. Stepwise discriminant analysis increased the overall accuracy rate to 87.7% when all measurements were jointly applied. We conclude that the humerus is an important bone which can be reliably used for sex determination based on standard metric methods despite minor tribal or ancestral differences amongst an otherwise homogenous population.

[Operative treatment of proximal humeral four-part fractures in elderly patients: comparison of two angular-stable implant systems].

PubMed

Kuhlmann, T; Hofmann, T; Seibert, O; Gundlach, G; Schmidt-Horlohé, K; Hoffmann, R

2012-04-01

Although being one of the most common fractures in elderly patients, there is still no standardised treatment protocol for four-part fractures of the proximal humerus. However, a wide variety of angular-stable implants is available. The present retrospective study compares the clinical and radiological outcome following operative treatment of four-part fractures of the proximal humerus with the Philos system (Philos, proximal humeral internal locking system, Synthes GmbH, Umkirch Germany) and the angular-stable Königsee plate system (Königsee Implantate GmbH, Allendorf, Germany) in patients older than 65 years. From July 2005 until December 2007 we identified 77 patients with a four-part fracture of the proximal humerus who were treated operatively with one of the two implant systems. Of the patients, 17 could not be located so that in total 60 patients (78 %) participated in this study. The mean age of the 30 patients (10 m, 20 f) in the Philos group was 69 years (65-92), whereas the mean age of the 30 patients (11 m, 19 f) in the Königsee group was 71 years (65-93). A comprehensive assessment was performed after a median of 17 months (12-24), including physical examination, radiographic examination and completion of the disabilities of the arm, shoulder and hand score (DASH) and the Constant score (CS) as patient-oriented, limb-specific questionnaires. Neither in the Philos nor in the Königsee group could excellent results be achieved. Using the CS 13 patients (43 %) of the Philos group achieved a good and 15 (50 %) a satisfactory result. Bad results were found in 2 patients (7 %). The mean CS was 61.53 points. In the Königsee group mean CS was 61.76 points. In detail, 14 patients (47 %) treated with the Königsee implant were rated as good and 15 (50 %) as satisfactory. Only 1 patient (3 %) was rated as poor. No significant statistical differences were found between the groups. Mean DASH score in the Philos group was 56.30 points and 55.37 points in the Königsee group. Again, no statistical difference was found. Partial humeral head necrosis was observed in 2 patients of the Philos and 1 of the Königsee group. In the remaining patients uneventful fracture consolidation was observed. There were no complications requiring further surgical intervention. To the date of follow-up all implants were still in situ and none of the patients reported discomfort with respect to the hardware. In this study we were able to demonstrate that good and satisfactory results can be achieved in the majority of patients, regardless of whether a Philos or a Königsee system was used. Significant differences between the two groups could not be found in any of the performed examinations. Both implants seem to be suitable in four-part fractures of the proximal humerus. However, the Königsee plate represents a more cost-effective option compared to the Philos system. © Georg Thieme Verlag KG Stuttgart · New York.

Severe humeral erosion in a bedridden patient: a comprehensive intervention to prevent bone fracture.

PubMed

Ferriero, Giorgio; Brunetto, Alessandro; Sartorio, Francesco; Vercelli, Stefano

2004-12-01

This article reports a 1-yr prospective study related to a bedridden patient with rotator cuff tear arthropathy featuring severe erosion of the proximal part of the humerus. To prevent spontaneous humeral fracture, a comprehensive intervention was planned. This included drug therapy for osteoporosis and pain, nurse team training on patient handling techniques, and patient and caregiver education. After 1 yr, clinical and radiologic findings are stable.

Unicameral bone cyst of the scaphoid: a report of two cases.

PubMed

Javdan, Mohammad; Zarezadeh, Abolghasem; Gaulke, Raulf; Eshaghi, Mohammad Amin; Shemshaki, Hamidreza

2012-08-01

Unicameral bone cysts are benign, fluid-filled lesions that occur mostly in long bones (proximal humerus, 50-60%; femur, 30%) of male children aged 5 to 15 years. Occurrence in the scaphoid of an adult is rare. We report 2 such patients who presented with wrist pain, with and without a history of trauma. Both underwent curettage and bone grafting (harvested from the distal radius) and achieved good functional recovery.

Exposure of the Distal Humerus Using a Triceps Hemi-peel Approach

DTIC Science & Technology

2014-05-14

kin and Deshmukh .17 A posterior midline incision is made over the elbow, and the skin and subcutaneous tissue are reflected medially and laterally...approach, as described by Deakin and Deshmukh ,17 reflects the triceps insertion in a lateral to medial direction and releas- es the anconeus insertion to...semiconstrained total elbow arthro- plasty. J Bone Joint Surg Am. 2000; 82:1379- 1386. 17. Deakin DE, Deshmukh SC. The triceps-flex- or carpi ulnaris (TRIFCU

Journal of Special Operations Medicine. Volume 8, Edition 1, Winter 2008

DTIC Science & Technology

2008-01-01

Open, comminuted humerus fracture , treated with external fixation. • Partial transection of the brachial artery. This injury was effectively...would have lost his arm had it not been for the excellent treatment in the field and the rapid evacuation to surgical care. • Three fractured ribs, one of...Soldier with GSW to his left thigh and buttock and left inferior pelvic ac- etabular and rami fractures with communication into the pelvic cavity, with a

Clinical Utility and Pitfalls of Ultrasound Guided Foreign Body Removal in War Fighters

DTIC Science & Technology

2012-10-01

surgeon noted that the 3 foreign bodies implanted in the third thigh with the traditional surgical removal were placed in the subcutaneous fat and...Conference Chicago, IL 16-17 April, 2005 235. Unique Aspects of Pediatric Fractures Course Moderator/Speaker AOCR Mid Year Conference Chicago...Otolaryngol Head Neck Surg. 2003; Mar;129(3):305-9 38. Jones GP, Seguin J, Shiels WE II: Salter-Harris II Fracture of the Proximal Humerus in a Preterm

Modeling of Prosthetic Limb Rotation Control by Sensing Rotation of Residual Arm Bone

PubMed Central

Kuiken, Todd A.

2011-01-01

We proposed a new approach to improve the control of prosthetic arm rotation in amputees. Arm rotation is sensed by implanting a small permanent magnet into the distal end of the residual bone, which produces a magnetic field. The position of the bone rotation can be derived from magnetic field distribution detected with magnetic sensors on the arm surface, and then conveyed to the prosthesis controller to manipulate the rotation of the prosthesis. Proprioception remains intact for residual limb skeletal structures; thus, this control system should be natural and easy-to-use. In this study, simulations have been conducted in an upper arm model to assess the feasibility and performance of sensing the voluntary rotation of residual humerus with an implanted magnet. A sensitivity analysis of the magnet size and arm size was presented. The influence of relative position of the magnet to the magnetic sensors, orientation of the magnet relative to the limb axis, and displacement of the magnetic sensors on the magnetic field was evaluated. The performance of shielding external magnetostatic interference was also investigated. The simulation results suggest that the direction and angle of rotation of residual humerus could be obtained by decoding the magnetic field signals with magnetic sensors built into a prosthetic socket. This pilot study provides important guidelines for developing a practical interface between the residual bone rotation and the prosthesis for control of prosthetic rotation. PMID:18713682

Developmental toxicity of diphenyl ether herbicides in nestling American kestrels.

PubMed

Hoffman, D J; Spann, J W; LeCaptain, L J; Bunck, C M; Rattner, B A

1991-11-01

Beginning the day after hatching, American kestrel (Falco sparverius) nestlings were orally dosed for 10 consecutive days with 5 microliters/g of corn oil (controls) or one of the diphenyl ether herbicides (nitrofen, bifenox, or oxyfluorfen) at concentrations of 10, 50, 250, or 500 mg/kg in corn oil. At 500 mg/kg, nitrofen resulted in complete nestling mortality, bifenox in high (66%) mortality, and oxyfluorfen in no mortality. Nitrofen at 250 mg/kg reduced nestling growth as reflected by decreased body weight, crown-rump length, and bone lengths including humerus, radius-ulna, femur, and tibiotarsus. Bifenox at 250 mg/kg had less effect on growth than nitrofen, but crown-rump, humerus, radius-ulna, and femur were significantly shorter than controls. Liver weight as a percent of body weight increased with 50 and 250 mg/kg nitrofen. Other manifestations of impending hepatotoxicity following nitrofen ingestion included increased hepatic GSH peroxidase activity in all nitrofen-treated groups, and increased plasma enzyme activities for ALT, AST, and LDH-L in the 250-mg/kg group. Bifenox ingestion resulted in increased hepatic GSH peroxidase activity in the 50- and 250-mg/kg groups. Nitrofen exposure also resulted in an increase in total plasma thyroxine (T4) concentration. These findings suggest that altricial nestlings are more sensitive to diphenyl ether herbicides than young or adult birds of precocial species.

The application of x-ray, computed tomography, and magnetic resonance imaging on 22 pediatric Langerhans cell histiocytosis patients with long bone involvement: A retrospective analysis.

PubMed

Zhang, Xiaojun; Zhou, Jing; Chai, Xuee; Chen, Guiling; Guo, Bin; Ni, Lei; Wu, Peng

2018-04-01

The studies focusing on x-ray, computed tomography (CT), and magnetic resonance imaging (MRI) in pediatric Langerhans cell histiocytosis (LCH) patients were still rare. Therefore, we aimed to evaluate the application of x-ray, CT, and MRI in pediatric LCH patients with long bone involvement.Total 22 pediatric LCH patients were included in this study. The diagnosis of LCH was confirmed by pathological examination. All patients were followed up for 3 years. X-ray, CT, or MRI was performed and the results were recorded for further analyses.Among 22 pediatric patients, x-ray (n = 20), CT (n = 18), or MRI (n = 12) were used to scan the lesion on long bones affected by LCH. Femurs (n = 13, 38.24%), tibia (n = 11, 32.35%), humerus (n = 5, 14.71%), and radius (n = 4, 11.76%) were the most frequently affected anatomic sites. Ovoid or round radiolucent lesions, aggressive periosteal reaction, and swelling of surrounding soft tissues were characteristic image of long bones on x-ray, CT, and MRI in pediatric LCH.Femurs, tibia, humerus, and radius were the most commonly affected long bones of pediatric LCH. The application of x-ray, CT, and MRI on long bones could help with the diagnosis of pediatric LCH.

The overarm-throwing pattern among U-14 ASA female softball players: a comparative study of gender, culture, and experience.

PubMed

Petranek, Laura Jones; Barton, Gina V

2011-06-01

A developmental description of overarm-throwing characteristics of U-14female ASA softballplayers is presented here. Comparisons were made between these athletes and teens of similar age in the United States (Runion, Roberton, & Langendorfe 2003) and in Germany (Ehl, Roberton, & Langendorfer, 2005). A majority of the softball players demonstrated the most advanced developmental levels for the backswing foot, humerus, and forearm components. Seventy percent (n = 26) demonstrated a Level 2 trunk, while 30% (n = 11) demonstrated a differentiated trunk, Level 3. The average throwing velocity was 62.58 ft/s (19.07 m/s). Comparisons were made to girls with less throwing experience in the United States (Runion et al.) and Germany (Ehl et al.); the softball players threw with greater velocity (9.12ft/s [2.77 m/s]and 15.89 ft/s [4.84 m/s], respectively) and demonstrated superior trunk, humerus, and forearm actions. The boys from both countries threw the ball faster than the softball players. Significant chi-square analyses found the softball players had superior humeral actions (Level 3) compared to the German boys and superior forearm actions (Level 3) compared to both groups of bays. Experience seems to have an impact when comparisons among girls are made; yet, explanations for differences seen between boys and girls still remain unclear and warrant further research.

Limb bone allometry during postnatal ontogeny in non-avian dinosaurs

PubMed Central

Kilbourne, Brandon M; Makovicky, Peter J

2010-01-01

Although the interspecific scaling of tetrapods is well understood, remarkably little work has been done on the ontogenetic scaling within tetrapod species, whether fossil or recent. Here the ontogenetic allometry of the femur, humerus, and tibia was determined for 23 species of non-avian dinosaur by regressing log-transformed length against log-transformed circumference for each bone using reduced major axis bivariate regression. The femora of large theropod species became more robust during ontogeny, whereas growth in the femora of sauropodomorphs and most ornithischians was not significantly different from isometry. Hadrosaur hindlimb elements became significantly more gracile during ontogeny. Scaling constants were higher in all theropods than in any non-theropod taxa. Such clear taxonomically correlated divisions were not evident in the ontogenetic allometry of the tibia and hindlimb bones did not scale uniformly within larger taxonomic groups. For taxa in which the ontogenetic allometry of the humerus was studied, only Riojasaurus incertus exhibited a significant departure from isometry. Using independent contrasts, the regression of femoral allometry against the log of adult body mass was found to have a significant negative correlation but such a relationship could not be established for other limb elements or growth parameters, mainly due to the small sample size. The intraspecific scaling patterns observed in dinosaurs and other amniotes do not support earlier hypotheses that intraspecific scaling differs between endothermic and ectothermic taxa. PMID:20557400

Analysis of fractal dimensions of rat bones from film and digital images

NASA Technical Reports Server (NTRS)

Pornprasertsuk, S.; Ludlow, J. B.; Webber, R. L.; Tyndall, D. A.; Yamauchi, M.

2001-01-01

OBJECTIVES: (1) To compare the effect of two different intra-oral image receptors on estimates of fractal dimension; and (2) to determine the variations in fractal dimensions between the femur, tibia and humerus of the rat and between their proximal, middle and distal regions. METHODS: The left femur, tibia and humerus from 24 4-6-month-old Sprague-Dawley rats were radiographed using intra-oral film and a charge-coupled device (CCD). Films were digitized at a pixel density comparable to the CCD using a flat-bed scanner. Square regions of interest were selected from proximal, middle, and distal regions of each bone. Fractal dimensions were estimated from the slope of regression lines fitted to plots of log power against log spatial frequency. RESULTS: The fractal dimensions estimates from digitized films were significantly greater than those produced from the CCD (P=0.0008). Estimated fractal dimensions of three types of bone were not significantly different (P=0.0544); however, the three regions of bones were significantly different (P=0.0239). The fractal dimensions estimated from radiographs of the proximal and distal regions of the bones were lower than comparable estimates obtained from the middle region. CONCLUSIONS: Different types of image receptors significantly affect estimates of fractal dimension. There was no difference in the fractal dimensions of the different bones but the three regions differed significantly.

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

PubMed

Baumgartner, Daniel; Nolan, Betsy M; Mathys, Robert; Lorenzetti, Silvio Rene; Stüssi, Edgar

2011-07-18

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. 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. 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. 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.

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

PubMed Central

2011-01-01

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. PMID:21762540

Middle and long term radiologic and functional results of childhood supracondylar humeral fractures operated in first 24 hours with limited medial approach.

PubMed

Dost, Abdulkadir; Yilmaz, Baris; Komur, Baran; Mutlu, Serhat; Mutlu, Harun; Ozkan, Korhan; Eren, Abdullah

2016-04-01

To investigate the middle- and long-term radiological and functional results of children with type III supracondylar humerus fractures treated with a limited medial approach and internal fixation. The retrospective study was conducted at Department of Orthopaedics in Goztepe Training and Research Hospital, Istanbul, Turkey, and comprised data of children who underwent surgery between April 1991 and June 2009. Patients in group I underwent surgery within the first 8 hours after admission, and those in group II did so 8-24 hours after admission. Patients were evaluated according to the Flynn scoring system. Of the 79 patients, 52(65.8%) were male and 27(34.2%) were female. Fractures involved the left side in 49(62%) patients. Group I had 39(49.4%) patients and group II 40(50.6%). The overall mean age was 6.2±2.95 years (range: 2-13 years), and the mean follow-up was 53.2±14.9 months (range: 26-193 months). Functional scores were satisfactory (excellent, good and fair results) in all cases in both groups (100%), and the cosmetic results were satisfactory in 37(95%) in group I, and 39(97.5%) in group II (p>0.05). Limited medial approach to the treatment of supracondylar humerus fractures yielded successful functional and cosmetic results.

Chronic opiate use in pregnancy and newborn head circumference.

PubMed

Visconti, Kevin C; Hennessy, Kerry C; Towers, Craig V; Howard, Bobby C

2015-01-01

The aim of the study is to evaluate whether chronic opiate use in pregnancy affects newborn head circumference (HC). All newborns from January 1, 2010, to June 30, 2012, admitted to the neonatal intensive care unit for treatment of neonatal abstinence syndrome were prospectively collected. The demographic, obstetrical, neonatal, and perinatal ultrasound data were retrospectively obtained. A gestational age-matched control was used for comparison purposes. Of 332 neonates admitted for the treatment of neonatal abstinence syndrome, 98 (29.5%) had a HC ≤ 10th percentile for gestational age that was significantly increased when compared with controls (p < 0.001). Of these 98, 25 had a HC ≤ 3rd percentile. Of the case population, 141 had an ultrasound in the perinatal unit within 10 days of birth. A HC < 5th percentile was found in 38.3% of cases of which 74% were ≤ 10th percentile postdelivery. The ultrasound femur and humerus length measurements were also < 5th percentile in 36.2 and 28.9%, respectively. Chronic opiate use in pregnancy appears to increase the risk for a HC ≤ 10th percentile and ≤ 3rd percentile when compared with controls. From ultrasound findings, femur and humerus lengths also appear to be shortened suggesting a possible effect on bone growth. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

SUPRACONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN: FIXATION WITH TWO CROSSED KIRSCHNER WIRES

PubMed Central

Carvalho, Roni Azevedo; Filho, Nelson Franco; Neto, Antonio Batalha Castello; Reis, Giulyano Dias; Dias, Marcos Pereira

2015-01-01

Objective: To analyze and present the surgical results from unstable supracondylar fractures of the humerus in children, treated by means of reduction and percutaneous fixation using two crossed Kirschner wires. Methods: A cross-sectional study was conducted on 20 children, taking into consideration sex, age at the time of the fracture, age at the time of the assessment, side affected, type and mechanism of trauma, postoperative complications and radiographic and clinic variables. Results: Ten fractures were observed in the left arm and ten in the right arm. The age at the time of the fracture ranged from 2 to 13 years (mean: 5.9 ± 2.48 years). Three fractures were classified as type II and 17 as type III. The length of follow-up ranged from four months to three years. Baumann's angle ranged from 69 to 100 (mean: 78.3) and cubitus varus was observed in four patients (values ranging from 84 to 100). According to the modified Flynn's criteria, 20 cases presented satisfactory outcomes: 17 excellent (85%), two good (10%) and one regular (5%). Two patients presented limited range of motion, two had paresthesia in the cubital region and one had transient neuropraxia of the ulnar nerve for six weeks. Conclusion: Percutaneous fixation with two crossed Kirschner wires leads to good results when carried out under direct viewing and with isolation of the ulnar nerve. PMID:27047887

Achieving interlocking nails without using an image intensifier

PubMed Central

Ogunlusi, Johnson D.; Ine, Henry R.

2006-01-01

Interlocking nails are commonly performed using an image intensifier. These are expensive and are not readily available in most resource-poor countries of the world. The aim of this study was to achieve interlocking nailing without the use of an image intensifier. This is a prospective descriptive analysis of 40 consecutive cases seen with shaft fractures of the humerus, femur, and tibia. Fracture fixation was done using Surgical Implant Generation Network (SIGN) nails. Forty limbs in 34 patients were studied. There were 12 females and 22 males, giving a ratio of 1:2. The mean age (years) was 35.75±13.16 and the range was 17–70 years. The studied bones were: humerus 10%, femur 65%, and tibia 25%. The fracture lines were: transverse 40%, oblique 15%, and communited 45%. Fracture grades were: closed 90%, grade I, 5%, grade II, 2.5%, and grade IIIA, 2.5%. Surgical approaches were: antegrade 62.5% and retrograde 37.5%. Indications for fixation were: recent fracture 92.5%, non-union 5%, and malunion 3%. Methods of reductions were: open 85% and closed 15%. The mean follow-up period (years) was 1.50±0.78. The union time averaged 3 months. Complication was mainly screw loosening due to severe osteoporoses in one case. It is, therefore, concluded that, with the aid of external jigs and slot finders, interlocking can be achieved without an image intensifier. PMID:17039384

Postoperative Evaluation of Reduction Loss in Proximal Humeral Fractures: A Comparison of Plain Radiographs and Computed Tomography.

PubMed

Jia, Xiao-Yang; Chen, Yan-Xi; Qiang, Min-Fei; Zhang, Kun; Li, Hao-Bo; Jiang, Yu-Chen; Zhang, Yi-Jie

2017-05-01

To compare postoperative CT images with plain radiographs for measuring prognostic factors of reduction loss of fractures of the proximal part of the humerus. A total of 65 patients who sustained fractures of the proximal humerus treated with locking plates from June 2012 to October 2015 were retrospectively analyzed. There were 24 men and 41 women, with a mean age of 60.0 years (range, 22-76 years). According to the Neer classification system of proximal humeral fracture, there were 26 two-part, 27 three-part and 12 four-part fractures of the proximal part of the humerus, and all fractures were treated with open reduction and internal fixation (ORIF) using locked plating. All postoperative CT images and plain radiographs of the patients were obtained. Prognostic factors of the reduction loss were the change of neck shaft angle (NSA) and the change of humeral head height (HHH). The change of NSA and HHH were evaluated by the difference between postoperative initial and final follow-up measurement. Reduction loss was defined as the change ≥10° for NSA or ≥5 mm for HHH. The NSA and HHH were measured using plain radiographs and 3-D CT images, both initially and at final follow-up. The paired t-test was used for comparison of NSA, change of NSA, HHH, and change of HHH between two image modalities. The differences between two image modalities in the assessment of reduction loss were examined using the χ 2 -test (McNemar test). Intraclass correlation coefficients (ICC) were used to assess the intra-observer and inter-observer reliability. 3-D CT images (ICC range, 0.834-0.967) were more reliable in all parameters when compared with plain radiographs (ICC range, 0.598-0.915). Significant differences were found between the two image modalities in all parameters (plain radiographs: initial NSA = 133.6° ± 3.8°, final NSA = 130.0° ± 1.9°, initial HHH = 17.9 ± 0.9 mm, final HHH = 15.8 ± 1.5 mm; 3-D CT: initial NSA = 131.4° ± 3.4°, final NSA = 128.8° ± 1.7°, initial HHH = 16.8 ± 1.2 mm, final HHH = 14.5 ± 1.1 mm; all P < 0.05). In the assessment of reduction loss, the percentage was 16.9% (11/65) for the plain radiographs and 7.7% (5/65) for the 3-D CT scans (P < 0.05). For the 5 patients with reduction loss, which were observed by two imaging modalities, the mean Constant-Murley score was 61.0 ± 1.6. The patients with reduction loss, observed only in plain radiographs but not CT images, had good shoulder function (Constant-Murley score: 82.7 ± 1.0). Our data reveal that 3-D CT images are more reliable than plain radiographs in the assessment of the prognostic factors of reduction loss of fractures of the proximal part of the humerus with treatment of locking plates; this reliable CT technique can serve as an effective guideline for the subsequent clinical management of patients. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Clinical Utility and Pitfalls of Ultrasound Guided Foreign Body Removal in War Fighters

DTIC Science & Technology

2011-10-01

implanted in the third thigh with the traditional surgical removal were placed in the subcutaneous fat and not the muscle which made locating the...16-17 April, 2005 235. Unique Aspects of Pediatric Fractures Course Moderator/Speaker AOCR Mid Year Conference Chicago, IL 16-17 April, 2005...Mar;129(3):305-9 38. Jones GP, Seguin J, Shiels WE II: Salter-Harris II Fracture of the Proximal Humerus in a Preterm Infant. Am J Perinatol

Osteolytic Bone Lesions - A Rare Presentation of AML M6.

PubMed

Geetha, N; Sreelesh, K P; Priya, M J; Lali, V S; Rekha, N

2015-01-01

Acute myeloid leukemia (AML) M6 is a rare form of AML accounting for < 5 % of all AML. Extramedullary involvement is very rarely seen in this entity. Skeletal lesion has not been described in AML M6 before. We discuss the case of a 17 year old boy with AML M6, who presented with osteolytic lesion of right humerus. He was treated with induction and consolidation chemotherapy. The present case is the first report in literature of AML M6 presenting with skeletal lesions.

Archaeological Investigations at Sites 45-DO-242 and 45-DO-243, Chief Joseph Dam Project, Washington.

DTIC Science & Technology

1984-01-01

from the dorsal and ventral surfaces. On the other, asymmetry was produced by Introduction of only one shoulder during flaking. Neither specimen shows...On the other, asymmetry was produced by Introduction of only one shoulder during flaking. Neither specimen shows any evidence of hafting, i.e., both...fragments, 4 humeri, 1 humerus fragment, I ulna, 1 pelvis , 1 Innomlnate fragment, 2 femurs. Zone 24: 4 mandibles, 8 mandible fragments, 1 skull, I

Anatomic characterization of the humeral nutrient artery: Application to fracture and surgery of the humerus.

PubMed

Ichimura, Koichiro; Kinose, Shota; Kawasaki, Yuto; Okamura, Taro; Kato, Kota; Sakai, Tatsuo

2017-10-01

Anatomic characterization of the humeral nutrient artery varies among the several textbooks on human anatomy. To clarify the anatomic characteristics of the humeral nutrient artery, we reexamined its origin and course by cadaveric dissection. In typical cases, one prominent nutrient foramen was situated on the anteromedial surface of the humeral shaft, and the nutrient canal distally penetrated the cortical bone layer. The humeral nutrient artery originated from the brachial artery below the level of the nutrient foramen as a short ascending branch. On reaching near the nutrient foramen, the humeral nutrient artery formed a hairpin loop on the periosteum to enter into the nutrient foramen. In some cases, an accessory nutrient foramen was also found near the groove for the radial nerve on the posterior surface of the humerus. This accessory nutrient foramen received an accessory humeral nutrient artery that originated from the radial collateral artery. The present findings corresponded well with the descriptions in the anatomy textbooks published in English-speaking countries. However, textbooks published in German-speaking countries describe only one type of humeral nutrient artery, the branch of the profunda brachii artery. Terminologia Anatomica, the international standard in human anatomic terminology, most likely adopted the description in the German anatomy textbooks, and thus, it is necessary to correct the position of the humeral nutrient artery in the hierarchy of Terminologia Anatomica for accurate morphological description. Clin. Anat. 30:978-987, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Bone scintigraphy elucidates different metabolic stages of melorheostosis.

PubMed

Izadyar, Sina; Gholamrezanezhad, Ali

2012-01-01

Melorheostosis is a rare benign non-hereditary sclerosing dysplasia involving the bone, often in a sclerotomal distribution. we report the case of a 27 years old lady with painful swelling of the left hand and forearm lasting for almost 15 years. The patient experienced aggravation of symptoms and limitation of motion during the past two months. Radiographic assessment revealed hyperostosis involving the left 3(rd) and 4(th) metacarpal bones and corresponding digits as well as the left ulna and distal humerus, with no soft tissue ossification. Angiographic and blood pool images of bone scintigraphy showed increased activity of mid-metacarpal region, corresponding to the sclerotom C-8. Delayed static views showed increased radiotracer uptake of the left 4(th) metacarpal bone and the corresponding digit as well as the left ulna and humerus, but no abnormal osteoblastic activity of the 3(rd) left metacarpal and digit. Histopathologic assessment confirmed the diagnosis of Melorheostosis. The case confirms that even in the same sclerotomal distribution, the multiple foci of involvement can present in different metabolic stages. In fact, the disease does not progress uniformly and different lesions can be seen in dissimilar stages of activity. Hence, metabolic imaging can be important to unmask which of the radiographically detected bony lesions are metabolically active and have the potential to be the source of current patient's symptoms and which of them are old, metabolically inactive and silent lesions, which are not clinically relevant to the patient's complaints.

Bone scintigraphy elucidates different metabolic stages of melorheostosis

PubMed Central

Izadyar, Sina; Gholamrezanezhad, Ali

2012-01-01

Melorheostosis is a rare benign non-hereditary sclerosing dysplasia involving the bone, often in a sclerotomal distribution. we report the case of a 27 years old lady with painful swelling of the left hand and forearm lasting for almost 15 years. The patient experienced aggravation of symptoms and limitation of motion during the past two months. Radiographic assessment revealed hyperostosis involving the left 3rd and 4th metacarpal bones and corresponding digits as well as the left ulna and distal humerus, with no soft tissue ossification. Angiographic and blood pool images of bone scintigraphy showed increased activity of mid-metacarpal region, corresponding to the sclerotom C-8. Delayed static views showed increased radiotracer uptake of the left 4th metacarpal bone and the corresponding digit as well as the left ulna and humerus, but no abnormal osteoblastic activity of the 3rd left metacarpal and digit. Histopathologic assessment confirmed the diagnosis of Melorheostosis. The case confirms that even in the same sclerotomal distribution, the multiple foci of involvement can present in different metabolic stages. In fact, the disease does not progress uniformly and different lesions can be seen in dissimilar stages of activity. Hence, metabolic imaging can be important to unmask which of the radiographically detected bony lesions are metabolically active and have the potential to be the source of current patient's symptoms and which of them are old, metabolically inactive and silent lesions, which are not clinically relevant to the patient's complaints. PMID:22514755

Analysis of intraosseous samples in endotoxemic shock--an experimental study in the anaesthetised pig.

PubMed

Strandberg, G; Larsson, A; Lipcsey, M; Berglund, L; Eriksson, M

2014-03-01

Intraosseous (IO) access is used in emergency situations to allow rapid initiation of treatment. IO access is also sometimes used for blood sampling, although data on accuracy of such sampling in critical illness are limited. There is also a potential risk that bone marrow fragments in IO samples may damage laboratory equipment. It is ethically questionable to perform a simultaneous comparison between IO and arterial/venous sampling in critically ill humans. We have, thus, studied the analytical performance of IO sampling in a porcine septic shock model using a cartridge-based analyser. Eight pigs with endotoxin-induced septic shock were sampled hourly for 6 h, and analysed for blood gases, acid base status, haemoglobin, glucose and lactate using point of care instruments. Samples were taken from three IO cannulae (tibia bilaterally, one with infusion, and humerus), one arterial and one venous. An interaction test was used to assess changes in agreement between methods over time. Bland–Altman plots were constructed to study bias between methods. There were, to a varying extent, differences between IO and arterial/venous levels for all studied variables, but agreement did not change significantly during the experiment. A general finding was a large dispersion of differences between methods. IO sample values should be treated with caution in this setting but may add useful information to the clinical picture. The tibia or humerus may be used for sampling. IO infusion decreases agreement, thus sampling during infusion should be avoided.

Effects of intravenous, sternal, and humerus intraosseous administration of Hextend on time of administration and hemodynamics in a hypovolemic swine model.

PubMed

Blouin, Dawn; Gegel, Brian T; Johnson, Don; Garcia-Blanco, Jose C

2016-01-01

To determine if there were significant differences among humerus intraosseous (HIO), sternal intraosseous (SIO), and intravenous (IV) administration of 500 mL Hextend in hemodynamics or administration time in a hypovolemic swine model. Vivarium. Yorkshire swine; sample size was based on a large effect size of 0.5, an α of 0.05, and a power of 80 percent Swine were randomly assigned to one of four groups: HIO (n = 9), SIO (n = 9), IV (n = 9), and control (n = 9). Swine were exsanguinated 30 percent of their blood volume. Hextend (500 mL) was administered by either the HIO, SIO, or IV route; the control group received none. Time of administration of Hextend; systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), and stroke volume (SV) data were collected every 2 minutes and compared by group over 8 minutes. A repeated analysis of variance found that there were no significant differences in SBP, DBP, MAP, HR, CO, and SV among HIO, SIO, and IV groups over 8 minutes (p > 0.05). An analyses of variance determined that there was no significant difference between groups relative to time of administration (p = 0.521). When IV access is difficult, both HIO and SIO are effective techniques for rapid vascular access and the administration of Hextend for patients in hypovolemic shock.

Effects of tibial and humerus intraosseous administration of epinephrine in a cardiac arrest swine model.

PubMed

Beaumont, Ltc Denise; Baragchizadeh, Asal; Johnson, Charles; Johnson, Don

2016-01-01

Compare maximum concentration (Cmax), time to maximum concentration (Tmax), mean serum concentration of epinephrine, return of spontaneous circulation (ROSC), time to ROSC, and odds of survival relative to epinephrine administration by humerus intraosseous (HIO), tibial intraosseous (TIO), and intravenous (IV) routes in a swine cardiac arrest model. Prospective, between subjects, randomized experimental design. TriService Research Facility. Yorkshire-cross swine (n = 28). Swine were anesthetized and placed into cardiac arrest. After 2 minutes, cardiopulmonary resuscitation was initiated. After an additional 2 minutes, a dose of 1 mg of epinephrine was administered by HIO, TIO, or the IV routes. Blood samples were collected over 4 minutes and analyzed by high-performance liquid chromatography tandem mass spectrometry. ROSC, time to ROSC, Cmax, Tmax, mean concentrations over time, and odds ratio. There was no significant difference in rate of the ROSC among the TIO, HIO, and IV groups (p > 0.05). There were significant differences in Cmax: the HIO group was significantly higher than the TIO group (p = 0.007), but no significant difference between the IV and HIO (p = 0.33) or the IV and TIO group (p = 0.060). The Tmax was significantly shorter for both the IV and HIO versus the TIO group (p < 0.05), but no difference between IV and HIO (p = 0.328). The odds of survival were higher in the HIO group compared to all other groups. The TIO and HIO provide rapid and reliable access to administer life-saving medications during cardiac arrest.

Constraint, natural selection, and the evolution of human body form

PubMed Central

Savell, Kristen R. R.; Auerbach, Benjamin M.; Roseman, Charles C.

2016-01-01

Variation in body form among human groups is structured by a blend of natural selection driven by local climatic conditions and random genetic drift. However, attempts to test ecogeographic hypotheses have not distinguished between adaptive traits (i.e., those that evolved as a result of selection) and those that evolved as a correlated response to selection on other traits (i.e., nonadaptive traits), complicating our understanding of the relationship between climate and morphological distinctions among populations. Here, we use evolutionary quantitative methods to test if traits previously identified as supporting ecogeographic hypotheses were actually adaptive by estimating the force of selection on individual traits needed to drive among-group differentiation. Our results show that not all associations between trait means and latitude were caused by selection acting directly on each individual trait. Although radial and tibial length and biiliac and femoral head breadth show signs of responses to directional selection matching ecogeographic hypotheses, the femur was subject to little or no directional selection despite having shorter values by latitude. Additionally, in contradiction to ecogeographic hypotheses, the humerus was under directional selection for longer values by latitude. Responses to directional selection in the tibia and radius induced a nonadaptive correlated response in the humerus that overwhelmed its own trait-specific response to selection. This result emphasizes that mean differences between groups are not good indicators of which traits are adaptations in the absence of information about covariation among characteristics. PMID:27482101

Constraint, natural selection, and the evolution of human body form.

PubMed

Savell, Kristen R R; Auerbach, Benjamin M; Roseman, Charles C

2016-08-23

Variation in body form among human groups is structured by a blend of natural selection driven by local climatic conditions and random genetic drift. However, attempts to test ecogeographic hypotheses have not distinguished between adaptive traits (i.e., those that evolved as a result of selection) and those that evolved as a correlated response to selection on other traits (i.e., nonadaptive traits), complicating our understanding of the relationship between climate and morphological distinctions among populations. Here, we use evolutionary quantitative methods to test if traits previously identified as supporting ecogeographic hypotheses were actually adaptive by estimating the force of selection on individual traits needed to drive among-group differentiation. Our results show that not all associations between trait means and latitude were caused by selection acting directly on each individual trait. Although radial and tibial length and biiliac and femoral head breadth show signs of responses to directional selection matching ecogeographic hypotheses, the femur was subject to little or no directional selection despite having shorter values by latitude. Additionally, in contradiction to ecogeographic hypotheses, the humerus was under directional selection for longer values by latitude. Responses to directional selection in the tibia and radius induced a nonadaptive correlated response in the humerus that overwhelmed its own trait-specific response to selection. This result emphasizes that mean differences between groups are not good indicators of which traits are adaptations in the absence of information about covariation among characteristics.

Three-part head-splitting proximal humerus fracture through a unicameral bone cyst.

PubMed

Younghein, John A; Eskander, Mark S; DeAngelis, Nicola A; Wixted, John J

2012-06-01

Unicameral bone cysts are rare in adults and are most often found incidentally on radiographs. However, they can persist from the adolescent period and may be present in locations that predispose to or exacerbate fractures.This article describes a case of a healthy 40-year-old woman who sustained a proximal humerus trauma that involved a large unicameral bone cyst, resulting in a 3-part head-splitting fracture. The epiphyseal location of the cyst contributed to the severity and extent of the fracture that resulted from a simple fall. Given the age of the patient, open reduction and internal fixation with a locking plate and lag screws was performed. The patient chose open reduction and internal fixation to preserve a hemiarthroplasty procedure in case of future revision. Successful humeral head reconstruction was achieved, and the patient fully recovered. One year postoperatively, the patient underwent arthroscopic debridement to alleviate subjective stiffness and decreased range of motion.Multipart head-splitting fractures require complex repair strategies. The gold standard for the treatment of these injuries is hemiarthroplasty. However, the decision process is difficult in a young patient given the average survival of autoplastic prostheses and the added difficulty of later revision. The current case demonstrates the complexity of decision making resulting from a rare injury in a young, healthy patient and shows that open reduction and internal fixation can provide acceptable reconstruction in such situations. Copyright 2012, SLACK Incorporated.

Fat embolism syndrome.

PubMed

Stein, Paul D; Yaekoub, Abdo Y; Matta, Fadi; Kleerekoper, Michael

2008-12-01

To assess the incidence and risk factors for fat embolism syndrome. Data from the National Hospital Discharge Survey (NHDS) were analyzed using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. From 1979 through 2005 among 928,324,000 patients discharged from short-stay hospitals in the United States, 41,000 (0.004%) had fat embolism syndrome. Among 21,538,000 patients with an isolated fracture of the femur (any site), tibia, fibula, pelvis, ribs, humerus, radius, or ulna, 25,000 (0.12%) developed fat embolism syndrome. Patients with multiple fractures of the femur (excluding neck) more often had fat embolism syndrome than those with isolated fractures (1.29% versus 0.54%). The incidence of fat embolism syndrome was lower with isolated fractures of the tibia or fibula (0.30%) and even lower with isolated fractures of the neck of the femur (0.06%). The incidence of fat embolism was too low to calculate with isolated fractures of the pelvis, ribs, humerus, radius, or ulna. Nonorthopedic conditions rarely, if ever, were accompanied by fat embolism syndrome. The fat embolism syndrome was more frequent in men (relative risk 5.71). Children, aged 0 to 9 years rarely had fat embolism syndrome. The fat embolism syndrome most commonly affected patients aged 10 to 39 years. The incidence of the fat embolism syndrome depends on the bone involved, whether fractures are isolated or multiple, the age of the patient and the gender. It rarely occurs as a result of medical conditions.

Clinical comparison between open plating and minimally invasive plate osteosynthesis for displaced proximal humeral fractures: A prospective randomized controlled trial.

PubMed

Sohn, Hoon-Sang; Jeon, Yoon Sang; Lee, JuHan; Shin, Sang-Jin

2017-06-01

Recently, minimally invasive plate osteosynthesis (MIPO) has been widely used for the treatment of proximal humeral fractures. However, there is concern about whether the MIPO in comminuted proximal humeral fractures is also comparable to open plating. The purpose of this study was to compare the clinical and radiographic outcomes of open plating and MIPO for acute displaced proximal humeral fractures. In this prospective, randomized controlled study, 107 patients who had an acute proximal humeral fracture were randomized to either the open plating or MIPO techniques. Forty-five patients treated with open plating and 45 with the MIPO technique who were followed up at least 1year were evaluated. Shoulder functional assessment, operating time, several radiographic parameters, and complications were evaluated at final follow-up. The mean follow-up period was 15.0 months in the open plating and 14.3 months in the MIPO technique. There were no statistically significant differences in functional assessment scores and radiographic parameters between the two groups. High complications rates were found in 4-part fracture in both surgical methods The average operation time in the MIPO group were significantly lower compared to the open plating group (p<0.05). This study showed MIPO in proximal humerus fractures had similar clinical and radiographic outcomes compared to the open plating. However, the MIPO technique in proximal humerus fracture provided significantly shorter operation time than the open plating. Copyright © 2017 Elsevier Ltd. All rights reserved.

Massive cuff tears treated with arthroscopically assisted latissimus dorsi transfer. Surgical technique

PubMed Central

De Cupis, Vincenzo; De Cupis, Mauro

2012-01-01

Summary Latissimus dorsi transfer is our preferred treatment for active disabled patients with a posterosuperior massive cuff tear. We present an arthroscopically assisted technique which avoids an incision through the deltoid obtaining a better and faster clinical outcome. The patient is placed in lateral decubitus. After the arthroscopic evaluation of the lesion through a posterior and a posterolateral portal, with the limb in traction we perform the preparation of the greater tuberosity of the humerus. We place the arm in abduction and internal rotation and we proceed to the harvest of the latissimus dorsi and the tendon preparation by stitching the two sides using very resistant sutures. After restoring limb traction, under arthroscopic visualization, we pass a curved grasper through the posterolateral portal by going to the armpit in the space between the teres minor and the posterior deltoid. Once the grasper has exited the access at the level of the axilla we fix two drainage transparent tubes, each with a wire inside, and, withdrawing it back, we shuttle the two tubes in the subacromial space. After tensioning the suture wires from the anterior portals these are assembled in a knotless anchor of 5.5 mm that we place in the prepared site on the greater tuberosity of the humerus. A shoulder brace at 15° of abduction and neutral rotation protect the patient for the first month post-surgery but physical therapy can immediately start. PMID:23738290

Fracture line morphology of complex proximal humeral fractures.

PubMed

Hasan, Afsana P; Phadnis, Joideep; Jaarsma, Ruurd L; Bain, Gregory I

2017-10-01

The aim of this study was to assess proximal humeral fracture patterns using 3-dimensional computed tomography images and relate them to the normal osseous landmarks and soft-tissue attachments. Forty-eight 3-dimensional computed tomography scans of proximal humeral fractures were retrospectively collected, and the fractures were transcribed onto proximal humeral templates. We analyzed the common location and orientation of the fracture lines, with a focus on fractures of the articular surface, tuberosities, metaphysis, and proximal diaphysis. These fractures were compared with the attachments of the rotator cuff and glenohumeral capsule. Fifty-two percent of the fractures involved the articular surface. No fractures passed through the bicipital groove, and fractures were more commonly found on the posterior lesser tuberosity and on the anterior greater tuberosity, coinciding with the intervals between the rotator cuff tendon insertions. Intracapsular fractures of the calcar were more common (68%) than extracapsular fractures (32%). On the anterolateral aspect of the proximal humerus, fractures radiated from the articular margin, vertically down through the tuberosity zone between the rotator cuff footprints, meeting horizontally oriented fractures in the metaphyseal zone. On the posterior aspect, vertical fractures from the tuberosity zone continued downward to the metaphyseal zone adjacent to the infraspinatus and teres minor footprints. Fractures of the proximal humerus follow characteristic patterns. Fractures frequently split the greater tuberosity and are closely related to the intervals of the rotator cuff attachments. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

The Development of Vibration System for Applying Magnetic Resonance Elastography (MRE) to the Supraspinatus Muscle.

PubMed

Ito, Daiki; Numano, Tomokazu; Mizuhara, Kazuyuki; Takamoto, Kouichi; Onishi, Takaaki; Nishijo, Hisao

2016-01-01

Palpation is a standard clinical tool to diagnose abnormal stiffness changes in soft tissues. However, it is difficult to palpate the supraspinatus muscle because it locates under the trapezius muscle. The magnetic resonance elastography (MRE) uses harmonic mechanical excitation to quantitatively measure the stiffness (shear modulus) of both the superficial and deep tissues. The purpose of this study was to build a vibration system for applying the MRE to the supraspinatus muscle. In this study, a power amplifier and a pneumatic pressure generator were used to supply vibrations to a vibration pad. Six healthy volunteers underwent MRE. We investigated the effects of position (the head of the humerus and the trapezius muscle) of the vibration pad on the patterns of wave propagation (wave image). When the vibration pad was placed in the trapezius muscle, the wave images represented clear wave propagation. On the other hand, when the vibration pad was placed in the head of the humerus, the wave images represented unclear wave propagation. This result might be caused by wave interferences resulting from the vibrations from bones and an intramuscular tendon of the supraspinatus muscle. The mean shear modulus also was 8.12 ± 1.83 (mean ± SD) kPa, when the vibration pad was placed in the trapezius muscle. Our results demonstrated that the vibration pad should be placed in the trapezius muscle in the MRE of the supraspinatus muscle.

Concomitant upper limb fractures and short-term functional recovery in hip fracture patients: does the site of upper limb injury matter?

PubMed

Di Monaco, Marco; Castiglioni, Carlotta; Vallero, Fulvia; Di Monaco, Roberto; Tappero, Rosa

2015-05-01

The aim of this study was to evaluate functional recovery in a subgroup of hip fracture patients who sustained a simultaneous fracture at the upper limb, taking into account the site of upper limb injury. Of 760 patients admitted consecutively to the authors' rehabilitation hospital because of a fall-related hip fracture, 700 were retrospectively investigated. Functional outcome was assessed using Barthel Index scores. In 49 of the 700 patients, a single fall resulted in both a hip fracture and a fracture of either wrist (n = 34) or proximal humerus (n = 15). The patients with concomitant shoulder fractures had lower median Barthel Index scores after rehabilitation (70 vs. 90, P = 0.003), lower median Barthel Index effectiveness (57.1 vs. 76.9, P = 0.018), and prolonged median length of stay (42 vs. 36 days, P = 0.011) than did the patients with isolated hip fractures. Significant differences persisted after adjustment for six potential confounders. The adjusted odds ratio for achieving a Barthel Index score lower than 85 was 6.71 (95% confidence interval, 1.68-26.81; P = 0.007) for the patients with concomitant shoulder fractures. Conversely, no prognostic disadvantages were associated with concomitant wrist fractures. Data show a worse functional recovery and a prolonged length of stay in the subgroup of hip fracture patients who sustained a concomitant fracture at the proximal humerus, but not at the wrist.

Musculoskeletal changes in mice from 20-50 cGy of simulated galactic cosmic rays.

PubMed

Bandstra, Eric R; Thompson, Raymond W; Nelson, Gregory A; Willey, Jeffrey S; Judex, Stefan; Cairns, Mark A; Benton, Eric R; Vazquez, Marcelo E; Carson, James A; Bateman, Ted A

2009-07-01

On a mission to Mars, astronauts will be exposed to a complex mix of radiation from galactic cosmic rays. We have demonstrated a loss of bone mass from exposure to types of radiation relevant to space flight at doses of 1 and 2 Gy. The effects of space radiation on skeletal muscle, however, have not been investigated. To evaluate the effect of simulated galactic cosmic radiation on muscle fiber area and bone volume, we examined mice from a study in which brains were exposed to collimated iron-ion radiation. The collimator transmitted a complex mix of charged secondary particles to bone and muscle tissue that represented a low-fidelity simulation of the space radiation environment. Measured radiation doses of uncollimated secondary particles were 0.47 Gy at the proximal humerus, 0.24-0.31 Gy at the midbelly of the triceps brachii, and 0.18 Gy at the proximal tibia. Compared to nonirradiated controls, the proximal humerus of irradiated mice had a lower trabecular bone volume fraction, lower trabecular thickness, greater cortical porosity, and lower polar moment of inertia. The tibia showed no differences in any bone parameter. The triceps brachii of irradiated mice had fewer small-diameter fibers and more fibers containing central nuclei. These results demonstrate a negative effect on the skeletal muscle and bone systems of simulated galactic cosmic rays at a dose and LET range relevant to a Mars exploration mission. The presence of evidence of muscle remodeling highlights the need for further study.

[Internal screwed plate for recent fractures of the humeral diaphysis in adults].

PubMed

Dayez, J

1999-06-01

Can medial plating of the humerus, through an antero lateral approach, diminish incidence of iatrogenic radial palsies? We carried out a prospective study of medial plating of humeral shaft fractures through an antero lateral approach between 1988 and 1997. 41 fractures were fixed, 36 were followed up for a mean period of 5.8 years. The indications were multiple injuries (10), displaced fractures (23), and failure of conservative treatment (3). Road traffic accidents and sports injuries were the cause in 68 per cent of cases. Two fractures were open and in 9 cases there was a radial palsy. Bone graft was never used. The approach to the medial aspect of the humerus an antero lateral incision was the essential feature of the technique. After a slightly curved incision on the antero lateral aspect of the arm, the space between biceps and brachialis anterior was bluntly dissected. The assistant holded the elbow flexed in order to relax the biceps and rotated il laterally to expose the medial aspect of the bone. Splitting brachialis fibres longitudinally exposed the fracture site. It was easy to check if the radial nerve was trapped and, if not, the nerve seen during the operation. Postoperatively patients were given a simple sling and mobilised freely, including rotation. We had no intra-operative complications, no infections, no fixation failure, no post operative radial palsies and no non-unions. Results were excellent in 89 per cent of cases (full recovery of pain free range of movement). Four patient had a restriction of elbow movements of 10 degrees but without any discomfort. The mean time to union was 80 days. All radial nerve palsies recovered between 24 hours and 1 year. The plate was removed in 11 cases. Iatrogenic complications of humeral plating have led to the increased popularity of intramedullary nailing. Even if secondary radial palsies and non-unions have decreased, union of the humeral shafts is often difficult. Placing the plate into the medial surface allowed to preserve the radial nerve, but still permitted to check its continuity when it was trapped in the fracture site. Restoration of the length and rotational alignment of the humerus puts the radial nerve in the best condition for its recovery. An antero lateral approach and a medially placed plate allowed to avoid secondary radial plasies and non-unions, which can complicate internal fixation of the humeral shaft.

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.

PubMed

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 score<70%. The following radiological criteria were evaluated during the preoperative assessment and at the last follow-up: initial displacement and reduction of humeral 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 general rules of internal fixation are applied: reduction of the tuberosities, varus correction and stabilization of the calcar area. IV, retrospective study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Securing a Difficult Airway: Tracheal Intubation Achieved after Deliberate Placement of an Endotracheal Tube in Esophagus: A New Approach

PubMed Central

Chopra, Vanilla; Mehta, Nandita; Dar, Mohd Reidwan

2017-01-01

Enlarged thyroid gland with retrosternal extension has an increased incidence of difficult intubation, and it poses real airway challenge for the anesthesiologists. Here, we present a case of successful management of a difficult airway in a female patient of enlarged thyroid gland, planned for open reduction and internal fixation of the upper end of humerus. Endotracheal intubation was achieved after deliberate insertion of an endotracheal tube in esophagus. The patient was extubated over a ventilating bougie, with uneventful postoperative course. PMID:29284880

Goal-Directed Ultrasound for the Diagnosis of Long-Bone Fractures by Crew Medical Officer Analogs

NASA Technical Reports Server (NTRS)

Marshburn, Thomas H.; Legome, Eric; Li, James; Melton, Shannon; Sargsyan, Ashot; Noble, Vickie; Sims, Carrie; Thomsen, Todd; Peralta, Ruben; Briggs, Sue

2002-01-01

Current construction activities on-board the International space Station (ISS) may increase fracture incidence in space, and ultrasound (US) is the only tm-board diagnostic imaging capability. The clinical utility of US in identifying long-bone fractures is un1aowe, particularly using non-radiologist operators. We sought to determine the accuracy of US in identifying fractures of the humerus and femur, as performed by emergency medicine physicians and surgeons with minimal experience in ultrasound image acquisition and interpretation, after a standardized taming session.

[Calcifying tendinitis of the rotator cuff with focal umeral osteolysis. Imaging features].

PubMed

Mascarenhas, V V; Morais, F; Marques, H; Guerra, A; Carpinteiro, E; Gaspar, A

2015-01-01

Calcifying tendinitis occurs most commonly in the rotator cuff tendons, particularly involving the supraspinatus tendon insertion, and is often asymptomatic. Cortical erosion secondary to calcifying tendinitis has been reported in multiple locations, including in the rotator cuff tendons. The authors report two cases of symptomatic calcifying tendinitis involving the infraspinatus tendon with cortical erosion with correlative radiographic, and MR findings. The importance of considering this diagnosis when evaluating lytic lesions of the humerus and the imaging differential diagnosis of calcifying tendinitis and cortical erosion are discussed.

Bipolar Latissimus Dorsi Transfer for Restoration of Pectoralis Major Function in Poland Syndrome.

PubMed

Buchanan, Patrick; Leyngold, Mark; Mast, Bruce A

2016-01-01

Poland syndrome typically presents as a unilateral congenital complete or partial absence of the pectoralis major muscle, variably with other associated anomalies. Reconstruction of the defect typically concentrates on aesthetic restoration with functional outcomes being unsuccessful or limited. We present an innovative means of true muscle transfer that provided functional benefit to increase upper extremity strength. A 16-year-old adolescent boy with Poland syndrome manifesting as left pectoralis major muscle agenesis wished to undergo functional reconstruction. He wanted to play on his high school football team, but could not meet the minimum weightlifting requirements. An ipsilateral latissimus dorsi muscle bipolar functional transfer was done with bone-anchored inset into the sternum and humerus so that muscle flexion would replace the absent pectoralis major. A progressive weight training program was then instituted postoperatively. At 9 months, a significant increase in left upper extremity strength was confirmed. The patient ultimately was able to surpass the weightlifting requirements for his high school football team, and joined the team. Our highlighted procedure restored functional outcome using both plastic surgical principles and orthopedic techniques for muscle and tendon repair: bipolar muscle transfer and load-bearing muscle inset. Heretofore, transfer of the latissimus for provision of pectoralis major function has not been reported. Functional reconstruction was possible due to stable, bipolar muscle transfer with load-bearing muscle attachments into cortical bone of the anterior sternum and anteromedial aspect of the humerus. The techniques described should be within the skill set of most plastic surgeons, so that functional restoration for those with Poland syndrome is possible and accessible.

Forearm Range of Motion in Australovenator wintonensis (Theropoda, Megaraptoridae)

PubMed Central

White, Matt A.; Bell, Phil R.; Cook, Alex G.; Barnes, David G.; Tischler, Travis R.; Bassam, Brant J.; Elliott, David A.

2015-01-01

The hypertrophied manual claws and modified manus of megaraptoran theropods represent an unusual morphological adaptation among carnivorous dinosaurs. The skeleton of Australovenator wintonensis from the Cenomanian of Australia is among the most complete of any megaraptorid. It presents the opportunity to examine the range of motion of its forearm and the function of its highly modified manus. This provides the basis for behavioural inferences, and comparison with other Gondwanan theropod groups. Digital models created from computed tomography scans of the holotype reveal a humerus range of motion that is much greater than Allosaurus, Acrocanthosaurus, Tyrannosaurus but similar to that of the dromaeosaurid Bambiraptor. During flexion, the radius was forced distally by the radial condyle of the humerus. This movement is here suggested as a mechanism that forced a medial movement of the wrist. The antebrachium possessed a range of motion that was close to dromaeosaurids; however, the unguals were capable of hyper-extension, in particular manual phalanx I-2, which is a primitive range of motion characteristic seen in allosaurids and Dilophosaurus. During flexion, digits I and II slightly converge and diverge when extended which is accentuated by hyperextension of the digits in particular the unguals. We envision that prey was dispatched by its hands and feet with manual phalanx I-2 playing a dominant role. The range of motion analysis neither confirms nor refutes current phylogenetic hypotheses with regards to the placement of Megaraptoridae; however, we note Australovenator possessed, not only a similar forearm range of motion to some maniraptorans and basal coelurosaurs, but also similarities with Tetanurans (Allosauroids and Dilophosaurus). PMID:26368529

Dual small fragment plating improves screw-to-screw load sharing for mid-diaphyseal humeral fracture fixation: a finite element study.

PubMed

Kosmopoulos, Victor; Luedke, Colten; Nana, Arvind D

2015-01-01

A smaller humerus in some patients makes the use of a large fragment fixation plate difficult. Dual small fragment plate constructs have been suggested as an alternative. This study compares the biomechanical performance of three single and one dual plate construct for mid-diaphyseal humeral fracture fixation. Five humeral shaft finite element models (1 intact and 4 fixation) were loaded in torsion, compression, posterior-anterior (PA) bending, and lateral-medial (LM) bending. A comminuted fracture was simulated by a 1-cm gap. Fracture fixation was modelled by: (A) 4.5-mm 9-hole large fragment plate (wide), (B) 4.5-mm 9-hole large fragment plate (narrow), (C) 3.5-mm 9-hole small fragment plate, and (D) one 3.5-mm 9-hole small fragment plate and one 3.5-mm 7-hole small fragment plate. Model A showed the best outcomes in torsion and PA bending, whereas Model D outperformed the others in compression and LM bending. Stress concentrations were located near and around the unused screw holes for each of the single plate models and at the neck of the screws just below the plates for all the models studied. Other than in PA bending, Model D showed the best overall screw-to-screw load sharing characteristics. The results support using a dual small fragment locking plate construct as an alternative in cases where crutch weight-bearing (compression) tolerance may be important and where anatomy limits the size of the humerus bone segment available for large fragment plate fixation.

Effects of tibial and humerus intraosseous and intravenous vasopressin in porcine cardiac arrest model.

PubMed

Adams, Timothy S; Blouin, Dawn; Johnson, Don

2016-01-01

Compare maximum concentration (Cmax), time to maximum concentration (Tmax), mean serum concentration of vasopressin, return of spontaneous circulation (ROSC), time to ROSC, and odds of survival relative to vasopressin administration by tibial intraosseous (TIO), humerus intraosseous (HIO), and intravenous (IV) routes in a hypovolemic cardiac arrest model. Prospective, between subjects, randomized experimental design. TriService Research Facility. Yorkshire-cross swine (n = 40). Swine were anesthetized, exsanguinated to a Class III hemorrhage, and placed into cardiac arrest. After 2 minutes, cardiopulmonary resuscitation was initiated. After an additional 2 minutes, a dose of 40 units of vasopressin was administered by TIO, HIO, or the IV routes. Blood samples were collected over 4 minutes and analyzed by high-performance liquid chromatography tandem mass spectrometry. ROSC, time to ROSC, Cmax, Tmax, mean concentrations over time, and odds ratio. There was no significant difference in rate of ROSC or time to ROSC between the TIO, HIO, and IV groups (p > 0.05). The Cmax was significantly higher in the IV group compared to the TIO group (p = 0.015), but no significant difference between the TIO versus HIO or HIO versus IV groups (p > 0.05). The Tmax was significantly shorter for the HIO compared to the TIO group (p = 0.034), but no significant differences between the IV group compared to the TIO or HIO groups (p > 0.05). The odds of survival were higher in the HIO group compared to all other groups. The TIO and HIO provide rapid and reliable access to administer life-saving medications during cardiac arrest.

Paediatric lateral humeral condyle fractures: internal oblique radiographs alter the course of conservative treatment.

PubMed

Kurtulmuş, Tuhan; Sağlam, Necdet; Saka, Gursel; Avcı, Cem Coşkun; Uğurlar, Meriç; Türker, Mehmet

2014-10-01

At first presentation of paediatric humeral lateral condyle fractures, radiological methods such as computerised tomography, ultrasonography, magnetic resonance imaging, arthrography, and internal oblique radiography are used to determine stability. Very few studies show which radiological method should be used to evaluate displacement at follow-up for conservatively treated patients. This study aimed to show that internal oblique radiography is a simple, effective method to determine the subsequent development of fracture displacement in patients with an initially non-displaced or minimally displaced fracture. In this retrospective study, 27 paediatric patients with non-displaced or minimally displaced (<2 mm) humerus lateral condyle fracture were evaluated by elbow anteroposterior radiograph. The degree of fracture displacement was evaluated by anteroposterior then by internal oblique radiographs. The first follow-up was made between the 5th and 8th day and thereafter at intervals of 7-10 days. Of the 27 patients identified with non-displaced or minimally displaced (<2 mm) fracture from the initial anteroposterior radiograph, 16 were accepted as displacement >2 mm as a result of the evaluation of the internal oblique radiography and underwent surgery. At follow-up, 2 of 11 patients were defined with displacement from anteroposterior and internal oblique radiographs and 4 from the internal oblique radiographs and underwent surgery. Conservative treatment was applied to 5 patients. Internal oblique radiography is the best imaging showing subsequent fracture displacement in initially non-displaced or minimally displaced humerus lateral condyle fractures. At the first week follow-up, anteroposterior and particularly internal oblique radiographs should be taken of conservatively treated patients.

Relationship Between Humeral Retroversion and Length of Baseball Career Before the Age of 16 Years.

PubMed

Nakase, Chihiro; Mihata, Teruhisa; Itami, Yasuo; Takeda, Atsushi; Neo, Masashi

2016-09-01

Humeral retroversion physiologically decreases during growth. However, in throwing athletes, the external forces caused by repetitive throwing are thought to increase humeral retroversion on the dominant side compared with that on the nondominant side. To investigate the correlation between humeral retroversion and length of baseball career before age 16 years. Cross-sectional study; Level of evidence, 3. A total of 112 high school baseball players (32 pitchers and 80 position players) with a mean age of 15.6 years (range, 15-16 years) were enrolled in the study. All participants completed questionnaires regarding their player position and the age when they started baseball and were given physical examinations. Shoulder range of motion and humeral retroversion were assessed on the dominant and nondominant sides. Humeral retroversion (rotation angle of the proximal humerus relative to the distal humerus) was measured ultrasonographically. Humeral retroversion was significantly greater on the dominant side than on the nondominant side in both pitchers (P < .0001) and position players (P = .0005). The side-to-side difference in humeral retroversion in pitchers (13.9° ± 11.2°) was significantly greater than that in position players (9.0° ± 11.1°, P = .0361). In pitchers, there was a significant negative correlation between humeral retroversion and the age at which the players had started baseball (P = .033, β = -2.494). These results suggest that humeral retroversion increases with decreasing age at commencement of a baseball career before age 16 years in pitchers. © 2016 The Author(s).

Exposed versus buried wires for fixation of lateral humeral condyle fractures in children: a comparison of safety and efficacy.

PubMed

Chan, Lester Wai Mon; Siow, Hua Ming

2011-10-01

Displaced fractures of the lateral condyle of the humerus are usually treated with open reduction and fixation with smooth Kirschner wires. These may be passed through the skin and left exposed or buried subcutaneously. Exposed wires may be removed in the outpatient clinic, whereas buried wires require a formal procedure under anaesthesia. This advantage may be offset if there is a higher rate of complications with exposed wires. The aim of this study was to compare the safety and efficacy of exposed and buried wires. Retrospective cohort. Children with lateral condyle fractures of the humerus who had undergone surgery were identified from our departmental database. Case records and X-rays of 75 patients were reviewed. Forty-two patients had buried wires and 33 had exposed wires. There were no serious complications in either group. In the exposed wires group, 1 patient had a superficial wound infection that was treated effectively with 1 week of oral antibiotics, while 2 patients had hypergranulation of pin tracts treated with topical silver nitrate. None of the patients showed loss of reduction, deep infection, or any other complications requiring additional procedures. There was no statistically significant difference in the rate of complications between the buried and exposed groups. We conclude that open reduction and exposed wiring is a safe and effective option for lateral condyle fractures, and recommend a period of 4 weeks of K-wire fixation followed by 2 weeks of backslab immobilisation as adequate for union with minimal risk of infection.

In vivo three-dimensional elbow biomechanics during forearm rotation.

PubMed

Omori, Shinsuke; Miyake, Junichi; Oka, Kunihiro; Tanaka, Hiroyuki; Yoshikawa, Hideki; Murase, Tsuyoshi

2016-01-01

It is unclear how elbow kinematics changes during forearm rotation. This study investigated in vivo 3-dimensional elbow kinematics during forearm rotation. We studied 12 normal elbows using in vivo 3-dimensional computed tomography data in maximum forearm supination, neutral, and maximum pronation with the elbows in extension. We measured the motion of the radius and ulna relative to the humerus using a markerless bone registration technique and the contact area of the radiocapitellar joint, proximal radioulnar joint, and ulnohumeral joint using a proximity mapping method. When the forearm rotated from the supinated position to the pronated position, the radius showed significant varus rotation, internal rotation, and extension relative to the humerus. The center of the radial head significantly translated anteriorly, proximally, and laterally. The ulna significantly rotated in valgus, and the deepest point on the sagittal ridge of the trochlear notch translated medially with forearm pronation. The contact area of the radiocapitellar joint was largest in pronation. The contact area of the proximal radioulnar joint was largest in supination. The contact area of the ulnohumeral joint showed no significant change during forearm rotation. In pronation, because of the proximal migration of the radial head, the radiocapitellar joint was most congruent compared with other positions. The proximal radioulnar joint was most congruent in supination. The ulnohumeral joint congruency was not affected by forearm rotation. This study provides useful information for understanding 3-dimensional elbow motion and joint osseous stability related to forearm rotation. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Locking plate fixation provides superior fixation of humerus split type greater tuberosity fractures than tension bands and double row suture bridges.

PubMed

Gaudelli, Cinzia; Ménard, Jérémie; Mutch, Jennifer; Laflamme, G-Yves; Petit, Yvan; Rouleau, Dominique M

2014-11-01

This paper aims to determine the strongest fixation method for split type greater tuberosity fractures of the proximal humerus by testing and comparing three fixation methods: a tension band with No. 2 wire suture, a double-row suture bridge with suture anchors, and a manually contoured calcaneal locking plate. Each method was tested on eight porcine humeri. A osteotomy of the greater tuberosity was performed 50° to the humeral shaft and then fixed according to one of three methods. The humeri were then placed in a testing apparatus and tension was applied along the supraspinatus tendon using a thermoelectric cooling clamp. The load required to produce 3mm and 5mm of displacement, as well as complete failure, was recorded using an axial load cell. The average load required to produce 3mm and 5mm of displacement was 658N and 1112N for the locking plate, 199N and 247N for the double row, and 75N and 105N for the tension band. The difference between the three groups was significant (P<0.01). The average load to failure of the locking plate (810N) was significantly stronger than double row (456N) and tension band (279N) (P<0.05). The stiffness of the locking plate (404N/mm) was significantly greater than double row (71N/mm) and tension band (33N/mm) (P<0.01). Locking plate fixation provides the strongest and stiffest biomechanical fixation for split type greater tuberosity fractures. Copyright © 2014 Elsevier Ltd. All rights reserved.

The effect of the arthroscopic augmentation of the subscapularis tendon on shoulder instability and range of motion: A biomechanical study.

PubMed

Schröter, S; Krämer, M; Welke, B; Hurschler, C; Russo, R; Herbst, M; Stöckle, U; Ateschrang, A; Maiotti, M

2016-10-01

Anterior shoulder dislocation is common. The treatment of recurrence with glenoid bone defect is still considered controversial. A new arthroscopic subscapularis augmentation has recently been described that functions to decrease the anterior translation of the humeral head. The purpose of the presented study was to examine the biomechanical effect on glenohumeral joint motion and stability. Eight fresh frozen cadaver shoulders were studied by use of a force guided industrial robot fitted with a six-component force-moment sensor to which the humerus was attached. The testing protocol includes measurement of glenohumeral translation in the anterior, anterior-inferior and inferior directions at 0°, 30° and 60° of glenohumeral abduction, respectively, with a passive humerus load of 30N in the testing direction. The maximum possible external rotation was measured at each abduction angle applying a moment of 1Nm. Each specimen was measured in a physiologic state, as well as after Bankart lesion with an anterior bone defect of 15-20% of the glenoid, after arthroscopic subscapularis augmentation and after Bankart repair. The arthroscopic subscapularis augmentation decreased the anterior and anterior-inferior translation. The Bankart repair did not restore the mechanical stability compared to the physiologic shoulder group. External rotation was decreased after arthroscopic subscapularis augmentation compared to the physiologic state, however, the limitation of external rotation was decreased at 60° abduction. The arthroscopic subscapularis augmentation investigated herein was observed to restore shoulder stability in an experimental model. Copyright © 2016 Elsevier Ltd. All rights reserved.

Clinico-radiological Outcome Analysis of Parallel Plating with Perpendicular Plating in Distal Humeral Intra-articular Fractures: Prospective Randomised Study

PubMed Central

Shekhawat, Vishal; Banshiwal, Ramesh Chandra; Verma, Rajender Kumar

2017-01-01

Introduction The distal humeral fractures are common fractures of upper limb and are difficult to treat. These fractures, if left untreated or inadequately treated, leads to poor outcomes. Management of distal humeral fractures are pertained to many controversies and one among them is position of plates. Aim To compare the clinical and radiological outcomes in patients with intra-articular distal humerus fractures, treated using parallel and perpendicular double plating methods. Materials and Methods A total of 38 patients with distal humerus fractures, 20 in perpendicular plating group (group A) and 18 in parallel plating group (group B), were included in this prospective randomised study. At each follow up patients were evaluated clinically and radiologically for union and the outcomes were measured in terms of Mayo Elbow Performance Score (MEPS) consisting of pain intensity, range of motion, stability and function. MEP score greater than 90 is considered as excellent; Score 75 to 89 is good; Score 60 to 74 is fair and Score less than 60 is poor. Results In our study, 15 patients (75%) in group A, and 13 patients (72.22%) in group B achieved excellent results. Two patients (10%) in group A and 4 patients (22.22%) in group B attained good results. Complications developed in 2 patients in each groups. No significant differences were found between the clinical outcomes of the two plating methods. Conclusion Neither of the plating techniques are superior to the other, as inferred from the insignificant differences in bony union, elbow function and complications between the two plating techniques. PMID:28384948

Clinico-radiological Outcome Analysis of Parallel Plating with Perpendicular Plating in Distal Humeral Intra-articular Fractures: Prospective Randomised Study.

PubMed

Govindasamy, Ramachandran; Shekhawat, Vishal; Banshiwal, Ramesh Chandra; Verma, Rajender Kumar

2017-02-01

The distal humeral fractures are common fractures of upper limb and are difficult to treat. These fractures, if left untreated or inadequately treated, leads to poor outcomes. Management of distal humeral fractures are pertained to many controversies and one among them is position of plates. To compare the clinical and radiological outcomes in patients with intra-articular distal humerus fractures, treated using parallel and perpendicular double plating methods. A total of 38 patients with distal humerus fractures, 20 in perpendicular plating group (group A) and 18 in parallel plating group (group B), were included in this prospective randomised study. At each follow up patients were evaluated clinically and radiologically for union and the outcomes were measured in terms of Mayo Elbow Performance Score (MEPS) consisting of pain intensity, range of motion, stability and function. MEP score greater than 90 is considered as excellent; Score 75 to 89 is good; Score 60 to 74 is fair and Score less than 60 is poor. In our study, 15 patients (75%) in group A, and 13 patients (72.22%) in group B achieved excellent results. Two patients (10%) in group A and 4 patients (22.22%) in group B attained good results. Complications developed in 2 patients in each groups. No significant differences were found between the clinical outcomes of the two plating methods. Neither of the plating techniques are superior to the other, as inferred from the insignificant differences in bony union, elbow function and complications between the two plating techniques.

Mitochondrial stress and redox failure in steroid-associated osteonecrosis

PubMed Central

Tsuchiya, Masanobu; Ichiseki, Toru; Ueda, Shusuke; Ueda, Yoshimichi; Shimazaki, Miyako; Kaneuji, Ayumi; Kawahara, Norio

2018-01-01

The purpose of the role of antioxidant enzymes and mitochondria in the developmental mechanism of steroid-associated osteonecrosis in the femur. In the present study Japanese white rabbits (mean weight 3.5kg) were injected into the gluteus with methylprednisolone (MP) 20mg/kg, and killed after 3 days (MP3 group), 5 days (MP5 group), and 14 days (MP14 group) (n=3 each). As a Control group (C group) Japanese white rabbits not administered MP were used. In experiment 1, the expression of the antioxidant enzymes Superoxide dismutade (SOD) and catalase was compared in liver, kidney, heart, humerus, and femur in C group, and the presence/absence of mitochondria transcription factor A (TFAM) expression was determined by Western blotting (WB) and used to evaluate the number of mitochondria and their function. In experiment 2, the presence/absence of necrosis was determined by immunohistochemistry, while changes in the expression of SOD, catalase, and TFAM in the femur after steroid administration were determined by Western blotting (WB). In experiment 1, intense expression of all of SOD, catalase, and TFAM was found in the liver, kidney, and heart as compared to the humerus and femur. In experiment 2, the expression of all of SOD, catalase, and TFAM in MP3 and MP5 groups was decreased on WB as compared with C group, while in MP14 group a tendency to improvement was seen. Accordingly, steroid-associated mitochondrial injury and redox failure are concluded to be important elements implicated in the pathogenesis of osteonecrosis. PMID:29483810

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

PubMed

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.

Beneficial effects of physical activity in an HIV-infected woman with lipodystrophy: a case report

PubMed Central

2011-01-01

Introduction Lipodystrophy is common in patients infected with human immunodeficiency virus receiving highly active antiretroviral therapy, and presents with morphologic changes and metabolic alterations that are associated with depressive behavior and reduced quality of life. We examined the effects of exercise training on morphological changes, lipid profile and quality of life in a woman with human immunodeficiency virus presenting with lipodystrophy. Case presentation A 31-year-old Latin-American Caucasian woman infected with human immunodeficiency virus participated in a 12-week progressive resistance exercise training program with an aerobic component. Her weight, height, skinfold thickness, body circumferences, femur and humerus diameter, blood lipid profile, maximal oxygen uptake volume, exercise duration, strength and quality of life were assessed pre-exercise and post-exercise training. After 12 weeks, she exhibited reductions in her total subcutaneous fat (18.5%), central subcutaneous fat (21.0%), peripheral subcutaneous fat (10.7%), waist circumference (WC) (4.5%), triglycerides (9.9%), total cholesterol (12.0%) and low-density lipoprotein cholesterol (8.6%). She had increased body mass (4.6%), body mass index (4.37%), humerus and femur diameter (3.0% and 2.3%, respectively), high-density lipoprotein cholesterol (16.7%), maximal oxygen uptake volume (33.3%), exercise duration (37.5%) and strength (65.5%). Quality of life measures improved mainly for psychological and physical measures, independence and social relationships. Conclusions These findings suggest that supervised progressive resistance exercise training is a safe and effective treatment for evolving morphologic and metabolic disorders in adults infected with HIV receiving highly active antiretroviral therapy, and improves their quality of life. PMID:21892961

Beneficial effects of physical activity in an HIV-infected woman with lipodystrophy: a case report.

PubMed

Mendes, Edmar Lacerda; Ribeiro Andaki, Alynne Christian; Brito, Ciro José; Córdova, Cláudio; Natali, Antônio José; Santos Amorim, Paulo Roberto Dos; de Oliveira, Leandro Licursi; de Paula, Sérgio Oliveira; Mutimura, Eugene

2011-09-05

Lipodystrophy is common in patients infected with human immunodeficiency virus receiving highly active antiretroviral therapy, and presents with morphologic changes and metabolic alterations that are associated with depressive behavior and reduced quality of life. We examined the effects of exercise training on morphological changes, lipid profile and quality of life in a woman with human immunodeficiency virus presenting with lipodystrophy. A 31-year-old Latin-American Caucasian woman infected with human immunodeficiency virus participated in a 12-week progressive resistance exercise training program with an aerobic component. Her weight, height, skinfold thickness, body circumferences, femur and humerus diameter, blood lipid profile, maximal oxygen uptake volume, exercise duration, strength and quality of life were assessed pre-exercise and post-exercise training. After 12 weeks, she exhibited reductions in her total subcutaneous fat (18.5%), central subcutaneous fat (21.0%), peripheral subcutaneous fat (10.7%), waist circumference (WC) (4.5%), triglycerides (9.9%), total cholesterol (12.0%) and low-density lipoprotein cholesterol (8.6%). She had increased body mass (4.6%), body mass index (4.37%), humerus and femur diameter (3.0% and 2.3%, respectively), high-density lipoprotein cholesterol (16.7%), maximal oxygen uptake volume (33.3%), exercise duration (37.5%) and strength (65.5%). Quality of life measures improved mainly for psychological and physical measures, independence and social relationships. These findings suggest that supervised progressive resistance exercise training is a safe and effective treatment for evolving morphologic and metabolic disorders in adults infected with HIV receiving highly active antiretroviral therapy, and improves their quality of life.

Variation in the insertion of the latissimus dorsi & its clinical importance.

PubMed

Bhatt, C R; Prajapati, B; Patil, D S; Patel, V D; Singh, Binodkumar G P; Mehta, C D

2013-01-01

The latissimus dorsi is the larger, flat, dorso-lateral muscle on the trunk, posterior to the arm, and partly covered by the trapezius on its median dorsal region. Origin of the latissimus dorsi is from spinous processes of thoracic T7-T12, thoracolumbar fascia, iliac crest and inferior 3 or 4 ribs, inferior angle of scapula and insertion on floor of intertubercular groove of the humerus. We have studied 50 cadavers in the different medical colleges in which we found 2% case of anterior and posterior slip of the muscle fibers with their extension up to the pectoralis major and teres major respectively. Usually, latissimus dorsi involve in extension, adduction, transverse extension also known as horizontal abduction, flexion from an extended position, and internal rotation of the shoulder joint. It also has a synergistic role in extension and lateral flexion of the lumbar spine. The latissimus dorsi may be used for the tendon graft surgeries. Tight latissimus dorsi has been shown to be one cause of chronic shoulder pain and chronic back pain. Because the latissimus dorsi connects the spine to the humerus, tightness in this muscle can manifest as either sub-optimal glenohumeral joint function (which leads to chronic shoulder pain) or tendinitis in the tendinous fasciae connecting the latissimus dorsi to the thoracic and lumbar spine. Latissimus dorsi used for pedicle transplant rotator cuff repair reconstruction of breast, face, scalp and cranium defect. The extra slip of the latissimus dorsi may puzzle any transplant operations. We as anatomist discuss the clinical implication of the extra slip of latissimus dorsi.

Variation in the insertion of the latissimus dorsi & its clinical importance

PubMed Central

Bhatt, C.R.; Prajapati, B.; Patil, D.S.; Patel, V.D.; Singh, Binodkumar G.P.; Mehta, C.D.

2013-01-01

The latissimus dorsi is the larger, flat, dorso-lateral muscle on the trunk, posterior to the arm, and partly covered by the trapezius on its median dorsal region. Origin of the latissimus dorsi is from spinous processes of thoracic T7–T12, thoracolumbar fascia, iliac crest and inferior 3 or 4 ribs, inferior angle of scapula and insertion on floor of intertubercular groove of the humerus. We have studied 50 cadavers in the different medical colleges in which we found 2% case of anterior and posterior slip of the muscle fibers with their extension up to the pectoralis major and teres major respectively. Usually, latissimus dorsi involve in extension, adduction, transverse extension also known as horizontal abduction, flexion from an extended position, and internal rotation of the shoulder joint. It also has a synergistic role in extension and lateral flexion of the lumbar spine. The latissimus dorsi may be used for the tendon graft surgeries. Tight latissimus dorsi has been shown to be one cause of chronic shoulder pain and chronic back pain. Because the latissimus dorsi connects the spine to the humerus, tightness in this muscle can manifest as either sub-optimal glenohumeral joint function (which leads to chronic shoulder pain) or tendinitis in the tendinous fasciae connecting the latissimus dorsi to the thoracic and lumbar spine. Latissimus dorsi used for pedicle transplant rotator cuff repair reconstruction of breast, face, scalp and cranium defect. The extra slip of the latissimus dorsi may puzzle any transplant operations. We as anatomist discuss the clinical implication of the extra slip of latissimus dorsi. PMID:24403744

Smad4 deficiency impairs chondrocyte hypertrophy via the Runx2 transcription factor in mouse skeletal development.

PubMed

Yan, Jianyun; Li, Jun; Hu, Jun; Zhang, Lu; Wei, Chengguo; Sultana, Nishat; Cai, Xiaoqiang; Zhang, Weijia; Cai, Chen-Leng

2018-06-15

Chondrocyte hypertrophy is the terminal step in chondrocyte differentiation and is crucial for endochondral bone formation. How signaling pathways regulate chondrocyte hypertrophic differentiation remains incompletely understood. In this study, using a Tbx18:Cre ( Tbx18 Cre /+ ) gene-deletion approach, we selectively deleted the gene for the signaling protein SMAD family member 4 ( Smad4 f/f ) in the limbs of mice. We found that the Smad4 -deficient mice develop a prominent shortened limb, with decreased expression of chondrocyte differentiation markers, including Col2a1 and Acan , in the humerus at mid-to-late gestation. The most striking defects in these mice were the absence of stylopod elements and failure of chondrocyte hypertrophy in the humerus. Moreover, expression levels of the chondrocyte hypertrophy-related markers Col10a1 and Panx3 were significantly decreased. Of note, we also observed that the expression of runt-related transcription factor 2 ( Runx2 ), a critical mediator of chondrocyte hypertrophy, was also down-regulated in Smad4 -deficient limbs. To determine how the skeletal defects arose in the mouse mutants, we performed RNA-Seq with ChIP-Seq analyses and found that Smad4 directly binds to regulatory elements in the Runx2 promoter. Our results suggest a new mechanism whereby Smad4 controls chondrocyte hypertrophy by up-regulating Runx2 expression during skeletal development. The regulatory mechanism involving Smad4-mediated Runx2 activation uncovered here provides critical insights into bone development and pathogenesis of chondrodysplasia. © 2018 Yan et al.

The impact of public versus private insurance on trauma patients.

PubMed

Jentzsch, Thorsten; Neuhaus, Valentin; Seifert, Burkhardt; Osterhoff, Georg; Simmen, Hans-Peter; Werner, Clément M L; Moos, Rudolf

2016-01-01

The socioeconomic status has been associated with disparities in the incidence and mortality of traumatic injuries. However, there is a lack of studies on the level of health insurance with regard to various epidemiologic data of traumatic injuries, which this study opted to clarify. All consecutive 6595 patients admitted to a level one trauma center in 2012 and 2013 were included in this retrospective cohort study. Patients were grouped according to their health insurance status (public versus private extended health care insurance) and compared with regard to several epidemiologic variables, that is, the type of injuries, inhospital outcome, and surgical procedures. Public insurance coverage was significantly more common than private insurance (75% versus 25%). Public insurance was associated with younger age, male sex, transfers to another hospital or mental institution, head concussions, head fractures, and increased mortality. Contrarily, patients with private insurance were more often associated with longer hospital stay, discharge to a rehabilitation clinic, fractures of the proximal humerus, and shoulder dislocations. However, there were no significant differences for the remaining majority of studied variables. In a trauma setting, the level of insurance does not seem to play a crucial role in most types of injuries and surgical procedures in a country with a high level of obligatory health care coverage. Nonetheless, it appears that publicly insured patients are more commonly younger, males, transferred to another hospital more often, more prone to head trauma, and subject to increased mortality, whereas privately insured patients show longer hospital stays, increased transfers to rehabilitation clinics, and more fractures of the proximal humerus. Copyright © 2016 Elsevier Inc. All rights reserved.

Midterm results of surgical treatment of displaced proximal humeral fractures in children.

PubMed

Pavone, Vito; de Cristo, Claudia; Cannavò, Luca; Testa, Gianluca; Buscema, Antonio; Condorelli, Giuseppe; Sessa, Giuseppe

2016-07-01

To analyse the clinical outcomes of 26 children treated surgically for displaced proximal humerus fracture. From January 2008 to December 2012, 26 children/adolescents (14 boys, 12 girls) were treated surgically for displaced fractures at the proximal extremity of the humerus. Ten were grade III and 16 were grade IV according to the Neer-Horowitz classification with a mean age of 12.8 ± 4.2 years. Twenty young patients were surgically treated with a closed reduction and direct percutaneous pinning; six required an open approach. To obtain a proper analysis, we compared the Costant scores with the contralateral shoulder (Δ Costant). The mean follow-up period was 34 months (range 10-55). Two grade IV patients showed a loss in the reduction after percutaneous treatment. This required open surgery with a plate and screws. On average, the treated fractures healed at 40 days. The mean Δ Costant score was 8.43 (range 2-22). There was a statistically significant improvement in the mean Δ Costant score in grade III patients. In grade IV patients, there was a significant improvement in the mean Δ Costant score in those treated with open surgery versus mini-invasive surgery. Our study shows excellent results with percutaneous k-wires. This closed surgery had success in these patients, and the excellent outcomes noted here lead us to prefer the mini-invasive surgical approach in NH grade III fractures. In grade IV, the best results were noted in patients treated with open surgery. We suggest an open approach for these patients. III.

A Randomized Cadaver Study Comparing First-Attempt Success Between Tibial and Humeral Intraosseous Insertions Using NIO Device by Paramedics: A Preliminary Investigation.

PubMed

Szarpak, Lukasz; Truszewski, Zenon; Smereka, Jacek; Krajewski, Paweł; Fudalej, Marcin; Adamczyk, Piotr; Czyzewski, Lukasz

2016-05-01

Medical personnel may encounter difficulties in obtaining intravenous (IV) access during cardiac arrest. The 2015 American Heart Association guidelines and the 2015 European Resuscitation Council guidelines for cardiopulmonary resuscitation (CPR) suggest that rescuers establish intraosseous (IO) access if an IV line is not easily obtainable.The aim of the study was to compare the success rates of the IO proximal tibia and proximal humerus head access performed by paramedics using the New Intraosseous access device (NIO; Persys Medical, Houston, TX, USA) in an adult cadaver model during simulated CPR.In an interventional, randomized, crossover, single-center cadaver study, a semi-automatic spring-load driven NIO access device was investigated. In total, 84 paramedics with less than 5-year experience in Emergency Medical Service participated in the study. The trial was performed on 42 adult cadavers. In each cadaver, 2 IO accesses to the humerus head, and 2 IO accesses to the proximal tibia were obtained.The success rate of the first IO attempt was 89.3% (75/84) for tibial access, and 73.8% (62/84) for humeral access (P = 0.017). The procedure times were significantly faster for tibial access [16.8 (interquartile range, IQR, 15.1-19.9] s] than humeral access [26.7 (IQR, 22.1-30.9) s] (P < 0.001).Tibial IO access is easier and faster to put in place than humeral IO access. Humeral IO access can be an alternative method to tibial IO access. clinicaltrials.gov Identifier: NCT02700867.

Phocomelia: Case report and differential diagnosis.

PubMed

Osadsky, Captain Rasto

2011-01-01

While rarely seen in the present-day Western world, phocomelia is not uncommon in underdeveloped countries. Phocomelia is an abnormality in which the limbs are not fully formed. It may be inherited as an autosomal recessive or dominant disorder. This case concerns a 12-year-old Afghan boy with multiple skeletal anomalies, most prominently of his right arm, including aplasia of the entire proximal humerus, hypoplasia of the clavicle and scapula, and absence of the radial ray and thumb. A hypoplastic left thumb was also present. Other anomalies included thoracic scoliosis, upper thoracic hemivertebrae, and mild cardiomegaly. The differential diagnosis and likely diagnosis are discussed.

Supracondylar fracture in children. Rehabilitation in occupational therapy. Yes or no?

NASA Astrophysics Data System (ADS)

Costa, Maria J.; Pires, Mafalda; Neves, Cassiano; Tavares, Delfin; Quintas, Alexandra M.; Ferreira, Ana I.; Espirito Santo, M. J.; Castro, Alexandra; Cabral, M. Salomé; João Gomes, J. F.

2013-10-01

The aim of this study was to evaluate the recovery time of elbow range of motion after treatment of Gartland's type II and III supracondylar fractures of distal humerus in children who attended a program of occupational therapy (OT). A randomized control design (RCD) was conducted to compare the two groups (OT group and Control group) and several statistical methodologies have been used to compare them. In all the cases the results point out to a faster recover in the OT group. All the analysis were performed using the package R version 3.0.1.

Multifocal avascular necrosis after liver transplantation: an unusual presentation of the antiphospholipid syndrome.

PubMed

Mundo, J; Peris, P; Monegal, A; Navasa, M; Cervera, R; Guañiabens, N

2006-01-01

We describe the case of a 31-year-old man who presented with an antiphospholipid syndrome (APS), which manifested as multifocal avascular necrosis (AVN) one year after orthotopic liver transplantation. The patient developed multiple AVN affecting hips, left knee, humerus and tarsal bones just after withdrawal of corticosteroid therapy. Three years later when lupus anticoagulant was detected, he began anticoagulant treatment and no further AVN episodes were observed. It is important to be aware of this clinical manifestation of APS, especially in these cases where it can be easily overlooked because of corticosteroid therapy.

In vivo kinematic analysis of the glenohumeral joint during dynamic full axial rotation and scapular plane full abduction in healthy shoulders.

PubMed

Kozono, Naoya; Okada, Takamitsu; Takeuchi, Naohide; Hamai, Satoshi; Higaki, Hidehiko; Ikebe, Satoru; Shimoto, Takeshi; Miake, Go; Nakanishi, Yoshitaka; Iwamoto, Yukihide

2017-07-01

The purpose of this study was to evaluate the kinematics of healthy shoulders during dynamic full axial rotation and scapular plane full abduction using three-dimensional (3D)-to-two-dimensional (2D) model-to-image registration techniques. Dynamic glenohumeral kinematics during axial rotation and scapular plane abduction were analysed in 10 healthy participants. Continuous radiographic images of axial rotation and scapular plane abduction were taken using a flat panel radiographic detector. The participants received a computed tomography scan to generate virtual digitally reconstructed radiographs. The density-based digitally reconstructed radiographs were then compared with the serial radiographic images acquired using image correlations. These 3D-to-2D model-to-image registration techniques determined the 3D positions and orientations of the humerus and scapula during dynamic full axial rotation and scapular plane full abduction. The humeral head centre translated an average of 2.5 ± 3.1 mm posteriorly, and 1.4 ± 1.0 mm superiorly in the early phase, then an average of 2.0 ± 0.8 mm inferiorly in the late phase during external rotation motion. The glenohumeral external rotation angle had a significant effect on the anterior/posterior (A/P) and superior/inferior (S/I) translation of the humeral head centre (both p < 0.05). 33.6 ± 15.6° of glenohumeral external rotation occurred during scapular plane abduction. The humeral head centre translated an average of 0.6 ± 0.9 mm superiorly in the early phase, then 1.7 ± 2.6 mm inferiorly in the late phase, and translated an average of 0.4 ± 0.5 mm medially in the early phase, then 1.6 ± 1.0 mm laterally in the late phase during scapular plane abduction. The humeral abduction angle had a significant effect on the S/I and lateral/medial (L/M) translation of the humeral head centre (both p < 0.05). This study investigated 3D translations of the humerus relative to the scapula: during scapular plane full abduction, the humerus rotated 33.6° externally relative to the scapula, and during external rotation motion in the adducted position, the humeral head centre translated an average of 2.5 mm posteriorly. Kinematic data will provide important insights into evaluating the kinematics of pathological shoulders. For clinical relevance, quantitative assessment of dynamic healthy shoulder kinematics might be a physiological indicator for the assessment of pathological shoulders.

The challenging surgical treatment of closed distal humerus fractures in elderly and octogenarian patients: radiographic and functional outcomes with a minimum follow-up of 24 months.

PubMed

Biz, Carlo; Sperotto, Silvano Pierluigi; Maschio, Nicola; Borella, Matteo; Iacobellis, Claudio; Ruggieri, Pietro

2017-10-01

The main purpose of this retrospective, non-randomized, case series study was to evaluate the clinical and radiographic outcomes of distal humerus fractures (DHFs) in a consecutive series of elderly patients operatively treated by two surgeons, and second, to identify proper indications for two elderly age ranges and two fracture pattern groups. From January 2009 to June 2014, 51 patients (pts) underwent open reduction and internal fixation (ORIF) using the locking compression plate (LCP) distal humerus plate (DHP) system at our institution. Medical records and radiographs were retrospectively assessed. Patients were divided into 3 groups according to gender, age (pts <85 years, pts ≥85 years) and AO classification (13-B1-B2-C1-C2 or 13-C3). All subjects completed MEPS, Quick-DASH and SF-36 PCS/MCS scores at final follow-up, and statistical analysis was performed. 36 patients (20 women, 16 men), mean age 80.3 years, with AO type 13-B and 13-C DHFs were included with a mean follow-up of 56 months (range 24-92). The most common mechanism of trauma was a fall from ground level (55.6%). The mean MEPS was 78.9 points, Quick-DASH 28.4, SF-36 PCS 48.3 and MCS 48.9. There was statistically significant evidence that having a 13-C3 fracture leads to worse results in MEPS, Quick-DASH and SF-36. The female gender correlates with worse results in SF-36. The patients ≥85 years had a worse prognosis according to Quick-DASH and SF-36, while the AO 13-C3 pattern obtained the worst ROM outcomes versus AO 13 B1-B2-C1-C2 (normal ROM 0°-140°): mean ROM 24°-114° vs 10°-130°, mean flexion deficit 26° vs 10°, mean extension deficit 24° vs 10°, respectively). Complications were presents in 36.1% of patients, overall belonging to the AO type 13-C fracture pattern and to the group ≥85 years. These study data seem to confirm our hypothesis that plate fixation for DHFs guarantees adequate fracture osteosynthesis and satisfactory functional outcomes at medium to long-term follow-up, not only in elderly patients, but also in octogenarian osteoporotic patients (≥85 years) with 13-C1 and 13-C2 fracture patterns, while an alternative solution should be considered for type C3 fractures, even in a primary trauma setting.

Optimizing intramedullary entry location on the proximal humerus based on variations of neck-shaft angle.

PubMed

Jeong, Jinyoung; Jung, Hyun-Woo

2015-09-01

The purpose of this study was to define the relationship between the humeral neck-shaft angle (NSA) and variations in the ideal entry portal aligned with the long axis of the intramedullary canal of the proximal humerus. Three-dimensional images of 36 cadaveric humeri with various NSAs were reconstructed by a computerized surgical simulation program. The anteroposterior, mediolateral, and linear distances between a line from the center of the proximal medullary canal to the bicipital groove were measured. Differences among humeri with various NSAs were analyzed. The intramedullary axis line was located a mean of 9 ± 2 mm posteriorly and 11 ± 3 mm medially from the bicipital groove. The axis line was 9 ± 2 mm posterior and 11 ± 2 mm medial with a standard NSA. The axis line in humeri with a varus NSA was 8 ± 2 mm posteriorly and 9 ± 2 mm medially, whereas the axis line was 10 ± 3 mm posteriorly and 14 ± 3 mm medially with a valgus NSA. The differences in the mediolateral distances between the groups were significant (P < .00009). Care should be taken in choosing the entry portal position in humeri with various NSAs as the entry portal position differs according to the NSA. It is recommended that the location of the entry portal be moved toward the center of the humeral head to align with the centerline of the intramedullary canal in humeri with a valgus NSA in particular. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Reidentification of avian embryonic remains from the cretaceous of mongolia.

PubMed

Varricchio, David J; Balanoff, Amy M; Norell, Mark A

2015-01-01

Embryonic remains within a small (4.75 by 2.23 cm) egg from the Late Cretaceous, Mongolia are here re-described. High-resolution X-ray computed tomography (HRCT) was used to digitally prepare and describe the enclosed embryonic bones. The egg, IGM (Mongolian Institute for Geology, Ulaanbaatar) 100/2010, with a three-part shell microstructure, was originally assigned to Neoceratopsia implying extensive homoplasy among eggshell characters across Dinosauria. Re-examination finds the forelimb significantly longer than the hindlimbs, proportions suggesting an avian identification. Additional, postcranial apomorphies (strut-like coracoid, cranially located humeral condyles, olecranon fossa, slender radius relative to the ulna, trochanteric crest on the femur, and ulna longer than the humerus) identify the embryo as avian. Presence of a dorsal coracoid fossa and a craniocaudally compressed distal humerus with a strongly angled distal margin support a diagnosis of IGM 100/2010 as an enantiornithine. Re-identification eliminates the implied homoplasy of this tri-laminate eggshell structure, and instead associates enantiornithine birds with eggshell microstructure composed of a mammillary, squamatic, and external zones. Posture of the embryo follows that of other theropods with fore- and hindlimbs folded parallel to the vertebral column and the elbow pointing caudally just dorsal to the knees. The size of the egg and embryo of IGM 100/2010 is similar to the two other Mongolian enantiornithine eggs. Well-ossified skeletons, as in this specimen, characterize all known enantiornithine embryos suggesting precocial hatchlings, comparing closely to late stage embryos of modern precocial birds that are both flight- and run-capable upon hatching. Extensive ossification in enantiornithine embryos may contribute to their relatively abundant representation in the fossil record. Neoceratopsian eggs remain unrecognized in the fossil record.

Community water fluoridation, bone mineral density, and fractures: prospective study of effects in older women.

PubMed

Phipps, K R; Orwoll, E S; Mason, J D; Cauley, J A

2000-10-07

To determine whether fluoridation influences bone mineral density and fractures in older women. Multicentre prospective study on risk factors for osteoporosis and fractures. Four community based centres in the United States. 9704 ambulatory women without bilateral hip replacements enrolled during 1986-8; 7129 provided information on exposure to fluoride. Bone mineral density of the lumbar spine, proximal femur, radius, and calcaneus plus incident fractures (fractures that occurred during the study) of vertebrae, hip, wrist, and humerus. Women were classified as exposed or not exposed or having unknown exposure to fluoride for each year from 1950 to 1994. Outcomes were compared in women with continuous exposure to fluoridated water for the past 20 years (n=3218) and women with no exposure during the past 20 years (n=2563). In women with continuous exposure mean bone mineral density was 2.6% higher at the femoral neck (0.017 g/cm(2), P<0.001), 2.5% higher at the lumbar spine (0.022 g/cm(2), P<0.001), and 1.9% lower at the distal radius (0.007 g/cm(2), P=0.002). In women with continuous exposure the multivariable adjusted risk of hip fracture was slightly reduced (risk ratio 0.69, 95% confidence interval 0.50 to 0.96, P=0.028) as was the risk of vertebral fracture (0.73, 0.55 to 0.97, P=0.033). There was a non-significant trend toward an increased risk of wrist fracture (1.32, 1.00 to 1.71, P=0.051) and no difference in risk of humerus fracture (0.85, 0.58 to 1.23, P=0.378). Long term exposure to fluoridated drinking water does not increase the risk of fracture.

Community water fluoridation, bone mineral density, and fractures: prospective study of effects in older women

PubMed Central

Phipps, Kathy R; Orwoll, Eric S; Mason, Jill D; Cauley, Jane A

2000-01-01

Objective To determine whether fluoridation influences bone mineral density and fractures in older women. Design Multicentre prospective study on risk factors for osteoporosis and fractures. Setting Four community based centres in the United States. Participants 9704 ambulatory women without bilateral hip replacements enrolled during 1986-8; 7129 provided information on exposure to fluoride. Main outcome measures Bone mineral density of the lumbar spine, proximal femur, radius, and calcaneus plus incident fractures (fractures that occurred during the study) of vertebrae, hip, wrist, and humerus. Results Women were classified as exposed or not exposed or having unknown exposure to fluoride for each year from 1950 to 1994. Outcomes were compared in women with continuous exposure to fluoridated water for the past 20 years (n=3218) and women with no exposure during the past 20 years (n=2563). In women with continuous exposure mean bone mineral density was 2.6% higher at the femoral neck (0.017 g/cm2, P<0.001), 2.5% higher at the lumbar spine (0.022 g/cm2, P<0.001), and 1.9% lower at the distal radius (0.007 g/cm2, P=0.002). In women with continuous exposure the multivariable adjusted risk of hip fracture was slightly reduced (risk ratio 0.69, 95% confidence interval 0.50 to 0.96, P=0.028) as was the risk of vertebral fracture (0.73, 0.55 to 0.97, P=0.033). There was a non-significant trend toward an increased risk of wrist fracture (1.32, 1.00 to 1.71, P=0.051) and no difference in risk of humerus fracture (0.85, 0.58 to 1.23, P=0.378). Conclusions Long term exposure to fluoridated drinking water does not increase the risk of fracture. PMID:11021862

Management of distal humeral coronal shear fractures

PubMed Central

Yari, Shahram S; Bowers, Nathan L; Craig, Miguel A; Reichel, Lee M

2015-01-01

Coronal shear fractures of the distal humerus are rare, complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the radial head in a hyper-extended or semi-flexed elbow or from spontaneous reduction of a posterolateral subluxation or dislocation. Due to the small number of soft tissue attachments at this site, almost all of these fractures are displaced. The incidence of distal humeral coronal shear fractures is higher among women because of the higher rate of osteoporosis in women and the difference in carrying angle between men and women. Distal humeral coronal shear fractures may occur in isolation, may be part of a complex elbow injury, or may be associated with injuries proximal or distal to the elbow. An associated lateral collateral ligament injury is seen in up to 40% and an associated radial head fracture is seen in up to 30% of these fractures. Given the complex nature of distal humeral coronal shear fractures, there is preference for operative management. Operative fixation leads to stable anatomic reduction, restores articular congruity, and allows initiation of early range-of-motion movements in the majority of cases. Several surgical exposure and fixation techniques are available to reconstruct the articular surface following distal humeral coronal shear fractures. The lateral extensile approach and fixation with countersunk headless compression screws placed in an anterior-to-posterior fashion are commonly used. We have found a two-incision approach (direct anterior and lateral) that results in less soft tissue dissection and better outcomes than the lateral extensile approach in our experience. Stiffness, pain, articular incongruity, arthritis, and ulnohumeral instability may result if reduction is non-anatomic or if fixation fails. PMID:25984515

Is the assessment of the central skeleton sufficient for osseous staging in breast cancer patients? A retrospective approach using bone scans.

PubMed

Krammer, Julia; Engel, Dorothee; Schnitzer, Andreas; Kaiser, Clemens G; Dinter, Dietmar J; Brade, Joachim; Schoenberg, Stefan O; Wasser, Klaus

2013-06-01

By analyzing bone scans we aimed to determine whether the assessment of the central skeleton is sufficient for osseous staging in breast cancer patients. This might be of interest for future staging modalities, especially positron emission tomography/computed tomography, usually sparing the peripheral extremities, as well as the skull. In this retrospective study, a total of 837 bone scans for initial staging or restaging of breast cancer were included. A total of 291 bone scans in 172 patients were positive for bone metastases. The localization and distribution of the metastases were re-evaluated by two readers in consensus. The extent of the central skeleton involvement was correlated to the incidence of peripheral metastases. In all 172 patients bone metastases were seen in the central skeleton (including the proximal third of humerus and femur). In 34 patients (19.8 %) peripheral metastases of the extremities (distally of the proximal third of humerus and femur) could be detected. Sixty-four patients (37.2 %) showed metastases of the skull. Summarizing the metastases of the distal extremities and skull, 79 patients (45.9 %) had peripheral metastases. None of the patients showed peripheral metastases without any affliction of the central skeleton. The incidence of peripheral metastases significantly correlated with the extent of central skeleton involvement (p<0.001). Regarding bone scans, an isolated metastatic spread to the peripheral skeleton without any manifestation in the central skeleton seems to be the exception. Thus, the assessment of the central skeleton should be sufficient in osseous breast cancer staging and restaging. However, in case of central metastases, additional imaging of the periphery should be considered for staging and restaging.

Medicaid payer status is linked to increased rates of complications after treatment of proximal humerus fractures.

PubMed

Sabesan, Vani J; Petersen-Fitts, Graysen; Lombardo, Daniel; Briggs, Daniel; Whaley, James

2017-06-01

Low socioeconomic status and Medicaid insurance as a primary payer have been associated with major disparities in resource utilization and risk-adjusted outcomes for patients undergoing total joint arthroplasty. With the expansion of Medicaid through the Affordable Care Act in 2014, examination of these disparities has become increasingly relevant for the treatment of proximal humerus fracture (PHF). The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to identify patients who were treated for PHF from 2002 to 2012. Primary outcomes included treatment type, surgical fixation method, in-hospital complications, mean length of stay, and mean total charges for Medicaid patients vs. a matched privately insured cohort. In an effort to minimize confounding variables, each Medicaid patient was matched to a privately insured patient on the basis of gender, race, year of procedure, and age. Of the 678,831 patients treated with PHF, 4.9% (33,263) had Medicaid as the primary payer during the 10-year period. Medicaid patients were found to have a significantly higher risk (P < .05) of postoperative in-hospital complications, including postoperative infection (odds ratio [OR], 2.00 [1.37-2.93]), wound complications (OR, 1.69 [1.04-2.75]), and acute respiratory distress syndrome (OR, 1.34 [1.15-1.59]). Medicaid patients have a significantly higher risk for certain postoperative hospital complications and consume more resources after treatment for PHFs. Additional work is needed to understand the optimal treatment type for Medicaid patients and to understand the complex interplay between socioeconomic status and outcomes to ensure appropriate resource allocation and risk stratification. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Subclinical hypervitaminosis A in rat: measurements of bone mineral density (BMD) do not reveal adverse skeletal changes.

PubMed

Lind, P M; Johansson, S; Rönn, M; Melhus, H

2006-01-05

We have previously shown that subclinical hypervitaminosis A in rats causes fragile bones. To begin to investigate possible mechanisms for Vitamin A action we extended our previous study. Forty-five mature female Sprague-Dawley rats were divided into three groups, each with 15 animals. They were fed a standard diet containing 12IU Vitamin A per g pellet (control, C), or a standard diet supplemented with 120 IU ("10xC") or 600 IU ("50xC") Vitamin A/g pellet for 12 weeks. At the end of the study, serum retinyl esters were elevated 4- and 20-fold. Although neither average food intake nor final body weights were significantly different between groups, a dose-dependent reduction in serum levels of Vitamin D and E, but not Vitamin K, was found. In the 50xC-group the length of the humerus was the same as in controls, but the diameter was reduced (-4.1%, p<0.05). Peripheral quantitative computed tomography (pQCT) at the diaphysis showed that bone mineral density (BMD) was unchanged and that periosteal circumference had decreased significantly (-3.7%, p<0.05). Ash weight of the humerus was not affected, but since bone volume decreased, volumetric BMD, as measured by the bone ash method, even increased (+2.5%, p<0.05). In conclusion, interference with other fat-soluble Vitamins is a possible indirect mechanism of Vitamin A action. Moreover, BMD measurements do not reveal early adverse skeletal changes induced by moderate excesses of Vitamin A in rats. Since the WHO criterium for osteoporosis is based on BMD, further studies are warranted to examine whether this is also true in humans.

Characteristics and prognosis of medial epicondylar fragmentation of the humerus in male junior tennis players.

PubMed

Harada, Mikio; Takahara, Masatoshi; Maruyama, Masahiro; Takagi, Michiaki

2014-10-01

Although medial epicondylar fragmentation of the humerus is a reported elbow injury in junior tennis players, there have been only a few studies on this entity, and none have investigated the characteristics and prognosis of medial epicondylar fragmentation. Forty-one male junior tennis players, aged 11 to 14 years (mean, 13 years), underwent elbow examination by ultrasonography. Elbow re-examination was performed in subjects with medial epicondylar fragmentation at an average of 20 months (12-30 months) after the initial examination. On examination, 9 subjects (22%) had elbow pain. Ultrasonography showed that 6 subjects (15%) had medial epicondylar fragmentation, all of whom had elbow pain. Medial epicondylar fragmentation was present in 5 (38%) of 13 subjects aged 11 to 12 years and in 1 (4%) of 28 aged 13 to 14 years. More subjects aged 11 to 12 years had medial epicondylar fragmentation (P = .0084). All 6 subjects with medial epicondylar fragmentation continued to play tennis between the initial elbow examination and the re-examination. At re-examination, although ultrasonography showed that 5 developed bone union and 1 had nonunion, 3 subjects (50%) reported elbow pain. Our results demonstrated that subjects aged 11 to 12 years had a high frequency (38%) of medial epicondylar fragmentation. Although medial epicondylar fragmentation was the main cause of elbow pain (67%) at the initial elbow examination, all 6 players with medial epicondylar fragmentation continued to play tennis between the initial elbow examination and the re-examination. At re-examination, 5 subjects presented spontaneous bone union (83%), but 3 subjects (50%) reported elbow pain. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Anthropometric and performance characteristics of the German rugby union 7s team.

PubMed

Hohenauer, Erich; Rucker, Alfred M; Clarys, Peter; Küng, Ursula M; Stoop, Rahel; Clijsen, Ron

2017-12-01

Somatotyping is advantageous in sports for the optimal development of performance level and injury prevention. The aim of this study was to describe the anthropometric and physical performance characteristics of the German national rugby union 7s team. Seventeen male rugby players, classified as forwards (N.=9; 24.2±2.1 years) and backs (N.=8; 24.3±5.05 years) were assessed. Anthropometric measurements included: body height, weight, height to weight ratio (H/W), five skinfolds, biepicondylar humerus and femur breadth, upper arm- and calf girth, estimated lower body fat percentage and determination of the individual and mean somatotype. The physical performance tests included: sit-and-reach, handgrip strength, one minute of sit-ups, one minute of push-ups, vertical jump performance, peak power performance, bent arm hanging, 40-m sprint, and the Yo-Yo Intermittent Endurance Test. The forward players were significantly taller (P=0.003), heavier (P=0.001) with a smaller H/W (P=0.009) compared to the backs. Humerus and femur bone breadths (P<0.05) and flexed upper arm and calf girths (P<0.05) were significantly different between the groups. Handgrip strength left (P=0.04), one minute of sit-ups (P=0.03), and peak power output (P=0.015) were also significantly different between the groups. The data indicate that German forward and back players have a similar somatotype and performance level. However, a higher body mass of forward players could be advantageous in that their playing position is much more body contact intensive, and requires a significant amount of tackling. The nominative data of this study may assist coaches to detect weak links in rugby specific athletic performance.

Complex proximal humeral fractures: a prospective study of 22 cases treated using the "Bilboquet" device.

PubMed

Doursounian, L; Kilinc, A; Cherrier, B; Nourissat, G

2011-02-01

Despite recent improvements in surgical devices, complex proximal humerus fractures internal fixation still encounters frequent mechanical failures. The aim of this study was to confirm that the Bilboquet device (a design mimicking the cup-and-ball game) helps solving mechanical difficulties associated with these fractures internal fixation and to present a simplified version of the original surgical procedure. This non-randomised prospective study included 22 fractures in 22 patients, mean age: 70 years. According to the Neer classification there were three-part fractures in seven cases and four-part fractures in 15 cases. Fractures were all reduced and treated by internal fixation in a simplified surgical procedure using the Bilboquet device. Mean postoperative follow-up was 34 months. The mean Constant score was 66 and the weighted Constant score was 86. Mean active forward elevation was 108° and mean active external rotation was 28°. No per- or postoperative complications occurred. Initial reduction of the tuberosity was incomplete in four cases. Union was obtained in all fractures. There was no secondary tilting of the head, and no migration or pseudarthrosis of the tuberosities. Five patients developed postoperative avascular necrosis of the humeral head. The Bilboquet staple component provides a supporting platform for the entire humeral head area. This peripheral stabilization associated with tension band wiring explains the lack of secondary displacement in these cases. Although the Bilboquet device provides a solution to the mechanical problems of complex fractures of the proximal humerus, it does not solve the problem of secondary avascular necrosis of the humeral head, which occurred in 23% of the patients in this series and in 33% of patients in the four-part fractures subgroup. IV (non-randomised prospective study). Copyright © 2010 Elsevier Masson SAS. All rights reserved.

A review of outcomes in 18 patients with floating elbow.

PubMed

Solomon, Harrison B; Zadnik, Mary; Eglseder, W Andrew

2003-09-01

To assess functional outcomes and predictors of success in floating elbow injuries. Retrospective clinical review. Level 1 trauma center. Eighteen patients with floating elbow injuries seen at the trauma center from 1995-2001. All injuries were managed surgically. Each forearm fracture was managed with open reduction and internal fixation. Humerus fractures were managed with either open reduction and internal fixation or intramedullary nail. Definitive fixation was performed in all cases within 48 hours of arrival at the trauma center. Eighteen patients were available for follow-up at a minimum of 1 year and consented to enroll in the study. Each patient was evaluated with a standardized elbow score based on a 100-point scale. These scores were correlated with injury features including age, severity of fracture (AO classification), open fractures, nerve injuries, vascular injuries, type of fixation on the humerus, and the presence of concomitant intra-articular elbow injuries. The average elbow score was 68/100. Outcomes were divided into two groups. Eleven patients had a score greater than 75 (group I), with a mean score of 83, and were considered to have a good or excellent result. Seven patients had a score less than 75 (group II), with a mean score of 45, and were considered to have a satisfactory or poor result. The distribution of outcomes revealed two statistically distinct clusters. Additionally, there was a significantly higher incidence of nerve injuries in group 2 compared with group 1. Functional outcomes in floating elbow injuries tend to cluster into two groups-patients with good or excellent results and patients with poor results. Patients with associated nerve injuries have lower functional outcomes at a minimum of 1-year follow-up.

Three-dimensional analysis of the proximal humeral and glenoid geometry using MicroScribe 3D digitizer.

PubMed

Owaydhah, Wejdan H; Alobaidy, Mohammad A; Alraddadi, Abdulrahman S; Soames, Roger W

2017-07-01

To understand the geometry of the proximal humerus and glenoid fossa to facilitate the design of components used in shoulder arthroplasty. The aim is to evaluate the geometry of the proximal humerus and glenoid fossa and their relationship using a MicroScribe 3D digitizer. Scans and measurements were obtained from 20 pairs of dry proximal humeri and scapulae [10 female and 10 male cadavers: median age 81 years (range 70-94 years)] using a MicroScribe 3D digitizer and Rhinoceros software. Means (±SD) of humeral inclination, medial wall angle of the bicipital groove, and radius of the humeral head values were 135 ± 11°, 39 ± 19°, and 14 ± 3 mm, respectively. Means (±SD) of glenoid height and width were 35 ± 4 and 26 ± 4 mm, while the means (±SD) of the angles of glenoid inclination, retroversion, and rotation were 87 ± 32°, 96 ± 10°, and 9 ± 6°, respectively. A significant difference in glenoid height (P ≤ 0.002) and width (P ≤ 0.0001) was observed between males and females, despite them having almost an identical radius of the humeral head, glenoid inclination, retroversion, and angle of rotation. There was also a significant difference (P ≤ 0.01) in the angle of glenoid retroversion between the right and left sides. Using a MicroScribe 3D digitizer, the glenoid fossa was observed to be significantly smaller in females than males; furthermore, there was a difference in glenoid retroversion between the right and left sides.

Gender Differences in Motor Skills of the Overarm Throw

PubMed Central

Gromeier, Michael; Koester, Dirk; Schack, Thomas

2017-01-01

In this cross-sectional study, the qualitative and quantitative throwing performance of male and female athletes (6 to 16 years of age) was analyzed. The goal of this study was to assess whether there were gender based qualitative and quantitative differences in throwing performance of young athletes, throughout three different age bands (childhood, pubescence, and adolescence). Furthermore, we explored whether all components of the throwing movement are equally affected by gender differences. Focus was placed on five essential components of action: trunk, forearm, humerus, stepping, and backswing. Therefore, children and adolescents (N = 96) were invited to throw three times from three different distances, while aiming at a target placed at shoulder height. The participants were aspiring athletes, competitive in the sport handball. For analyzing the quality of movement the component approach of Halverson and Roberton (1984) was used. The throwing accuracy was noted and used to evaluate the quantitative performance of the throwing movement. Throughout three different age bands, no statistically significant difference was found between genders in throwing accuracy, i.e., quantitative performance. Regarding the qualitative evaluation of the throwing movement, male and female athletes differed significantly. The component approach yielded higher scores for male than for female participants. As expected, with increasing age qualitative and quantitative performance of male and female athletes improved. These results suggest that there are gender-specific differences in qualitative throwing performance, but not necessarily in quantitative throwing performance. Exploration shows that differences in the qualitative throwing performance were seen in specific components of action. Male and female athletes demonstrated similar movement patterns in humerus and forearm actions, but differed in trunk, stepping, and backswing actions. PMID:28261142

Ontogenetic scaling of fore limb and hind limb joint posture and limb bone cross-sectional geometry in vervets and baboons.

PubMed

Burgess, M Loring; Schmitt, Daniel; Zeininger, Angel; McFarlin, Shannon C; Zihlman, Adrienne L; Polk, John D; Ruff, Christopher B

2016-09-01

Previous studies suggest that the postures habitually adopted by an animal influence the mechanical loading of its long bones. Relatively extended limb postures in larger animals should preferentially reduce anteroposterior (A-P) relative to mediolateral (M-L) bending of the limb bones and therefore decrease A-P/M-L rigidity. We test this hypothesis by examining growth-related changes in limb bone structure in two primate taxa that differ in ontogenetic patterns of joint posture. Knee and elbow angles of adult and immature vervets (Chlorocebus aethiops, n = 16) were compared to published data for baboons (Papio hamadryas ursinus, n = 33, Patel et al., ). Ontogenetic changes in ratios of A-P/M-L bending rigidity in the femur and humerus were compared in skeletal samples (C. aethiops, n = 28; P. cynocephalus, n = 39). Size changes were assessed with linear regression, and age group differences tested with ANOVA. Only the knee of baboons shows significant postural change, becoming more extended with age and mass. A-P/M-L bending rigidity of the femur decreases during ontogeny in immature and adult female baboons only. Trends in the humerus are less marked. Adult male baboons have higher A-P/M-L bending rigidity of the femur than females. The hypothesized relationship between more extended joints and reduced A-P/M-L bending rigidity is supported by our results for immature and adult female baboon hind limbs, and the lack of significant age changes in either parameter in forelimbs and vervets. Adult males of both species depart from general ontogenetic trends, possibly due to socially mediated behavioral differences between sexes. Am J Phys Anthropol 161:72-83, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Prediction of elbow joint contact mechanics in the multibody framework.

PubMed

Rahman, Munsur; Cil, Akin; Stylianou, Antonis P

2016-03-01

Computational multibody musculoskeletal models of the elbow joint that are capable of simultaneous and accurate predictions of muscle and ligament forces, along with cartilage contact mechanics can be immensely useful in clinical practice. As a step towards producing a musculoskeletal model that includes the interaction between cartilage and muscle loading, the goal of this study was to develop subject-specific multibody models of the elbow joint with discretized humerus cartilage representation interacting with the radius and ulna cartilages through deformable contacts. The contact parameters for the compliant contact law were derived using simplified elastic foundation contact theory. The models were then validated by placing the model in a virtual mechanical tester for flexion-extension motion similar to a cadaver experiment, and the resulting kinematics were compared. Two cadaveric upper limbs were used in this study. The humeral heads were subjected to axial motion in a mechanical tester and the resulting kinematics from three bones were recorded for model validation. The maximum RMS error between the predicted and measured kinematics during the complete testing cycle was 2.7 mm medial-lateral translation and 9.7° varus-valgus rotation of radius relative to humerus (for elbow 2). After model validation, a lateral ulnar collateral ligament (LUCL) deficient condition was simulated and, contact pressures and kinematics were compared to the intact elbow model. A noticeable difference in kinematics, contact area, and contact pressure were observed for LUCL deficient condition. LUCL deficiency induced higher internal rotations for both the radius and ulna during flexion and an associated medial shift of the articular contact area. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

Morphology and structure of Homo erectus humeri from Zhoukoudian, Locality 1

PubMed Central

Wei, Pianpian; He, Jianing; Liu, Wu

2018-01-01

Background Regional diversity in the morphology of the H. erectus postcranium is not broadly documented, in part, because of the paucity of Asian sites preserving postcranial fossils. Yet, such an understanding of the initial hominin taxon to spread throughout multiple regions of the world is fundamental to documenting the adaptive responses to selective forces operating during this period of human evolution. Methods The current study reports the first humeral rigidity and strength properties of East Asian H. erectus and places its diaphyseal robusticity into broader regional and temporal contexts. We estimate true cross-sectional properties of Zhoukoudian Humerus II and quantify new diaphyseal properties of Humerus III using high resolution computed tomography. Comparative data for African H. erectus and Eurasian Late Pleistocene H. sapiens were assembled, and new data were generated from two modern Chinese populations. Results Differences between East Asian and African H. erectus were inconsistently expressed in humeral cortical thickness. In contrast, East Asian H. erectus appears to exhibit greater humeral robusticity compared to African H. erectus when standardizing diaphyseal properties by the product of estimated body mass and humeral length. East Asian H. erectus humeri typically differed less in standardized properties from those of side-matched Late Pleistocene hominins (e.g., Neanderthals and more recent Upper Paleolithic modern humans) than did African H. erectus, and often fell in the lower range of Late Pleistocene humeral rigidity or strength properties. Discussion Quantitative comparisons indicate that regional variability in humeral midshaft robusticity may characterize H. erectus to a greater extent than presently recognized. This may suggest a temporal difference within H. erectus, or possibly different ecogeographical trends and/or upper limb loading patterns across the taxon. Both discovery and analysis of more adult H. erectus humeri are critical to further evaluating and potentially distinguishing between these possibilities. PMID:29372121

The Clinical and Economic Impact of Generic Locking Plate Utilization at a Level II Trauma Center.

PubMed

Mcphillamy, Austin; Gurnea, Taylor P; Moody, Alastair E; Kurnik, Christopher G; Lu, Minggen

2016-12-01

In today's climate of cost containment and fiscal responsibility, generic implant alternatives represent an interesting area of untapped resources. As patents have expired on many commonly used trauma implants, generic alternatives have recently become available from a variety of sources. The purpose of this study was to examine the clinical and economic impact of a cost containment program using high quality, generic orthopaedic locking plates. The implants available for study were anatomically precontoured plates for the clavicle, proximal humerus, distal radius, proximal tibia, distal tibia, and distal fibula. Retrospective review. Level II Trauma center. 828 adult patients with operatively managed clavicle, proximal humerus, distal radius, proximal tibia, tibial pilon, and ankle fractures. Operative treatment with conventional or generic implants. The 414 patients treated with generic implants were compared with 414 patients treated with conventional implants. There were no significant differences in age, sex, presence of diabetes, smoking history or fracture type between the generic and conventional groups. No difference in operative time, estimated blood loss or intraoperative complication rate was observed. No increase in postoperative infection rate, hardware failure, hardware loosening, malunion, nonunion or need for hardware removal was noted. Overall, our hospital realized a 56% reduction in implant costs, an average savings of $1197 per case, and a total savings of $458,080 for the study period. Use of generic orthopaedic implants has been successful at our institution, providing equivalent clinical outcomes while significantly reducing implant expenditures. Based on our data, the use of generic implants has the potential to markedly reduce operative costs as long as quality products are used. Therapeutic Level III.

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

PubMed

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 addressed (1) factors associated with a recommendation for operative treatment, (2) factors associated with recommendation for arthroplasty, (3) concordance with the recommendations of the treating surgeons, and (4) factors affecting the inter-rater reliability of treatment recommendations. A total of 238 surgeons of the Science of Variation Group rated 40 radiographs of patients with proximal humerus fractures. Participants were randomized to receive information about the patient and mechanism of injury. The response variables included the choice of treatment (operative vs nonoperative) and the percentage of matches with the actual treatment. Participants who received patient information recommended operative treatment less than those who received no information. The patient information that had the greatest influence on treatment recommendations included age (55%) and fracture mechanism (32%). The only other factor associated with a recommendation for operative treatment was region of practice. There was no significant difference between participants who were and were not provided with information regarding agreement with the actual treatment (operative vs nonoperative) provided by the treating surgeon. Patient information-older age in particular-is associated with a higher likelihood of recommending nonoperative treatment than radiographs alone. Clinical information did not improve agreement of the Science of Variation Group with the actual treatment or the generally poor interobserver agreement on treatment recommendations. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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

PubMed

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.

Telangiectatic osteosarcoma of the rib: a rare entity and a potential diagnostic pitfall.

PubMed

Saguem, I; Ayadi, L; Kallel, R; Charfi, S; Bahri, I; Gouiaa, N; Sellami-Boudawara, T

2016-12-01

Osteosarcoma (OS) is a common primary malignant tumor of bones that produces osteoid matrix. Telangiectatic osteosarcoma (TOS) is a rare variant of OS. It affects the long bones especially the lower end of femur and the upper ends of tibia and humerus, a distribution similar to the conventional osteosarcoma. The rib involvement is very infrequent. We present a case of TOS of the rib that posed a diagnostic difficulty owing to its unusual location and to its resemblance to giant cell tumor and aneurysmal bone cyst. Correspondence. © Copyright Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology.

Close-wedge osteotomy for bony locking stiffness of the elbow in Gorham disease patients: a case report.

PubMed

Wang, Hsien-Chung; Lin, Gau-Tyan

2004-05-01

Gorham disease is a so-called massive idiopathic osteolysis or vanishing bone disorder. Massive osteolysis remains an enigmatic condition that involves various skeletal locations and is caused by endothelial proliferation. The diagnosis is difficult and is established via the association of clinical, radiologic and histologic pictures. Treatment modalities yield variable results. We report a case of vanishing bone in the elbow joint and carpal bones following trauma. This 13-year-old boy complained of severe restricted motion and deformity of the right elbow. We managed the problem using arthroplasty with close-wedge osteotomy on the lateral condyle of the humerus.

[Obesity, fat and bones: friends or foes ?

PubMed

Biver, Emmanuel

2017-04-19

Low fat mass is associated with an increased risk of fracture because of low bone mineral density (BMD) and altered bone micro-architecture. Conversely, overweight and obese patients also have an increased risk of fracture, particularly of the humerus and ankle, despite greater BMD. Visceral abdominal fat, which is the most metabolically active, may be associated with poorer quality of bone tissue properties, as suggested in diabetes. Other factors may contribute to higher fracture risk in overweight patients, notably higher frequency of falls and lower bioavailability of vitamin D stoked in fat. Thus, fat mass and its distribution should be taken into account beyond BMD and classical clinical risk factors in the assessment of fracture risk.

Long-term use of nerve block catheters in paediatric patients with cancer related pathologic fractures

PubMed Central

BURGOYNE, L. L.; PEREIRAS, L. A.; BERTANI, L. A.; KADDOUM, R. N.; NEEL, M.; FAUGHNAN, L. G.; ANGHELESCU, D. L.

2013-01-01

SUMMARY We report three cases of children with osteosarcoma and pathologic fractures treated with long-term continuous nerve blocks for preoperative pain control. One patient with a left distal femoral diaphysis fracture had a femoral continuous nerve block catheter for 41 days without complications. Another with a fractured left proximal femoral shaft had three femoral continuous nerve block catheters for 33, 26 and 22 days respectively. The third patient, whose right proximal humerus was fractured, had a brachial plexus continuous nerve block catheter for 36 days without complication. In our experience, prolonged use of continuous nerve block is safe and effective in children with pathologic fractures for preoperative pain control. PMID:22813501

Use of Sugammadex in a Patient with Amyotrophic Lateral Sclerosis

PubMed Central

Kelsaka, Ebru; Karakaya, Deniz; Zengin, Eyüp Cağatayn

2013-01-01

Objective To report on general anesthesia management in amyotrophic lateral sclerosis. Case Presentation and Intervention A 47-year-old man presented with fracture of the humerus. The patient was diagnosed with amyotrophic lateral sclerosis. General anesthesia was induced with propofol, rocuronium and remifentanil. After uneventful surgical repair, TOF (train-of-four) ratio reached >0.90 at the end of operation. However, muscle strength and tidal volume were inadequate. After sugammadex 2 mg kg−1 i.v. was given, the patient was extubated 120 s later. Conclusion This case highlights that rocuronium and sugammadex can be used safely in patients with amyotrophic lateral sclerosis undergoing surgery with general anesthesia. PMID:23075763

Fabrication method, structure, mechanical, and biological properties of decellularized extracellular matrix for replacement of wide bone tissue defects.

PubMed

Anisimova, N Y; Kiselevsky, M V; Sukhorukova, I V; Shvindina, N V; Shtansky, D V

2015-09-01

The present paper was focused on the development of a new method of decellularized extracellular matrix (DECM) fabrication via a chemical treatment of a native bone tissue. Particular attention was paid to the influence of chemical treatment on the mechanical properties of native bones, sterility, and biological performance in vivo using the syngeneic heterotopic and orthotopic implantation models. The obtained data indicated that after a chemical decellularization treatment in 4% aqueous sodium chlorite, no noticeable signs of the erosion of compact cortical bone surface or destruction of trabeculae of spongy bone in spinal channel were observed. The histological studies showed that the chemical treatment resulted in the decellularization of both bone and cartilage tissues. The DECM samples demonstrated no signs of chemical and biological degradation in vivo. Thorough structural characterization revealed that after decellularization, the mineral frame retained its integrity with the organic phase; however clotting and destruction of organic molecules and fibers were observed. FTIR studies revealed several structural changes associated with the destruction of organic molecules, although all organic components typical of intact bone were preserved. The decellularization-induced structural changes in the collagen constituent resulted changed the deformation under compression mechanism: from the major fracture by crack propagation throughout the sample to the predominantly brittle fracture. Although the mechanical properties of radius bones subjected to decellularization were observed to degrade, the mechanical properties of ulna bones in compression and humerus bones in bending remained unchanged. The compressive strength of both the intact and decellularized ulna bones was 125-130 MPa and the flexural strength of humerus bones was 156 and 145 MPa for the intact and decellularized samples, respectively. These results open new avenues for the use of DECM samples as the replacement of wide bone tissue defects. Copyright © 2015 Elsevier Ltd. All rights reserved.

Humerus shaft fracture associated with traumatic radial nerve palsy: An international survey among orthopedic trauma surgeons from Latin America and Asia/Pacific.

PubMed

Giordano, Vincenzo; Belangero, William; Pires, Robinson Esteves; Labronici, Pedro José

2017-01-01

The purpose of this article is to explore the real-life practice of clinical management of humeral shaft fracture associated with traumatic radial nerve palsy among orthopedic trauma surgeons. Two hundred seventy-nine orthopedic surgeons worldwide reviewed 10 real cases of a humeral shaft fracture associated with traumatic radial nerve palsy answering two questions: (1) What treatment would you choose/recommend: nonoperative or operative? (2) What are the reasons for your decision-making? The survey was developed in an online survey tool. All participants were active members from AOTrauma International. Two hundred sixty-six (95.3%) participants were from Latin America and Asia/Pacific. One hundred sixty-two participants (58.1%) had more than 10 years in practice and 178 (63.8%) of them did trauma as the main area of interest. One hundred fifty-one (54.1%) participants treated less than three humeral shaft fractures a month. Traumatic radial nerve palsy was the main reason (88.4%) for surgeons to recommend surgical treatment. Open reduction and internal fixation (ORIF) or percutaneous fixation of the fracture associated with acutely explore of radial nerve was the first option in 62.0% of the cases. A combination of morphology and level of the fracture and the presence of the radial nerve palsy was the most suggested reason to surgically treat the humerus fracture. The main isolated factor was the morphology of the fracture. Our survey highlight the tendency for a more aggressive management of any humeral shaft fracture associated with a traumatic radial nerve palsy, with surgeons preferring to use ORIF with acute exploration of the radial nerve. Nonsurgical management was the less chosen option among the 279 respondents. Fracture morphology, level of the fracture, and the presence of the radial nerve palsy were most influential for guiding their treatment.

Effects of badminton and ice hockey on bone mass in young males: a 12-year follow-up.

PubMed

Tervo, Taru; Nordström, Peter; Nordström, Anna

2010-09-01

The purpose of the present study was to investigate the influence of different types of weight bearing physical activity on bone mineral density (BMD, g/cm(2)) and evaluate any residual benefits after the active sports career. Beginning at 17 years of age, BMD was measured 5 times, during 12 years, in 19 badminton players, 48 ice hockey players, and 25 controls. During the active career, badminton players gained significantly more BMD compared to ice hockey players at all sites: in their femoral neck (mean difference (Delta) 0.06 g/cm(2), p=0.04), humerus (Delta 0.06 g/cm(2), p=0.01), lumbar spine (Delta 0.08 g/cm(2), p=0.01), and their legs (Delta 0.05 g/cm(2), p=0.003), after adjusting for age at baseline, changes in weight, height, and active years. BMD gains in badminton players were higher also compared to in controls at all sites (Delta 0.06-0.17 g/cm(2), p<0.01 for all). Eleven badminton players and 37 ice hockey players stopped their active career a mean of 6 years before the final follow-up. Both these groups lost significantly more BMD at the femoral neck and lumbar spine compared to the control group (Delta 0.05-0.12 g/cm(2), p<0.05 for all). At the final follow-up, badminton players had significantly higher BMD of the femoral neck, humerus, lumbar spine, and legs (Delta 0.08-0.20 g/cm(2), p<0.01 for all) than both ice hockey players and controls. In summary, the present study may suggest that badminton is a more osteogenic sport compared to ice hockey. The BMD benefits from previous training were partially sustained with reduced activity. Copyright 2010 Elsevier Inc. All rights reserved.

The gender- and age-specific 10-year and lifetime absolute fracture risk in Tromsø, Norway.

PubMed

Ahmed, Luai A; Schirmer, Henrik; Bjørnerem, Ashild; Emaus, Nina; Jørgensen, Lone; Størmer, Jan; Joakimsen, Ragnar M

2009-01-01

Aim of this study is to estimate the gender- and age-specific 10-year and lifetime absolute risks of non-vertebral and osteoporotic (included hip, distal forearm and proximal humerus) fractures in a large cohort of men and women. This is a population-based 10 years follow-up study of 26,891 subjects aged 25 years and older in Tromsø, Norway. All non-vertebral fractures were registered from 1995 throughout 2004 by computerized search in radiographic archives. Absolute risks were estimated by life-table method taking into account the competing risk of death. The absolute fracture risk at each year of age was estimated for the next 10 years (10-year risk) or up to the age of 90 years (lifetime risk). The estimated 10-year absolute risk of all non-vertebral fracture was higher in men than women before but not after the age of 45 years. The 10-year absolute risk for non-vertebral and osteoporotic fractures was over 10%, respectively, in men over 65 and 70 years and in women over 45 and 50 years of age. The 10-year absolute risks of hip fractures at the age of 65 and 80 years were 4.2 and 18.6% in men, and 9.0 and 24.0% in women, respectively. The risk estimates for distal forearm and proximal humerus fractures were under 5% in men and 13% in women. The estimated lifetime risks for all fracture locations were higher in women than men at all ages. At the age of 50 years, the risks were 38.1 and 24.8% in men and 67.4 and 55.0% in women for all non-vertebral and osteoporotic fractures, respectively. The estimated gender- and age-specific 10-year and lifetime absolute fracture risk were higher in Tromsø than in other populations. The high lifetime fracture risk reflects the increased burden of fractures in this cohort.

Unicameral Bone Cysts in the Humerus: Treatment Outcomes.

PubMed

Kadhim, Muayad; Sethi, Samir; Thacker, Mihir M

2016-06-01

Several treatment modalities have been described for the treatment of unicameral bone cysts (UBC). The aim of this study was to examine the outcome of various treatment modalities of UBC in a specific anatomic location, the humerus. This study is a retrospective case-only study of patients with humeral UBC with minimum follow-up of 1 year. Medical records and radiographs were assessed and UBC healing status was determined based on most recent follow-up radiographs and divided into 3 groups (healed, partially healed, and not healed). Descriptive statistics were utilized to summarize study outcome. Sixty-eight patients (54 boys and 14 girls) with humeral UBC comprised the study population. Sixty-four cases (94.1%) presented with a pathologic fracture. Fifty-one cases were in the proximal metaphysis and 17 were in the diaphysis. Mean age at diagnosis was 9.2±3.7 years, and mean follow-up was 4.0±2.6 years. Twenty-five patients were treated with observation, 38 by injection (27 with steroids and 11 with bone marrow), and 5 by open surgery. Patients who underwent open surgery had relatively larger cyst length, width, and cyst index, and all healed or partially healed at last follow-up. UBC persistence was observed in 29% of diaphyseal and 27.5% of metaphyseal cysts. Of the 19 patients with persistence, 8 were treated with observation, 9 with steroid injection, and 2 with bone marrow injection. Inner wall disruption before injection was performed in 17 patients (24% did not heal), whereas 21 patients did not have inner wall disruption (33% did not heal). Twenty patients received >1 injection. Eleven patients complained of pain at the last visit (8 had a persistent cyst, 2 were partially healed, and 1 had a healed UBC). Complete healing of humeral UBC is challenging to achieve irrespective of treatment modality. UBCs treated with open surgery tended to heal better. Unhealed cysts were more likely to be associated with pain. Level III-a retrospective comparative study.

Hemiarthroplasty for proximal humerus fracture and consequences of a comminuted greater tubercle fragment.

PubMed

Hoel, S; Jensen, T G; Falster, O; Ulstrup, A

2016-04-01

A prerequisite for a satisfying functional result in the treatment of comminuted fractures of the proximal humerus with hemiarthroplasty is anatomical reduction, fixation and healing of the tuberculi around the prosthetic neck in order to restore normal function of the rotator cuff. This was a retrospective study to examine the outcome after hemiarthroplasty using a prosthetic stem designed to optimise re-attachment and healing of the tuberculi (Aequalis; Tornier and Global Fx, DePuy). A special emphasis was on the effect on outcome a comminuted greater tubercle might have. At follow-up, clinical results were evaluated using the Constant score and WOOS index. All patients had radiographs taken of the injured shoulder. Quality of tubercle healing and prosthetic height were estimated; acromiohumeral distance was registered as well as greater tubercle comminution and resorption. Thirty-four patients with 35 hemiarthroplasties were included. Mean age was 71 years (range 47-88) at the time of injury. At follow-up (mean 38 months, range 23-67), the mean Constant score was 44 points (range 18-87). The mean WOOS index was 58 (range 15-96). A comminuted tubercle was associated with tubercle resorption and superior migration of the arthroplasty. Also, there was a correlation for the functional Constant score, but for the WOOS index, there was none. Like several other studies, we generally saw a group of patients with limited pain but poor range of movement in the shoulder. Our hypothesis was that comminution of the greater tubercle would correlate with both rotator cuff arthropathic radiographical features and more detrimental functional scores than average. Thus, a subtype of fracture could be identified at the time of injury and perhaps be allocated to a different treatment than hemiarthroplasty. Due to a limited number of patients in this study, we are unable to make any strong statistically supported conclusions regarding this hypothesis. Level 4 evidence.

Treatment of proximal humerus fractures with locking plates: a systematic review.

PubMed

Thanasas, Christos; Kontakis, George; Angoules, Antonios; Limb, David; Giannoudis, Peter

2009-01-01

Locking plates with special configuration for the anatomic region of the proximal humerus have been introduced recently to address the difficulties of stabilizing proximal humeral fractures. The purpose of this study was to carry out a systematic review of the literature on the efficacy and early to medium term functional results of locking plates for stabilization of proximal humeral fractures. Using the PubMed database, a systematic review of the English and German literature was carried out in order to assess the efficacy and complications related to the use of these plates and the patients' functional outcome, using the key words "locking plates proximal humeral fractures," "angular stability plates proximal humeral fractures," "PHILOS plate," and "LPHP plate." Our criteria for eligibility were clinical studies with more than ten cases followed-up, adult patients, and adequate data provided at least in terms of implant related complications. Articles written in English and German language were included. Exclusion criteria were: studies dealing exclusively with 2-part fractures (since this category has a more favorable outcome); experimental studies; case reports; and, literature other than English or German. Each one of the articles was evaluated for quality of the study using the Structured Effectiveness Quality Evaluation Scale (SEQES). Twelve studies including 791 patients met the inclusion criteria. Patients in these studies continued to improve up to one year, achieving a mean Constant score of 74.3. The incidence of the reported complications was: avascular necrosis 7.9%, screw cut-out 11.6% and re-operation rate 13.7%. The high incidence of cut-out may be secondary to the rigidity of the implant in combination with medial inadequate support, in cases compromised by severe underlying osteoporotic bone. Definition of indications for the use of locking plates and attention on technical aspects of applying them would help optimization of the results. Systematic Review.

Closed Versus Open Supracondylar Fractures of the Humerus in Children: A Comparison of Clinical and Radiographic Presentation and Results.

PubMed

Lewine, Eliza; Kim, Jaehon M; Miller, Patricia E; Waters, Peter M; Mahan, Susan T; Snyder, Brian; Hedequist, Daniel; Bae, Donald S

2018-02-01

The purpose of this investigation was to compare the presentation and postoperative results of children treated for open and closed, completely displaced type III supracondylar humerus fractures (SCFs). Thirty patients with open and 66 patients with closed, completely displaced type III SCFs were evaluated. Open fractures underwent irrigation and debridement, and all patients were treated by open or closed reduction and pin fixation. Medical records were reviewed to obtain demographic information as well as preoperative and postoperative clinical data regarding mechanism of injury, neurovascular status, associated injuries, postoperative range of motion, infections, and pain. Radiographs were evaluated to quantify displacement, Baumann's angle, humeral capitellar angle, position of the anterior humeral line, and adequacy of reduction. Outcomes were assessed using Flynn criteria. Mean clinical follow-up for the open and closed fracture groups was 8.9 and 5.7 months, respectively. Both groups were similar with respect to age, sex distribution, weight and body mass index, laterality of involvement, and mechanism of injury. At presentation, 35% of closed SCFs and 23% of open SCFs presented with abnormal neurovascular status. There was a higher prevalence of diminished/absent pulses or distal limb ischemia in patients with open injuries (27%) compared with closed fractures (18%). Conversely, severely displaced closed fractures were more commonly associated with nerve injury/palsy at presentation (35%) than those with open fractures (23%). Spontaneous nerve recovery was seen in 87% within 3 to 6 months. Postoperative loss of reduction and malunion were more common in the closed fracture group. However, 84% of patients achieved good-to-excellent results by Flynn criteria, with no appreciable difference based upon open versus closed fractures. With timely wound and fracture treatment, the clinical and radiographic results of children treated for open SCFs is similar to those with closed type III injuries, with little increased risk for infection, malunion, or neurovascular compromise. Level III.

Utility of the AAOS Appropriate Use Criteria (AUC) for Pediatric Supracondylar Humerus Fractures in Clinical Practice.

PubMed

Ibrahim, Talal; Hegazy, Abdelsalam; Abulhail, Safa I S; Ghomrawi, Hassan M K

2017-01-01

The American Academy of Orthopaedic Surgeons (AAOS) recently developed an Appropriate Use Criteria (AUC) for pediatric supracondylar humerus fractures (PSHF). The AUC is intended to improve quality of care by informing surgeon decision making. The aim of our study was to cross-reference the management of operatively treated PSHF with the AAOS-published AUC. The AUC for PSHF include 220 patient scenarios, based on different combinations of 6 factors. For each patient scenario, 8 treatment options are evaluated as "appropriate," "maybe appropriate," and "rarely appropriate." We retrospectively reviewed the medical charts and radiographs of all operatively treated PSHF at our hospital from January 2013 to December 2014 and determined the appropriateness of the treatment. Over the study period, 94 children (mean age: 5.2 y; 51 male, 43 female) were admitted with PSHF and underwent a surgical procedure (type IIA: 7, type IIB: 14, type III: 70, flexion type: 3). Only 8 of the 220 scenarios were observed in our patient cohort. The most frequent scenario was represented by a type III fracture, palpable distal pulse, no nerve injury, closed soft-tissue envelope, no radius/ulna fracture, and typical swelling. Of the 94 fractures, the AUC was "appropriate" for 84 cases and "maybe appropriate" for 9 cases. There was only 1 case of "rarely appropriate" management. Closed reduction with lateral pinning and immobilization was the most prevalent treatment option (58.5%). The rate of appropriateness was not affected by the operating surgeon. However, the definition of a case as emergent had a significant impact on the rate of appropriateness. Application of the AUC to actual clinical data was relatively simple. The majority of operatively treated PSHF (89.4%) were managed appropriately. With the introduction of electronic medical charts, an AUC application becomes attractive and easy for orthopaedic surgeons to utilize in clinical practice. However, validity studies of the AUC in different clinical settings are still required. Level IV.

The paleobiology of Amphipithecidae, South Asian late Eocene primates.

PubMed

Kay, Richard F; Schmitt, Daniel; Vinyard, Christopher J; Perry, Jonathan M G; Shigehara, Nobuo; Takai, Masanaru; Egi, Naoko

2004-01-01

Analysis of the teeth, orbital, and gnathic regions of the skull, and fragmentary postcranial bones provides evidence for reconstructing a behavioral profile of Amphipithecidae: Pondaungia, Amphipithecus, Myanmarpithecus (late middle Eocene, Myanmar) and Siamopithecus (late Eocene, Thailand). At 5-8 kg, Pondaungia, Amphipithecus, and Siamopithecus are perhaps the largest known Eocene primates. The dental and mandibular anatomy suggest that large-bodied amphipithecids were hard-object feeders. The shape of the mandibular corpus and stiffened symphysis suggest an ability to resist large internal loads during chewing and to recruit significant amounts of muscle forces from both the chewing and non-chewing sides of the jaw so as to increase bite force during mastication. The large spatulate upper central incisor of Pondaungia and projecting robust canines of all the larger amphipithecids suggest that incisal food preparation was important. The molars of Siamopithecus, Amphipithecus, and Pondaungia have weak shearing crests. This, and the thick molar enamel found in Pondaungia, suggests a diet of seeds and other hard objects low in fiber. In contrast, Myanmarpithecus was smaller, about 1-2 kg; its cheek teeth suggest a frugivorous diet and do not imply seed eating. Postcranial bones (humerus, ulna, and calcaneus) of a single large amphipithecid individual from Myanmar suggest an arboreal quadrupedal locomotor style like that of howler monkeys or lorises. The humeral head is rounded, proximally oriented, and the tuberosities are low indicating an extremely mobile glenohumeral joint. The great thickness of the midshaft cortical bone of the humerus implies enhanced ability to resist bending and torsion, as seen among slow moving primate quadrupeds. The elbow joint exhibits articular features for enhanced stability in habitually flexed positions, features also commonly found in slow moving arboreal quadrupeds. The short distal load arm of the calcaneus is consistent with, but not exclusive to, slow, arboreal quadrupedalism, and suggests no reliance on habitual leaping.

Microstructure and Cross-Sectional Shape of Limb Bones in Great Horned Owls and Red-Tailed Hawks: How Do These Features Relate to Differences in Flight and Hunting Behavior?

PubMed Central

Marelli, Crystal A.; Simons, Erin L. R.

2014-01-01

The Red-tailed Hawk and Great Horned Owl are two species of raptor that are similar in body size, diet, and habitat. Both species use their hindlimbs during hunting, but differ in foot morphology, how they approach and immobilize prey, and the average size of prey captured. They also differ in primary flight style: the Red-tailed Hawk uses static soaring and the Great Horned Owl uses flap-gliding. The objectives of this study were to characterize the microstructure and cross-sectional shape of limb bones of these species and examine the relationship with flight and hunting behaviors. The mid-shaft of six limb bones from six individuals of each species was sampled. The degree of bone laminarity (proportion of circular primary vascular canals) and cross-sectional geometric parameters were calculated. In both species, the humerus and femur exhibited features that suggest high resistance to torsional loading, whereas the tibiotarsus and phalanges had a shape more likely to resist compression and bending in a specific plane. The femur of the Red-tailed Hawk exhibited higher laminarity and larger polar moment of area than that of the Great Horned Owl. The tibiotarsus was more elliptical than that of the Great Horned Owl. The hawk approaches prey from a more horizontal axis, takes prey of greater mass, and is more likely to pursue prey on the ground, which could potentially be causing more torsional loads on the femur and bending loads on the tibiotarsus. In addition, differences in polar moment of area of the phalanges between the species could relate to differences in foot morphology or digit length. The humerus and ulna of the flap-gliding Great Horned Owl are more elliptical than the static soaring Red-tailed Hawk, a shape that may better resist the bending loads associated with a larger amount of flapping. PMID:25162595

Microstructure and cross-sectional shape of limb bones in Great Horned Owls and Red-tailed Hawks: how do these features relate to differences in flight and hunting behavior?

PubMed

Marelli, Crystal A; Simons, Erin L R

2014-01-01

The Red-tailed Hawk and Great Horned Owl are two species of raptor that are similar in body size, diet, and habitat. Both species use their hindlimbs during hunting, but differ in foot morphology, how they approach and immobilize prey, and the average size of prey captured. They also differ in primary flight style: the Red-tailed Hawk uses static soaring and the Great Horned Owl uses flap-gliding. The objectives of this study were to characterize the microstructure and cross-sectional shape of limb bones of these species and examine the relationship with flight and hunting behaviors. The mid-shaft of six limb bones from six individuals of each species was sampled. The degree of bone laminarity (proportion of circular primary vascular canals) and cross-sectional geometric parameters were calculated. In both species, the humerus and femur exhibited features that suggest high resistance to torsional loading, whereas the tibiotarsus and phalanges had a shape more likely to resist compression and bending in a specific plane. The femur of the Red-tailed Hawk exhibited higher laminarity and larger polar moment of area than that of the Great Horned Owl. The tibiotarsus was more elliptical than that of the Great Horned Owl. The hawk approaches prey from a more horizontal axis, takes prey of greater mass, and is more likely to pursue prey on the ground, which could potentially be causing more torsional loads on the femur and bending loads on the tibiotarsus. In addition, differences in polar moment of area of the phalanges between the species could relate to differences in foot morphology or digit length. The humerus and ulna of the flap-gliding Great Horned Owl are more elliptical than the static soaring Red-tailed Hawk, a shape that may better resist the bending loads associated with a larger amount of flapping.

Prognostic factors of early metastasis and mortality in dogs with appendicular osteosarcoma after receiving surgery: an individual patient data meta-analysis.

PubMed

Schmidt, A F; Nielen, M; Klungel, O H; Hoes, A W; de Boer, A; Groenwold, R H H; Kirpensteijn, J

2013-11-01

Recently an aggregated data meta-analysis showed that serum alkaline phosphatase (SALP) and proximal humerus location are predictors for shorter survival in canine osteosarcoma. To identify additional prognostic factors of mortality and metastasis an individual patient data meta-analysis (IPDMA) was conducted. Individual patient data from 20 studies, identified via the VSSO society, were pooled. Univariable and multivariable hazard ratios (HR) for metastasis and mortality were assessed, using stratified Cox models. The study included 1405 dogs who received surgical treatment, of which the metastasis status was measured in 1155 dogs and mortality status in 1336 dogs; median survival was 256 days. High versus normal SALP and weight (kg) were associated with an increase in hazard of metastasis [HR 1.34 (95%CI 1.07; 1.68) and HR 1.02 (per kg increase) (95%CI 1.01; 1.03)] and for mortality [HR 1.43 (95%CI 1.16; 1.77) and HR 1.02 (95%CI 1.01; 1.02)]. Distal radius tumor was associated with a lower hazard of metastasis compared to other locations: HR 0.75 (95%CI 0.58; 0.96). Proximal humerus and distal femur or proximal tibia location were related with an increased mortality: HR 1.53 (95%CI 1.26; 1.84) and HR 1.23 (95%CI 1.01; 1.49) compared to other locations. Older age (years) was associated with a higher hazard for mortality [HR 1.06 per year (95%CI 1.03; 1.09)] but not for metastasis: HR 1.03 (95%CI 0.99; 1.06). These results confirm findings from a recent aggregated data meta-analysis and (in addition) showed that tumor location, SALP, weight were prognostic factors for both mortality and metastasis. Age was a prognostic factor for mortality but not for metastasis. Copyright © 2013 Elsevier B.V. All rights reserved.

Do group-specific equations provide the best estimates of stature?

PubMed

Albanese, John; Osley, Stephanie E; Tuck, Andrew

2016-04-01

An estimate of stature can be used by a forensic anthropologist with the preliminary identification of an unknown individual when human skeletal remains are recovered. Fordisc is a computer application that can be used to estimate stature; like many other methods it requires the user to assign an unknown individual to a specific group defined by sex, race/ancestry, and century of birth before an equation is applied. The assumption is that a group-specific equation controls for group differences and should provide the best results most often. In this paper we assess the utility and benefits of using group-specific equations to estimate stature using Fordisc. Using the maximum length of the humerus and the maximum length of the femur from individuals with documented stature, we address the question: Do sex-, race/ancestry- and century-specific stature equations provide the best results when estimating stature? The data for our sample of 19th Century White males (n=28) were entered into Fordisc and stature was estimated using 22 different equation options for a total of 616 trials: 19th and 20th Century Black males, 19th and 20th Century Black females, 19th and 20th Century White females, 19th and 20th Century White males, 19th and 20th Century any, and 20th Century Hispanic males. The equations were assessed for utility in any one case (how many times the estimated range bracketed the documented stature) and in aggregate using 1-way ANOVA and other approaches. This group-specific equation that should have provided the best results was outperformed by several other equations for both the femur and humerus. These results suggest that group-specific equations do not provide better results for estimating stature while at the same time are more difficult to apply because an unknown must be allocated to a given group before stature can be estimated. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Variation of the latissimus dorsi

PubMed Central

Shah, Ishani P; Yadav, Amit; Mehta, Rujuta; Thatte, Mukund

2014-01-01

A typical muscle variation of latissimus dorsi — the axillary arch is represented by the muscular or fibromuscular slip detached from the anteroinferior border of the musculus latissimus dorsi passing over the axilla under the axillary fascia crossing the medial side of the brachial plexus to continue as a septum intermusculare mediale brachii distally to the medial epicondyle of humerus. The full extent of the muscle is rarely present. Slips of muscle extend from the latissimus dorsi at the inferior angle of scapula to insert into pectoralis major (Langer), coracobrachilis, biceps or coracoid process forming what is described as a common variant - the muscular axillary arch. We report three cases of variants of latissimus dorsi, one of which has not been reported in the literature before. PMID:25593441

Posterolaterally Displaced and Flexion Type Supracondylar Fractures are Associated with a Higher Risk of Open Reduction

PubMed Central

Novais, Eduardo N.; Carry, Patrick M.; Mark, Bryan J.; Sayan, DE; Miller, Nancy H.

2016-01-01

Objective To identify factors predictive of the risk of conversion from closed to open reduction. Methods ICD-9 codes were used to identify completely displaced pediatric supracondylar humerus fractures that underwent planned closed reduction and percutaneous pinning. Clinical and radiographic variables were retrospectively collected. Results Compared to posterior extension fractures, flexion [Risk Ratio (RR): 34.1, 95% CI: 8.1 to 143.6, p<0.0001] and posterolateral extension [RR: 6.0, 95% CI: 1.3 to 27.5, p=0.0221] fractures were significantly more likely to undergo conversion from closed to open reduction. Conclusions The direction of displacement should be considered during the pre-operative evaluation of supracondylar fractures. PMID:27035497

Complications of Elastic Stable Intramedullary Nailing for treating paediatric long bone fractures

PubMed Central

Nisar, Aamer; Bhosale, Abhijit; Madan, Sanjeev S.; Flowers, Mark J.; Fernandes, James A.; Jones, Stanley

2013-01-01

This study reports the complications observed in children with long bone fractures treated using Elastic Stable Intramedullary Nailing (ESIN). One hundred and sixty-four (n = 164) fractures in 160 patients under the age of 16 years formed the basis of our review. This included 108 boys and 52 girls with the median age of 11 years and median follow up of 7.5 months. The analysis included fractures of the radius/ulna, humerus, femur and tibia. All pathological fractures were excluded. In this series 54 patients (34%) had complications however majority of these were minor complications with irritation due to prominent nail ends being the commonest complication. No long-term sequelae were encountered in our patients. PMID:24403743

The ulnar collateral ligament of the human elbow joint. Anatomy, function and biomechanics.

PubMed Central

Fuss, F K

1991-01-01

The posterior portion of the ulnar collateral ligament, which arises from the posterior surface of the medial epicondyle, is taut in maximal flexion. The anterior portion, which takes its origin from the anterior and inferior surfaces of the epicondyle, contains three functional fibre bundles. One of these is taut in maximal extension, another in intermediate positions between middle position and full flexion while the third bundle is always taut and serves as a guiding bundle. Movements of the elbow joint are checked by the ligaments well before the bony processes forming the jaws of the trochlear notch lock into the corresponding fossae on the humerus. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:2050566

Severe neurologic manifestations of fat embolism syndrome in a polytrauma patient.

PubMed

Makarewich, Chris A; Dwyer, Kevin W; Cantu, Robert V

2015-01-01

Fat embolism syndrome (FES) is most commonly diagnosed when the classic triad of respiratory difficulty, neurologic abnormalities, and petechial rash are present in the appropriate clinical setting. Neurologic manifestations can range from headache, confusion, and agitation to stupor and, less commonly, coma. This article describes a case of FES with severe neurologic sequelae without typical pulmonary involvement in a polytrauma patient with proximal humerus and L1 compression fractures. The case highlights the importance of considering FES in the patient with deteriorating mental status in the setting of multiple fractures, particularly in the absence of other characteristic clinical findings. Early recognition allows for the anticipation of other complications, such as respiratory distress and the potential need for mechanical ventilation.

Osteomalacia: a case series of patients with atypical clinical orthopaedic presentations.

PubMed

Fok, A W M; Ng, T P

2010-12-01

Osteomalacia is uncommon in an affluent subtropical city like Hong Kong, where sunlight exposure is adequate and nutritional support is good. We present three patients who had osteomalacia with different presentations. A 74-year-old male with oncogenic osteomalacia presented with multiple bone pain. His biochemical markers returned to normal 4 days postoperatively after resection of a second toe giant cell tumour of tendon sheath. A 62-year-old woman with a history of liver problem and proximal muscle weakness was admitted with atraumatic fracture of the left distal humerus due to osteomalacia. An 81-year-old vegetarian woman with inadequate sun exposure complained of multiple bone pains. Subsequent investigation revealed dietary- and sunlight-deficient osteomalacia with multiple bony abnormalities including marked femur bowing.

Aneurysmal Bone Cyst: An Analysis of 38 Cases and Report of Four Unusual Surface Ones

PubMed Central

Shooshtarizadeh, Tina; Movahedinia, Sajjadeh; Mostafavi, Hassan; Jamshidi, Khodamorad; Sami, Sam Hajialiloo

2016-01-01

Aneurysmal bone cyst (ABC) is a benign expansile bone tumor, most commonly involving the medulla of long bones. ABC rarely arises within the cortex or in the subperiosteal region, radiographically mimicking other conditions, in particular surface osteosarcomathat is low-grade in nature and may go secondary ABC changes, and telangiectatic osteosarcoma. Both of these are sometimes mistaken microscopically for primary ABC. We review the characteristics of ABC cases in our center and report four unusualsurface ABCs arising in the subperiosteal or cortical region of long bones, identified among 38 histologically proven ABCs during a four-year period in our center. The surface ABCs occurred at an older agewith a predilection for diaphysis of femur, tibia, and humerus. PMID:27200397

Variation of the latissimus dorsi.

PubMed

Shah, Ishani P; Yadav, Amit; Mehta, Rujuta; Thatte, Mukund

2014-01-01

A typical muscle variation of latissimus dorsi - the axillary arch is represented by the muscular or fibromuscular slip detached from the anteroinferior border of the musculus latissimus dorsi passing over the axilla under the axillary fascia crossing the medial side of the brachial plexus to continue as a septum intermusculare mediale brachii distally to the medial epicondyle of humerus. The full extent of the muscle is rarely present. Slips of muscle extend from the latissimus dorsi at the inferior angle of scapula to insert into pectoralis major (Langer), coracobrachilis, biceps or coracoid process forming what is described as a common variant - the muscular axillary arch. We report three cases of variants of latissimus dorsi, one of which has not been reported in the literature before.

A High-Grade Chondrosarcoma of Calcaneum Mimicking as a Benign Pathology: Delayed Diagnosis and Management.

PubMed

Baba, Muzamil Ahmad; Nazir, Naila; Shabeer, Maajid; Mir, Bashir Ahmed; Kawoosa, Altaf Ahmad

2016-10-01

This case is presented to highlight a rare case of chondrosarcoma of calcaneum in a young adult mimicking as a benign pathology and to highlight the diagnosis and early management of such cases to prevent complications and even death. Chondrosarcoma constitutes less than 10% of all primary malignancies of bone and occurs mostly in proximal locations such as pelvis, proximal femur, and proximal humerus. We present a case of high-grade chondrosarcoma at a very rare site, calcaneum of a 40-year-old male that was mimicking as a benign pathology. This case report highlights the importance of proper clinical examination, evaluation, and suspicion for benign occurring lesions to prevent complications related to a delay in diagnosis. Therapeutic, Level IV: Case study. © 2016 The Author(s).

Active Monitoring of a Humeral Osteoblastoma in a 52-Year-Old Male: A Case Report

PubMed Central

Bouchet, Juliette; Lassoued, Donia; Boussier, Nathalie; Birebent, Jordan; Oustric, Stephane; Rouge-Bugat, Marie-Eve

2015-01-01

An osteoblastoma is an uncommon benign but painful tumor, typically found on the axial skeleton or on long bones in the case of young patients. Some cases of humeral osteoblastomas have been described in literature but not in men older than 30. We report the case of a painless bone tumor on the humerus of a 52-year-old patient. The CT scan shows a 30 mm hypodense lacunar formation, surrounded by thickened cortical bone resembling an osteoid osteoma. The anatomopathological and immunohistological analyses support the thesis of an osteoblastoma. A course of radiological monitoring without surgical resection was adopted. This unusual case introduces the possibility of carrying out a differential diagnosis with an osteosarcoma and raises the question of the treatment that should be adopted. PMID:29147426

Unicameral bone cysts: general characteristics and management controversies.

PubMed

Pretell-Mazzini, Juan; Murphy, Robert Francis; Kushare, Indranil; Dormans, John P

2014-05-01

Unicameral bone cysts are benign bone lesions that are often asymptomatic and commonly develop in the proximal humerus and femur of skeletally immature patients. The etiology of these lesions remains unknown. Most patients present with a pathologic fracture, but these cysts can be discovered incidentally, as well. Radiographically, a unicameral bone cyst appears as a radiolucent lesion with cortical thinning and is centrally located within the metaphysis. Although diagnosis is frequently straightforward, management remains controversial. Because the results of various management methods are heterogeneous, no single method has emerged as the standard of care. New minimally invasive techniques involve cyst decompression with bone grafting and instrumentation. These techniques have yielded promising results, with low rates of complications and recurrence reported; however, prospective clinical trials are needed to compare these techniques with current evidence-based treatments.

[Limb lengthening in dwarfism].

PubMed

Correll, J; Held, P

2000-09-01

Limb lengthening in dwarfism has become a standardised procedure with a good prognosis. In most cases external fixation is used. Gain of leg length up to 15 cm and more is possible in the lower leg and the femur and 8.5 cm in the humerus. Limb lengthening is useful in many cases of dwarfism due to skeletal dysplasia. There are a number of risks and possible complications involved and the procedure also requires considerable time. We report the results of 48 patients with dwarfism operated on in the Orthopädische Kinderklinik Aschau (Orthopaedic Hospital for Children). It must not be recommended as a normal tool in handling the problems of dwarfism, but it makes sense in some cases of dwarfism. We describe and discuss the prerequisites for the operative treatment.

[APPLICATION OF COMPRESSION MINI-SCREWS IN TREATMENT OF PATIENTS WITH INJURY OF ELBOW JOINT BONES].

PubMed

Neverov, V A; Egorov, K S

2015-01-01

A case report presents the experience of application of compression pileateless mini-screws (Gerbert's screws) in treatment of intra-articular fractures, which formed the elbow joint (44 cases). There were performed 32 operations concerning fracture of head of radius, 10 operations on the occasion of fractures of distal section of the humerus and 2 operations on the coronoid process. Long-term treatment results were followed-up in 31 patients during more than 6 months. On basis of analysis of treatment results the authors made a conclusion that the application of mini-screws in case of bone fractures, which formed the elbow joint, allowed realization of stable osteosynthesis after anatomic reposition of articular surfaces, obtaining good anatomical and functional result and shortened the terms of patient's treatment.

Pituitary pars intermedia dysfunction (equine Cushing’s disease) in a Thoroughbred stallion: a single report

PubMed Central

HATAZOE, Takashi; KAWAGUCHI, Hiroaki; HOBO, Seiji; MISUMI, Kazuhiro

2016-01-01

ABSTRACT Equine pituitary pars intermedia dysfunction (PPID) generally occurs in older horses showing hirsutism, delayed molting, weight loss, polydipsia, polyuria, laminitis, and reproductive disorders (in broodmares), but there have been no reports on stallions. This report presents a case of a 21-year-old Thoroughbred stallion that developed hirsutism and experienced delayed molting. There were no abnormal findings for semen quality or the stallion’s sexual desire. The horse was diagnosed with PPID based on dexamethasone suppression test and plasma levels of adrenocorticotropic hormone. It was then medicated with pergolide mesylate. Since the horse died due to humerus fracture, an autopsy was conducted, and pituitary adenoma was confirmed. No pathological findings were defined in the testicles; therefore, reproductive activity might not have been impaired. PMID:26858577

New evidence from China for the nature of the pterosaur evolutionary transition

NASA Astrophysics Data System (ADS)

Wang, Xiaoli; Jiang, Shunxing; Zhang, Junqiang; Cheng, Xin; Yu, Xuefeng; Li, Yameng; Wei, Guangjin; Wang, Xiaolin

2017-02-01

Pterosaurs are extinct flying reptiles, the first vertebrates to achieve powered flight. Our understanding of the evolutionary transition between basal, predominantly long-tailed forms to derived short-tailed pterodactyloids remained poor until the discovery of Wukongopterus and Darwinopterus in western Liaoning, China. In this paper we report on a new genus and species, Douzhanopterus zhengi, that has a reduced tail, 173% the length of the humerus, and a reduced fifth pedal digit, whose first phalange is ca. 20% the length of metatarsal III, both unique characters to Monofenestra. The morphological comparisons and phylogenetic analysis presented in this paper demonstrate that Douzhanopterus is the sister group to the ‘Painten pro-pterodactyloid’ and the Pterodactyloidea, reducing the evolutionary gap between long- and short-tailed pterosaurs.

Stemless shoulder arthroplasty: a literature review

PubMed Central

PETRICCIOLI, DARIO; BERTONE, CELESTE; MARCHI, GIACOMO

2015-01-01

The design of humeral implants for shoulder arthroplasty has evolved over the years. The new-generation modular shoulder prostheses have an anatomical humeral stem that replicates the three-dimensional parameters of the proximal humerus. An anatomical reconstruction is the best way to restore stability and mobility of the prosthetic shoulder and improve implant durability. However, a perfect anatomical match is not always possible in, for example, patients with post-traumatic osteoarthritis of the shoulder and deformities in the metaphyseal region. To avoid stem-related complications while retaining the advantages of the fourth generation of shoulder implants, different stemless implants have been developed. The stemless shoulder prosthesis is a new concept in shoulder arthroplasty. The authors review the indications, surgical technique, clinical and radiological midterm results, and complications of these humeral implants. PMID:26151038

No Side-to-Side Difference in Humeral Retroversion in Baseball Players with Shoulder Disorders Using a True Three-Dimensional Measurement Technique: Validation and Comparison

PubMed Central

Saka, Masayuki; Yamauchi, Hiroki; Yoshioka, Toru; Hamada, Hidetoshi; Gamada, Kazuyoshi

2014-01-01

Objectives: Increased humeral retroversion in the throwing shoulder is considered to exist in many baseball players and is often considered as a cause of internal rotation deficit. However, retroversion angles using two-dimensional (2D) methods utilized in previous studies did not correlated with a true three-dimensional measurement technique (3D retroversion) in our study. The purposes of this study were to determine 1) if significant side-to-side differences in retroversion exist, and 2) the relationships between retroversion and glenohumeral range of motion (ROM) in baseball players with a shoulder disorder. Methods: Fourteen male baseball players (age: 21.4 ± 1.5 years; mean ± standard deviation) with a throwing shoulder disorder were enrolled, including 11 in the collegiate and 3 in the adult levels, comprising 5 pitchers and 9 position players. The mean age when the athletes had started playing baseball was 9.1 years (range, 6 to 10 years) and the mean playing experience was 12.1 years (range, 9 to 17 years). Patients with history of fracture or surgery in the shoulder or elbow were excluded. Outcome measurements included a 3D retroversion angle and glenohumeral ROM in bilateral shoulders. Patients underwent CT scan at 1.0 mm slice pitch for the bilateral humerus and geometric bone models were created. The 3D retroversion angle was defined as an angle between the projected humeral neck line (connecting the spherical center of the humeral head and the cylindrical axis of the humeral shaft) onto the horizontal plane and the flexion-extension axis of the distal humerus obtained by a cylinder-fitting method for the capitulum and trochlea (intratester reliability: ICC 0.98, standard error of measurement: 1.7º). The CT slices for the proximal and distal humerus were used to measure a 2D-CT retroversion angle using a reported convention. An indirect measurement of retroversion was performed using a bicipital grove-ulna angle by an ultrasound images dusing a reported convention. Glenohumeral ROM measurements included internal rotation (IR) and horizontal adduction (HAd) in the supine position with the scapula manually stabilized on the treatment table. Independent t tests were used to determine if significant side-to-side differences exist in retroversion and glenohumeral ROM. Pearson correlation coefficients were used to determine the association between retroversion and glenohumeral ROM in the throwing shoulders. Statistical analysis was performed with PASW Statistics 18 (SPSS, Inc, Chicago, IL). An alpha level of 0.05 was set a priori for statistical significance. Results: No significant difference was found in 3D retroversion between the throwing and non-throwing shoulders (P = .182). The throwing shoulders demonstrated decreased IR and HAd compared with the non-throwing shoulders (P < .001 and P = .002, respectively). There were no significant correlations between retroversion and glenohumeral ROM for the throwing shoulders (Table). The 2D-CT retroversion and bicipital grove-ulna angles were greater in the throwing shoulder (P = .007 and .009, respectively). Conclusion: Contradicted to the previous studies, no side-to-side difference in retroversion and no association between retroversion and glenohumeral ROM were observed in the baseball players with a shoulder disorder. We believe that deficit in shoulder IR and HAd may be attributed to soft tissue tightness. The results of the previous studies involving humeral retroversion should be reassessed.

Shape and size of the body vs. musculoskeletal stress markers.

PubMed

Myszka, Anna; Piontek, Janusz

2010-01-01

The objective of this paper is to assess the relationship between the degree of development of muscle attachment sites (musculoskeletal stress markers - MSM1) and the length and circumference measurements of long bones and the body build expressed with the reconstructed values of body height (BH) and body mass (BM). The bone material (102 male and 99 female skeletons) used in the study was collected in the medieval burial ground in Cedynia, Poland. The authors analyzed 10 musculoskeletal stress markers located on the scapula (2), humerus (2), radius (2), femur (2) and tibia (2). The frequency and the degree of expression of muscle attachment size was carried out using the scale prepared by Myszka (2007). The scale encompassed three degrees of expression of muscle attachment size. Only changes of robusticity type (nonpathological changes) were taken into account. The assessment of body build of individuals was carried out according to the method proposed by Vancata & Charvátová (2001). Body height was reconstructed from the length of the humerus and femur using eight equations. Body mass was reconstructed from the measurements of the breadth of the proximal and distal sections of the femur and tibia (mechanical method) using twenty one equations. The equations were developed for different reference populations. The same equations were used for men and women. The correlation between the MSM and the length and circumference measurements of the bones was analyzed using the principal components analysis and the Gamma correlation coefficient. The strength of the correlation between the reconstructed body build traits (BH, BM) and the moderate degree of musculoskeletal stress markers expression was studied based on the principal components method and the Pearson correlation coefficient. A linear correlation was found between musculoskeletal stress markers and the circumference measurements and the reconstructed body mass, but no relationship with body height and the length measurements of long bones was revealed. From previous research it is evident that the relationship between the MSM and metric skeletal traits does not occur in every population. Divergent findings necessitate further corroboration of results on diverse skeletal material.

Reliability of internal oblique elbow radiographs for measuring displacement of medial epicondyle humerus fractures: a cadaveric study.

PubMed

Gottschalk, Hilton P; Bastrom, Tracey P; Edmonds, Eric W

2013-01-01

Standard elbow radiographs (AP and lateral views) are not accurate enough to measure true displacement of medial epicondyle fractures of the humerus. The amount of perceived displacement has been used to determine treatment options. This study assesses the utility of internal oblique radiographs for measurement of true displacement in these fractures. A medial epicondyle fracture was created in a cadaveric specimen. Displacement of the fragment (mm) was set at 5, 10, and 15 in line with the vector of the flexor pronator mass. The fragment was sutured temporarily in place. Radiographs were obtained at 0 (AP), 15, 30, 45, 60, 75, and 90 degrees (lateral) of internal rotation, with the elbow in set positions of flexion. This was done with and without radio-opaque markers placed on the fragment and fracture bed. The 45 and 60 degrees internal oblique radiographs were then presented to 5 separate reviewers (of different levels of training) to evaluate intraobserver and interobserver agreement. Change in elbow position did not affect the perceived displacement (P=0.82) with excellent intraobserver reliability (intraclass correlation coefficient range, 0.979 to 0.988) and interobserver agreement of 0.953. The intraclass correlation coefficient for intraobserver reliability on 45 degrees internal oblique films for all groups ranged from 0.985 to 0.998, with interobserver agreement of 0.953. For predicting displacement, the observers were 60% accurate in predicting the true displacement on the 45 degrees internal oblique films and only 35% accurate using the 60 degrees internal oblique view. Standardizing to a 45 degrees internal oblique radiograph of the elbow (regardless of elbow flexion) can augment the treating surgeon's ability to determine true displacement. At this degree of rotation, the measured number can be multiplied by 1.4 to better estimate displacement. The addition of a 45 degrees internal oblique radiograph in medial humeral epicondyle fractures has good intraobserver and interobserver reliability to more accurately estimate the true displacement of these fractures. Diagnostic study, Level II (Development of diagnostic study with universally applied reference "gold" standard).

Biomechanical analysis of plate systems for proximal humerus fractures: a systematic literature review.

PubMed

Jabran, Ali; Peach, Chris; Ren, Lei

2018-04-27

Proximal humerus fractures are the third most common in the human body but their management remains controversial. Open reduction and internal fixation with plates is one of the leading modes of operative treatment for these fractures. The development of technologies and techniques for these plates, during the recent decades, promise a bright future for their clinical use. A comprehensive review of in vitro biomechanical studies is needed for the comparison of plates' mechanical performance and the testing methodologies. This will not only guide clinicians with plate selection but also with the design of future in vitro biomechanical studies. This review was aimed to systematically categorise and review the in vitro biomechanical studies of these plates based on their protocols and discuss their results. The technologies and techniques investigated in these studies were categorised and compared to reach a census where possible. Web of Science and Scopus database search yielded 62 studies. Out of these, 51 performed axial loading, torsion, bending and/or combined bending and axial loading while 11 simulated complex glenohumeral movements by using tendons. Loading conditions and set-up, failure criteria and performance parameters, as well as results for each study, were reviewed. Only two studies tested four-part fracture model while the rest investigated two- and three-part fractures. In ten studies, synthetic humeri were tested instead of cadaveric ones. In addition to load-displacement data, three-dimensional motion analysis systems, digital image correlation and acoustic emission testing have been used for measurement. Overall, PHILOS was the most tested plate and locking plates demonstrated better mechanical performance than non-locking ones. Conflicting results have been published for their comparison with non-locking blade plates and polyaxial locking screws. Augmentation with cement [calcium phosphate or poly(methyl methacrylate)] or allografts (fibular and femoral head) was found to improve bone-plate constructs' mechanical performance. Controversy still lies over the use of rigid and semi-rigid implants and the insertion of inferomedial screws for calcar region support. This review will guide the design of in vitro and in silico biomechanical tests and also supplement the study of clinical literature.

[Total reverse shoulder replacement. Evaluation of the clinical results and complications in a series of 52 cases].

PubMed

Cáceres-Sánchez, L; Mesa-Mateo, A; Barrionuevo-Sánchez, F J; García-Benítez, B; Expósito-Triano, S

2015-01-01

To evaluate the clinical results and analyse the complications of total reverse shoulder replacement performed in our centre over an 8 year period. A retrospective study was conducted on 50 patients (52 shoulders), with a mean age of 70.15 years (range 51 to 84 years) between December 2004 and December 2012, who received a total reverse shoulder replacement, all performed by the same surgeon. The results have been evaluated according to clinical data, radiography study, a satisfaction scale, and the Constant scale, with a minimum follow-up of 16 months. Five of the cases (9.62%) had been intervened due to fractures of the proximal end of the humerus, 6 cases (11.53%) as surgical consequence of a prosthesis revision, 10 cases (19.23%) due to fracture sequelae, and 30 cases (59.62%) were patients with arthropathy due to a massive fracture of the rotator cuff. After a mean follow up of 35.78 months (range, 16-82), satisfactory clinical results were obtained in 80% of cases, with a mean preoperative Constant of 27.7 points, and reaching 67.1 points 12 months after the operation. On the visual analogue scale, 8.25 points were obtained before the surgery, which decreased to 2.25 points 12 months later. The complications rate was 15.38%, which were due to an intra-operative fracture (1.92%), deep infection (3.84%), instability (3.84%), and early mechanical loosening (3.84%). Scapular notching was observed in the radiographic study in 9 (17.3%) cases. After the results obtained, it could be said that total reverse shoulder replacement achieved encouraging results in the short term for the treatment of glenohumeral arthrosis and massive tears of the rotary cuff. On analysing our series, it can be seen that the complications rate is much higher when it is used to treat fracture sequelae in which there is a loss of proximal humerus bone stock. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

97% accuracy of intra-articular glenohumeral injection with a modified (Delaware) posterior bone touch technique.

PubMed

Axe, Jeremie M; Axe, Michael J

2013-10-01

Unguided approaches have not demonstrated evidence of highly accurate intra-articular glenohumeral injections. The purpose of this study was to assess the accuracy of a posterior approach bone touch technique in conscious subjects without shoulder pathology as a first step in developing an accurate, reliable technique for use in patients. Twenty-six young subjects (age 22-26) without shoulder pathology (BMI 24 +/- 3), had bilateral shoulders injected while awake and seated. A 20 gauge 3.5-inch needle was introduced 1.5 cm below the scapular spine mid-way between the posterior lateral acromial corner and the posterior axillary crease. In Trial I, 20 shoulders were injected. After touching the humerus, the arm was oscillated. The needle advanced to 4-5 cm and 10 mL of dye injected. Pop and ease of flow were recorded. Immediate room change, spot fluoroscopy, and independent experienced radiology reading followed. In Trial II, 32 shoulders were injected. The technique was modified to touching the humerus, externally rotating the arm 25 degrees, and while remaining in bone contact, delivering 10 mL of dye. The same data as Trial I was recorded. In Trial I, 14/20 (70 percent) had dye within the glenohumeral joint. Five of seven failures were too anterior showing dye around the subscapularis muscle and all were associated with a pop. In Trial II, 31/32 (97 percent) had dye within glenohumeral joint. Twenty-three of 32 (72 percent) had a "pop," including the failure. Overall, 45/52 (87 percent) had dye within glenohumeral joint. Thirty-one of 52 (71 percent) of all shoulders had a "pop." Twenty-three of 52 (44 percent) shoulders had pain, resolving within 24 hours. A modified (Delaware) posterior bone touch technique for glenohumeral joint injection is 97 percent accurate in conscious healthy young subjects. Pop and ease of flow are not always indicative of correct needle placement. This study serves as an important first step in determining an optimum approach for injecting pathologic glenohumeral joints with corticosteroids or hyaluronic acid. IV Case Series.

The Neandertals of northeastern Iberia: new remains from the Cova del Gegant (Sitges, Barcelona).

PubMed

Quam, Rolf; Sanz, Montserrat; Daura, Joan; Robson Brown, Kate; García-González, Rebeca; Rodríguez, Laura; Dawson, Heidi; Rodríguez, Rosa Flor; Gómez, Sandra; Villaescusa, Lucía; Rubio, Ángel; Yagüe, Almudena; Ortega Martínez, María Cruz; Fullola, Josep Maria; Zilhão, João; Arsuaga, Juan Luis

2015-04-01

The present study describes a new juvenile hominin mandible and teeth and a new juvenile humerus from level V of the GP2 gallery of Cova del Gegant (Spain). The mandible (Gegant-5) preserves a portion of the right mandibular corpus from the M1 distally to the socket for the dc mesially, and the age at death is estimated as 4.5-5.0 years. Gegant-5 shows a single mental foramen located under the dm1/dm2 interdental septum, a relatively posterior placement compared with recent hominins of a similar developmental age. The mental foramen in Gegant-5 is also placed within the lower half of the mandibular corpus, as in the previously described late adolescent/adult mandible (Gegant-1) from this same Middle Paleolithic site. The Gegant-5 canine shows pronounced marginal ridges, a distal accessory ridge, and a pronounced distolingual tubercle. The P3 shows a lingually-displaced protoconid cusp tip and a distal accessory ridge. The P4 shows a slightly asymmetrical crown outline, a continuous transverse crest, a mesially placed metaconid cusp tip, a slight distal accessory ridge, and an accessory lingual cusp. The M1 shows a Y5 pattern of cusp contact and a well-developed and deep anterior fovea bounded posteriorly by a continuous midtrigonid crest. Gegant-4 is the distal portion of a left humerus from a juvenile estimated to be between 5 and 7 years old at death. The specimen shows thick cortical bone. Although fragmentary, the constellation of morphological and metric features indicates Neandertal affinities for these specimens. Their spatial proximity at the site and similar ages at death suggest these remains may represent a single individual. The addition of these new specimens brings the total number of Neandertal remains from the Cova del Gegant to five, and this site documents the clearest evidence for Neandertal fossils associated with Middle Paleolithic stone tools in this region of the Iberian Peninsula. Copyright © 2015 Elsevier Ltd. All rights reserved.

Healing bone lesion defects using injectable CaSO4 /CaPO4 -TCP bone graft substitute compared to cancellous allograft bone chips in a canine model.

PubMed

Hall, Deborah J; Turner, Thomas M; Urban, Robert M

2018-04-16

CaSO 4 /CaPO 4 -TCP bone graft substitute has been shown to be effective for treatment of bone lesion defects, but its mechanical, histological, and radiographic characteristics have not been studied in direct comparison with a conventional treatment such as cancellous allograft bone. Thirteen canines had a critical-size axial defect created bilaterally into the proximal humerus. CaSO 4 /CaPO 4 -TCP bone graft substitute (PRO-DENSE™, Wright Medical Technology) was injected into the defect in one humerus, and an equal volume of freeze-dried cancellous allograft bone chips was placed in the contralateral defect. The area fraction of new bone, residual graft, and fibrous tissue and the compressive strength and elastic modulus of bone within the defects were determined after 6, 13, or 26 weeks and correlated with radiographic changes. The data were analyzed using Friedman and Mann-Whitney tests. There was more bone in defects treated with the CaSO 4 /CaPO 4 -TCP bone graft substitute compared to defects treated with cancellous bone allograft at all three time points, and the difference at 13 weeks was significant (p = 0.025). The new bone was significantly stronger and stiffer in defects treated with the CaSO 4 /CaPO 4 -TCP bone graft substitute compared to defects treated with cancellous bone allograft at 13 (p = 0.046) and 26 weeks (p = 0.025). At 26 weeks, all defects treated with CaSO 4 /CaPO 4 -TCP bone graft substitute demonstrated complete healing with new bone, whereas healing was incomplete in all defects treated with cancellous allograft chips. The CaSO 4 /CaPO 4 -TCP bone graft substitute could provide faster and significantly stronger healing of bone lesions compared to the conventional treatment using freeze-dried cancellous allograft bone. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018. © 2018 Wiley Periodicals, Inc.

The Inadequacy of Pediatric Fracture Care Information in Emergency Medicine and Pediatric Literature and Online Resources.

PubMed

Tileston, Kali; Bishop, Julius A

2015-01-01

Emergency medicine and pediatric physicians often provide initial pediatric fracture care. Therefore, basic knowledge of the various treatment options is essential. The purpose of this study was to determine the accuracy of information commonly available to these physicians in textbooks and online regarding the management of pediatric supracondylar humerus and femoral shaft fractures. The American Academy of Orthopaedic Surgeons Clinical Practice Guidelines for pediatric supracondylar humerus and femoral shaft fractures were used to assess the content of top selling emergency medicine and pediatric textbooks as well as the top returned Web sites after a Google search. Only guidelines that addressed initial patient management were included. Information provided in the texts was graded as consistent, inconsistent, or omitted. Five emergency medicine textbooks, 4 pediatric textbooks, and 5 Web sites were assessed. Overall, these resources contained a mean 31.6% (SD=32.5) complete and correct information, whereas 3.6 % of the information was incorrect or inconsistent, and 64.8% was omitted. Emergency medicine textbooks had a mean of 34.3% (SD=28.3) correct and complete recommendations, 5.7% incorrect or incomplete recommendations, and 60% omissions. Pediatric textbooks were poor in addressing any of the American Academy of Orthopaedic Surgeons guidelines with an overall mean of 7.14% (SD=18.9) complete and correct recommendations, a single incorrect/incomplete recommendation, and 91.1% omissions. Online resources had a mean of 48.6% (SD=33.1) complete and correct recommendations, 5.72% incomplete or incorrect recommendations, and 45.7% omissions. This study highlights important deficiencies in resources available to pediatric and emergency medicine physicians seeking information on pediatric fracture management. Information in emergency medicine and pediatric textbooks as well as online is variable, with both inaccuracies and omissions being common. This lack of high-quality information could compromise patient care. Resources should be committed to ensuring accurate and complete information is readily available to all physicians providing pediatric fracture care. In addition, orthopaedic surgeons should take an active role to ensure that nonorthopaedic textbooks and online resources contain complete and accurate information.

[Seasonal distribution of diagnoses and DRG in trauma surgery].

PubMed

von Dercks, N; Melz, R; Hepp, P; Marquass, B; Theopold, J; Josten, C

2011-11-01

Recording DRGs and diagnoses allows their distribution to be shown over the course of the year. Thus, cumulative seasonal occurrence of diseases can be detected. From 2004 to 2010 we recorded 22,293 main diagnoses and DRGs at the clinic for trauma surgery. Injuries with the same localization and treatment were pooled. The most frequent injuries were concussion, followed by spinal and lower leg fractures. They showed no seasonal accumulation. Proximal fractures of the humerus occurred approx. 25% more often in winter and ankle fractures about 33% more frequently. The diagnosis of osteoarthritis of the knee is twice as high in the winter as in the summer. It has to be verified if logistic conclusions of these results can lead to more efficiency in a hospital. The underlying analysis is applicable for every hospital and poses a valid controlling tool.

Unicameral (simple) bone cysts.

PubMed

Baig, Rafath; Eady, John L

2006-09-01

Since their original description by Virchow, simple bone cysts have been studied repeatedly. Although these defects are not true neoplasms, simple bone cysts may create major structural defects of the humerus, femur, and os calcis. They are commonly discovered incidentally when x-rays are taken for other reasons or on presentation due to a pathologic fracture. Various treatment strategies have been employed, but the only reliable predictor of success of any treatment strategy is the age of the patient; those being older than 10 years of age heal their cysts at a higher rate than those under age 10. The goal of management is the formation of a bone that can withstand the stresses of use by the patient without evidence of continued bone destruction as determined by serial radiographic follow-up. The goal is not a normal-appearing x-ray, but a functionally stable bone.

Unicameral bone cyst of the proximal tibia in a five year old girl.

PubMed

Tahririan, Mohammadali; Motiffard, Mehdi

2012-01-01

Unicameral bone cysts (UBCs) are benign, osteolytic lesions which are often asymptomatic and are commonly seen in the proximal of humerus and femur. The average age at diagnosis is 9-11 years and there is a male preponderance with a male-to-female ratio of approximately 2-2.5 to 1. We describe a case of 5-year-old girl who presented to orthopedic clinic with a 4-month history of painful limping. Plain radiography of the right knee demonstrated a well-defined lytic lesion in the proximal of the tibia. Open biopsy and then curettage and bone grafting with bone- substitute was performed. The diagnosis of this condition requires a high index of suspicion. This report demonstrates that all UBCs do not have the same clinical patterns and with adequate attention good results can be achieved.

Andreas Vesalius' five hundreth anniversary: initiation of the rotator cuff concept.

PubMed

Brinkman, Romy J; Hage, J Joris

2015-12-01

The rotator cuff concept refers to the four scapulohumeral muscles that stabilize and rotate the humerus relative to the scapula. To date, the first description of the rotator cuff remained unidentified. In light of the 500th birthday of Andreas Vesalius (1515-1564) we searched his 1543 masterwork "Fabrica Corporis Humani Libri Septem" for references to the morphology and function of the rotator cuff muscles. Even though he distinguished three rather than four scapulohumeral muscles, Vesalius recognized the need for structures that prevent dislocation of the shoulder inherent to the morphology of the humeral caput and scapular socket. He recorded "three strong ligaments" and the "three muscles that rotate the arm" of which the tendons completely "embrace the ligaments of the joint" as such structures. Vesalius defined the rotator cuff concept avant la lettre.

Occupational therapy interventions for shoulder conditions: a systematic review.

PubMed

von der Heyde, Rebecca L

2011-01-01

The objectives of this systematic review were (1) to identify, evaluate, and synthesize the research literature of relevance to occupational therapy regarding interventions for work-related shoulder conditions and (2) to interpret and apply the research literature to occupational therapy. Twenty-two studies were reviewed for this study-16 of Level I evidence, 2 of Level II evidence, and 4 of Level III evidence. In this systematic review, limited evidence from Level I studies was found to support exercise for shoulder pain; manual therapy and laser for adhesive capsulitis; conservative management of shoulder instability; early intervention without immobilization for specific, nondisplaced proximal humerus fractures; and exercise, joint mobilizations, and laser for patients with shoulder impingement. Further prospective studies are necessary for the delineation of specific surgical and therapeutic variables that facilitate positive outcomes in the treatment of patients with shoulder conditions.

Conjunct rotation: Codman's paradox revisited.

PubMed

Wolf, Sebastian I; Fradet, Laetitia; Rettig, Oliver

2009-05-01

This contribution mathematically formalizes Codman's idea of conjunct rotation, a term he used in 1934 to describe a paradoxical phenomenon arising from a closed-loop arm movement. Real (axial) rotation is distinguished from conjunct rotation. For characterizing the latter, the idea of reference vector fields is developed to define the neutral axial position of the humerus for any given orientation of its long axis. This concept largely avoids typical coordinate singularities arising from decomposition of 3D joint motion and therefore can be used for postural (axial) assessment of the shoulder joint both clinically and in sports science in almost the complete accessible range of motion. The concept, even though algebraic rather complex, might help to get an easier and more intuitive understanding of axial rotation of the shoulder in complex movements present in daily life and in sports.

Dinosaur evolution. A Jurassic ornithischian dinosaur from Siberia with both feathers and scales.

PubMed

Godefroit, Pascal; Sinitsa, Sofia M; Dhouailly, Danielle; Bolotsky, Yuri L; Sizov, Alexander V; McNamara, Maria E; Benton, Michael J; Spagna, Paul

2014-07-25

Middle Jurassic to Early Cretaceous deposits from northeastern China have yielded varied theropod dinosaurs bearing feathers. Filamentous integumentary structures have also been described in ornithischian dinosaurs, but whether these filaments can be regarded as part of the evolutionary lineage toward feathers remains controversial. Here we describe a new basal neornithischian dinosaur from the Jurassic of Siberia with small scales around the distal hindlimb, larger imbricated scales around the tail, monofilaments around the head and the thorax, and more complex featherlike structures around the humerus, the femur, and the tibia. The discovery of these branched integumentary structures outside theropods suggests that featherlike structures coexisted with scales and were potentially widespread among the entire dinosaur clade; feathers may thus have been present in the earliest dinosaurs. Copyright © 2014, American Association for the Advancement of Science.

Spontaneous telangiectatic osteosarcoma in a rhesus macaque (Macaca mulatta).

PubMed

Goldschmidt, B; Calado, M I Z; Resende, F C; Caldas, R M; Pinto, L W; Lopes, C A A; França, F G O; Meireles, B S; Souza, I V

2017-04-01

Osteosarcoma (OS) is the most common type of bone cancer, especially in young. Telangiectatic osteosarcoma (TO) is a rare variant of OS, and hence, its occurrence, presentation, and prognosis are poorly understood. A 4-year-old female rhesus monkey presenting lameness and swelling was examined for a mass on the right humerus. Radiography revealed fracture and disorganized structure of bone tissue. Histopathological examination revealed malignant neoplasm composed of anaplastic osteoblasts, which invaded the bone marrow and surrounded blood-filled cysts in the epiphysis and diaphysis forming septa. Cytogenetic analysis showed aneuploid cells, supernumerary AgNORs, and a marker fragment. The neoplasm was diagnosed as TO. To our knowledge, the occurrence of TO and its cytogenetic analysis were reported for the first time in non-human primates. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Efficacy of Radiation Therapy for Esophageal Cancer with Bone Metastases].

PubMed

Katayanagi, So; Watanabe, Takafumi; Makuuchi, Yosuke; Shigoka, Masatoshi; Sumi, Tetsuo; Takagaki, Shinichi; Okubo, Mitsuru; Tachibana, Shingo; Oosaka, Yoshiaki; Tsuchida, Akihiko; Kawachi, Shigeyuki

2015-11-01

We retrospectively considered the validity of radiotherapy for patients with bone metastases from esophageal cancer. Eight patients have received radiotherapy in our hospital since 2007. The median age of the patients was 63 years, with 5 men and 3 women. Bone metastatic sites were 4 to the vertebrae, 3 to the ribs, 3 to the femur and 1 each to the humerus, ulna, and radius, respectively. All of the patients had other unresectable sites of metastasis. Radiotherapy reduced pain of 3 patients of PS 1 clearly. Median survival time from the start of radiation therapy was 50 days. When PS was relatively good, the possibility of easing pain and improving QOL was suggested by our data. There is a possibility that radiation therapy for patients with bone metastases from esophageal cancer can improve the QOL and alleviate pain.

Supracondylar process syndrome: two cases of median nerve neuropathy due to compression by the ligament of Struthers.

PubMed

Shon, Hyun-Chul; Park, Ji-Kang; Kim, Dong-Soo; Kang, Sang-Woo; Kim, Kook-Jong; Hong, Seok-Hyun

2018-01-01

The supracondylar process is a beak-shaped bony process on the anteromedial aspect of the distal humerus. The ligament of Struthers is a fibrous band extending from the tip of the process to the medial epicondyle. The median nerve and brachial artery pass under the ligament of Struthers and consequently can be compressed, causing supracondylar process syndrome. As a rare cause of proximal median nerve entrapment, supracondylar process syndrome is triggered when the median nerve is located in the superficial or deep layer of the ligament of Struthers as a result of anatomical variation. The supracondylar process can be easily detected on X-ray images obtained in oblique views but may not be identified in only anteroposterior or lateral views. In this article, we present 2 cases of supracondylar process syndrome and describe the process of diagnosis and treatment and results of a literature review.

Extracting Information about the Rotator Cuff from Magnetic Resonance Images Using Deterministic and Random Techniques

PubMed Central

De Los Ríos, F. A.; Paluszny, M.

2015-01-01

We consider some methods to extract information about the rotator cuff based on magnetic resonance images; the study aims to define an alternative method of display that might facilitate the detection of partial tears in the supraspinatus tendon. Specifically, we are going to use families of ellipsoidal triangular patches to cover the humerus head near the affected area. These patches are going to be textured and displayed with the information of the magnetic resonance images using the trilinear interpolation technique. For the generation of points to texture each patch, we propose a new method that guarantees the uniform distribution of its points using a random statistical method. Its computational cost, defined as the average computing time to generate a fixed number of points, is significantly lower as compared with deterministic and other standard statistical techniques. PMID:25650281

Resuscitation in massive obstetric haemorrhage using an intraosseous needle.

PubMed

Chatterjee, D J; Bukunola, B; Samuels, T L; Induruwage, L; Uncles, D R

2011-04-01

A 38-year-old woman experienced a massive postpartum haemorrhage 30 minutes after emergency caesarean delivery. The patient became severely haemodynamically compromised with an unrecordable blood pressure. Rapid fluid resuscitation was limited by the capacity of the intravenous cannula in place at the time and inability to establish additional vascular access using conventional routes in a timely manner. An intraosseous needle was inserted in the proximal humerus at the first attempt and administration of resuscitation fluid by this route subsequently enabled successful placement of further intravenous lines. Blood and blood products were deployed in conjunction with intra-operative cell salvage and transoesophageal Doppler cardiac output monitoring was used to assess adequacy of volume replacement. Haemorrhage control was finally achieved with the use of recombinant factor VIIa and hysterectomy. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

Mesomelic dwarfism in pseudoachondroplasia.

PubMed

Song, Hae-Ryong; Li, Qi-Wei; Oh, Chang-Wug; Lee, Kwang-Soo; Koo, Soo Kyung; Jung, Sung-Chul

2004-09-01

Pseudoachondroplasia (PSACH) is associated with mutations in the cartilage oligomeric matrix protein (COMP) gene and the clinical characteristics include short stature, deformities of the extremities involving the epiphyses and metaphyses, early onset arthritis, and ligament laxity. PSACH has been considered a rhizomelic form of dwarfism. So far no previous report has described mesomelic shortening of the limbs in PSACH. We reviewed nine patients with a diagnosis of PSACH based on clinical and radiographic examination and mutation analysis of the COMP gene. The mean height in the adults was 116 cm. All patients showed mesomelic dwarfism. The average ratios of radial length to humeral length and tibial length to femoral length were 0.62 and 0.63, respectively. The tibia and the radius showed more severe bony deformity than the femur and humerus. The degree of short stature was related to the site of the mutation in the COMP gene, but there was no correlation between bony deformity and height or gene mutation.

Hand to Mouth in a Neandertal: Right-Handedness in Regourdou 1

PubMed Central

Volpato, Virginie; Macchiarelli, Roberto; Guatelli-Steinberg, Debbie; Fiore, Ivana; Bondioli, Luca; Frayer, David W.

2012-01-01

We describe and analyze a Neandertal postcranial skeleton and dentition, which together show unambiguous signs of right-handedness. Asymmetries between the left and right upper arm in Regourdou 1 were identified nearly 20 years ago, then confirmed by more detailed analyses of the inner bone structure for the clavicle, humerus, radius and ulna. The total pattern of all bones in the shoulder and arm reveals that Regourdou 1 was a right-hander. Confirmatory evidence comes from the mandibular incisors, which display a distinct pattern of right oblique scratches, typical of right-handed manipulations performed at the front of the mouth. Regourdou's right handedness is consistent with the strong pattern of manual lateralization in Neandertals and further confirms a modern pattern of left brain dominance, presumably signally linguistic competence. These observations along with cultural, genetic and morphological evidence indicate language competence in Neandertals and their European precursors. PMID:22937134

Towards completion of the early Eocene aviary: A new bird group from the Messel oil shale (Aves, Eopachypterygidae, fam. nov.).

PubMed

Mayr, Gerald

2015-09-08

A new avian species is described from the early Eocene Messel fossil site in Germany. Eopachypteryx praeterita, gen. et sp. nov. is a small bird and exhibits a characteristic morphology with a short and robust beak, a distinctively shaped coracoid, stout humerus, robust pectoral girdle skeleton, and short hindlimbs. Although similarities to the Paleogene Eocuculus as well as to some extant telluravian and strisorine taxa are noted, the phylogenetic affinities of the new species are unresolved. To account for the fact that the new species is clearly distinguished from any of the known fossil or extant avian taxa, it is here assigned to the new taxon Eopachypterygidae, fam. nov.. Eopachypteryx praeterita is represented by three partial skeletons. A further partial skeleton from Messel belongs to a second, unnamed species, which is tentatively referred to Eopachypteryx.

Response and adaptation of Beagle dogs to hypergravity

NASA Technical Reports Server (NTRS)

Oyama, J.

1975-01-01

Eight male Beagle dogs, five months old, were centrifuged continuously for three months at progressively increasing loads. Heart rate and deep body temperature were monitored continuously by implant biotelemetry. Initially, centrifuged dogs showed transient decreases in heart rate and body temperature along with changes in their diurnal rhythm patterns. Compared with normal gravity controls, exposed dogs showed a slower growth rate and a reduced amount of body fat. Blood protein, total lipids, cholesterol, calcium, packed cell volume, red blood cell count, and hemoglobin were also decreased significantly. Absolute weights of the leg bones of centrifuged dogs were significantly greater than controls. Photon absorptiometry revealed significant density increases in selective regions of the femur and humerus of centrifuged dogs. In spite of the various changes noted, results from this and other studies affirm the view that dogs can tolerate and adapt to sustained loads as high as 2.5 g without serious impairment of their body structure and function.

Hyoid Bone and Thyroid Cartilage Metastases from Sigmoid Colon Adenocarcinoma: A Case Report.

PubMed

Bracanovic, Djurdja; Vukovic, Vesna; Janovic, Aleksa; Radosavljevic, Davorin; Rakocevic, Zoran

2017-05-05

Secondary tumours of the hyoid bone and thyroid cartilage are extremely rare. In this paper, we present a case of the hyoid bone and thyroid cartilage metastases in a patient treated for sigmoid colon adenocarcinoma. Four years after sigmoid colon adenocarcinoma was diagnosed and treated with surgery and chemotherapy, the patient developed bone metastases in the left sacroiliac joint and right proximal humerus. Although the patient did not complain of any related symptoms, in a bone scintigraphy the accumulation of Technetium-99m was incidentally detected in the two sites of the anterior neck. On ultrasound examination there were two hyperechoic and heterogeneous masses with calcifications placed in front of the hyoid bone and thyroid cartilage. Computerized tomography demonstrated massive hyoid bone and thyroid cartilage destruction. In patients with progressive sigmoid colon adenocarcinoma, destruction of the hyoid bone and thyroid cartilage could be suspected for metastases.

Unicameral bone cyst of the proximal tibia in a five year old girl

PubMed Central

Tahririan, Mohammadali; Motiffard, Mehdi

2012-01-01

Unicameral bone cysts (UBCs) are benign, osteolytic lesions which are often asymptomatic and are commonly seen in the proximal of humerus and femur. The average age at diagnosis is 9-11 years and there is a male preponderance with a male-to-female ratio of approximately 2-2.5 to 1. We describe a case of 5-year-old girl who presented to orthopedic clinic with a 4-month history of painful limping. Plain radiography of the right knee demonstrated a well-defined lytic lesion in the proximal of the tibia. Open biopsy and then curettage and bone grafting with bone- substitute was performed. The diagnosis of this condition requires a high index of suspicion. This report demonstrates that all UBCs do not have the same clinical patterns and with adequate attention good results can be achieved. PMID:23248665

Management strategy for unicameral bone cyst.

PubMed

Chuo, Chin-Yi; Fu, Yin-Chih; Chien, Song-Hsiung; Lin, Gau-Tyan; Wang, Gwo-Jaw

2003-06-01

The management of a unicameral bone cyst varies from percutaneous needle biopsy, aspiration, and local injection of steroid, autogenous bone marrow, or demineralized bone matrix to the more invasive surgical procedures of conventional curettage and grafting (with autogenous or allogenous bone) or subtotal resection with bone grafting. The best treatment for a unicameral bone cyst is yet to be identified. Better understanding of the pathology will change the concept of management. The aim of treatment is to prevent pathologic fracture, to promote cyst healing, and to avoid cyst recurrence and re-fracture. We retrospectively reviewed 17 cases of unicameral bone cysts (12 in the humerus, 3 in the femur, 2 in the fibula) managed by conservative observation, curettage and bone grafting with open reduction and internal fixation, or continuous decompression and drainage with a cannulated screw. We suggest percutaneous cannulated screw insertion to promote cyst healing and prevent pathologic fracture. We devised a protocol for the management of unicameral bone cysts.

Complications of shoulder dystocia.

PubMed

Dajani, Nafisa K; Magann, Everett F

2014-06-01

Complications of shoulder dystocia are divided into fetal and maternal. Fetal brachial plexus injury (BPI) is the most common fetal complication occurring in 4-40% of cases. BPI has also been reported in abdominal deliveries and in deliveries not complicated by shoulder dystocia. Fractures of the fetal humerus and clavicle occur in about 10.6% of cases of shoulder dystocia and usually heal with no sequel. Hypoxic ischemic brain injury is reported in 0.5-23% of cases of shoulder dystocia. The risk correlates with the duration of head-to-body delivery and is especially increased when the duration is >5 min. Fetal death is rare and is reported in 0.4% of cases. Maternal complications of shoulder dystocia include post-partum hemorrhage, vaginal lacerations, anal tears, and uterine rupture. The psychological stress impact of shoulder dystocia is under-recognized and deserves counseling prior to home discharge. Copyright © 2014 Elsevier Inc. All rights reserved.

A practical method of estimating stature of bedridden female nursing home patients.

PubMed

Muncie, H L; Sobal, J; Hoopes, J M; Tenney, J H; Warren, J W

1987-04-01

Accurate measurement of stature is important for the determination of several nutritional indices as well as body surface area (BSA) for the normalization of creatinine clearances. Direct standing measurement of stature of bedridden elderly nursing home patients is impossible, and stature as recorded in the chart may not be valid. An accurate stature obtained by summing five segmental measurements was compared to the stature recorded in the patient's chart and calculated estimates of stature from measurement of a long bone (humerus, tibia, knee height). Estimation of stature from measurement of knee height was highly correlated (r = 0.93) to the segmental measurement of stature while estimates from other long-bone measurements were less highly correlated (r = 0.71 to 0.81). Recorded chart stature was poorly correlated (r = 0.37). Measurement of knee height provides a simple, quick, and accurate means of estimating stature for bedridden females in nursing homes.

Can we predict body height from segmental bone length measurements? A study of 3,647 children.

PubMed

Cheng, J C; Leung, S S; Chiu, B S; Tse, P W; Lee, C W; Chan, A K; Xia, G; Leung, A K; Xu, Y Y

1998-01-01

It is well known that significant differences exist in the anthropometric data of different races and ethnic groups. This is a cross-sectional study on segmental bone length based on 3,647 Chinese children of equal sex distribution aged 3-18 years. The measurements included standing height, weight, arm span, foot length, and segmental bone length of the humerus, radius, ulna, and tibia. A normality growth chart of all the measured parameters was constructed. Statistical analysis of the results showed a very high linear correlation of height with arm span, foot length, and segmental bone lengths with a correlation coefficient of 0.96-0.99 for both sexes. No differences were found between the right and left side of all the segmental bone lengths. These Chinese children were found to have a proportional limb segmental length relative to the trunk.

Development of a Finite Element Model of the Human Shoulder to Investigate the Mechanical Responses and Injuries in Side Impact

NASA Astrophysics Data System (ADS)

Iwamoto, Masami; Miki, Kazuo; Yang, King H.

Previous studies in both fields of automotive safety and orthopedic surgery have hypothesized that immobilization of the shoulder caused by the shoulder injury could be related to multiple rib fractures, which are frequently life threatening. Therefore, for more effective occupant protection, it is important to understand the relationship between shoulder injury and multiple rib fractures in side impact. The purpose of this study is to develop a finite element model of the human shoulder in order to understand this relationship. The shoulder model included three bones (the humerus, scapula and clavicle) and major ligaments and muscles around the shoulder. The model also included approaches to represent bone fractures and joint dislocations. The relationships between shoulder injury and immobilization of the shoulder are discussed using model responses for lateral shoulder impact. It is also discussed how the injury can be related to multiple rib fractures.

First Partial Skeleton of a 1.34-Million-Year-Old Paranthropus boisei from Bed II, Olduvai Gorge, Tanzania

PubMed Central

Domínguez-Rodrigo, Manuel; Pickering, Travis Rayne; Baquedano, Enrique; Mabulla, Audax; Mark, Darren F.; Musiba, Charles; Bunn, Henry T.; Uribelarrea, David; Smith, Victoria; Diez-Martin, Fernando; Pérez-González, Alfredo; Sánchez, Policarpo; Santonja, Manuel; Barboni, Doris; Gidna, Agness; Ashley, Gail; Yravedra, José; Heaton, Jason L.; Arriaza, Maria Carmen

2013-01-01

Recent excavations in Level 4 at BK (Bed II, Olduvai Gorge, Tanzania) have yielded nine hominin teeth, a distal humerus fragment, a proximal radius with much of its shaft, a femur shaft, and a tibia shaft fragment (cataloged collectively as OH 80). Those elements identified more specifically than to simply Hominidae gen. et sp. indet are attributed to Paranthropus boisei. Before this study, incontrovertible P. boisei partial skeletons, for which postcranial remains occurred in association with taxonomically diagnostic craniodental remains, were unknown. Thus, OH 80 stands as the first unambiguous, dentally associated Paranthropus partial skeleton from East Africa. The morphology and size of its constituent parts suggest that the fossils derived from an extremely robust individual who, at 1.338±0.024 Ma (1 sigma), represents one of the most recent occurrences of Paranthropus before its extinction in East Africa. PMID:24339873

[Postoperative implant-associated osteomyelitis of the shoulder: Hardware-retaining revision concept using temporary drainage].

PubMed

Schnetzke, M; Aytac, S; Herrmann, P; Wölfl, C; Grützner, P A; Heppert, V; Guehring, T

2015-06-01

Posttraumatic and postoperative osteomyelitis (PPO) is a subgroup of bone infections with increasing importance. However, to date no standardized reoperation concept exists particularly for patients with PPO of the shoulder region. Therefore the purpose of this study was to evaluate a revision concept including débridement, irrigation, and insertion of temporary drainage with hardware retention until healing. A total of 31 patients with PPO were included with a proximal humerus fracture (n = 14), clavicle fracture (n = 10), or AC-joint separation (n = 7). In all, 27 of these patients could be followed for > 1 year. Hardware retention until fracture or ligament healing could be achieved in > 83%. Six patients required follow-up débridement due to recurrent infections, but then were unremarkable. Clinical outcome showed excellent Constant scores (91.6 ± 2.8). A cost-efficient, simple, and successful revision concept for patients with PPO of the shoulder region is described.

SHOULDER ARTHROPLASTY RECORDS

PubMed Central

Filho, Geraldo Motta; Galvão, Marcus Vinicius; Monteiro, Martim; Cohen, Marcio; Brandão, Bruno

2015-01-01

The study's objective is to evaluate the characteristics and problems of patients who underwent shoulder arthroplasties between July 2004 and November 2006. Methodology: During the period of the study, 145 shoulder arthroplasties were performed. A prospective protocol was used for every patient; demographic, clinical and surgical procedure data were collected. All gathered data were included in the data base. The patients were divided in three major groups: fractures, degenerative diseases and trauma sequels. Information obtained from the data base was correlated in order to determine patients' epidemiologic, injuries, and surgical procedure profiles. Results: Of the 145 shoulder arthroplasties performed, 37% presented trauma sequels, 30% degenerative diseases, and 33% proximal humerus fracture. 12% of the cases required total arthroplasties and 88% partial arthroplasties. Five major complications were observed on early postoperative period. Conclusion: Shoulder arthroplasties have become a common procedure in orthopaedic practice. Surgical records are important in evidencing progressive evolution and in enabling future clinical outcomes evaluation. PMID:26998463

Humeral stress edema: an injury in overhead athletes quarterback with humeral "shin" splints-a case report.

PubMed

Alpert, Justin; Flannery, Robert; Epstein, Robert; Monaco, Robert; Prendergast, Nancy

2014-09-01

Stress injury to the distal humerus has been reported as a cause of chronic arm pain among competitive tennis players. As the serve is technically similar to an overhead throwing motion, it is conceivable that this injury could occur in other overhead athletes. Overuse injuries, including rotator cuff tears, ulnar collateral ligament injuries, and joint sprains have routinely been reported in quarterbacks, but there are few reported cases of upper extremity bony stress injuries in these athletes. Magnetic resonance imaging aids in the diagnostic evaluation of an upper extremity injury as it can identify numerous structural injuries and early stress changes within bone. Accurately diagnosing stress reactions helps prevent progression toward stress fracture, which is possible if conservative measures are initiated early in the rehabilitation period. In this article, we report the case of an elite college quarterback who presented with localized elbow pain while throwing.

Appendicular robusticity and the paleobiology of modern human emergence.

PubMed

Trinkaus, E

1997-11-25

The emergence of modern humans in the Late Pleistocene, whatever its phylogenetic history, was characterized by a series of behaviorally important shifts reflected in aspects of human hard tissue biology and the archeological record. To elucidate these shifts further, diaphyseal cross-sectional morphology was analyzed by using cross-sectional areas and second moments of area of the mid-distal humerus and midshaft femur. The humeral diaphysis indicates a gradual reduction in habitual load levels from Eurasian late archaic, to Early Upper Paleolithic early modern, to Middle Upper Paleolithic early modern hominids, with the Levantine Middle Paleolithic early modern humans being a gracile anomalous outlier. The femoral diaphysis, once variation in ecogeographically patterned body proportions is taken into account, indicates no changes across the pre-30,000 years B.P. samples in habitual locomotor load levels, followed by a modest decrease through the Middle Upper Paleolithic.

A late Jurassic pterosaur (Reptilia, Pterodactyloidea) from northwestern Patagonia, Argentina

NASA Astrophysics Data System (ADS)

Codorniú, Laura; Gasparini, Zulma; Paulina-Carabajal, Ariana

2006-03-01

A small to medium-sized pterodactyloid pterosaur (wingspan approximately 1.10 m) from the Upper Jurassic (middle-late Tithonian) marine deposits of the Vaca Muerta Formation of Patagonia (Los Catutos area, central Neuquén Province, Argentina) is reported. The specimen lacks the skull but constitutes a nearly complete postcranial skeleton, which includes cervical and dorsal vertebrae; a few thoracic ribs; both pectoral girdles; the left pelvic girdle; a proximal right wing (humerus, ulna, and radius) and metacarpal IV; a left wing that lacks only wing phalanx four; and both hindlimbs, the right one without the foot. Ontogenetic features suggest that the new fossil corresponds to a relatively mature individual, probably a subadult. Observed characters support its assignment to the Archaeopteroactyloidea, a basal clade within the Pterodactyloidea. This specimen is the second pterosaur from Los Catutos and the most complete Jurassic pterosaur so far known from South America.

Resection followed by vascularized bone autograft in patients with possible recurrence of malignant bone tumors after conservative treatment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Metaizeau, J.P.; Olive, D.; Bey, P.

1984-04-01

In conservative treatment of malignant bone tumors, assessment of the local condition is difficult. The radiological changes seen in the irradiated tumor and the frequent occurrence of pathological fractures at this site may give rise to the fear that the tumor has relapsed. Resection of the whole of the involved bone is the best way to assure adequate local control but the extent of the bone defect and the bad local conditions secondary to irradiation make reconstruction hazardous. In two patients (one with Ewing's sarcoma of the femur and one with osteogenic sarcoma of the humerus) the authors used amore » free, vascularized fibular graft for the reconstruction having obtained consolidation of the limb after resection of the irradiated tumor, with preservation of its function. The encouraging results obtained have suggested a conservative attitude as primary treatment of specific malignant bone tumors.« less

Intramedullary nail fixation of non-traditional fractures: Clavicle, forearm, fibula.

PubMed

Dehghan, Niloofar; Schemitsch, Emil H

2017-06-01

Locked intramedullary fixation is a well-established technique for managing long-bone fractures. While intramedullary nail fixation of diaphyseal fractures in the femur, tibia, and humerus is well established, the same is not true for other fractures. Surgical fixations of clavicle, forearm and ankle are traditionally treated with plate and screw fixation. In some cases, fixation with an intramedullary device is possible, and may be advantageous. However, there is however a concern regarding a lack of rotational stability and fracture shortening. While new generation of locked intramedullary devices for fractures of clavicle, forearm and fibula are recently available, the outcomes are not as reliable as fixation with plates and screws. Further research in this area is warranted with high quality comparative studies, to investigate the outcomes and indication of these fractures treated with intramedullary nail devices compared to intramedullary nail fixation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Bone growth and calcium balance during simulated weightlessness in the rat

NASA Technical Reports Server (NTRS)

Roer, Robert D.; Dillaman, Richard M.

1990-01-01

Rats, age 28 days, experiencing tail suspension in modified metabolic cages for 1, 2, and 3 wk were compared with littermate controls. Food and water consumption, urinary and fecal Ca excretion, and serum Ca were measured; hearts, fore- and hindlimb bones, skulls, and mandibles were removed for determination of wet, dry, and ash weights and Ca concentration and for histological examination. Weight gain and Ca intake and excretion were the same for both groups; both displayed net Ca gain. Suspended rats had significantly lower wet, dry, and ash weights of femora and tibiae. Dry weights of the humeri and radii/ulnae were moderately higher, and the skull and mandible dry and ash weights were significantly higher in suspended than in control rats. Cortical thickness of the femur, but not humerus, was less in suspended rats. The data are consistent with the hypothesis that bone growth is influenced by the cardiovascular changes associated with tail suspension.

Advances in cancer pain from bone metastasis.

PubMed

Zhu, Xiao-Cui; Zhang, Jia-Li; Ge, Chen-Tao; Yu, Yuan-Yang; Wang, Pan; Yuan, Ti-Fei; Fu, Cai-Yun

2015-01-01

With the technological advances in cancer diagnosis and treatment, the survival rates for patients with cancer are prolonged. The issue of figuring out how to improve the life quality of patients with cancer has become increasingly prominent. Pain, especially bone pain, is the most common symptom in malignancy patients, which seriously affects the life quality of patients with cancer. The research of cancer pain has a breakthrough due to the development of the animal models of cancer pain in recent years, such as the animal models of mouse femur, humerus, calcaneus, and rat tibia. The establishment of several kinds of animal models related to cancer pain provides a new platform in vivo to investigate the molecular mechanisms of cancer pain. In this review, we focus on the advances of cancer pain from bone metastasis, the mechanisms involved in cancer pain, and the drug treatment of cancer pain in the animal models.

How can we reliably identify a taxon based on humeral morphology? Comparative morphology of desmostylian humeri

PubMed Central

2017-01-01

Desmostylia is a clade of marine mammals belonging to either Tethytheria or Perissodactyla. Rich fossil records of Desmostylia were found in the Oligocene to Miocene strata of the Northern Pacific Rim, especially in the northwestern region, which includes the Japanese archipelago. Fossils in many shapes and forms, including whole or partial skeletons, skulls, teeth, and fragmentary bones have been discovered from this region. Despite the prevalent availability of fossil records, detailed taxonomic identification based on fragmentary postcranial materials has been difficult owing to to our limited knowledge of the postcranial diagnostic features of many desmostylian taxa. In this study, I propose the utilization of diagnostic characters found in the humerus to identify desmostylian genus. These characters can be used to identify isolated desmostylian humeri at the genus level, contributing to a better understanding of the stratigraphic and geographic distributions of each genus. PMID:29134151

Current data on acute haematogenous osteomyelitis in children in Southern Israel: epidemiology, microbiology, clinics and therapeutic consequences.

PubMed

Cohen, Eugen; Lifshitz, Karin; Fruchtman, Yariv; Eidelman, Mark; Leibovitz, Eugene

2016-09-01

Acute haematogenous osteomyelities (AHO) is the most common form of osteomyelitis, occurring when bone is infected secondary to transient bacteremia. The prevalence, aetiology and outcome of AHO may vary from region to region and period to period. The study objectives were to define the epidemiology, clinical, laboratory and imaging characteristics and treatment consequences of AHO in children in southern Israel. This was a retrospective cohort study, enrolling all children <16 years of age hospitalized with AHO. Epidemiologic, clinical, laboratory and imaging data were recorded from medical charts. Ninety-one patients were diagnosed with AHO (52.7 % <4 years of age). Most children (80.24 %) did not receive antibiotic treatment prior to diagnosis. During 2005-2012 the AHO incidence was 5.6:100,000; the AHO incidence in the Bedouin and Jewish population was 7.3 and 4.1:100,000, respectively. Fifty-four (57.8 %) patients were afebrile at admission and 34 (37.4 %) showed leukocytosis >15,000/mm(3). The most involved bone was tibia (39.6 %), followed by femur (19.8 %), humerus (8.8 %) and pelvis (8.8 %). Positive cultures were reported in 26 (28.6 %) patients. The most common pathogen was methicillin-susceptible Staphylococcus aureus (MSSA, 18 patients, 19.8 %). There was only one case of MRSA. More positive cultures were recorded among children requiring surgery compared to children treated conservatively (P < 0.01). MSSA representation in cases requiring surgical intervention was higher than in cases treated conservatively (P = 0.01). There were nine bone biopsies and 33 bone aspirations (MSSA in 44.4 % and 24.2 %, respectively). The longest hospitalization was observed in patients with humerus-AHO (14.8 ± 12.2 days). There was no difference in the number of days of hospitalization between patients who received previous antibiotics compared with children who did not receive antibiotics before admission. Tibia was the most frequently involved bone, but humeral AHO required more surgical intervention and longer hospitalization. Negative cultures were frequent, MSSA was the most commonly involved pathogen and MRSA was rare. Culture positive AHO was associated with higher requirement for surgical intervention.

Abnormalities of the axial and proximal appendicular skeleton in adults with Laron syndrome (growth hormone insensitivity).

PubMed

Kornreich, L; Konen, O; Schwarz, M; Siegel, Y; Horev, G; Hershkovitz, I; Laron, Z

2008-02-01

To investigate abnormalities in the skeleton (with the exclusion of the skull, cervical spine, hands and feet) in patients with Laron syndrome, who have an inborn growth hormone resistance and congenital insulin-like growth factor-1 (IGF-1) deficiency. The study group was composed of 15 untreated patients with Laron syndrome (seven male and eight female) aged 21-68 years. Plain films of the axial and appendicular skeleton were evaluated retrospectively for abnormalities in structure and shape. The cortical width of the long bones was evaluated qualitatively and quantitatively (in the upper humerus and mid-femur), and the cortical index was calculated and compared with published references. Measurements were taken of the mid-anteroposterior and cranio-caudal diameters of the vertebral body and spinous process at L3, the interpedicular distance at L1 and L5, and the sacral slope. Thoracic and lumbar osteophytes were graded on a 5-point scale. Values were compared with a control group of 20 healthy persons matched for age. The skeleton appeared small in all patients. No signs of osteopenia were visible. The cortex of the long bones appeared thick in the upper limbs in 11 patients and in the lower limbs in four. Compared with the reference values, the cortical width was thicker than average in the humerus and thinner in the femur. The vertebral diameters at L3 and the interpedicular distances at L1 and L5 were significantly smaller in the patients than in the control subjects (P<0.001); however, at L5 the canal was wider, relative to the vertebral body. The study group had a higher rate of anterior osteophytes in the lumbar spine than the controls had, and their osteophytes were also significantly larger. In the six patients for whom radiographs of the upper extremity in its entirety were available on one film, the ulna appeared to be rotated. In one 22-year-old man, multiple epiphyses were still open. Congenital IGF-1 deficiency leads to skeletal abnormalities characterized by small bones, narrow spinal canal, and delayed bone age. The limitation in elbow distensibility common to patients with Laron syndrome may be related to a marked retroversion of the humeral head.

Upper-extremity phocomelia reexamined: a longitudinal dysplasia.

PubMed

Goldfarb, Charles A; Manske, Paul R; Busa, Riccardo; Mills, Janith; Carter, Peter; Ezaki, Marybeth

2005-12-01

In contrast to longitudinal deficiencies, phocomelia is considered a transverse, intercalated segmental dysplasia. Most patients demonstrate severe, but not otherwise classifiable, upper-extremity deformities, which usually cannot be placed into one of three previously described phocomelia groups. Additionally, these phocomelic extremities do not demonstrate true segmental deficits; the limb is also abnormal proximal and distal to the segmental defect. The purpose of this investigation was to present evidence that upper-extremity abnormalities in patients previously diagnosed as having phocomelia in fact represent a proximal continuum of radial or ulnar longitudinal dysplasia. The charts and radiographs of forty-one patients (sixty extremities) diagnosed as having upper-extremity phocomelia were reviewed retrospectively. On the basis of the findings on the radiographs, the disorders were categorized into three groups: (1) proximal radial longitudinal dysplasia, which was characterized by an absent proximal part of the humerus, a nearly normal distal part of the humerus, a completely absent radius, and a radial-sided hand dysplasia; (2) proximal ulnar longitudinal dysplasia, characterized by a short one-bone upper extremity that bifurcated distally and by severe hand abnormalities compatible with ulnar dysplasia; and (3) severe combined dysplasia, with type A characterized by an absence of the forearm segment (i.e., the radius and ulna) and type B characterized by absence of the arm and forearm (i.e., the hand attached to the thorax). Twenty-nine limbs in sixteen patients could be classified as having proximal radial longitudinal dysplasia. Systemic medical conditions such as thrombocytopenia-absent radius syndrome were common in those patients, but additional musculoskeletal conditions were rare. Twenty limbs in seventeen patients could be classified as having proximal ulnar longitudinal dysplasia. Associated musculoskeletal abnormalities, such as proximal femoral focal deficiency, were common in those patients. Eleven limbs in ten patients were identified as having severe combined dysplasia, which was type A in seven of them and type B in four. Four patients with severe combined dysplasia had congenital cardiac anomalies, and four had associated musculoskeletal abnormalities. Three of the four patients with the type-B disorder had a contralateral ulnar longitudinal dysplasia. We propose that cases previously classified as upper-extremity phocomelia represent a spectrum of severe longitudinal dysplasia, as none of the sixty extremities that we studied demonstrated a true intercalary deficiency. These findings have both developmental and genetic implications.

The clinical anatomy of the insertion of the rotator cuff tendons.

PubMed

Vosloo, M; Keough, N; De Beer, M A

2017-04-01

The rotator cuff (RC) insertions according to most anatomical texts are described as being separate from one another. However, clear fusion of the RC tendon fibres exists with prior studies showing this interdigitation forming a common, continuous insertion onto and around the lesser and greater tubercles (LT and GT) of the humerus. Current surgical repair methods (especially arthroscopic techniques) rarely mention or consider these connections during repair and suture anchor implantation. The general principles of RC surgery remain a controversial subject, due to various available techniques, surgeon experience and preference, and the contradicting success rates. This results from old-fashioned knowledge of the anatomy of the RC complex and its functional aspects. Therefore, the purpose of this project was to visualise and define the RC footprint and extension insertions with the aim of enhancing and improving knowledge of the basic anatomy in the hopes that this will be considered during orthopaedic repair. Twenty shoulders (16 cadaveric and 4 fresh) were used in the study. The fresh shoulders were received from the National Tissue Bank, and ethical clearance was obtained (239/2015). Reverse dissection was performed to better visualise the RC unit exposing the interdigitated rotator hood (extension insertions), as well as the complete RC unit (tendons + internal capsule) separated from the scapula and humerus. Once the insertions were exposed and documented, the RC muscle footprint (articular surface area) was measured and recorded, using AutoCAD 2016. No statistical significant difference between left and right (p = 0.424) was noted, but a significant difference between males and females (p = 0.000) was. Collectively, these findings indicate and strengthen evidence towards the notion that the RC muscles/tendons and the internal capsule are one complete and inseparable unit/complex. The fact that the RC unit is more complex in its structure and attachment places importance on the biomechanical stresses encountered after repair. Functions of one RC muscle are not necessarily isolated but instead can be influenced by surrounding muscles as well. In addition to providing greater understanding of the basic anatomy of the RC unit, these findings also provide clarity for surgeons with the goal of improving and enhancing surgical methods for better post-operative patient outcome.

Functional outcomes of Gartland III supracondylar humerus fractures with early neurovascular complications in children: A retrospective observational study.

PubMed

Wang, Sung Il; Kwon, Tae Young; Hwang, Hong Pil; Kim, Jung Ryul

2017-06-01

This was a retrospective observational study. The aim of this study was to evaluate functional outcomes in children treated for Gartland III supracondylar humerus (SCH) fracture with neurovascular (NV) injuries using validated outcome measures. A secondary goal was to determine whether clinical parameters such as age at injury, sex, weight, fracture site, and/or direction of displacement could predict NV injury at the time of fracture or long-term functional outcomes in these patients.One hundred fifty-four patients of Gartland III SCH fractures between March 2004 and May 2013 were studied retrospectively. The patients were divided into 2 groups according to the presence of NV injury. Medical records and radiographs were reviewed to assess several parameters, including age, sex, weight, treatment intervention, the extremity involved, direction of fracture displacement, and NV injury. Functional outcome was assessed on final follow-up using the Pediatric Outcomes Data Collection Instrument (PODCI) and Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) outcome measures. Statistical analysis was used to determine the relationship between NV injury and functional outcomes.There were 33 cases with Gartland III SCH fracture associated with NV injuries (10 cases of vascular compromise, 14 cases of neural injury, and 9 cases involving both vascular compromise and neural injury). There were significant differences between the 2 groups in age (P  =  .048), weight (P  =  .009), and direction of displacement (P  =  .004). Vascular compromise and median nerve injury were most common in fractures with posterolateral displacement, and radial nerve injuries were common in fractures with posteromedial displacement. The mean global function score in the PODCI was 91.4 points, and the mean Quick DASH score was 11.7 points, with excellent functional outcomes. No differences in outcomes were identified based upon age, fracture site, sex, weight, direction of displacement, or operative technique in NV injury patients (P > .05).The majority of patients with Gartland III SCH fractures associated with NV injuries returned to a high functioning level after treatment of their injuries. NV injury does not appear to influence functional outcomes. Good functional results can be expected regardless of age, fracture site, sex, weight, direction of displacement, and operative technique.

Clinical outcome and complications using a polyaxial locking plate in the treatment of displaced proximal humerus fractures. A reliable system?

PubMed

Königshausen, M; Kübler, L; Godry, H; Citak, M; Schildhauer, T A; Seybold, D

2012-02-01

The surgical treatment of displaced proximal humeral fractures (ORIF) is a perpetual challenge to the surgeon. For this reason, the principle of polyaxiality was developed to provide an improved primary stability of the fracture through better anchorage of the screws, especially in osteoporotic bone. The aim of this study was to present clinical results with the polyaxial locking plate in the operative treatment of proximal humerus fractures in order to determine whether the technique of polyaxiality leads to better functional outcome and lower complication rates in comparison to monoaxial plates in the literature. Seventy-three patients with displaced proximal humeral fractures were treated surgically with the polyaxial locking Suture Plate™ (Arthrex(®)) between 03/2007 and 06/2009. Fifty-two of the patients (mean age, 69.9 ± 12.1) were included in a radiographical and clinical examination using the Constant score (CS) and the Disabilities of the Arm, Shoulder and Hand score (DASH). The follow-up examinations were on average 13.9 ± 4.5 months (10-27 months) after surgical treatment. The mean CS of the patients was 66.0 ± 13.7 points, the age- and gender-related CS was 90.9% ± 20.0% and the mean DASH score was 23.8 ± 19.8 points for the injured side. The patients with a nearly anatomical reduction of their fracture (n = 13) reached a significantly higher CS (75.1 ± 8.5; p = 0.004) and DASH-score (13.6 ± 11.6; p = 0.043) and none of these patients had a complication. The complications were identified in 12 (23.1%) cases, 5 of which involved loss of reduction. All of these 5 cases were lacking of initial medial column support and 4 of which were type C2.3 AO-Classification. The data show that the combination of angular stability with the possibility of variable polyaxial screw direction is a good concept for reduction and fixation of displaced proximal humeral fractures, but anatomical reduction and medial support remain important preconditions for a good outcome. However, a significantly lower rate of complications or better clinical outcome than that reported in the literature could not be found. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Supracondylar humerus fracture in childhood--an efficacy study. Results of a multicenter study by the Pediatric Traumatology Section of the German Society of Trauma Surgery--II: Costs and effectiveness of the treatment].

PubMed

von Laer, L; Günter, S M; Knopf, S; Weinberg, Annelie M

2002-03-01

The following are the results and conclusions of a retrospective research study done on 886 patients with supracondylar fractures of the humerus. The study evaluates how effective the treatment procedures of the fractures are. The patients' fractures were categorized into four groups. It made it easier to differentiate between dislocated and undislocated fractures (see part I Weinberg A et al.). The following parameters were established to evaluate the treatment procedures and to create relevancy to the final outcome depending on the degree of difficulty of the fractures: Length of hospitalization, amount of repositioning procedures (including if an open or closed procedure was needed), amount of post repositioning procedures and the recommended change of therapy, method of retention and fixation, necessary metal removal, amount of check ups needed. The amount of x-ray exams could not be established due to insufficient documentation. The study showed a rather random pattern regarding length of hospitalization and the amount of check ups especially among type I and II patients. Open versus closed repositioning procedures did not seem to be advantageous. The implanted wires did not prevent infections. It just increased the treatment procedure by another hospitalization and anesthesia to remove the implanted wires. Physical therapy was not necessary and was only prescribed in cases of prolonged immobilization. The results of this study generated consequences regarding treatment procedures and developed a more efficient treatment protocol: Type I and II (dislocated and undislocated fractures in one plane) will be treated conservatively on an out-patient basis. Type I in a cast. Type II in a blount or plaster cast with flexed angle between 100 degrees and 130 degrees. Type III an IV (dislocated and undislocated fractures in two or three planes) will be treated if possible with a closed repositioning procedure. Otherwise a close repositioning procedure will be necessary and followed with some kind of KD-osteosynthese to capture the fracture. The patient will be hospitalized for a short period. The blount procedure will not be sufficient for this type of fracture. Therapy and procedure will be translated put in a perspective research study.

Post-fracture care: do we need to educate patients rather than doctors? The PREVOST randomized controlled trial.

PubMed

Merle, B; Chapurlat, R; Vignot, E; Thomas, T; Haesebaert, J; Schott, A-M

2017-05-01

We conducted a multicenter, randomized controlled trial to evaluate the impact of a population-based patient-centered post-fracture care program with a dedicated case manager, PREVention of OSTeoporosis (PREVOST), on appropriate post-fracture osteoporosis management. We showed that, compared to usual care, BMD investigation post-fracture was significantly improved (+20%) by our intervention program. Our study aims to evaluate the impact of a population-based patient-centered post-fracture care program, PREVOST, on appropriate post-fracture care. Multicenter, randomized controlled trial enrolling 436 women aged 50 to 85 years and attending a French hospital, for a low-energy fracture of the wrist or humerus. Randomization was stratified by age, hospital department, and site of fracture. The intervention was performed by a trained case manager who interacted only with the patients, with repeated oral and written information about fragility fractures and osteoporosis management, and prompting them to visit their primary care physicians. Control group received usual care. The primary outcome was the initiation of an appropriate post-fracture care defined by Bone Mineral Density (BMD) and/or anti-osteoporotic treatment prescription at 6 months. At 6 months, 53% of women in intervention group initiated a post-fracture care versus 33% for usual care (adjOR 2.35, 95%CI [1.58-3.50], p < 0.001). Post-fracture care was more frequent after wrist than humerus fracture (adjOR 1.93, 95%CI [1.14-3.30], p = 0.015) and decreased with age (adjOR for 10 years increase 0.76, 95%CI [0.61-0.96], p = 0.02). The intervention resulted in BMD prescription in 50% of patients (adjOR 2.10, 95%CI [1.41-3.11], p < 0.001) and in BMD performance in 41% of patients (adjOR 2.12, 95%CI [1.40-3.20], p < 0.001) versus 33 and 25% for usual care, respectively. Having performed a BMD increased treatment prescription; however, only 46% of women with a low BMD requiring a treatment according to the French guidelines received a prescription. A patient-centered care program with a dedicated case manager can significantly improve post-fracture BMD investigation.

THE RESPONSE OF X-IRRADIATED LIMBS OF ADULT URODELES TO NORMAL TISSUE GRAFTS. I. EFFECTS OF AUTOGRAFTS OF SIXTY-DAY FOREARM REGENERATES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stinson, B.D.

1963-06-01

Results are reported of autoplastic transplantation of parts of nonirradiated, regenerated forelimb to the contralateral x-irradiated forelimb in adult Triturus viridescens. The right forelimbs were exposed to various doses of localized irradiation (1000 to 5000 r) followed by amputation of both left and right forelimbs through the mid forearm. Left limbs regenerated normally, but irradiated right limbs failed to exhibit any significant degree of regenerative activity over a 3-month period. Both forelimbs were reamputated through the distal humerus and observed for an additional two months. Left limbs produced normal regenerates, but irradiated right limbs gave no gross evidence of regenerationmore » at any of the radiation dose levels. Normal left regenerates were reamputated immediately distal to the elbow on the 60th day after the second amputation; the severed forearm was trimmed with scissors along anterior and posterior borders and denuded of skin over its proximal half, leaving an essentially complete forearm region as a normal autograft. This was implanted into the irradiated right upper arm stump, after ablation of the distal half of its humerus, with normal proximodistal polarity in all cases. The irradiated stump was reamputated through the distal portion of the implanted normal autograft two weeks after implantation, and was observed for four months. Periodic gross observations showed that over 90% of irradiated upper arms formed regenerates at a rate which paralleled that of nonirradiated controls. However, regenerates formed on irradiated upper arms exhibited a restriction of morphogenetic capacity, only 60% attaining 3- and 4-digit stages. Most of the morphologically more complex regenerates which developed on the irradiated upper arm stumps manifested left limb asymmetry despite their formation on right irradiated stumps, suggesting a relation between the asymmetry of the normal graft and that of the resulting regenerate. All regenerates which developed on irradiated upper arms showed marked deficiencies in the restoration of a complete proximodistal structural pattern appropriate to the level of amputation through the irradiated stump. However, the actual pattern produced was appropriate to the level of amputation through the implanted normal autograft. These findings support the hypothesis that normal grafts promote the formation of regenerates on irradiated limbs through the autonomous developmental activity of the transected graft. (BBB)« less

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

PubMed

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 term 'intermuscular fracture'. A distinct classification system for proximal humeral shaft fractures seems meaningful and is proposed. There is clear evidence of specific characteristics which differentiate proximal third humeral shaft fractures from those of midshaft and distal third. They explain the specific problems of reduction and fixation. If disrespected they will lead to higher rates of therapeutic failure. Copyright © 2013 Elsevier Ltd. All rights reserved.

Vascularized fibular epiphyseal transfer for proximal humeral reconstruction in children with a primary sarcoma of bone.

PubMed

Stevenson, J D; Doxey, R; Abudu, A; Parry, M; Evans, S; Peart, F; Jeys, L

2018-04-01

Aims Preserving growth following limb-salvage surgery of the upper limb in children remains a challenge. Vascularized autografts may provide rapid biological incorporation with the potential for growth and longevity. In this study, we aimed to describe the outcomes following proximal humeral reconstruction with a vascularized fibular epiphyseal transfer in children with a primary sarcoma of bone. We also aimed to quantify the hypertrophy of the graft and the annual growth, and to determine the functional outcomes of the neoglenofibular joint. Patients and Methods We retrospectively analyzed 11 patients who underwent this procedure for a primary bone tumour of the proximal humerus between 2004 and 2015. Six had Ewing's sarcoma and five had osteosarcoma. Their mean age at the time of surgery was five years (two to eight). The mean follow-up was 5.2 years (1 to 12.2). Results The overall survival at five and ten years was 91% (confidence interval (CI) 95% 75% to 100%). At the time of the final review, ten patients were alive. One with local recurrence and metastasis died one-year post-operatively. Complications included seven fractures, four transient nerve palsies, and two patients developed avascular necrosis of the graft. All the fractures presented within the first postoperative year and united with conservative management. One patient had two further operations for a slipped fibular epiphysis of the autograft, and a hemi-epiphysiodesis for lateral tibial physeal arrest. Hypertrophy and axial growth were evident in nine patients who did not have avascular necrosis of the graft. The mean hypertrophy index was 65% (55% to 82%), and the mean growth was 4.6 mm per annum (2.4 to 7.6) in these nine grafts. At final follow-up, the mean modified functional Musculoskeletal Tumour Society score was 77% (63% to 83%) and the mean Toronto Extremity Salvage Score (TESS) was 84% (65% to 94%). Conclusion Vascularized fibular epiphyseal transfer preserves function and growth in young children following excision of the proximal humerus for a malignant bone tumour. Function compares favourably to other limb-salvage procedures in children. Longer term analysis is required to determine if this technique proves to be durable into adulthood. Cite this article: Bone Joint J 2018;100-B:535-41.

Temporo-mandibular joint chondrosarcoma: Case report and review of the literature.

PubMed

Giorgione, C; Passali, F M; Varakliotis, T; Sibilia, M; Ottaviani, F

2015-06-01

Chondrosarcoma is a malignant mesenchymal tumour of cartilaginous origin. It represents 11% of all malignant primary bone tumours, and the pelvis, ribs, femur and humerus are most frequently involved. Chondrosarcoma of the head and neck region is a rare disease, and represents approximately 0.1% of all head and neck neoplasms. This report describes a rare localisation of chondrosarcoma in a 56-year-old man who presented with swelling in the right preauricular area and mild limitation and pain in the mouth opening. Since 1959, just a few cases of temporomandibular joint (TMJ) chondrosarcoma have been described. Computed tomography revealed a large mass (39 x 46 x 40 mm) in the right preauricular and parotid region with morpho-structural alterations of the condyle and an intense periostotic reaction. The tumour was treated by total parotidectomy and condylotomy. The VII cranial nerve was preserved. Histopathologic examination revealed a low grade chondrosarcoma with a 50% proliferation index. At present, the patient is still receiving routine follow-up after radiotherapy and physiotherapy.

Comparative limb proportions reveal differential locomotor morphofunctions of alligatoroids and crocodyloids

NASA Astrophysics Data System (ADS)

Iijima, Masaya; Kubo, Tai; Kobayashi, Yoshitsugu

2018-03-01

Although two major clades of crocodylians (Alligatoroidea and Crocodyloidea) were split during the Cretaceous period, relatively few morphological and functional differences between them have been known. In addition, interaction of multiple morphofunctional systems that differentiated their ecology has barely been assessed. In this study, we examined the limb proportions of crocodylians to infer the differences of locomotor functions between alligatoroids and crocodyloids, and tested the correlation of locomotor and feeding morphofunctions. Our analyses revealed crocodyloids including Gavialis have longer stylopodia (humerus and femur) than alligatoroids, indicating that two groups may differ in locomotor functions. Fossil evidence suggested that alligatoroids have retained short stylopodia since the early stage of their evolution. Furthermore, rostral shape, an indicator of trophic function, is correlated with limb proportions, where slender-snouted piscivorous taxa have relatively long stylopodia and short overall limbs. In combination, trophic and locomotor functions might differently delimit the ecological opportunity of alligatoroids and crocodyloids in the evolution of crocodylians.

New options for vascularized bone reconstruction in the upper extremity.

PubMed

Houdek, Matthew T; Wagner, Eric R; Wyles, Cody C; Nanos, George P; Moran, Steven L

2015-02-01

Originally described in the 1970s, vascularized bone grafting has become a critical component in the treatment of bony defects and non-unions. Although well established in the lower extremity, recent years have seen many novel techniques described to treat a variety of challenging upper extremity pathologies. Here the authors review the use of different techniques of vascularized bone grafts for the upper extremity bone pathologies. The vascularized fibula remains the gold standard for the treatment of large bone defects of the humerus and forearm, while also playing a role in carpal reconstruction; however, two other important options for larger defects include the vascularized scapula graft and the Capanna technique. Smaller upper extremity bone defects and non-unions can be treated with the medial femoral condyle (MFC) free flap or a vascularized rib transfer. In carpal non-unions, both pedicled distal radius flaps and free MFC flaps are viable options. Finally, in skeletally immature patients, vascularized fibular head epiphyseal transfer can provide growth potential in addition to skeletal reconstruction.

Latissimus dorsi transfer to restore external rotation with reverse shoulder arthroplasty: a biomechanical study.

PubMed

Favre, Philippe; Loeb, Michael D; Helmy, Naeder; Gerber, Christian

2008-01-01

In patients with pseudoparesis of the shoulder resulting from irreparable rotator cuff tears, reverse shoulder arthroplasty (RSA) can restore active elevation, but external rotation remains less predictable. Latissimus dorsi transfer (LDT) has been shown to be effective in restoring external rotation in patients with posterosuperior tears of the rotator cuff. The aim of this study is to determine the capacity of the LDT to restore external rotation in combination with RSA and to investigate the mechanical advantage produced by 3 different insertion sites. A biomechanical model was created using a reverse total shoulder prosthesis with 3 different transfer insertions. Moment arms were measured for 2 static positions and 1 motion of the humerus. The moment arm analysis showed that LDT can improve active external rotation in the setting of a reverse prosthesis. An insertion site on the posterior side of the greater tuberosity (adjacent to the teres minor insertion) produced a greater external rotation moment arm.

MicroCT Analysis of Micro-Nano Titanium Implant Surface on the Osseointegration.

PubMed

Ban, Jaesam; Kang, Seongsoo; Kim, Jihyun; Lee, Kwangmin; Hyunpil, Lim; Vang, Mongsook; Yang, Hongso; Oh, Gyejeong; Kim, Hyunseung; Hwang, Gabwoon; Jung, Yongho; Lee, Kyungku; Park, Sangwon; Yunl, Kwidug

2015-01-01

This study was to investigate the effects of micro-nano titanium implant surface on the osseointegration. A total of 36 screw-shaped implants were used. The implant surfaces were classified into 3 groups (n = 12): machined surface (M group), nanosurface which is nanotube formation on the machined surface (MA group) and nano-micro surface which is nanotube formation on the RBM surface (RA group). Anodic oxidation was performed at a 20 V for 10 min with 1 M H3PO4 and 1.5 wt% HF solutions. The implants were installed on the humerus on 6 beagles. After 4 and 12 weeks, the morphometric analysis with micro CT (skyscan 1172, SKYSCAN, Antwerpen, Belgium) was done. The data were statistically analyzed with two-way ANOVA. Bone mineral density and bone volume were significantly increased depending on time. RA group showed the highest bone mineral density and bone volume at 4 weeks and 12 weeks significantly. It indicated that nano-micro titanium implant surface showed faster and more mature osseointegration.

Growth of erythroid burst-forming units (BFU-E) in cultures of canine bone marrow and peripheral blood cells: effect of serum from irradiated dogs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kreja, L.; Baltschukat, K.; Nothdurft, W.

1988-08-01

Erythroid burst-forming units (BFU-E) from canine bone marrow and peripheral blood could be grown in methylcellulose in the presence of an appropriate batch of fetal calf serum (FCS), transferrin, and erythropoietin (Epo). However, improved colony formation (size and number of bursts) was obtained when serum from total body irradiated dogs was present in the culture. This serum, obtained from dogs at day 9 after total body irradiation with a dose of 3.9 Gy, reduced markedly the Epo requirement of BFU-E. Furthermore, it allowed the omission of FCS from the culture medium if cholesterol and bovine serum albumin (BSA) were usedmore » as FCS substitutes. BFU-E concentrations were found to be rather different in the peripheral blood and in bone marrow samples from different sites (i.e., iliac crest, sternum, and humerus) of normal beagles. The studies further show that canine bone marrow BFU-E can be cryopreserved in liquid nitrogen.« less

Shoulder arthrodesis in adult brachial plexus injury: what is the optimal position?

PubMed

Sousa, R; Pereira, A; Massada, M; Trigueiros, M; Lemos, R; Silva, C

2011-09-01

Brachial plexus injuries are a major indication for shoulder arthrodesis. However, there is no consensus concerning the optimal position of the glenohumeral joint for fusion. Between 1997 and 2008, 19 shoulder arthrodeses were performed using pelvic reconstruction plates. The radiographic and functional characteristics of 13 patients of mean age 46 years were examined at a mean of 101 months after arthrodesis. Arthrodeses showed 30° mean angle of abduction, 32° forward flexion and 44° internal rotation of the humerus with respect to the scapula. Abduction >35° and forward flexion ≥30° seem to offer slightly better functional results. Internal rotation ≤45° significantly relates to better ability of the hand to reach the face (p = 0.012). Neither abduction >35° nor forward flexion ≥30° showed a higher prevalence of periscapular pain. Abduction around 35° and forward flexion around 30° are needed for good functional results. Internal rotation should not exceed 45°.

Axillary nerve injury.

PubMed

Perlmutter, G S

1999-11-01

Axillary nerve injury remains the most common peripheral nerve injury to affect the shoulder. It most often is seen after glenohumeral joint dislocation, proximal humerus fracture, or a direct blow to the deltoid muscle. Compression neuropathy has been reported to occur in the quadrilateral space syndrome, although the true pathophysiology of this disorder remains unclear. The axillary nerve is vulnerable during any operative procedure involving the inferior aspect of the shoulder and iatrogenic injury remains a serious complication of shoulder surgery. During the acute phase of injury, the shoulder should be rested, and when clinically indicated, a patient should undergo an extensive rehabilitation program emphasizing range of motion and strengthening of the shoulder girdle muscles. If no axillary nerve recovery is observed by 3 to 6 months after injury, surgical exploration may be indicated, especially if the mechanism of injury is consistent with nerve rupture. Patients who sustain injury to the axillary nerve have a variable prognosis for nerve recovery although return of function of the involved shoulder typically is good to excellent, depending on associated ligamentous or bony injury.

Hematopoiesis and aging. V. A decline in hematocrit occurs in all aging female B6D2F1 mice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Boggs, D.R.; Patrene, K.

Longitudinal studies of hematocrits were done in aging B6D2F1 female mice at 54, 64, 91, 105 and 115 weeks of age. A modest decline in hematocrit was observed in 41/42 mice; we have previously shown that the decreased hematocrit of aged as compared to young mice is due to an expansion of plasma volume. Mice which died spontaneously after 91 weeks had lower hematocrits at 91 weeks and 105 weeks than did those which survived to 115 weeks. At each time interval, a sub-group of mice was killed and uptake of /sup 59/Fe into blood, foreleg, spleen and liver wasmore » studied and total nucleated cells per humerus was determined. The results were generally compatible with the thesis that aging mice maintain normal rates of erythropoiesis under basal conditions. Thus, it would appear that a decrease in hematocrit can be considered an expected part of the aging process in this mouse.« less

Somatotype of Competitive Youth Soccer Players From Brazil

PubMed Central

Fidelix, Yara Lucy; Berria, Juliane; Ferrari, Elisa Pinheiro; Ortiz, Jaelson Gonçalves; Cetolin, Tiago; Petroski, Edio Luiz

2014-01-01

The aim of this study was to identify the morphological configuration of youth athletes from professional soccer clubs and to verify their differences according to the tactical position on the field. Overall, 67 male players aged 15 to 17 years were evaluated. The examined anthropometric measurements included body mass, body height, skinfolds (triceps, subscapular, supraspinal and medial calf), girths (flexed and tensed arm and calf) and breadths (humerus and femur). For statistical purposes, analysis of variance and post hoc Bonferroni and Kruskal-Wallis tests were used. We concluded that goalkeepers were heavier and taller than center backs (p = 0.015 and p = 0.001), midfielders (p = 0.005 and p <0.001) and center forward players (p = 0.024 and p <0.001). The average somatotype for defense, forward and goalkeeper positions was a balanced mesomorph. Midfield players showed ectomorphic-mesomorph characteristics. It was concluded that goalkeepers were characterized as being taller and heavier and that somatotype features of athletes were similar between positions, except for midfield players. PMID:25414758

[An integrated approach including paediatric and forensic medical expertise on suspicion of child abuse].

PubMed

Schouten, M C M; Karst, W A; van der Stel, H F; Teeuw, A H; van de Putte, E M

2016-01-01

A false accusation of child abuse has a major impact on child and family. Conversely, a missed diagnosis of child abuse may have significant and lifelong consequences for the child. For health professionals the assessment of the nature of the injury and differentiating between accidental and inflicted injury, disease manifestation or a physiological phenomenon can be challenging. For adequate determination of the cause of injury, an integrated approach including paediatric knowledge and forensic medical expertise is essential. Therefore, a national expertise centre for child abuse (LECK) was established in the Netherlands in 2014. The first results of this integrated approach are described and illustrated with three case reports. Case A, a 7-month-old boy with an accidental humerus fracture. Case B, an 8-year-old boy with a false positive suspicion of child abuse who was eventually diagnosed with Henoch-Schönlein syndrome. Case C, boy of 3 months with bruises and a metaphyseal fracture of the femur, both highly suspected of being inflicted injury.

A gigantic new dinosaur from Argentina and the evolution of the sauropod hind foot.

PubMed

González Riga, Bernardo J; Lamanna, Matthew C; Ortiz David, Leonardo D; Calvo, Jorge O; Coria, Juan P

2016-01-18

Titanosauria is an exceptionally diverse, globally-distributed clade of sauropod dinosaurs that includes the largest known land animals. Knowledge of titanosaurian pedal structure is critical to understanding the stance and locomotion of these enormous herbivores and, by extension, gigantic terrestrial vertebrates as a whole. However, completely preserved pedes are extremely rare among Titanosauria, especially as regards the truly giant members of the group. Here we describe Notocolossus gonzalezparejasi gen. et sp. nov. from the Upper Cretaceous of Mendoza Province, Argentina. With a powerfully-constructed humerus 1.76 m in length, Notocolossus is one of the largest known dinosaurs. Furthermore, the complete pes of the new taxon exhibits a strikingly compact, homogeneous metatarsus--seemingly adapted for bearing extraordinary weight--and truncated unguals, morphologies that are otherwise unknown in Sauropoda. The pes underwent a near-progressive reduction in the number of phalanges along the line to derived titanosaurs, eventually resulting in the reduced hind foot of these sauropods.

Molecular genetic analysis of ancient cattle bones excavated from archaeological sites in Jeju, Korea.

PubMed

Kim, Jae-Hwan; Oh, Ju-Hyung; Song, Ji-Hoon; Jeon, Jin-Tae; Han, Sang-Hyun; Jung, Yong-Hwan; Oh, Moon-You

2005-12-31

Ancient cattle bones were excavated from archaeological sites in Jeju, Korea. We used molecular genetic techniques to identify the species and establish its relationship to extant cattle breeds. Ancient DNA was extracted from four sources: a humerus (Gonae site, A.D. 700-800), two fragments of radius, and a tooth (Kwakji site, A.D. 0-900). The mitochondrial DNA (mtDNA) D-loop regions were cloned, sequenced, and compared with previously reported sequences of various cattle breeds (9 Asian, 8 European, and 3 African). The results revealed that these bones were of the breed, Bos taurus, and a phylogenetic tree indicated that the four cattle bones formed a monophyletic group with Jeju native black cattle. However, the patterns of sequence variation and reports from archaeological sites suggest that a few wild cattle, with a different maternal lineage, may have existed on Jeju Island. Our results will contribute to further studies of the origin of Jeju native cattle and the possible existence of local wild cattle.

An animal model in sheep for biocompatibility testing of biomaterials in cancellous bones

PubMed Central

Nuss, Katja MR; Auer, Joerg A; Boos, Alois; Rechenberg, Brigitte von

2006-01-01

Background The past years have seen the development of many synthetic bone replacements. To test their biocompatibility and ability for osseointegration, osseoinduction and -conduction requires their placement within bone preferably in an animal experiment of a higher species. Methods A suitable experimental animal model in sheep with drill holes of 8 mm diameter and 13 mm depth within the proximal and distal humerus and femur for testing biocompatibility issues is introduced. Results This present sheep model allows the placing of up to 8 different test materials within one animal and because of the standardization of the bone defect, routine evaluation by means of histomorphometry is easily conducted. This method was used successfully in 66 White Alpine Sheep. When the drill holes were correctly placed no complications such as spontaneous fractures were encountered. Conclusion This experimental animal model serves an excellent basis for testing the biocompatibility of novel biomaterials to be used as bone replacement or new bone formation enhancing materials. PMID:16911787

An animal model in sheep for biocompatibility testing of biomaterials in cancellous bones.

PubMed

Nuss, Katja M R; Auer, Joerg A; Boos, Alois; von Rechenberg, Brigitte

2006-08-15

The past years have seen the development of many synthetic bone replacements. To test their biocompatibility and ability for osseointegration, osseoinduction and -conduction requires their placement within bone preferably in an animal experiment of a higher species. A suitable experimental animal model in sheep with drill holes of 8 mm diameter and 13 mm depth within the proximal and distal humerus and femur for testing biocompatibility issues is introduced. This present sheep model allows the placing of up to 8 different test materials within one animal and because of the standardization of the bone defect, routine evaluation by means of histomorphometry is easily conducted. This method was used successfully in 66 White Alpine Sheep. When the drill holes were correctly placed no complications such as spontaneous fractures were encountered. This experimental animal model serves an excellent basis for testing the biocompatibility of novel biomaterials to be used as bone replacement or new bone formation enhancing materials.

Fragility and composition of growing rat bone after one week in spaceflight

NASA Technical Reports Server (NTRS)

Patterson-Buckendahl, P.; Arnaud, S. B.; Mechanic, G. L.; Martin, R. B.; Grindeland, R. E.; Cann, C. E.; Mrchanic, G. L. (Principal Investigator)

1987-01-01

To gain some insight into the early effects of spaceflight on skeletal metabolism, we quantified the major chemical constituents and a noncollagenous protein, osteocalcin, in the third-lumbar vertebrae and humeri from 8-wk-old rats that were part of the 7-day NASA Spacelab 3 flight experiments. The ratio of calcium to hydroxyproline in the humeral diaphysis increased from 8.5 in preflight to 9.8 in ground simulation control and only to 8.9 in flight bones. There was no demonstrable change in the fraction of nonmineralized collagen. Osteocalcin content was reduced in the humerus and vertebra. Reduced accumulation of mineral and osteocalcin with no associated decrease in collagen in flight animals suggests that both mineralization and collagen metabolism are impaired in growing animals during spaceflight within a few days after launch. Strength tests of the humeri of flight rats showed substantial deficits that appeared to be related, not only to the reduced bone mass, but also to the composition and quality of new bone formed.

A gigantic new dinosaur from Argentina and the evolution of the sauropod hind foot

PubMed Central

González Riga, Bernardo J.; Lamanna, Matthew C.; Ortiz David, Leonardo D.; Calvo, Jorge O.; Coria, Juan P.

2016-01-01

Titanosauria is an exceptionally diverse, globally-distributed clade of sauropod dinosaurs that includes the largest known land animals. Knowledge of titanosaurian pedal structure is critical to understanding the stance and locomotion of these enormous herbivores and, by extension, gigantic terrestrial vertebrates as a whole. However, completely preserved pedes are extremely rare among Titanosauria, especially as regards the truly giant members of the group. Here we describe Notocolossus gonzalezparejasi gen. et sp. nov. from the Upper Cretaceous of Mendoza Province, Argentina. With a powerfully-constructed humerus 1.76 m in length, Notocolossus is one of the largest known dinosaurs. Furthermore, the complete pes of the new taxon exhibits a strikingly compact, homogeneous metatarsus—seemingly adapted for bearing extraordinary weight—and truncated unguals, morphologies that are otherwise unknown in Sauropoda. The pes underwent a near-progressive reduction in the number of phalanges along the line to derived titanosaurs, eventually resulting in the reduced hind foot of these sauropods. PMID:26777391

Humeral loads during swimming and walking in turtles: implications for morphological change during aquatic reinvasions.

PubMed

Young, Vanessa K H; Wienands, Charlotte E; Wilburn, Brittany P; Blob, Richard W

2017-11-01

During evolutionary reinvasions of water by terrestrial vertebrates, ancestrally tubular limb bones often flatten to form flippers. Differences in skeletal loading between land and water might have facilitated such changes. In turtles, femoral shear strains are significantly lower during swimming than during walking, potentially allowing a release from loads favoring tubular shafts. However, flipper-like morphology in specialized tetrapod swimmers is most accentuated in the forelimbs. To test whether the forelimbs of turtles also experience reduced torsional loading in water, we compared strains on the humerus of river cooters ( Pseudemys concinna ) between swimming and terrestrial walking. We found that humeral shear strains are also lower during swimming than during terrestrial walking; however, this appears to relate to a reduction in overall strain magnitude, rather than a specific reduction in twisting. These results indicate that shear strains show similar reductions between swimming and walking for forelimb and hindlimb, but these reductions are produced through different mechanisms. © 2017. Published by The Company of Biologists Ltd.

Surgical Interventions for the Treatment of Supracondylar Humerus Fractures in Children: Protocol of a Systematic Review

PubMed Central

Belloti, João Carlos; Matsunaga, Fabio Teruo

2017-01-01

Background 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. Objective 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. Methods 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. Results 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 by a government-based noncommercial agency, Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP). Conclusions This study may provide surgical treatment effects evidence for SHFC. The results will assist clinical practice by demonstrating the effectiveness and potential complications of these interventions and might serve as a reference for future clinical trials on the topic. Trial Registration PROSPERO CRD42014009304; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=9304 (Archived by WebCite at http://www.webcitation.org/6usiDHzD7) PMID:29162558

The Bare Area of the Proximal Ulna: An Anatomic Study With Relevance to Chevron Osteotomy.

PubMed

Ao, Rongguang; Zhang, Xu; Li, Dejian; Chen, Fancheng; Zhou, Jianhua; Yu, Baoqing

2017-06-01

A chevron osteotomy of the ulna is widely used to obtain intra-articular access to the elbow in the treatment of type C distal humerus fractures. The trochlear notch of the proximal ulna is divided into 2 articular parts by the "bare area." Ideally, the olecranon osteotomy should be centered on the bare area to minimize damage to the joint cartilage. The goals of this study were to describe the anatomy of the bare area and design an ideal chevron-shaped osteotomy. We dissected 38 cadaver elbows and measured the width of the bare area, the distance between the tip of the triceps insertion and the area on the olecranon cortex corresponding to the bare area. We then designed a chevron osteotomy to stay within the bare area and measured the distance from the tip of the triceps insertion to the osteotomy apex as well as the angle of the osteotomy plane and the angle of the chevron cuts. The bare area existed in all 38 cadavers. The mean longitudinal and transverse widths were 4.0 mm (range, 1.0-8.6 mm) and 19.0 mm (range, 16.9-23.8 mm), respectively. The mean distance between the tip of the triceps insertion and the area on the olecranon cortex corresponding to the bare area was 19.0 mm (range, 16.0-23.0 mm). The mean transverse and longitudinal widths of the cortical notch were 3.0 mm (range, 1.6-4.5 mm) and 8.0 mm (range, 6.5-14.8 mm), respectively. The mean distance between the tip of the triceps insertion and the osteotomy apex was 22.0 mm (range, 18.0-24.0 mm) and the mean angle between the osteotomy surface and the vertical plane corresponding to the tangent plane was 20° (range, 10° to 25°). The mean angle of the V shape was 140° (range, 130° to 150°). Using the narrowest edge lacking cartilage (lateral or medial side) as a point of reference to locate the bare area, the designed chevron osteotomy entered the joint in the bare area in most specimens and decreased associated damage to the joint cartilage. This study describes the anatomy of the bare area and the design of the ideal chevron-shaped osteotomy to treat type C distal humerus fractures. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Osteology of Galeamopus pabsti sp. nov. (Sauropoda: Diplodocidae), with implications for neurocentral closure timing, and the cervico-dorsal transition in diplodocids

PubMed Central

Mateus, Octávio

2017-01-01

Diplodocids are among the best known sauropod dinosaurs. Numerous specimens of currently 15 accepted species belonging to ten genera have been reported from the Late Jurassic to Early Cretaceous of North and South America, Europe, and Africa. The highest diversity is known from the Upper Jurassic Morrison Formation of the western United States: a recent review recognized 12 valid, named species, and possibly three additional, yet unnamed ones. One of these is herein described in detail and referred to the genus Galeamopus. The holotype specimen of Galeamopus pabsti sp. nov., SMA 0011, is represented by material from all body parts but the tail, and was found at the Howe-Scott Quarry in the northern Bighorn Basin in Wyoming, USA. Autapomorphic features of the new species include a horizontal canal on the maxilla that connects the posterior margin of the preantorbital and the ventral margin of the antorbital fenestrae, a vertical midline groove marking the sagittal nuchal crest, the presence of a large foramen connecting the postzygapophyseal centrodiapophyseal fossa and the spinopostzygapophyseal fossa of mid- and posterior cervical vertebrae, a very robust humerus, a laterally placed, rugose tubercle on the concave proximal portion of the anterior surface of the humerus, a relatively stout radius, the absence of a distinct ambiens process on the pubis, and a distinctly concave posteroventral margin of the ascending process of the astragalus. In addition to the holotype specimen SMA 0011, the skull USNM 2673 can also be referred to Galeamopus pabsti. Histology shows that the type specimen SMA 0011 is sexually mature, although neurocentral closure was not completed at the time of death. Because SMA 0011 has highly pneumatized cervical vertebrae, the development of the lamination appears a more important indicator for individual age than neurocentral fusion patterns. SMA 0011 is one of very few sauropod specimens that preserves the cervico-dorsal transition in both vertebrae and ribs. The association of ribs with their respective vertebrae shows that the transition between cervical and dorsal vertebrae is significantly different in Galeamopus pabsti than in Diplodocus carnegii or Apatosaurus louisae, being represented by a considerable shortening of the centra from the last cervical to the first dorsal vertebra. Diplodocids show a surprisingly high diversity in the Morrison Formation. This can possibly be explained by a combination of geographical and temporal segregation, and niche partitioning. PMID:28480132

The Effects of Hypergravity and Adrenalectomy on Bone Mineral Content, Urine Calcium and Body Mass in Rats

NASA Technical Reports Server (NTRS)

Lau, A.; Ramirez, J.; Melson, E.; Moran, M.; Baer, L.; Arnaud, S.; Wade, C.; Girten, B.; Dalton, Bonnie (Technical Monitor)

2001-01-01

The effects of 14 days of increased gravitational load, and the absence of adrenal stress hormones on total body bone mineral content (BMC) were examined in male Sprague-Dawley rats. Centrifugation at 2 Gs (2G) was used to increase the gravitational load, and bilateral adrenalectomy (ADX) was used to eliminate the production of adrenal stress hormones. Stationary groups at 1 G (1G) and sham operated (SHAM) animals served as controls. Thirty rats (n=6 or 8) made up the four experimental groups (1G SHAM, 1G ADX, 2G SHAM and 2G ADX). BMC was assessed by dual energy x-ray absorptiometry (DXA) which was performed to determine the total body bone mineral content, and also through bone ashing of the left femur and the left humerus. Activity was determined through biotelemetry, also body mass and food intake were measured. Multi-factorial analysis of variance (MANCOVA) and Newman Keuls post hoc tests were used to analyze significant effects (p is less than 0.05) for the primary variables. Results from both DXA and the ashed femur indicated that BMC decreased significantly with increased G for both the SHAM and ADX groups. The BMC determined by DXA for the 1G ADX group was also significantly lower than the 1G SHAM group, however the 2G SHAM and 2G ADX groups were not significantly different. However, the bone ashing results showed the femur differed significantly only between the rates of centrifugation and not between the ADX and SHAM. The humerus showed no significant difference between any of the groups. There was a significant decrease in body mass with increased G and there was no ADX effect on body mass. When DXA BMC was normalized for body mass changes, there were no significant group differences. However, with bone ashing, the femur BMC/BW still showed significant difference between rates of centrifugation, with the 2G group being lower. Activity level decreased with body mass, and food intake data showed there was significant hypophagia during the first few days of centrifugation. Urine calcium was measured and was found decrease at the start of centrifugation for the 2G groups and rise to a level higher than that of the stationary groups. Finally, the correlation between BW and BMC was determined to be highly correlated (r = .71). These results suggest that the decrease in total body BMC seen with hypergravity may be based to a large extent on the differences in body mass induced by the 2G load.

[The possibilities for determining the passenger position inside the car passenger compartment based on the injuries to the extremities estimated with the use of the sequential mathematical analysis].

PubMed

Smirenin, S A; Khabova, Z S; Fetisov, V A

2015-01-01

The objective of the present study was to determine the diagnostic coefficients (DC) of injuries to the upper and lower extremities of the passengers inside the car passenger compartment based on the analysis of 599 archival expert documents available from 45 regional state bureaus of forensic medical examination of the Russian federation for the period from 1995 till 2014. These materials included the data obtained by the examination of 200 corpses and 300 live persons involved in the traffic accidents. The statistical and mathematical treatment of these materials with the use the sequential analysis method based on the Byes and Wald formulas yielded the diagnostic coefficients that made it possible to identify the most important signs characterizing the risk of injuries for the passenger occupying the front seat of the vehicle. In the case of the lethal outcome, such injuries include fractures of the right femur (DC -8.9), bleeding (DC -7.1), wounds in the soft tissues of the right thigh (DC -5.0) with the injurious force applied to its anterior surface, bruises on the posterior surface of the right shoulder (DC -6.2), the right deltoid region (DC -5.9), and the posterior surface of the right forearm (DC -5.5), fractures of the right humerus (DC -5.), etc. When both the driver and the passengers survive, the most informative signs in the latter are bleeding and scratches (DC -14.5 and 11.5 respectively) in the soft tissues at the posterior surface of the right shoulder, fractures of the right humerus (DC -10.0), bruises on the anterior surface of the right thigh (DC -13.0), the posterior surface of the right forearm (DC -10.0) and the fontal region of the right lower leg (DC -10.0), bleeding in the posterior region of the right forearm (DC -9.0) and the anterior region of the left thigh (DC -8.6), fractures of the right femur (DG -8.1), etc. It is concluded that the knowledge of diagnostic coefficients helps to draw attention of the experts to the analysis of the above morphological signs for the objective determination of the passenger position inside the car passenger compartment during traffic accidents and thereby to improve the quality of expert conclusions and the results of forensic medical examination of the injuries inflicted in car crashes.

Complications after pinning of supracondylar distal humerus fractures.

PubMed

Bashyal, Ravi K; Chu, Jennifer Y; Schoenecker, Perry L; Dobbs, Matthew B; Luhmann, Scott J; Gordon, J Eric

2009-01-01

Supracondylar distal humerus fractures are one of the most common skeletal injuries in children. The current treatment of choice in North America is closed reduction and percutaneous pin fixation. Often surgeons leave the pins exposed beneath a cast but outside the skin. Great variation exists with respect to preoperative skin preparation, and perioperative antibiotic administration. Few data exist regarding the rate of infection and other complications. The purpose of this study is to review a large series of children to evaluate the rate of infection and other complications. A retrospective review was carried out of all patients treated at our institution over an 11-year period. A total of 622 patients were identified that were followed for a minimum of 2 weeks after pin removal. Seventeen patients had flexion-type fractures, 294 had type II fractures, and 311 had type III fractures. Seventy-four fractures (11.9%) had preoperative nerve deficits with anterior interosseous palsies being the most common (33 fractures, 5.3%). Preoperative antibiotics were given to 163 patients (26.2%). Spray and towel draping were used in 362 patients, paint and towel draping were used in 65 patients, alcohol paint and towel draping were used in 146 patients, and a full preparation and draping were used in 13 patients. The pins were left exposed under the cast in 591 fractures (95%), and buried beneath the skin in 31 fractures (5.0%). A medial pin was placed in 311 fractures with a small incision made to aid placement in 18 of these cases. The most common complication was pin migration necessitating unexpected return to the operating room for pin removal in 11 patients (1.8%). One patient developed a deep infection with septic arthritis and osteomyelitis (0.2%). Five additional patients had superficial skin infections and were treated with oral antibiotics for a total infection rate of 6 of 622 patients (1.0%). One patient ultimately had a malunion and 4 others returned to the operating room for repeat reduction and pinning. Three patients developed compartment syndromes. Ulnar nerve injury was rare with only 1 postoperative ulnar nerve injury occurring in 311 patients treated with a medial pin (0.3%). Closed reduction with percutaneous pinning is effective and has a low complication rate with a very low rate of infection even when simple betadine preparation and towel draping are used. Preoperative antibiotics seem to have little effect on infection rate. Level III retrospective comparative study.

Low bone mass density at multiple skeletal sites, including the appendicular skeleton in amenorrheic runners.

PubMed

Pettersson, U; Stålnacke, B; Ahlénius, G; Henriksson-Larsén, K; Lorentzon, R

1999-02-01

The aim of this study was to investigate any difference in bone mass at different sites between female long-distance runners with amenorrhea and those with eumenorrhea. We compared 10 amenorrheic and 10 eumenorrheic athletes to determine whether athletes with amenorrhea have lower BMD in multiple skeletal regions, including weight-bearing lower limbs. The amenorrheic group had experienced menstrual dysfunction ranging from 3 to 43 months. As a further control group, 16 eumenorrheic soccer players were compared with the former two running groups regarding their BMD measurements. The two groups were matched for age, height, and amount of training. Areal bone mineral density (BMD) was measured and was found to be significantly lower in the total body, humerus, spine, lumbar spine, pelvis, femoral neck, trochanter, total femur, femur diaphysis, tibia diaphysis and in the nonweight-bearing head of the femur in the amenorrheic group. Body weight, BMI, fat mass, and body fat percent were significantly lower in the amenorrheic group. The differences in the BMD of the head, humerus, femoral neck, total femur, femur diaphysis, and tibia diaphysis disappeared when adjusted for body weight. Compared with the soccer group, the amenorrheic subjects had significantly lower BMD values at all sites except for the head, Ward's triangle, and femur diaphysis. Blood samples were obtained in the two running groups for analysis of osteocalcin, carboxy terminal telopeptide (ICTP), procollagen I (PICP), and estradiol. There were no significant differences between the groups but there was a strong tendency towards a lower estradiol level and a higher osteocalcin level in the amenorrheic group. A free estradiol index (FE2) was derived as the ratio of estradiol to sex hormone binding globulin (SHBG) and was significantly lower in the amenorrheic group. No difference in their daily intake of total energy, protein, carbohydrates, fiber, calcium, and vitamin D was observed. However, both groups showed a surprisingly low energy intake in relation to their training regimens. Stepwise regression analyses revealed that weight was the best predictor of spine BMD in both groups. Estradiol and FE2 were significant predictors of the BMD of the proximal femur in the eumenorrheic group, but did not predict any BMD site in the amenorrheic group. In conclusion, amenorrhea in athletic women affects trabecular and cortical bone in both axial and appendicular skeleton. However, some of the discrepancy can be explained by a lower body weight. Physical weight-bearing activity does not seem to completely compensate for the side effects of reduced estrogen levels even in weight-bearing bones in the lower extremity and spine.

SU-E-T-209: Comparison of Plan Quality Between Arm Avoidance (AA) Vs. Non Arm Avoidance VMAT Planning Techniques for Breast Cancer Patients with Bilateral Implant Reconstructions Receiving Postmastectomy Radiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kuo, L; Ballangrud, A; Ho, A

Purpose: Breast cancer patients with bilateral implant reconstructions who require postmastectomy radiotherapy can pose unique treatment planning challenges. The use of VMAT may provide advantages over conventional tangent or multi-beam IMRT techniques. Moreover, daily setup uncertainly of the arm position, however, could have significant impact on accurate dose delivery. This study compares the plan qualities between non-AA and AA VMAT techniques. Methods: Three breast cancer patients receiving left chest wall and regional nodal irradiation with bilateral implant reconstructions were studied. PTV included chest wall and IMNs (PTV-CW), and supraclavicular and axillary lymph nodes (PTV-SCV). For each patient, one non-AA VMATmore » plan (VMAT-S) with 4 partial arcs encompassing the ipsilateral arm and three AA VMAT plans where no arcs were entering or existing through the ipsilateral arm were generated. VMAT-AA1 uses 2 arcs for PTV-CW and 2 arcs for PTV-SCV. VMAT-AA2 used two static fields for PTV-SCV with 2 arcs for PTV-CW. VMAT-AA3 used 2 narrow arcs for PTV-CW and 2 long arcs for all PTVs. Prescription dose (PD) was 50 Gy (25 fractions). All plans were normalized to have 95% of PD to 95 % of PTV. PTV dose inhomogeneity and dose to the heart, left lung, right thyroid dose and left humerus were evaluated. Results: For VMAT-S, VMAT-AA1, VMAT-AA2 and VMAT-AA3, respectively, the average and standard deviation (in Gy unless specified otherwise) of PTV D05 are 54.7±0.9, 55.9±0.4, 56.7±0.7 and 55.7±0.4; mean Heart dose: 7.1±0.7, 7.2±0.8, 7.3±0.9 and 6.9±1.0; left lung V20Gy (in %): 28.1±1.0, 28.8+2.2, 32.2±4.1 and 27.8±2.0; mean right thyroid dose: 8.1±0.6, 5.1±2.1, 2.1±0.4 and 5.0±2.0; mean left humerus dose: 20.0±4.4,15.6±4.4, 15.2±8.2 and 15.3±4.6. Conclusion: AA VMAT can produce acceptable clinical plans while eliminating dosimetric impact related to arm setup uncertainty. These data require validation in larger planning studies prior to routine clinical implantation.« less

Spectacular improvement in vitamin D status in elderly osteoporotic women: 8-year analysis of an osteoporotic population treated in a dedicated fracture liaison service.

PubMed

Amouzougan, A; Deygat, A; Trombert, B; Constant, E; Denarié, D; Marotte, H; Thomas, T

2015-12-01

In a population of postmenopausal women with a fragility fracture, we found a drastic reduction in the proportion of women with severe (<25 nmol/L) and moderate (25 to 75 nmol/L) hypovitaminosis D, especially from 2009 onwards. These results show that supplementation has been very widely integrated into current practice. Vitamin D (25(OH)D) is essential for bone health. In institutionalised osteoporotic women, it reduces the risk of fragility fractures. Numerous articles suggesting the possibility of extraosseous effects have generated a growing number of publications and recommendations on more widespread administration, to limit the risks of moderate or severe hypovitaminosis D. We assessed the impact on clinical practice of these recommendations concerning 25(OH)D supplementation in elderly at-risk populations. A total of 1486 postmenopausal osteoporotic women were seen in the context of a fracture liaison service (i.e. a rheumatology consultation following a peripheral fragility fracture), between May 2005 and December 2012. Of these, 1107 had a 25(OH)D assay (femur, n = 520; humerus, n = 207; wrist, n = 380). The average age of the total population was 76.7 ± 9.9 years, while for women with an available 25(OH)D assay, the average age was 75.1 ± 11.8 years. The average 25(OH)D (nmol/L) level was similar for the three fracture sites: femur, 30 ± 36.2; humerus, 27.5 ± 24; and wrist, 31 ± 26. A drastic reduction in the proportion of women with severe (<25 nmol/L) and moderate (25 to 75 nmol/L) hypovitaminosis D was observed, especially from 2009 onwards, with a mean prevalence of 69 and 30 % respectively before that year and 35 and 52 % thereafter. Conversely, the proportion of women with 25(OH)D at the threshold value of 75 nmol/L increased from 1.2 to 24 %. Overall, mean serum 25(OH)D levels were significantly higher when comparing the two periods 2005-2008 and 2009-1012 (17.6 ± 14.6 and 48.4 ± 39.2 nmol/L, respectively; p < 0.0001). These results show that supplementation has been very widely integrated into current practice. We can expect it to yield beneficial effects in osseous and extraosseous terms in osteoporotic women, particularly the very elderly.

A shift in anterior–posterior positional information underlies the fin-to-limb evolution

PubMed Central

Onimaru, Koh; Kuraku, Shigehiro; Takagi, Wataru; Hyodo, Susumu; Sharpe, James; Tanaka, Mikiko

2015-01-01

The pectoral fins of ancestral fishes had multiple proximal elements connected to their pectoral girdles. During the fin-to-limb transition, anterior proximal elements were lost and only the most posterior one remained as the humerus. Thus, we hypothesised that an evolutionary alteration occurred in the anterior–posterior (AP) patterning system of limb buds. In this study, we examined the pectoral fin development of catshark (Scyliorhinus canicula) and revealed that the AP positional values in fin buds are shifted more posteriorly than mouse limb buds. Furthermore, examination of Gli3 function and regulation shows that catshark fins lack a specific AP patterning mechanism, which restricts its expression to an anterior domain in tetrapods. Finally, experimental perturbation of AP patterning in catshark fin buds results in an expansion of posterior values and loss of anterior skeletal elements. Together, these results suggest that a key genetic event of the fin-to-limb transformation was alteration of the AP patterning network. DOI: http://dx.doi.org/10.7554/eLife.07048.001 PMID:26283004

Reevaluation of the superior radial collateral artery in the human upper arm.

PubMed

Ichimura, Koichiro; Kinose, Shota; Kawasaki, Yuto; Kato, Kota; Sakai, Tatsuo

2018-01-01

The superior radial collateral artery (SRCA) was described in well-established anatomy textbooks published in the 1800s. According to those textbooks, the SRCA originates from the brachial artery, passes transversely between the coracobrachialis and the humerus, and distributes to the most distal portion of the deltoid. The SRCA is not listed in the international standard on anatomical terminology, Terminologia Anatomica, or in modern anatomy textbooks. In the present study, we reevaluated the anatomical features of the SRCA by cadaveric dissection. We found that two kinds of SRCAs were consistently present in the upper arm. One was similar to the previous descriptions of the SRCA in terms of origin and course, but the distribution was somewhat different. The other was similar to the previous descriptions in terms of the distribution, although it differed in origin and course. The discrepancy between the description of the SRCA in classical textbooks and the actual morphologies of the SRCA presumably prompted previous anatomists to question the existence of the SRCA, resulting in its absence from anatomical textbooks after a particular time point.

Sizing the Jurassic theropod dinosaur Allosaurus: assessing growth strategy and evolution of ontogenetic scaling of limbs.

PubMed

Bybee, Paul J; Lee, Andrew H; Lamm, Ellen-Thérèse

2006-03-01

Allosaurus is one of the most common Mesozoic theropod dinosaurs. We present a histological analysis to assess its growth strategy and ontogenetic limb bone scaling. Based on an ontogenetic series of humeral, ulnar, femoral, and tibial sections of fibrolamellar bone, we estimate the ages of the largest individuals in the sample to be between 13-19 years. Growth curve reconstruction suggests that maximum growth occurred at 15 years, when body mass increased 148 kg/year. Based on larger bones of Allosaurus, we estimate an upper age limit of between 22-28 years of age, which is similar to preliminary data for other large theropods. Both Model I and Model II regression analyses suggest that relative to the length of the femur, the lengths of the humerus, ulna, and tibia increase in length more slowly than isometry predicts. That pattern of limb scaling in Allosaurus is similar to those in other large theropods such as the tyrannosaurids. Phylogenetic optimization suggests that large theropods independently evolved reduced humeral, ulnar, and tibial lengths by a phyletic reduction in longitudinal growth relative to the femur.

Reverse shoulder arthroplasty in young patient with achondroplasia - Ten year follow up: Case report.

PubMed

van den Broek, M; Verborgt, O; Declercq, G

2017-11-01

Skeletal dysplasia in achondroplasia can affect all body joints - including the glenohumeral joint - and is prone to develop to degenerative osteoarthritis (OA). This may cause pain and mobility problems at young age. Surgical treatment is challenging due to the dysplastic anatomy of the shoulder joint - with a dysplastic deformed short humerus, a small, hypoplastic medialized glenoid and lateralized acromion - and the long life expectancy of these patients. The indications for reverse shoulder arthroplasty (RSA) evolved during years with rotator cuff tears and rotator cuff arthropathy in combination with or without glenohumeral OA as the main indicator, with good short to mid-term results. Long term results of RSA are rarely found in literature, especially in young patients. The use of a RSA in glenohumeral OA with an intact rotator cuff has rarely been reported. In this case report we present the ten-year clinical and radiographic results of a RSA for the treatment of degenerative OA with glenohumeral dysplasia in a young patient with achondroplasia. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Clinical results of the re-fixation of a Chevron olecranon osteotomy using an intramedullary cancellous screw and suture tension band.

PubMed

Wagener, Marc L; Dezillie, Marleen; Hoendervangers, Yvette; Eygendaal, Denise

2015-04-01

Exposure of the distal humerus in case of an articular fracture is often performed through a Chevron osteotomy of the olecranon. Several options have been described for re-fixation of the Chevron osteotomy. Pull-out of the hard-wear is often seen as complication. In this study, an evaluation of the re-fixation of the Chevron osteotomy through a cancellous screw and suture tension band was performed. The data of 19 patients in whom a Chevron osteotomy was re-fixated with a cancellous screw in combination with a suture tension band were used. Evaluation was performed by assessment of the post-operative X-rays and documentation of complications. In all 19 cases, evaluation of the post-operative X-rays showed complete consolidation without dislocation or other complications. Re-fixation of a Chevron osteotomy of the olecranon with a large cancellous screw with a suture tension band provides adequate stability to result in proper healing of the osteotomy in primary cases when early post-operative mobilisation is allowed. Complications as pull-out of the hard-wear were not reported.

Pectoral girdle and fin anatomy of Gogonasus andrewsae Long, 1985: implications for tetrapodomorph limb evolution.

PubMed

Holland, Timothy

2013-02-01

Recently discovered material has yielded new information on the pectoral girdle and fin endoskeleton of Gogonasusandrewsae (Frasnian Gogo Formation, Kimberley Region, Western Australia). These elements permit the first comprehensive description of the anocleithrum, cleithrum, scapulocoracoid, and lepidotrichia. New autapomorphies of Gogonasus include a square exposed region on the supracleithrum, an unusual knob-like process on the scapulocoracoid, a relatively small entepicondyle, and lepidotrichia with I-beam-shaped cross sections. Several poorly ossified regions on the scapulocoracoid and humerus indicate an early ontogenetic state, as with other immature tetrapodomorph fish specimens. A phylogenetic analysis indicates a more stemward position for Gogonasus in a weakly supported clade with other "osteolepidid" taxa, compared to other recent studies placing Gogonasus crownward of osteolepidid fishes and the Tristichopteridae, as the sister taxon to the "Elpistosteglia" + Tetrapoda. A phylogenetic position among megalichthyid fishes is suggested for Sterropterygion, while radiographs of the megalichthyid Cladarosymblema show a scythe-like radius terminating distally with that of the intermedium. New data on the scapulocoracoid of the rhizodontid Barameda reveals a coroacoid crest and small supraglenoid foramen. Copyright © 2012 Wiley Periodicals, Inc.

A Large Ornithurine Bird (Tingmiatornis arctica) from the Turonian High Arctic: Climatic and Evolutionary Implications

NASA Astrophysics Data System (ADS)

Bono, Richard K.; Clarke, Julia; Tarduno, John A.; Brinkman, Donald

2016-12-01

Bird fossils from Turonian (ca. 90 Ma) sediments of Axel Heiberg Island (High Canadian Arctic) are among the earliest North American records. The morphology of a large well-preserved humerus supports identification of a new volant, possibly diving, ornithurine species (Tingmiatornis arctica). The new bird fossils are part of a freshwater vertebrate fossil assemblage that documents a period of extreme climatic warmth without seasonal ice, with minimum mean annual temperatures of 14 °C. The extreme warmth allowed species expansion and establishment of an ecosystem more easily able to support large birds, especially in fresh water bodies such as those present in the Turonian High Arctic. Review of the high latitude distribution of Northern Hemisphere Mesozoic birds shows only ornithurine birds are known to have occupied these regions. We propose physiological differences in ornithurines such as growth rate may explain their latitudinal distribution especially as temperatures decline later in the Cretaceous. Distribution and physiology merit consideration as factors in their preferential survival of parts of one ornithurine lineage, Aves, through the K/Pg boundary.

Use of intramedullary fibular strut graft: a novel adjunct to plating in the treatment of osteoporotic humeral shaft nonunion

PubMed Central

Vamsi, K.; Rao, Sharath K.; Gnanadoss, James J.; Pandian, S.

2008-01-01

Humeral shaft fractures respond well to conservative treatment and unite without much problem. Since it is uncommon, there is not much discussion regarding the management of nonunion in the literature, and hence this is a challenge to the treating orthopaedic surgeon. Osteoporosis of the fractured bone and stiffness of the surrounding joints compounds the situation further. The Ilizarov fixator, locking compression plate, and vascularised fibular graft are viable options in this scenario but are technically demanding. We used a fibular strut graft for bridging the fracture site in order to enhance the pull-out strength of the screws of the dynamic compression plate. Six patients in the study had successful uneventful union of the fracture at the last follow-up. The fibula is easy to harvest and produces less graft site morbidity. None of the study patients needed additional iliac crest bone grafting. This is the largest reported series of patients with osteoporotic atrophic nonunion of humerus successfully treated solely using the combination of an intramedullary fibular strut graft and dynamic compression plate. PMID:18563410

Simple Bone Cyst of Metacarpal: Rare Lesion with Unique Treatment

PubMed Central

Patwardhan, Sandeep; Shah, Kunal; Shyam, Ashok; Sancheti, Parag

2014-01-01

Introduction: Simple bone cyst or unicameral bone cyst (UBC) are benign cystic lesions commonly found in femur and humerus. However hand is a very rare site of occurrence. Treatment described for UBC of hand commonly involves curettage and bone grafting. Case Report: A 7 year old right hand dominant girl presented to us with chief complaints of pain and swelling in right 4th metacarpal since 2 month. On imaging, plain radiographs of right hand showed expansile lytic lesion on Metaphyseal-diaphyseal region of 4th metacarpal with pathological fracture. MRI showed cystic lesions with internal loculations and fluid-fluid levels (Fig 2). There was minimal soft tissue extension. We performed aspiration which showed serosanguinous fluid with haemorrhagic tinge. With the diagnosis of unicameral bone cyst in mind we performed and closed intramedullary nail with k wire. The cyst healed up completely within 2 months. There was no recurrence at 18 month follow up. Conclusion: In conclusion simple bone cyst is very rare in metacarpal bone. However it should be considered as important differential since it warrants simple treatment and extensive procedures should be avoided. PMID:27298987

Unicameral Bone Cysts of the Pelvis

PubMed Central

Hammoud, Sommer; Weber, Kristy; McCarthy, Edward F

2005-01-01

Unicameral bone cysts of the pelvis are extremely rare. This study summarizes the clinical, radiologic and pathologic features of 16 cases. Patients ranged in age from nine to 69. Most lesions were in the anterior portion of the iliac wing; many appeared to be related to an open iliac crest apophysis. This suggests that the pathogenesis of unicameral bone cysts in this portion of the ilium is similar to that seen in the proximal humerus and the proximal femur. The correct diagnosis was made preoperatively in only five cases. This indicates that, although they are well documented, unicameral bone cysts of the pelvis remain a diagnostic problem. Patients received a spectrum of treatments from curettage to observation. There appeared to be no difference in the outcome after any form of treatment. Therefore, unicameral bone cysts of the pelvis can be managed conservatively. The choice to manage patients conservatively depends on making the correct diagnosis based on clinical history and imaging. The most effective imaging is a combination of plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). PMID:16089077

Percutaneous Method of Management of Simple Bone Cyst

PubMed Central

Lakhwani, O. P.

2013-01-01

Introduction. Simple bone cyst or unicameral bone cysts are benign osteolytic lesions seen in metadiaphysis of long bones in growing children. Various treatment modalities with variable outcomes have been described in the literature. The case report illustrates the surgical technique of minimally invasive method of treatment. Case Study. A 14-year-old boy was diagnosed as active simple bone cyst proximal humerus with pathological fracture. The patient was treated by minimally invasive percutaneous curettage with titanium elastic nail (TENS) and allogenic bone grafting mixed with bone marrow under image intensifier guidance. Results. Pathological fracture was healed and allograft filled in the cavity was well taken up. The patient achieved full range of motion with successful outcome. Conclusion. Minimally invasive percutaneous method using elastic intramedullary nail gives benefit of curettage cyst decompression and stabilization of fracture. Allogenic bone graft fills the cavity and healing of lesion by osteointegration. This method may be considered with advantage of minimally invasive technique in treatment of benign cystic lesions of bone, and the level of evidence was therapeutic level V. PMID:23819089

Unicameral bone cysts of the pelvis: a study of 16 cases.

PubMed

Hammoud, Sommer; Weber, Kristy; McCarthy, Edward F

2005-01-01

Unicameral bone cysts of the pelvis are extremely rare. This study summarizes the clinical, radiologic and pathologic features of 16 cases. Patients ranged in age from nine to 69. Most lesions were in the anterior portion of the iliac wing; many appeared to be related to an open iliac crest apophysis. This suggests that the pathogenesis of unicameral bone cysts in this portion of the ilium is similar to that seen in the proximal humerus and the proximal femur. The correct diagnosis was made preoperatively in only five cases. This indicates that, although they are well documented, unicameral bone cysts of the pelvis remain a diagnostic problem. Patients received a spectrum of treatments from curettage to observation. There appeared to be no difference in the outcome after any form of treatment. Therefore, unicameral bone cysts of the pelvis can be managed conservatively. The choice to manage patients conservatively depends on making the correct diagnosis based on clinical history and imaging. The most effective imaging is a combination of plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI).

[Prediction, prevention and management of shoulder dystocia].

PubMed

Csorba, Roland

2012-05-20

Shoulder dystocia is one of the most tragic, fatal and unexpected obstetrical events, which is mostly unpredictable and unpreventable. This clinical picture is defined as a delivery that requires additional obstetric maneuvers to release the shoulders after gentle downward traction has failed. Shoulder dystocia occurs when the fetal shoulder impacts on the maternal symphysis or sacral promontory. The incidence of shoulder dystocia is 0.2-0.6%. High perinatal mortality and morbidity is associated with the condition, even when it is managed appropriately. Obstetricians should be aware of the existing risk factors, but should always be alert to the possibility of shoulder dystocia in all labors. Maternal morbidity is also increased, particularly postpartum hemorrhage, rupture of the uterus, injury of the bladder, urethra and the bowels and fourth-degree perineal tears. Complications of the newborn include asphyxia, perinatal mortality, fracture of the clavicula and the humerus. Brachial plexus injuries are one of the most important fetal complications of shoulder dystocia, complicating 4-16% of such deliveries. The purpose of this article is to review the current evidence regarding the possible prediction, prevention and management of shoulder dystocia.

Anthropometric measurements in Iranian men.

PubMed

Gharehdaghi, Jaber; Baazm, Maryam; Ghadipasha, Masoud; Solhi, Sadra; Toutounchian, Farhoud

2018-01-01

There is inevitable need for data regarding anthropometric measurements of each community's population. These anthropometric data have various applications, including health assessment, industrial designing, plastic & orthopedic surgery, nutritional studies, anatomical studies and forensic medicine investigations. Anthropometric parameters vary from race to race throughout the world, hence providing an anthropometric profile model of residents of different geographic regions seems to be necessary. To our knowledge, there is no report of bone parameters of the Iranian population. The present study was carried out to provide data on anthropomorphic bone parameters of the Iranian population, as a basis for future relevant studies. We calculated most of the known anthropometric parameters including skull, mandible, clavicle, scapula, humerus, radius, ulna, sacrum, hip, femur, tibia and fibula of 225 male corpses during a period of 2 years (2014-2016). Data expression was done as mean ± standard deviation. The results consist the first documented report on anthropometric bone measurement profile of Iranian male population, that can be considered a valuable source of data for future research on Iranian population in this regard. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Rich but poor: life in the Roman period with extreme rheumatoid arthritis.

PubMed

Bašić, Željana; Jerković, Ivan; Kružić, Ivana; Anđelinović, Šimun

2017-01-01

In a Sidonian sarcophagus, from the Late Antique/early Christian period, skeletal remains of two persons were found. One of them, male, 30-50 years old, was found almost completely ankylosed, with highly osteoporotic bones and prominent erosion of joint surfaces. We diagnosed rheumatoid arthritis based on the eroded odontoid process, mandibular condyles, distal humerus, proximal and distal ulna, as well ankylosed hand and foot bones. Despite the fact that ankyloses of vertebrae and sacroiliac joint could point towards ankylosing spondylitis, the lack of typical vertebral ankyloses and new bone formation led to exclusion. In a practical sense, due to the advanced stage of the disease, the man was fixed in the supine position, on the left, with his head turned to the right. Apparently, he could not move and had problems with chewing and breathing. But, the high standard of provided healthcare probably enabled him to survive in advanced stages of the disease. This case shed light on the antiquity of the disease, its medical, and social context and provided the example of most extreme osteological changes reported in the paleopathological and medical literature.

Osteochondritis Dissecans Involving the Trochlear Groove Treated With Retrograde Drilling

PubMed Central

Kaji, Yoshio; Nakamura, Osamu; Yamaguchi, Konosuke; Yamamoto, Tetsuji

2015-01-01

Abstract Osteochondritis dissecans (OCD) occurs frequently in the humeral capitellum of the upper extremity, whereas OCD involving the trochlear groove (trochlear groove OCD) is rarely reported. A standard treatment for trochlear groove OCD has therefore not been determined, although several methods have been tried. The case of a 14-year-old male gymnast with bilateral trochlear groove OCD is presented. Retrograde drilling from the lateral condyle of the humerus was applied for the OCD lesion of the left elbow, since it was larger in size than that in the right elbow and was symptomatic. Conversely, since the right lesion was small and asymptomatic, it was managed conservatively. After treatment, consolidation of the OCD lesions was observed in both elbows. However, the time to healing was shorter in the left elbow treated surgically than in the right elbow managed conservatively. In conclusion, retrograde drilling is a very simple and minimally invasive treatment. This case suggests that retrograde drilling for trochlear groove OCD may be a useful procedure that may accelerate the healing process for OCD lesions. PMID:26356703

A Unique Branching Pattern of the Axillary Artery: A Case Report

PubMed Central

Bagoji, Ishwar B.; Hadimani, Gavishiddappa A.; Bannur, Balappa M.; Patil, B.G.; Bharatha, Ambadasu

2013-01-01

During routine dissection classes for under graduate students, we found a unique and unusual case regarding the anomalous branching in the third part of the axillary artery was terminated into subscapular arterial trunk, superficial brachial artery and deep brachial artery. The subscapular arterial trunk was origin of several important arteries as the circumflex scapular, thoracodorsal, posterior circumflex humeral, thoraco-acromial and lateral thoracic arteries. The deep brachial artery in the arm gave anterior circumflex humeral artery at the surgical neck of humerus, which terminated in the cubital fossa by dividing into radial and ulnar arteries. The superficial brachial artery gave two profunda brachii arteries, both of which passed through spiral groove, along with radial nerve and three muscular branches, to brachialis muscle. This variation is very rare. As per our knowledge, we did not find any literature which explained variations which were similar to this. The normal and abnormal anatomy of the axillary region has practical importance among vascular radiologists and surgeons and it should be known for making an accurate diagnostic interpretation. PMID:24551680

A unique branching pattern of the axillary artery: a case report.

PubMed

Bagoji, Ishwar B; Hadimani, Gavishiddappa A; Bannur, Balappa M; Patil, B G; Bharatha, Ambadasu

2013-12-01

During routine dissection classes for under graduate students, we found a unique and unusual case regarding the anomalous branching in the third part of the axillary artery was terminated into subscapular arterial trunk, superficial brachial artery and deep brachial artery. The subscapular arterial trunk was origin of several important arteries as the circumflex scapular, thoracodorsal, posterior circumflex humeral, thoraco-acromial and lateral thoracic arteries. The deep brachial artery in the arm gave anterior circumflex humeral artery at the surgical neck of humerus, which terminated in the cubital fossa by dividing into radial and ulnar arteries. The superficial brachial artery gave two profunda brachii arteries, both of which passed through spiral groove, along with radial nerve and three muscular branches, to brachialis muscle. This variation is very rare. As per our knowledge, we did not find any literature which explained variations which were similar to this. The normal and abnormal anatomy of the axillary region has practical importance among vascular radiologists and surgeons and it should be known for making an accurate diagnostic interpretation.

[Experimental study of dislocations of the scapulohumeral joint].

PubMed

Gagey, O; Gagey, N; Boisrenoult, P; Hue, E; Mazas, F

1993-01-01

One may produce easily an experimental dislocation (anterior or erecta) of the scapulohumeral joint. The authors discuss, the experimental model then they describe the anatomical lesion produced through the experimental dislocation of 32 shoulders and the correlation observed after RMI assessment of 24 recurrent dislocations. The tear of the inferior glenohumeral ligament is constant, in 20 per cent of the cases the tear lies on the anterior aspect of the glenoid, in the other cases the tear was found on its humeral side. Whatever the situation of the tear of the inferior glenohumeral ligament, the lesion of the labrum was constant. The erecta dislocation was produced with the same movement but with a particular tear of the glenohumeral ligament: the tear was longitudinal. The experimental dislocation needs, in 7 or 8 cases, a desinsertion of the deep aspect of the rotator cuff. The Hill Sachs lesion occurs when the humerus falls along the chest wall after the dislocation. In 50 per cent of the patients, MRI shows modifications of the cuff which are compatible with our results. Hills Sachs lesions appear to be constant after MRI examination.

An Abnormal Bone Lesion of the Scapula in a Collegiate Basketball Player: A Case Report

PubMed Central

O'Brien, Matthew S.; Donnell, Allison; Miller, Jason; Iven, Val Gene; Pascale, Mark

2013-01-01

Objective: To present the case of a bone lesion of the scapula in a collegiate basketball player. Background: A 19-year-old National Collegiate Athletic Association Division I male basketball player presented with pain in the posterior region of the right shoulder. During practice, he was performing a layup when his arm was forced into hyperflexion by a defender. Evaluation revealed a bone lesion involving the scapular spine and base of the acromion. Differential Diagnosis: Acromioclavicular joint sprain, subacromial bursitis, subscapular bursitis, humeral head contusion, acromial fracture. Treatment: The patient was treated for 2 months with therapeutic modalities and rehabilitation exercises. Because of persistent pain and the risk of a pathologic fracture, open surgical biopsy and bone grafting were then undertaken. Uniqueness: Most simple bone cysts affect the proximal humerus and femur, whereas our patient's lesion was in the acromial complex. Conclusions: Athletic trainers should be alert to the unusual possibility of bone cysts, which are usually identified incidentally when radiographs are obtained for other reasons. Most simple bone cysts are asymptomatic, but a pathologic fracture can occur with trauma. PMID:23725460

A new internal fixation technique for fractures of the proximal humerus--the Bilboquet device: a report on 26 cases.

PubMed

Doursounian, L; Grimberg, J; Cazeau, C; Jos, E; Touzard, R C

2000-01-01

We describe a novel internal fixation device and report on 26 patients (mean age, 70 years) whose proximal humeral fractures were managed with this technique. The 2-part titanium implant consists of a circular staple impacted into the humeral head cancellous bone and a spigoted diaphyseal stem that inserts into the staple "cup." Of the 26 cases reviewed, 16 had 3-part fractures and 10 had 4-part fractures. Mean follow-up was 25.9 months. In the 16 3-part fractures, the mean active forward elevation was 114 degrees and the results were as follows: excellent, 7; good, 5; fair, 3; poor, 1. In the 10 4-part fracture patients, the mean active forward elevation was 101 degrees and the results were as follows: excellent, 2; good, 4; fair, 3; poor, 1. There were 5 cases of avascular necrosis and 1 case of tuberosity nonunion. Only 2 cases needed conversion to hemiarthroplasty. The new technique should simplify the surgery of these fractures and reduce the need for arthroplasty.

Record-Breaking Pain: The Largest Number and Variety of Forelimb Bone Maladies in a Theropod Dinosaur.

PubMed

Senter, Phil; Juengst, Sara L

2016-01-01

Bone abnormalities are common in theropod dinosaur skeletons, but before now no specimen was known with more than four afflicted bones of the pectoral girdle and/or forelimb. Here we describe the pathology of a specimen of the theropod dinosaur Dilophosaurus wetherilli with eight afflicted bones of the pectoral girdle and forelimb. On its left side the animal has a fractured scapula and radius and large fibriscesses in the ulna and the proximal thumb phalanx. On its right side the animal has abnormal torsion of the humeral shaft, bony tumors on the radius, a truncated distal articular surface of metacarpal III, and angular deformities of the first phalanx of the third finger. Healing and remodeling indicates that the animal survived for months and possibly years after its ailments began, but its right third finger was permanently deformed and lacked the capability of flexion. The deformities of the humerus and the right third finger may be due to developmental osteodysplasia, a condition known in extant birds but unreported in non-avian dinosaurs before now.

Histomorphometric, fractal and lacunarity comparative analysis of sheep (Ovis aries), goat (Capra hircus) and roe deer (Capreolus capreolus) compact bone samples.

PubMed

Gudea, A I; Stefan, A C

2013-08-01

Quantitative and qualitative studies dealing with histomorphometry of the bone tissue play a new role in modern legal medicine/forensic medicine and archaeozoology nowadays. This study deals with the differences found in case of humerus and metapodial bones of recent sheep (Ovis aries), goat (Capra hircus) and roedeer (Capreolus capreolus) specimens, both from a qualitative point of view, but mainly from a quantitative perspective. A novel perspective given by the fractal analysis performed on the digital histological images is approached. This study shows that the qualitative assessment may not be a reliable one due to the close resemblance of the structures. From the quantitative perspective (several measurements performed on osteonal units and statistical processing of data),some of the elements measured show significant differences among 3 species(the primary osteonal diameter, etc.). The fractal analysis and the lacunarity of the images show a great deal of potential, proving that this type of analysis can be of great help in the separation of the material from this perspective.

Study on clinical application of nano-hydroxyapatite bone in bone defect repair.

PubMed

Zhu, Weimin; Wang, Daping; Xiong, Jianyi; Liu, Jianquan; You, Wei; Huang, Jianghong; Duan, Li; Chen, Jielin; Zeng, Yanjun

2015-01-01

To study the clinical effect of bone defect treated with nano-hydroxyapatite(Nano-HA) artificial bone. From September 2009 to June 2012, 27 cases of bone defect were analyzed retrospectively. The position of bone defect included humerus, radius, ulna, femur, tibia and calcaneus. The range of bone defect was from 0.3 × 1.0 cm to 3 × 6.5 cm. Among them, there were 22 cases with fractures and 5 cases with tumors. All patients were treated with Nano-HA artificial bone. The ability of bone defect repair was evaluated by X-ray exams performed preoperatively and postoperatively. HSS scores were adopted for final evaluation at the latest follow-up. The patients were followed up from 11 to 26 months (average of 18.5 months). No general side effects occurred. X-ray photo showed an integrity interface between Nano-HA and bone. Primary healing was obtained in all cases without any complication. The Nano-HA artificial bone had a good biocompatibility and could be an ideal artificial bone in the reconstruction of bone defect.

First evidence of “ancient deer” (cervid) in the late Miocene Bira Formation, Northern Israel

PubMed Central

Shaked Gelband, Dotan; Stein, Mordechai; Mienis, Henk K.; Rabinovich, Rivka

2017-01-01

Despite the extensive geological and paleontological searches in the south Levant, no terrestrial fauna of late Neogene age was yet reported. Here, we report the first evidence of “ancient deer”–cervid in the late Miocene (Tortonian) lacustrine section of the Bira Formation at Hagal Stream, Jordan Valley, northern Israel. The section comprises rich assemblage of macrofauna fossils, mostly freshwater mollusks. The mammalian bone was discovered among the macrofauna fossils, and is described as an almost complete left humerus of an adult animal identified as an artiodactyls element probably of a cervid. This terrestrial mammal shares similar paleoenvironmental conditions with other contemporaneous localities, where cervids prevailed with bovids and other taxa. It appears that the freshwater lakes provided favorite habitat for the development of the cervids and possibly other mammals. The specific conditions of preservation of the cervid illuminate the role of post depositional processes (taphonomic constrains) in masking terrestrial fauna remains in the region. Accordingly, further efforts will be devoted to unveil the mute part of the southern Levant–east Mediterranean terrestrial faunistic realm at the end of the Miocene. PMID:29091714

Surgical Interventions for the Treatment of Supracondylar Humerus Fractures in Children: Protocol of a Systematic Review.

PubMed

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 by a government-based noncommercial agency, Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP). This study may provide surgical treatment effects evidence for SHFC. The results will assist clinical practice by demonstrating the effectiveness and potential complications of these interventions and might serve as a reference for future clinical trials on the topic. PROSPERO CRD42014009304; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=9304 (Archived by WebCite at http://www.webcitation.org/6usiDHzD7). ©Oreste Lemos Carrazzone, João Carlos Belloti, Fabio Teruo Matsunaga, Nacime Salomão Barbachan Mansur, Marcelo Hide Matsumoto, Flavio Faloppa, Marcel Jun Sugawara Tamaoki. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 21.11.2017.

Skeletal Phenotype of Transgenic Mice Expressing the Beta1 Integrin Cytoplasmic Tail In Osteoblasts

NASA Technical Reports Server (NTRS)

Globus, R. K.; vanderMeulen, M. C. H.; Damsky, D.; Kim, J.-B.; Amblard, D.; Amblard, D.; Nishimura, Y.; Almeida, E.; Iwaniec, U. T.; Wronski, T. J.;

Three-dimensional skeletal kinematics of the shoulder girdle and forelimb in walking Alligator

PubMed Central

Baier, David B; Gatesy, Stephen M

2013-01-01

Crocodylians occupy a key phylogenetic position for investigations of archosaur locomotor evolution. Compared to the well-studied hindlimb, relatively little is known about the skeletal movements and mechanics of the forelimb. In this study, we employed manual markerless XROMM (X-ray Reconstruction Of Moving Morphology) to measure detailed 3-D kinematics of the shoulder girdle and forelimb bones of American alligators (Alligator mississippiensis) walking on a treadmill. Digital models of the interclavicle, scapulocoracoid, humerus, radius and ulna were created using a 3-D laser scanner. Models were articulated and aligned to simultaneously recorded frames of fluoroscopic and standard light video to reconstruct and measure joint motion. Joint coordinate systems were established for the coracosternal, glenohumeral and elbow joints. Our analysis revealed that the limb joints only account for about half of fore/aft limb excursion; the remaining excursion results from shoulder girdle movements and lateral bending of the vertebral column. Considerable motion of each scapulocoracoid relative to the vertebral column is consistent with coracosternal mobility. The hemisellar design of the glenohumeral joint permits some additional translation, or sliding in the fore-aft plane, but this movement does not have much of an effect on the distal excursion of the bone. PMID:24102540

The cheetah Acinonyx pardinensis (Croizet et Jobert, 1828) s.l. at the hominin site of Dmanisi (Georgia) - A potential prime meat supplier in Early Pleistocene ecosystems

NASA Astrophysics Data System (ADS)

Hemmer, Helmut; Kahlke, Ralf-Dietrich; Vekua, Abesalom K.

2011-09-01

The fossil site of Dmanisi (southern Georgia) has yielded a significant amount of hominin remains dated to around 1.8 Ma, in addition to a rich contemporaneous faunal record. Based on topographic information combined with an updated list of the vertebrate faunal assemblage, the corresponding palaeo-landscape has been reconstructed. Over a distance of some kilometres the landscape pattern changed from that of a forested valley floor, to tree savannah and open grasslands, thus providing typical habitats for carnivores hunting in open spaces. Morphological analysis of the elements from a nearly complete cat's foreleg reveals the existence of a large and stoutly built cheetah, Acinonyx pardinensis (Croizet et Jobert, 1828) s.l., in the Dmanisi faunal assemblage. Body mass estimations based on the humerus and metacarpals point to a cat of around 100 kg. The amount of pure meat and associated leftovers produced by the cheetah's hunting activity available for other consumers has been estimated. Within Early Pleistocene ecosystems, the cheetah must be considered as a potential fresh prime meat supplier, above that of any other felid.

Kinanthropometric comparison between young elite kayakers and canoeists.

PubMed

Alacid, Fernando; Marfell-Jones, Michael; Muyor, José Maria; López-Miñarro, Pedro Angel; Martínez, Ignacio

2015-03-01

The aims of this study were to describe and compare kinanthropometric characteristics of elite young kayakers and canoeists and to compare their proportionality with Olympic paddlers. One hundred and twenty young elite sprint paddlers (66 kayakers and 58 canoeists), aged 13- and 14-years-old, were assessed using a battery of 32 anthropometric dimensions. Somatotypes, Phantom Z-scores and corrected girths were calculated. Comparison between kayakers and canoeists showed that kayakers had greater height, body weight, sitting height, arm span and upper body lengths, breadths and girths than canoeists. Higher proportional humerus breadth and arm girths were also found in kayakers. However, canoeists had higher Z-scores in femur breadth. Olympic paddlers had higher proportional dimensions in upper body girths, and biacromial breadth in both disciplines. Mean somatotypes of kayakers were best described as balanced mesomorphs, while canoeists were ecto-mesomorphs. Differences between kayak and canoe paddlers may be explained by the continual need for physical development in kayakers, in order to remain competitive, compared to the young canoeists' need to place much greater emphasis on the development of their technical ability. The data provided in this study could be used as a guideline for talent identification in sprint canoeing and kayaking.

Middle Pleistocene Human Remains from Tourville-la-Rivière (Normandy, France) and Their Archaeological Context

PubMed Central

Faivre, Jean-Philippe; Maureille, Bruno; Bayle, Priscilla; Crevecoeur, Isabelle; Duval, Mathieu; Grün, Rainer; Bemilli, Céline; Bonilauri, Stéphanie; Coutard, Sylvie; Bessou, Maryelle; Limondin-Lozouet, Nicole; Cottard, Antoine; Deshayes, Thierry; Douillard, Aurélie; Henaff, Xavier; Pautret-Homerville, Caroline; Kinsley, Les; Trinkaus, Erik

2014-01-01

Despite numerous sites of great antiquity having been excavated since the end of the 19th century, Middle Pleistocene human fossils are still extremely rare in northwestern Europe. Apart from the two partial crania from Biache-Saint-Vaast in northern France, all known human fossils from this period have been found from ten sites in either Germany or England. Here we report the discovery of three long bones from the same left upper limb discovered at the open-air site of Tourville-la-Rivière in the Seine Valley of northern France. New U-series and combined US-ESR dating on animal teeth produced an age range for the site of 183 to 236 ka. In combination with paleoecological indicators, they indicate an age toward the end of MIS 7. The human remains from Tourville-la-Rivière are attributable to the Neandertal lineage based on morphological and metric analyses. An abnormal crest on the left humerus represents a deltoid muscle enthesis. Micro- and or macro-traumas connected to repetitive movements similar to those documented for professional throwing athletes could be origin of abnormality. PMID:25295956

Possible complication of bee stings and a review of the cardiac effects of bee stings.

PubMed

Gupta, Prabha Nini; Kumar, B Krishna; Velappan, Praveen; Sudheer, M D

2016-11-01

We report the case of a patient who, ∼3 weeks after multiple bee stings, developed a prolonged heart block, syncope and cardiac arrest. This required a temporary pacemaker to be implanted, which was later replaced with a permanent pacemaker. An ECG taken following surgery for a fractured humerus 6 years earlier was reportedly normal. The patient had been a rubber tapper who walked ∼1.5 km/day, but after the bee attack he was no longer able to walk or get up from the bed without experiencing syncope. We presume that the bee venom caused these signs, as well as the resulting heart block, which persisted long after the bee sting had subsided. Since his coronary angiogram was normal we believe he had a Kounis type involvement of the cardiovascular system, namely profound coronary spasm that caused complete heart block that did not recover. Another probable reason for the complete heart block could have been that the bees had consumed the pollen of a rhododendron flower, causing 'grayanotoxin' poisoning and severe heart block. The other effects of bee sting are discussed briefly. 2016 BMJ Publishing Group Ltd.

Testing multiple statistical hypotheses resulted in spurious associations: a study of astrological signs and health.

PubMed

Austin, Peter C; Mamdani, Muhammad M; Juurlink, David N; Hux, Janet E

2006-09-01

To illustrate how multiple hypotheses testing can produce associations with no clinical plausibility. We conducted a study of all 10,674,945 residents of Ontario aged between 18 and 100 years in 2000. Residents were randomly assigned to equally sized derivation and validation cohorts and classified according to their astrological sign. Using the derivation cohort, we searched through 223 of the most common diagnoses for hospitalization until we identified two for which subjects born under one astrological sign had a significantly higher probability of hospitalization compared to subjects born under the remaining signs combined (P<0.05). We tested these 24 associations in the independent validation cohort. Residents born under Leo had a higher probability of gastrointestinal hemorrhage (P=0.0447), while Sagittarians had a higher probability of humerus fracture (P=0.0123) compared to all other signs combined. After adjusting the significance level to account for multiple comparisons, none of the identified associations remained significant in either the derivation or validation cohort. Our analyses illustrate how the testing of multiple, non-prespecified hypotheses increases the likelihood of detecting implausible associations. Our findings have important implications for the analysis and interpretation of clinical studies.

Clinical factors affecting pathological fracture and healing of unicameral bone cysts

PubMed Central

2014-01-01

Background Unicameral bone cyst (UBC) is the most common benign lytic bone lesion seen in children. The aim of this study is to investigate clinical factors affecting pathological fracture and healing of UBC. Methods We retrospectively reviewed 155 UBC patients who consulted Nagoya musculoskeletal oncology group hospitals in Japan. Sixty of the 155 patients had pathological fracture at presentation. Of 141 patients with follow-up periods exceeding 6 months, 77 were followed conservatively and 64 treated by surgery. Results The fracture risk was significantly higher in the humerus than other bones. In multivariate analysis, ballooning of bone, cyst in long bone, male sex, thin cortical thickness and multilocular cyst were significant adverse prognostic factors for pathological fractures at presentation. The healing rates were 30% and 83% with observation and surgery, respectively. Multivariate analysis revealed that fracture at presentation and history of biopsy were good prognostic factors for healing of UBC in patients under observation. Conclusion The present results suggest that mechanical disruption of UBC such as fracture and biopsy promotes healing, and thus watchful waiting is indicated in these patients, whereas patients with poor prognostic factors for fractures should be considered for surgery. PMID:24884661

Clinical factors affecting pathological fracture and healing of unicameral bone cysts.

PubMed

Urakawa, Hiroshi; Tsukushi, Satoshi; Hosono, Kozo; Sugiura, Hideshi; Yamada, Kenji; Yamada, Yoshihisa; Kozawa, Eiji; Arai, Eisuke; Futamura, Naohisa; Ishiguro, Naoki; Nishida, Yoshihiro

2014-05-17

Unicameral bone cyst (UBC) is the most common benign lytic bone lesion seen in children. The aim of this study is to investigate clinical factors affecting pathological fracture and healing of UBC. We retrospectively reviewed 155 UBC patients who consulted Nagoya musculoskeletal oncology group hospitals in Japan. Sixty of the 155 patients had pathological fracture at presentation. Of 141 patients with follow-up periods exceeding 6 months, 77 were followed conservatively and 64 treated by surgery. The fracture risk was significantly higher in the humerus than other bones. In multivariate analysis, ballooning of bone, cyst in long bone, male sex, thin cortical thickness and multilocular cyst were significant adverse prognostic factors for pathological fractures at presentation. The healing rates were 30% and 83% with observation and surgery, respectively. Multivariate analysis revealed that fracture at presentation and history of biopsy were good prognostic factors for healing of UBC in patients under observation. The present results suggest that mechanical disruption of UBC such as fracture and biopsy promotes healing, and thus watchful waiting is indicated in these patients, whereas patients with poor prognostic factors for fractures should be considered for surgery.

[Adjuvant cryosurgery in the treatment of unicameral bone cysts].

PubMed

Tena-Sanabria, Mario Edgar; Hernández-Hernández, Melissa Jesús; Tena-González, Mario Edgar; Mejía-Aranguré, Juan Manuel

2014-01-01

Multiple treatments have been used for the unicameral bone cyst lesion, such as steroid application, multiple perforations, bone curettages, partial resection and bone grafting. The purpose of this study was to describe the evolution of children with unicameral bone cyst who were treated with cryosurgery as coadjuvant therapy. Cross-sectional descriptive study over the period between January 2001 and December 2006. Twelve patients were studied and treated at the Pediatric Orthopedics Department of the Pediatrics Hospital at the Centro Médico Nacional Siglo XXI. Twelve patients were analyzed; all of them were treated with curettage, cryotherapy and bone grafting. In 7 patients, the lesions were located in the humerus (58.3 %), in 3 in the tibia (25 %), in 1 in the ilio-ischiopubic branch (8.3 %), and in 1 in the clavicle (8.3 %). Follow-up ranged from 12 to 36 months. Bone healing required 2 to 3 months after the surgery; the response was complete in 9 (75 %) patients and partial in 3 (25 %). Function was restored in all cases, without recurrences. Cryosurgery as an adjuvant treatment and autologous or homologous bone grafting prevented local recurrence of unicameral bone cyst lesions, favored bone healing and allowed for a full range of motion functionality without complications.

Axillary lymph node uptake of technetium-99m-MDP

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ongseng, F.; Goldfarb, C.R.; Finestone, H.

We sought to determine the frequency and significance of axillary lymph node visualization on bone scans performed with diphosphonates. Consecutive {sup 99m}Tc-methylene diphosphonate ({sup 99m}Tc-MDP) bone scans (2435) were inspected for axillary soft-tissue uptake. In positive cases, the results of physical examination, correlative imaging studies and serial bone scans were recorded, as was the site of venipuncture. Forty-eight studies (2%) showed axillary uptake ipsilateral to the injection site. Extravasation of tracer, documented by focal activity near the injection site, was present in every case. There was no association with axillary adenopathy, mass, induration of radiographically visible calcification. On some images,more » foci adjacent to the axilla were superimposed on the rib, scapula, or humerus. The bone-to-background ratio was frequently reduced; repeat imaging after 1-2 hr usually improved osseous detail. Ipsilateral axillary lymph node visualization due to extravasation of {sup 99m}Tc-MDP is frequently associated with additional foci superimposed on osseous structures simulating pathology. Delayed skeletal uptake is common in such cases and necessitates a greater time interval between injection and imaging. 7 refs., 3 figs.« less

Assessing age in the desert tortoise Gopherus agassizii: Testing skeletochronology with individuals of known age

USGS Publications Warehouse

Curtin, A.J.; Zug, G.R.; Medica, P.A.; Spotila, J.R.

2008-01-01

Eight desert tortoises Gopherus agassizii from a long-term mark-recapture study in the Mojave Desert, Nevada, USA, afforded an opportunity to examine the accuracy of skeletochronological age estimation on tortoises from a seasonal, yet environmentally erratic environment. These 8 tortoises were marked as hatchlings or within the first 2 yr of life, and their carcasses were salvaged from predator kills. Using d blind protocol, 2 skeletochronological protocols (correction-factor and ranking) provided age estimates for a set of 4 bony elements (humerus, scapula, femur, ilium) from these tortoises of known age. The age at death of the tortoises ranged from 15 to 50 yr. The most accurate protocol - ranking using the growth layers within each of the 4 elements - provided estimates from 21 to 47 yr, with the highest accuracy from the ilia. The results indicate that skeletochronological age estimation provides a reasonably accurate method for assessing the age at death of desert tortoises and, if used with a large sample of individuals, will provide a valuable tool for examining age-related mortality parameters in desert tortoise and likely in other gopher tortoises (Gopherus). ?? Inter-Research 2008.

Effect of reverse shoulder design philosophy on muscle moment arms.

PubMed

Hamilton, Matthew A; Diep, Phong; Roche, Chris; Flurin, Pierre Henri; Wright, Thomas W; Zuckerman, Joseph D; Routman, Howard

2015-04-01

This study analyzes the muscle moment arms of three different reverse shoulder design philosophies using a previously published method. Digital bone models of the shoulder were imported into a 3D modeling software and markers placed for the origin and insertion of relevant muscles. The anatomic model was used as a baseline for moment arm calculations. Subsequently, three different reverse shoulder designs were virtually implanted and moment arms were analyzed in abduction and external rotation. The results indicate that the lateral offset between the joint center and the axis of the humerus specific to one reverse shoulder design increased the external rotation moment arms of the posterior deltoid relative to the other reverse shoulder designs. The other muscles analyzed demonstrated differences in the moment arms, but none of the differences reached statistical significance. This study demonstrated how the combination of variables making up different reverse shoulder designs can affect the moment arms of the muscles in different and statistically significant ways. The role of humeral offset in reverse shoulder design has not been previously reported and could have an impact on external rotation and stability achieved post-operatively. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Histological Evaluation of Nano-Micro Titanium Implant Surface Treatment in Beagle Humerus.

PubMed

Yun, Kwidug; Kang, Seongsoo; Oh, Gyejeong; Lim, Hyunpil; Lee, Kwangmin; Yang, Hongso; Vang, Mongsook; Park, Sangwon

2016-02-01

The objective of this study was to investigate the effects of nano-micro titanium implant surface using histology in beagle dogs. A total of 48 screw-shaped implants (Megagen, Daegu, Korea) which dimensions were 4 mm in diameter and 8.5 mm in length, were used. The implants were classified into 4 groups (n = 12): machined surface (M group), RBM (Resorbable Blasting Media) surface (R group), nano surface which is nanotube formation on the machined surface (MA group) and nano-micro surface which is nanotube formation on the RBM surface (RA group). Anodic oxidation was performed at a constant voltage of 20 V for 10 min using a DC power supply (Fine Power F-3005; SG EMD, Anyang, Korea). The bone blocks were investigated using histology. There was no inflammation around implants, and new bone formation was shown along with the nano-micro titanium implant surfaces. The amount of bone formation was increased depending on time comparing 4 weeks and 12 weeks. At 12 weeks, lamellar bone was more formed along with the nano-micro titanium implant surfaces than 4 weeks. It indicated that nano-micro surface showed good result in terms of osseointegration.

Lateral Condyle Fracture of the Humerus in Children Treated with Bioabsorbable Materials

PubMed Central

Tercier, Stéphane; Bregou-Bourgeois, Aline; Zambelli, Pierre-Yves

2013-01-01

The aim of this study was to compare clinical and radiological outcome of lateral condyle fracture of the elbow in children treated with bioabsorbable or metallic material. From January 2008 to December 2009, 16 children with similar fractures and ages were grouped according to the fixation material used. Children were seen at 3, 6, and 12 months and more than 4 years (mean 51.8 months) postoperatively. The clinical results were compared using the Mayo Elbow Performance Score (MEPS). Radiographic studies of the fractured and opposite elbow were assessed at last follow-up control. Twelve children had a sufficient followup and could be included in the study. Seven could be included in the traditional group and 5 in the bioabsorbable group. At 12 months, the MEPS was 100 for every child in both groups. Asymptomatic bony radiolucent visible tracks and heterotopic ossifications were noted in both groups. There were no significant differences in terms of clinical and radiological outcome between the two groups. The use of bioabsorbable pins or screws is a reasonable alternative to the traditional use of metallic materials for the treatment of lateral condyle fracture of the elbow in children. PMID:24228016

Analysis and Fem Simulation Methodology of Dynamic Behavior of Human Rotator Cuff in Repetitive Routines: Musician Case Study.

PubMed

Islan, Manuel; Blaya, Fernando; Pedro, Pilar San; D'Amato, Roberto; Urquijo, Emilio Lechosa; Juanes, Juan Antonio

2018-02-05

The majority of musculoskeletal injuries located in the shoulder are often due to repetitive or sustained movements that occur in work routines in different areas. In the case of musicians, such as violinists, who have long and daily training routines, the repetitive movements they perform are forced and sometimes the postures are not natural. Therefore, this article aims to study and simulate the dynamic behavior of the glenohumeral joint under repetitive conditions that represent the different postures assumed by a violinist during his daily training. For this purpose, the criteria provided by the RULA (rapid upper limb assessment) method have been used. Subsequently, by using as a reference geometry that of the articulation under study generated and modeled in CATIA®[VERSIÓN 5R21], a FEM analysis has been proposed with the software ANSYS®[VERSIÓN 17.1] simulating the short and cyclic movements of the Humerus of the violinists. With the analysis carried out, thanks to linear and isotropic approximations of the joint, it has been possible to know the approximate dynamic behavior of tissues, muscles and tendons, and the response of the joint in terms of fatigue.

Intra-articular injuries of the elbow: pitfalls of diagnosis and treatment.

PubMed Central

Fowles, J. V.; Rizkallah, R.

1976-01-01

Poor results in treating fractures and dislocations about the elbow may be avoided if the surgeon is aware of the possible injuries, examines good radiographs of both elbows, and treats the injury promptly and appropriately. A displaced fracture of the lateral or medial condyle of the humerus should be suspected if there is a flake fracture of the adjoining metaphysis; open reduction and internal fixation give better results than closed reduction. A shear fracture of the capitulum humeri can only be seen on a lateral radiograph; excision of the fragment, followed by mobilization, is sufficient for a good functional result. Dislocation of the elbow in a child may avulse the medial epicondyle, which sometimes lodges in the joint; it is essential to recognize this and remove the fragment without delay to avoid early degenerative arthritis. An apparently isolated fracture of the ulna should alert the surgeon to the possibility of a dislocation of the radial head; the dislocation and the fracture must be reduced and stabilized to conserve elbow function. Images FIG. 1 FIG. 2 FIG. 3 FIG. 4 FIG. 5 FIG. 6 FIG. 7 FIG. 8 PMID:943224

Birth-associated long-bone fractures.

PubMed

Basha, Asma; Amarin, Zouhair; Abu-Hassan, Freih

2013-11-01

To assess the incidence and outcome of neonatal long-bone fractures at a tertiary teaching hospital. A retrospective study of all neonates with long-bone fractures delivered at Jordan University Hospital between January 1, 2000, and December 31, 2010. Among a total of 34 519 live births, 8 neonates had a long-bone fracture (incidence 0.23/1000 live births); of these, 6 had a femur fracture (0.17/1000 live births) and 2 had a humerus fracture (0.05/1000 live births). The route of delivery was emergency cesarean delivery for 6 infants, elective cesarean delivery for 1 infant, and the vaginal route for 1 infant. The mean birth weight was 2723g. All neonates weighed more than 2200g and their gestational age was more than 35weeks, with the exception of 1 neonate born at 31weeks weighing 1500g. The mean time interval from birth to fracture diagnosis was 1.5days. All fractures healed with no residual deformity. Emergency cesarean delivery carries a higher risk of long-bone fracture than vaginal delivery. Prematurity, malpresentation, abnormal lie, and multiple pregnancies may predispose to long-bone fractures. The prognosis of birth-associated long-bone fractures is good. © 2013.

Three-dimensional scapular kinematics during the throwing motion.

PubMed

Meyer, Kristin E; Saether, Erin E; Soiney, Emily K; Shebeck, Meegan S; Paddock, Keith L; Ludewig, Paula M

2008-02-01

Proper scapular motion is crucial for normal shoulder mechanics. Scapular motion affects glenohumeral joint function during throwing, yet little is known about this dynamic activity. Asymptomatic subjects (10 male and 10 female), ages 21 to 45, were analyzed. Electromagnetic surface sensors on the sternum, acromion, and humerus were used to collect 3-D motion data during three trials of low-velocity throwing. Scapular angular position data were described or five predetermined events throughout the throw corresponding with classic descriptions of throwing phases, and trial-to-trial reliability was determined. ANOVA compared scapular angles across events. Subjects demonstrated good to excellent reliability between trials of the throw (ICC 0.74-0.98). The scapula demonstrated a pattern of external rotation, upward rotation (peak of approx. 40 degrees), and poster humeral horizontal abduction. During the arm acceleration phase, the scapula moved toward greater internal rotation and began anteriorly tilting. At maximum humeral internal rotation, the scapula ended in internal rotation (55 degrees), upward rotation (20 degrees), and anterior tilting (3 degrees). Significant differences in scapular position (p<0.05) were identified across the throwing motion. Scapular data identify events in the throwing motion in which throwers may be more susceptible to shoulder pathologies related to abnormal scapular kinematics.

Developmental ossification sequences of the appendicular and axial skeleton in Kuttanad duck embryos (Anas platyrhynchos domesticus)

PubMed Central

Firdous, A.D.; Maya, S.; Massarat, K.; Baba, M.A.

2016-01-01

The processes of ossification sequences are poorly investigated for birds in general, even for domestic and experimental species and when it comes to the waterfowl it is almost negligible. Such sequences constitute a rich source of data on character evolution, and may even provide phylogenetic information. A pre-hatch developmental study on ossification sequences of axial and appendicular skeletal system in Kuttanad duck embryos was undertaken using 78 viable embryos. From day 3 to day 7 of incubation no ossification densities were seen both by alizarin red staining and computerized radiography. The first indication of ossification as small ossification centers in skull bones, clavicle, scapula, humerus, radius and ulna in forelimb and ilium, pubis femur and fibula in hind limb were observed on the 9th day of incubation. The ossification of the body of the ribs started at the 11th day of incubation towards the proximal extremity. On day 13th the ossification process of vertebrae was started from cervical end. The variation in appearance of the ossification centers in different bones at different stages of incubation period suggests relative importance of phylogeny to the sequences. PMID:26862514

A coincidental variation of the axillary artery: the brachioradial artery and the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle

PubMed Central

Konarik, Marek; Kachlik, David; Baca, Vaclav

2014-01-01

A case of anomalous terminal branching of the axillary artery was encountered and described in a left upper limb of a male cadaver. A series of 214 upper limbs of Caucasian race was dissected. A variant artery, stemming from the very end of the axillary artery followed a superficial course distally. It passed the cubital fossa, ran on the lateral side of the forearm as usual radial artery, crossed ventrally to the palm and terminated in the deep palmar arch. This vessel is a case of the brachioradial artery (incorrectly termed as the “radial artery with high origin”). Moreover, it was associated with another variation, concerning the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle. The anatomical knowledge of the axillary region is essential for radiodiagnostic, surgical and traumatologic procedures. The superficially located artery brings an elevated danger of heavy bleeding in all unexpected situations, its variant branching can cause problems in radial catheterization procedures and the anomalously coursing other arterial variant poses an elevated danger in surgical procedures concerning the surgical neck of humerus. PMID:25428677

Design and evaluation of prosthetic shoulder controller

PubMed Central

Barton, Joseph E.; Sorkin, John D.

2015-01-01

We developed a 2-degree-of-freedom (DOF) shoulder position transducer (sensing shoulder protraction-retraction and elevation-depression) that can be used to control two of a powered prosthetic humerus' DOFs. We also developed an evaluation protocol based on Fitts' law to assess the performance of our device. The primary motivation for this work was to support development of powered prosthetic shoulder joints of a new generation of prosthetic arms for people with shoulder disarticulation and very high-level transhumeral amputation. We found that transducers that provided resistance to shoulder movement performed better than those providing no resistance. We also found that a position control scheme, where effector position is proportional to shoulder position, performed better than a velocity control scheme, where effector velocity is proportional to shoulder position. More generally, our transducer can be used to control motion along any two DOFs. It can also be used in a more general 4-DOF control scheme by sequentially controlling two DOFs at a time. The evaluation protocol has general applicability for researchers and practitioners. Researchers can employ it to compare different prosthesis designs and control schemes, while practitioners may find the evaluation protocol useful in evaluating and training people with amputation in the use of prostheses. PMID:25357185

The Iceman's last weeks

NASA Astrophysics Data System (ADS)

Spindler, Konrad

1994-06-01

The author presents the archaeological, botanical and anatomical of medical evidence relating to the events of the last few days of the Iceman's life. The unfinished arrows and the half-completed bow indicate that he had lost his weapons and was in the process of re-arming himself. The quiver and the two primed arrows show clear signs of damage that has been proved to originate from before entombment in the ice of Hauslabjoch. An intravital series of fractured ribs and atrophic changes to the humerus on the same side of the body are also indicative of a violent conflict. The presence of threshing and winnowing fragments proves that, shortly before his death, the Iceman spent some time in a human settlement in which the grain crop was threshed. The theory is therefore proposed that shortly before his death the Iceman suffered some personal catastrophe involving damage to his possessions and physical injury. He fled in the direction of the inner Ötz Valley, a region of high alpine pastures he may have been familiar with from summer transhumance. Just beyond the ridge of the main Alpine chain he was caught by a sudden fall in temperature and snowfall, which he did not survive.

A new species of extinct scops owl (Aves: Strigiformes: Strigidae: Otus) from São Miguel Island (Azores Archipelago, North Atlantic Ocean).

PubMed

Rando, Juan Carlos; Alcover, Josep Antoni; Olson, Storrs L; Pieper, Harald

2013-01-01

The extinct São Miguel Scops Owl Otusfrutuosoi n. sp. is described from fossil bones found in Gruta de Água de Pau, a volcanic tube in São Miguel Island (Azores Archipelago, North Atlantic Ocean). It is the first extinct bird described from the Azores and, after the Madeiran Scops Owl (O. mauli Rando, Pieper, Alcover & Olson 2012a), the second extinct species of Strigiformes known in Macaronesia. The forelimb elements of the new taxon are shorter, the hindlimb elements are longer, and the pelvis is shorter and broader than in the Eurasian Scops Owl (O. scops Linnaeus). The new species differs from O. mauli in the smaller size of many of its bones, especially the ulna and tibiotarsus. Its measurements (estimated weight, wing area, and wing loading, and the ratio of humerus + ulna + carpometacarpus length/femur length) indicate weak powers of flight and ground-dwelling habits. The latest occurrence of the new species, as evidenced by a radiocarbon date of 1970 ± 40 BP from bone collagen, indicates a Late Holocene extinction event subsequent to 49 cal BC, and was probably linked to human arrival and subsequent habitat alterations.

Nerve ultrasound reliability of upper limbs: Effects of examiner training.

PubMed

Garcia-Santibanez, Rocio; Dietz, Alexander R; Bucelli, Robert C; Zaidman, Craig M

2018-02-01

Duration of training to reliably measure nerve cross-sectional area with ultrasound is unknown. A retrospective review was performed of ultrasound data, acquired and recorded by 2 examiners-an expert and either a trainee with 2 months (novice) or a trainee with 12 months (experienced) of experience. Data on median, ulnar, and radial nerves were reviewed for 42 patients. Interrater reliability was good and varied most with nerve site but little with experience. Coefficient of variation (CoV) range was 9.33%-22.5%. Intraclass correlation coefficient (ICC) was good to excellent (0.65-95) except ulnar nerve-wrist/forearm and radial nerve-humerus (ICC = 0.39-0.59). Interrater differences did not vary with nerve size or body mass index. Expert-novice and expert-experienced interrater differences and CoV were similar. The ulnar nerve-wrist expert-novice interrater difference decreased with time (r s  = -0.68, P = 0.001). A trainee with at least 2 months of experience can reliably measure upper limb nerves. Reliability varies by nerve and location and slightly improves with time. Muscle Nerve 57: 189-192, 2018. © 2017 Wiley Periodicals, Inc.

Tumor-associated FGF-23-induced hypophosphatemic rickets in children: a case report and review of the literature.

PubMed

Burckhardt, Marie-Anne; Schifferli, Alexandra; Krieg, Andreas H; Baumhoer, Daniel; Szinnai, Gabor; Rudin, Christoph

2015-01-01

Tumor-associated fibroblast growth factor 23 (FGF-23)-induced hypophosphatemic rickets is a rare but known pediatric entity first described in 1959. It results from local production of phosphatonins by benign and malignant mesenchymal tumors. We report an 8-year-old boy with tumor-associated hypophosphatemic rickets due to paraneoplastic FGF-23 secretion from a benign mesenchymal pelvic-bone tumor. Excessive FGF-23 production was visualized by immunohistochemistry in the resected tumor. Phosphate wasting stopped immediately after tumor resection. We reviewed 26 reports of pediatric patients with tumor-induced hypophosphatemic rickets; paraneoplastic FGF-23 secretion was documented in only three of them. All tumors developed inside bone, were benign in 21/26 cases, and were localized in femur/tibia (13/26), radius/ulna/humerus (7/26), pelvis (4/26), rib (1/26), and craniofacial (1/26) bones. Mean interval between onset of signs and/or symptoms and diagnosis was 34 months. In patients with hypophosphatemic rickets acquired beyond infancy, radiologic investigations for bone tumors need to be performed rapidly. In contrast to biochemical screening for increased circulating FGF-23 levels, immunohistochemical confirmation of FGF-23 production in resected tumor tissue can be regarded as being well established.

A Six-Week Resistance Training Program Does Not Change Shear Modulus of the Triceps Brachii.

PubMed

Akagi, Ryota; Shikiba, Tomofumi; Tanaka, Jun; Takahashi, Hideyuki

2016-08-01

We investigated the effect of a 6-week resistance training program on the shear modulus of the triceps brachii (TB). Twenty-three young men were randomly assigned to either the training (n = 13) or control group (n = 10). Before and after conducting the resistance training program, the shear modulus of the long head of the TB was measured at the point 70% along the length of the upper arm from the acromial process of the scapula to the lateral epicondyle of the humerus using shear wave ultrasound elastography. Muscle thickness of the long head of the TB was also determined at the same site by ultrasonography used during both tests. A resistance exercise was performed 3 days a week for 6 weeks using a dumbbell mass-adjusted to 80% of the 1-repetition maximum (1RM). The training effect on the muscle thickness and 1RM was significant. Nevertheless, the muscle shear modulus was not significantly changed after the training program. From the perspective of muscle mechanical properties, the present results indicate that significant adaptation must occur to make the TB more resistant to subsequent damaging bouts during the 6-week training program to target the TB.

Developmental toxicity of diphenyl ether herbicides in birds

USGS Publications Warehouse

Hoffman, D.J.; Rattner, B.A.; Bunck, C.M.

1991-01-01

Diphenyl ether herblcldes, includlng nitrofen, have been identified as mammalian teratogens and cause perinatal mortality. American kestrel (Falco sparverius) nestlings were orally dosed for 10 days w1th 5 ul/g of corn oil (controls) or one of the diphenyl ether herbicides (nitrofen, bifenox, or oxyfluorofen). At 500 mg/kg, nitrofen resulted in complete mortality, bifenox in high (66%) mortality, and oxyfluorofen in no mortality. Nitrofen, at 250 mg/kg, reduced nestling growth, as reflected by decreased body weight and bone length. Bifenox at 250 mg/kg had less effect on growth than nitrofen but crown rump, humerus, radiusulna and femur lengths were significantly less than controls. Liver welght (percent of body welght) increased with 50 mg/kg nitrofen. Other manifestations of hepatotoxicity following nitrofen ingestion included increased hepatic GSH peroxidase activity with 0 mg/kg nitrofen, and increased plasma enzyme activities for ALT, AST. and LDHL with 250 mg/kg. Blfenox lngestion (50 mg/kg) resulted in increased hepatlc GSH peroxidase activity. Nitrofen exposure increased total plasma thyroxlne (T4) concentratlon. These findings suggest that altricial nestllng kestrels are more sensitive to diphenyl ether herbicides than precocial young or adult birds.

Florid reactive periostitis ossificans of the humerus: Case report and differential diagnosis of periosteal lesions of long bones

PubMed Central

Soni, Abha; Weil, Alec; Wei, Shi; Jaffe, Kenneth A; Siegal, Gene P

2015-01-01

A case of florid reactive periostitis ossificans (RPO) arising in a long bone is presented. This is a rare bone proliferation with a pronounced periosteal reaction. Less than 100 cases have been described in the literature with far fewer outside the bones of the hand, feet, fingers, and toes. Although the etiology is unknown, a relationship to preceding trauma is suggested. The imaging and histologic features show an overlap with other bone lesions including bizarre parosteal osteochondromatous proliferation, subungual exostosis, and malignant surface tumors of bone and cartilage which include, periosteal and parosteal osteosarcoma. It is important to recognize the clinical presentation and diagnostic features of RPO as a benign entity so that it is not mistaken for a more aggressive neoplasm. We present a case of a right distal humeral lesion that on histopathological review revealed florid RPO. This diagnosis was not suspected on imaging studies, but was made on open biopsy of the mass. The patient remains disease free, years postoperatively. In addition to presenting this unique case report, we review the pertinent literature, and offer a differential diagnosis and treatment strategy for its management. PMID:26301184

A new basal bird from China with implications for morphological diversity in early birds

PubMed Central

Wang, Min; Wang, Xiaoli; Wang, Yan; Zhou, Zhonghe

2016-01-01

The Chinese Lower Cretaceous Jehol Group is the second oldest fossil bird-bearing deposit, only surpassed by Archaeopteryx from the German Upper Jurassic Solnhofen Limestones. Here we report a new bird, Chongmingia zhengi gen. et sp. nov., from the Jehol Biota. Phylogenetic analyses indicate that Chongmingia zhengi is basal to the dominant Mesozoic avian clades Enantiornithes and Ornithuromorpha, and represents a new basal avialan lineage. This new discovery adds to our knowledge regarding the phylogenetic differentiation and morphological diversity in early avian evolution. The furcula of Chongmingia is rigid (reducing its efficiency), consequently requiring more power for flight. However, the elongated forelimb and the large deltopectoral crest on the humerus might indicate that the power was available. The unique combination of features present in this species demonstrates that numerous evolutionary experimentations took place in the early evolution of powered flight. The occurrence of gastroliths further confirms that herbivory was common among basal birds. The Jehol birds faced competition with pterosaurs, and occupied sympatric habitats with non-avian theropods, some of which consumed birds. Thus, avialan herbivory may have reduced ecological competition from carnivorous close relatives and other volant vertebrates early in their evolutionary history. PMID:26806355

Pediatric and adolescent anterior shoulder instability: clinical management of first-time dislocators.

PubMed

Lin, Kenneth M; James, Evan W; Spitzer, Elad; Fabricant, Peter D

2018-02-01

The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and clinical management of pediatric and adolescent patients following a first-time shoulder dislocation. Shoulder instability is becoming increasingly common as pediatric and adolescent patients engage in earlier organized sports competition. Recommended treatment following a first-time glenohumeral dislocation event in adolescents depends on several factors, but surgical stabilization is becoming more frequently performed. Surgical indications include bony Bankart lesion, ALPSA lesion, bipolar injury (e.g. Hill-Sachs humeral head depression fracture) or off-season injury in an overhead or throwing athlete. Complications following surgical treatment are rare but most commonly are associated with recurrent instability. Young children (eg. open proximal humerus growth plate), individuals averse to surgery, or in-season athletes who accept the risk of redislocation may complete an accelerated rehabilitation program for expedited return to play in the absence of the structural abnormalities listed above. Following a first-time dislocation event in pediatric and adolescent patients, a detailed discussion of the risks and benefits of nonoperative versus operative management is critical to match the recommended treatment with the patient's injury pattern, risk factors, and activity goals.

Short stature and growth hormone deficiency in a girl with encephalocraniocutaneous lipomatosis and Jaffe-Campanacci syndrome: a case report.

PubMed

Choi, Eun Mi; Jung, Nani; Shim, Ye Jee; Choi, Hee Joung; Kim, Joon Sik; Kim, Heung Sik; Song, Kwang Soon; Lee, Hee Jung; Kim, Sang Pyo

2016-12-01

A 9-year-old Tajikistani girl presented to Keimyung University Dongsan Medical Center for evaluation of a skin lesion on her left eyelid, focal alopecia, unilateral ventricular dilatation, and aortic coarctation. She was diagnosed with encephalocraniocutaneous lipomatosis (ECCL) according to Moog's diagnostic criteria. Café-au-lait spots were found on the left side of her trunk. Multiple nonossifying fibromas were found on her left proximal humerus, left distal femur, both proximal tibias, and left proximal fibula, suggesting Jaffe-Campanacci syndrome (JCS), following imaging of the extremities. Many JCS cases with multiple Café-au-lait macules, multiple nonossifying fibromas may actually have Neurofibromatosis type-1 (NF1). Thus, comprehensive molecular analysis to exclude NF1 mutation was performed using her blood sample. The NF1 mutation was not found. Her height was under the 3rd percentile and her bone age was delayed as compared with her chronological age. Baseline growth hormone (GH) level was below the normal range. Using the insulin stimulation and levo-dihydroxyphenylalanine tests, GH deficiency was confirmed. We present a case of GH deficiency with typical features of ECCL and JCS.

Duocentric® reversed shoulder prosthesis and Personal Fit® templates: innovative strategies to optimize prosthesis positioning and prevent scapular notching.

PubMed

Trouilloud, P; Gonzalvez, M; Martz, P; Charles, H; Handelberg, F; Nyffeler, R W; Baulot, E

2014-05-01

We describe our experience with a new system of patient-specific template called Personal Fit(®), which is unique in shoulder surgery and used in combination with Duocentric(®) prosthesis. The reverse prosthesis's concept is the invention of Paul Grammont, developed with Grammont's team of Dijon University as from 1981, which led to the first reversed total shoulder prosthesis called Trumpet in 1985. The Duocentric(®) prosthesis developed in 2001 is the third-generation prosthesis, coming from the Trumpet and the second-generation prosthesis Delta(®) (DePuy). This prosthesis provides a novel solution to the notching problem with an inferior overhang integrated onto the glenoid baseplate. Personal Fit(®) system is based on reconstructing the shoulder joint bones in three dimensions using CT scan data, placing a landmark on the scapula and locating points on the glenoid and humerus. That will be used as a reference for the patient-specific templates. We study the glenoid position planned with Personal Fit(®) software relative to native glenoid position in 30 cases. On average, the difference between the planned retroversion (or anteversion in one case) and native retroversion was 8.6°.

Survival, growth, and histopathological effects of paraquat ingestion in nestling American kestrels (Falco sparverius)

USGS Publications Warehouse

Hoffman, D.J.; Franson, J.C.; Pattee, O.H.; Bunck, C.M.

1985-01-01

The use of paraquat as a herbicide is becoming more extensive with the increasing popularity of no tillage agriculture, increasing the possibility of exposure for wildlife species. American kestrel (Falco sparverius) nestlings were orally dosed daily with 5 ?l/g of distilled water (controls), 10 mg/kg, 25 mg/kg, or 60 mg/kg of paraquat dichloride (1, 1'-dimethyl-4,4'-bipyridinium) in distilled water from day 1 through day 10. Forty-four percent of the nestlings given 60 mg/kg died after 4 days. Significant differences in growth rates occurred between controls and all paraquat-dosed groups. Reduced skeletal growth occurred in the humerus and femur in the 25 mg/kg and 60 mg/kg groups, and in the radius-ulna and tibiotarsus in the 60 mg/kg group. Skeletons were otherwise normal in appearance. Histopathological examination revealed localized focal necrosis in the liver of one nestling in the 60 mg/kg group and tubular cell degeneration and focal tubular dilation in the kidneys of another. The brain and lungs were unremarkable histologically. These findings suggest that altricial nestling kestrels are more sensitive to paraquat exposure than young or adult birds of precocial species.

Ultrasonography of the equine shoulder: technique and normal appearance.

PubMed

Tnibar, M A; Auer, J A; Bakkali, S

1999-01-01

This study was intended to document normal ultrasonographic appearance of the equine shoulder and anatomic landmarks useful in clinical imaging. Both forelimbs of five equine cadavers and both forelimbs of six live adult horses were used. To facilitate understanding of the images, a zoning system assigned to the biceps brachii and to the infraspinatus tendon was developed. Ultrasonography was performed with a real-time B-mode semiportable sector scanner using 7.5- and 5-MHz transducers. On one cadaver limb, magnetic resonance imaging (MRI) was performed using a system at 1.5 Tesla, T1-weighted spin-echo sequence. Ultrasonography images were compared to frozen specimens and MRI images to correlate the ultrasonographic findings to the gross anatomy of the shoulder. Ultrasonography allowed easy evaluation of the biceps brachii and the infraspinatus tendon and their bursae, the supraspinatus muscle and tendons, the superficial muscles of the shoulder, and the underlying humerus and scapula. Only the lateral and, partially, the caudal aspects of the humeral head could be visualized with ultrasound. Ultrasonographic appearance, orientation, and anatomic relationships of these structures are described. Ultrasonographic findings correlated well with MRI images and with gross anatomy in the cadavers' limbs.

Developed Design for Humeral Head Replacement Using 3D Surface Mapping

NASA Astrophysics Data System (ADS)

Salah, H. R.

2014-12-01

Assessment of dimensional and geometrical data on the humeral head replacement (HHR) objects is essential for solving the relevant designing problems in the physics of reverse engineering (RE). In this work, 2D-assessment for human humerus was performed using the computed tomography (CT) technique within the RE plan, after which the 2D images of humeral objects were converted into 3D images. The conversion was successful and indicated a clear difference in the 2D and 3D estimates of sizes and geometry of the humerus. The authors have analyzed and confirmed experimentally the statistical information on the relevant anatomical objects. The results of finite-element simulation of the compressive stresses affecting the geometry of 3D surface mapping were analyzed using SolidWorks software. For developing the biomechanical design of an HHR object suitable biomaterials were selected, and different metal-based biomaterials are discussed as applied at various loads. New methodology is presented for the size estimation of humeral head - both anatomical and artificial - in 3D-shape. A detailed interpretation is given for the results of CT D-measurements. Izmēru un ģeometrisko datu novērtējums, kas attiecas uz pleca kaula galviņas nomaiņas (PKGN) objektiem, nepieciešams, lai risinātu virkni reversīvās inženierijas (RI) problēmu. Šajā darbā cilvēka pleca kaula galviņas divdimensiju novērtējums tika veikts ar datortomogrāfijas palīdzību (RI) ietvaros, un pēc tam objekta divdimensiju attēlojums tika pārveidots trīsdimensiju. Pārveidojums bija sekmīgs, parādot pleca kaula galviņas izmēru un ģeometrijas atšķirības starp 2D un 3D novērtējumiem. Autori izanalizēja un eksperimentāli apstiprināja statistisko informāciju pēc dotā veida anatomiskiem objektiem. Saspiešanas sasprindzinājumi, kuri ietekmē trīsdimensiju virsmas attēlojuma ģeometriju, tika analizēti ar gala-elementu simulācijas metodi, lietojot programmu SolidWorks. Biomehaniskajam PKGN dizainam tika atlasīti piemēroti materiāli. Apspriesta dažādu biomateriālu ar metālisko pamatu reakcija uz mainīgām slodzēm. Tiek piedāvāta pleca kaula galviņas - kā anatomiskas, tā mākslīgas - trīs dimensijas mērīšanas metodoloģijas. Dota datortomogrāfisko precīzo mērījumu rezultātu detalizēta interpretācija.

Experiences with sheep as an animal model for shoulder surgery: strengths and shortcomings.

PubMed

Turner, A Simon

2007-01-01

Sheep (and goats) are a convenient large-animal model for rotator cuff repair because of availability, ease of handling and housing, animal cost, and acceptance to society as a research animal. Tenotomy of the infraspinatus tendon and subsequent reattachment to the proximal humerus is useful to address the biomechanical, histologic, and biochemical processes of rotator cuff repair. Detaching this tendon and immediately reattaching it does not represent the clinical picture but serves as a relatively rapid way to screen different suture anchors, suture patterns, scaffolds, growth factors, and other biologics or a combination of these treatments to enhance the healing process. To minimize spontaneous reattachment and reproduce a chronic rotator cuff injury, the end of the tendon can be covered and then reattached 4 weeks later if bone-to-tendon healing is to be evaluated. This chronic model is useful to understand the biology (degree of muscle atrophy and fatty infiltration) of rotator cuff muscles as well as innovative methods of repair. Close-stall confinement is required during the convalescence in acute and chronic studies. Ultrasound in the awake animal can be used to monitor gap formation and tissue organization. Sheep have also been used to determine whether capsular healing after plication is equivalent to open capsular shift.

Pectoralis Major Injury During Basic Airborne Training.

PubMed

McIntire, Sean; Boujie, Lee; Leasiolagi, John

2016-01-01

Injuries involving rupture of the pectoralis major are relatively rare. When they do occur, it is mostly frequently in a young, athletic man. The most common cause is weight lifting that results in eccentric muscle contraction (muscle contraction against an overbearing force, leading to muscle lengthening)-specifically, the bench press. Other mechanisms for this injury include forceful abduction and external rotation of the arm. Injury can occur anywhere along the pectoralis major from its medial origin on the sternum and clavicle to its lateral tendinous insertion on the humerus. At the time of injury, patients may report feeling a tearing sensation or hearing a pop, with immediate onset of pain. Physical examination findings can include a deformed appearance of the chest, ecchymosis of the chest and upper arm, pain and weakness with arm adduction and internal rotation, or noticeable asymmetry of the anterior axilla with arm abduction. Magnetic resonance imaging is the imaging study of choice to aid diagnosis. In a young and active population, such as the Special Operations community, appropriate and timely diagnosis is important because surgical intervention often is recommended. This report presents the case of an active-duty Servicemember who sustained a pectoralis major injury while exiting an aircraft during the Basic Airborne Course. 2016.

Orthopaedic injuries in children with nonaccidental trauma: demographics and incidence from the 2000 kids' inpatient database.

PubMed

Loder, Randall T; Feinberg, Judy R

2007-06-01

The purpose of this study was to examine the demographic and injury characteristics of children hospitalized with nonaccidental trauma as a causative factor using a large national database. Of the nearly 2.5 million cases in the database, 1794 (0.1%) were identified through diagnostic coding of abuse. Both sexes were equally represented, and two thirds had Medicaid as their primary payer. About one half of the children were younger than 1 year, but all ages were represented. The most common orthopaedic injuries were fractures of the femur or humerus, and most of those fractures occurred in children younger than 2 years. The most common nonorthopaedic injuries were contusions and brain injuries, with or without skull fracture, and 62 (3.5%) of the abused children died; almost all deaths were associated with brain trauma. Nearly one half of the abused hospitalized children between the ages of 3 and 20 years had a concomitant psychiatric or neurological condition. These data provide the orthopaedic surgeon with additional information to assist in identification of potential cases of nonaccidental trauma. In addition to presence of long bone fractures in infants and toddlers, older children with concomitant psychiatric or neurological conditions presenting with nonaccidental injuries should be assessed for possible abuse.

Biomechanics of Polyhydroxyalkanoate Mesh-Augmented Single-Row Rotator Cuff Repairs.

PubMed

Tashjian, Robert Z; Kolz, Christopher W; Suter, Thomas; Henninger, Heath B

Polyhydroxyalkanoate (PHA) mesh is a bioresorbable scaffold used to reinforce the suture-tendon interface in rotator cuff repairs (RCRs). We conducted a study of cyclic and ultimate failure properties of PHA mesh-augmented single-row RCRs and nonaugmented RCRs. Eight pairs of fresh-frozen cadaver humeri (6 male, 2 female) were tested. Mean (SD) age was 61 (9) years. The supraspinatus tendon was resected and reattached in a single-row configuration using 2 triple-loaded suture anchors and 6 simple stitches. The opposite humerus underwent RCR augmented with 2 strips of 13-mm × 23-mm PHA mesh. Humeri were mounted in an Instron load frame, cycled 1000 times to 1.0 MPa of effective stress, and loaded to failure. Construct gapping and ultimate failure loads/displacements were recorded. Paired t tests compared augmented and nonaugmented RCRs (P ≤ .05 was significant). There was no difference in gapping over 1000 cycles (P = .879). Mean (SD) failure load was higher for PHA mesh-augmented RCRs, 571 (173) N, than for nonaugmented (control) RCRs, 472 (120) N (P = .042), and failures were consistent within pairs because of tissue failure at the knots or anchor pullout. This technique for arthroscopic augmentation can be used to improve initial biomechanical repair strength in tears at risk for failure.

Functional-adaptive anatomy of the forelimb in the Didelphidae, and the paleobiology of the Paleocene marsupials Mayulestes ferox and Pucadelphys andinus.

PubMed

Argot, C

2001-01-01

An attempt to determine the locomotor activities of Mayulestes ferox (Borhyaenoidea) and Pucadelphys andinus (Didelphoidea) from the early Paleocene site of Tiupampa (Bolivia) is presented. The functional anatomy of the forelimbs of these South American marsupials is compared to that of some living didelphids: Caluromys philander, Micoureus demerarae, Marmosa murina, Didelphis marsupialis, Monodelphis brevicaudata and Metachirus nudicaudatus. Deductions from bone morphology to myology and locomotor behavior in the fossils are inferred from the comparisons with living forms. Some features of the postcranial skeleton, indicative of arboreal adaptations, are found in the extinct marsupials: anteriorly projected acromion, hemispherical head of the humerus, extended humeral lateral epicondylar ridge, medially protruding humeral entepicondyle, proximal ulnar posterior convexity, and deep flexor fossa on the medial side of the ulna. But other features are related to a more terrestrial pattern: the well-developed tubercles of the humeral head, the elongated olecranon process of the ulna, and the oval shape of the radial head. Mayulestes had clear arboreal abilities, but, as a predaceous mammal, probably hunted on the ground. Pucadelphys was less specialized, close to the living Monodelphis, a terrestrial insectivorous form with some skeletal features related to arboreal locomotion that are probably plesiomorphic for marsupials. Copyright 2001 Wiley-Liss, Inc.

Discovery of a rare arboreal forest-dwelling flying reptile (Pterosauria, Pterodactyloidea) from China.

PubMed

Wang, Xiaolin; Kellner, Alexander W A; Zhou, Zhonghe; Campos, Diogenes de Almeida

2008-02-12

A previously undescribed toothless flying reptile from northeastern China, Nemicolopterus crypticus gen. et sp. nov., was discovered in the lacustrine sediments of the Early Cretaceous Jiufotang Formation, western Liaoning, China. The specimen consists of an almost complete articulated skeleton (IVPP V14377) and, despite representing an immature individual, based on the ossification of the skeleton, it is not a hatchling or newborn, making it one of the smallest pterosaurs known so far (wing span approximately 250 mm). It can be distinguished from all other pterosaurs by the presence of a short medial nasal process, an inverted "knife-shaped" deltopectoral crest of the humerus, and the presence of a well developed posterior process on the femur above the articulation with the tibia. It further shows the penultimate phalanges of the foot curved in a degree not reported in any pterosaur before, strongly indicating that it had an arboreal lifestyle, more than any other pterodactyloid pterosaur known so far. It is the sister-group of the Ornithocheiroidea and indicates that derived pterosaurs, including some gigantic forms of the Late Cretaceous with wingspans of >6 m, are closely related to small arboreal toothless creatures that likely were living in the canopies of the ancient forests feeding on insects.

Comparison of Local Injection of Platelet Rich Plasma and Corticosteroids in the Treatment of Lateral Epicondylitis of Humerus.

PubMed

Yadav, Raman; Kothari, S Y; Borah, Diganta

2015-07-01

Lateral epicondylitis or Tennis Elbow is one of the most common causes of upper extremity pain with various treatment options. Platelet-rich plasma (PRP) offers a new option for the treatment of lateral epicondylitis. This study was conducted with an aim to compare the efficacy of PRP versus methyl-prednisolone local injection in patients with lateral epicondylitis. Sixty five patients with lateral epicondylitis were included in the study and randomized into two groups. Group A was treated with single injection of 1ml PRP with absolute platelet count of at least 1 million platelets/ mm(3). Group B was treated with single injection of 1ml (40mg) methyl-prednisolone. Pain, grip strength and functional improvements were assessed using visual analogue scale, dynamometer and quick Disabilities of the Arm, Shoulder and Hand scale respectively at baseline, 15 days, 1 month and 3 months. Sixty patients completed the follow up. All assessment parameters improved significantly in both the Groups at each follow up compared to baseline. At the end of three months group A showed significantly better improvement as compared to Group B. PRP and methyl-prenisolone both are effective in the treatment of lateral epicondylitis. However, PRP is a superior treatment option for longer duration efficacy.

In vivo validation of a new technique that compensates for soft tissue artefact in the upper-arm: preliminary results.

PubMed

Cutti, Andrea Giovanni; Cappello, Angelo; Davalli, Angelo

2006-01-01

Soft tissue artefact is the dominant error source for upper extremity motion analyses that use skin-mounted markers, especially in humeral axial rotation. A new in vivo technique is presented that is based on the definition of a humerus bone-embedded frame almost "artefact free" but influenced by the elbow orientation in the measurement of the humeral axial rotation, and on an algorithm designed to solve this kinematic coupling. The technique was validated in vivo in a study of six healthy subjects who performed five arm-movement tasks. For each task the similarity between a gold standard pattern and the axial rotation pattern before and after the application of the compensation algorithm was evaluated in terms of explained variance, gain, phase and offset. In addition the root mean square error between the patterns was used as a global similarity estimator. After the application, for four out of five tasks, patterns were highly correlated, in phase, with almost equal gain and limited offset; the root mean square error decreased from the original 9 degrees to 3 degrees . The proposed technique appears to help compensate for the soft tissue artefact affecting axial rotation. A further development is also proposed to make the technique effective also for the pure prono-supination task.

The palaeobiology of high latitude birds from the early Eocene greenhouse of Ellesmere Island, Arctic Canada

PubMed Central

Stidham, Thomas A.; Eberle, Jaelyn J.

2016-01-01

Fossils attributable to the extinct waterfowl clade Presbyornithidae and the large flightless Gastornithidae from the early Eocene (~52–53 Ma) of Ellesmere Island, in northernmost Canada are the oldest Cenozoic avian fossils from the Arctic. Except for its slightly larger size, the Arctic presbyornithid humerus is not distinguishable from fossils of Presbyornis pervetus from the western United States, and the Gastornis phalanx is within the known size range of mid-latitude individuals. The occurrence of Presbyornis above the Arctic Circle in the Eocene could be the result of annual migration like that of its living duck and geese relatives, or it may have been a year-round resident similar to some Eocene mammals on Ellesmere and some extant species of sea ducks. Gastornis, along with some of the mammalian and reptilian members of the Eocene Arctic fauna, likely over-wintered in the Arctic. Despite the milder (above freezing) Eocene climate on Ellesmere Island, prolonged periods of darkness occurred during the winter. Presence of these extinct birds at both mid and high latitudes on the northern continents provides evidence that future increases in climatic warming (closer to Eocene levels) could lead to the establishment of new migratory or resident populations within the Arctic Circle. PMID:26867798

The palaeobiology of high latitude birds from the early Eocene greenhouse of Ellesmere Island, Arctic Canada.

PubMed

Stidham, Thomas A; Eberle, Jaelyn J

2016-02-12

Fossils attributable to the extinct waterfowl clade Presbyornithidae and the large flightless Gastornithidae from the early Eocene (~52-53 Ma) of Ellesmere Island, in northernmost Canada are the oldest Cenozoic avian fossils from the Arctic. Except for its slightly larger size, the Arctic presbyornithid humerus is not distinguishable from fossils of Presbyornis pervetus from the western United States, and the Gastornis phalanx is within the known size range of mid-latitude individuals. The occurrence of Presbyornis above the Arctic Circle in the Eocene could be the result of annual migration like that of its living duck and geese relatives, or it may have been a year-round resident similar to some Eocene mammals on Ellesmere and some extant species of sea ducks. Gastornis, along with some of the mammalian and reptilian members of the Eocene Arctic fauna, likely over-wintered in the Arctic. Despite the milder (above freezing) Eocene climate on Ellesmere Island, prolonged periods of darkness occurred during the winter. Presence of these extinct birds at both mid and high latitudes on the northern continents provides evidence that future increases in climatic warming (closer to Eocene levels) could lead to the establishment of new migratory or resident populations within the Arctic Circle.