MyMedR

Delayed management of fracture of the lateral humeral condyle in children

Dhillon KS, Sengupta S, Singh BJ

Acta Orthop Scand, 1988 Aug;59(4):419-24.

Thirty-nine displaced fractures of the lateral humeral condyle in children were followed for an average of 5 (2-5) years. The results were evaluated from functional and cosmetic aspects. Patients treated within 2 weeks by open reduction and internal fixation did well. Those operated on after 6 weeks did not do better than nonoperated on cases. Complications included cubitus varus and valgus deformities, osteonecrosis, nonunion and malunion, and loss of motion. We recommend that patients presenting late be left alone and any sequelae evaluated at a late stage.

Matched MeSH terms: Humeral Fractures/surgery*; Humeral Fractures/therapy

A modified surgical technique for neglected fracture of lateral humeral condyle in children

Sulaiman AR, Munajat I, Mohd EF

J Pediatr Orthop B, 2011 Nov;20(6):366-71.

PMID: 21716140 DOI: 10.1097/BPB.0b013e32834920df

Operative treatment for neglected fracture of lateral humeral condyle (LHC) is difficult because of contracted muscle, fibrous tissue formation, and indistinct bony edges. Its success depends on the ability to preserve blood supply during the surgery. We retrospectively reviewed eight cases of neglected fracture of LHC in children treated with open reduction with selected multiple 'V' lengthening of common extensor muscle and internal fixation. The patients were between 3 and 8 years of age. The period of neglect was between 3 and 20 weeks. Four patients with displacement of more than 10 mm and neglect for 5 weeks or more required lengthening of common extensor muscle aponeurosis. The follow-up assessments were between 1 and 6.3 years with a mean of 4.4 years. All patients had union by 2 months. They gained improvement of flexion range of motion between 60° and 120° with a mean of 86.3°. Loss of final range of motion compared with the normal side was between 5° and 35° with a mean of 10°. No patient had limitation of activities or pain. Six cases had excellent and two cases had good Dillon functional score. All patients had lateral condyle prominent with different severities. There was one mild avascular necrosis and one fishtail deformity. Both of them had almost full range of motion. All patients had early physeal closure, except one, who had only 1 year follow-up. There was no case of progressive valgus deformity. Children with neglected fracture of LHC would benefit from anatomical reduction and internal fixation through a proper exposure and if indicated combined with multiple 'V' lengthening of common extensor muscle aponeurosis. This is a level IV study.

Matched MeSH terms: Humeral Fractures/physiopathology; Humeral Fractures/radiography; Humeral Fractures/surgery*

Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases

Louahem DM, Bourelle S, Buscayret F, Mazeau P, Kelly P, Dimeglio A, et al.

Arch Orthop Trauma Surg, 2010 May;130(5):649-55.

PMID: 19960347 DOI: 10.1007/s00402-009-1009-3

Elbow instability is a common feature after medial epicondyle fractures, displaced or not, even in the absence of dislocation. Undisplaced or minimally displaced fractures often have an underestimated degree of instability secondary to unrecognised capsuloligamentous and muscular injuries. The purpose of this retrospective study was to analyze and to assess objectively the results of the surgical treatment of these acute injuries.

Matched MeSH terms: Humeral Fractures/complications; Humeral Fractures/radiography; Humeral Fractures/surgery*

Fulltext Metastatic penile cancer presenting as hypercalcemia and pathological fracture of the humerus: a rare event

Ho CC, Nazri J, Zulkifli MZ, Sritharan S, Hayati AR

Med J Malaysia, 2006 Oct;61(4):503-5.

PMID: 17243535 MyJurnal

Distant haematogenous metastasis in penile cancer is rare. A patient who had total penectomy and bilateral inguinal lymphadenectomy for penile cancer but later presented with hypercalcemia of malignancy and pathological fracture of the humerus is reported.

Matched MeSH terms: Humeral Fractures/diagnosis; Humeral Fractures/etiology*; Humeral Fractures/surgery

Letter to the Editor: Minimally invasive plate osteosynthesis for proximal humeral fractures

Sinha N, Rao BS, Trivedy PD, Rao AS

J Orthop Surg (Hong Kong), 2016 04;24(1):139.

PMID: 27122535

Matched MeSH terms: Humeral Fractures/surgery

Fulltext The efficacy of side arm traction in the reduction of supracondylar fracture humerus in children

Harwant S, Borhan TA

Med J Malaysia, 2000 Sep;55(3):311-7.

PMID: 11200710

156 consecutive children with supracondylar fracture humerus were reviewed. Of these, 56 children with severely displaced fractures were treated with side arm traction. A retrospective review revealed that a mean post-reduction Baumann angle of 74.2 degrees for boys and 75.9 degrees for girls; and mean post-reduction humero-ulna angle of 11.6 degrees for boys and 12.7 degrees for girls was achieved. A linear correlation was noted between the duration of traction and the age of the patient, older patients requiring longer traction. The region below the line in the graph, plotting the duration of traction (y-axis) versus the age of the patient (x-axis) shows when the fracture is unstable; and the region above the line shows when the fracture is stable and can only be reduced by surgery. 10 children presented late; 6 presented within the unstable period and were successfully reduced with traction; while 4 presented stable and required open reduction. We conclude that traction is an acceptable and safe method for reduction of this fracture, and can be used to reduce late presentations while their fractures are still unstable.

Matched MeSH terms: Humeral Fractures/therapy*

Fulltext The results of open reduction and pin fixation in displaced supracondylar fractures of the humerus in children

Srivastava S

Med J Malaysia, 2000 Sep;55 Suppl C:44-8.

PMID: 11200044

The treatment of displaced supracondylar fracture humerus (Gartland Type III) in children continues to be a challenging problem. We did a retrospective study of such fractures treated in Hospital Muar, over a 2 years period (from January 1998 to December 1999). A total of 42 cases with displaced supracondylar fractures, treated with open reduction and internal fixation were studied. All cases were operated using a posterior triceps splitting approach and crossed kirschner wires were used to stabilize the fracture site. An excellent outcome was seen in 34 patients (81%) and a good outcome in 7 patients (17%). The incidence of complications such as pin tract infection (14%), nerve injury (2%) was very low. None of the patients had vascular complications or myositis ossificans.

Matched MeSH terms: Humeral Fractures/surgery*

An epidemiological study of humeral fractures in Singapore

Wong PC

Med J Malaya, 1966 Jun;20(4):300-5.

PMID: 4224338

Matched MeSH terms: Humeral Fractures/epidemiology*

Fulltext Minimal Invasive Plate Osteosynthesis (MIPO) Technique Using Anterolateral Approach for Treating Closed Proximal Humerus Fracture

Ismail H, Boedijono D, Hidayat H, Simbardjo D

Malays Orthop J, 2012 Mar;6(1):18-24.

PMID: 25279037 DOI: 10.5704/MOJ.1203.008

ABSTRACT: Proximal humerus fracture is the second most common fracture of the upper extremity and presents several unique problems such as anatomical complexity, high risk of avascular necrosis, minimal bone stock for purchase, significant morbidity, and lack of a universally accepted treatment. Recent treatments for proximal humerus fractures include use of minimally invasive plate osteosynthysis (MIPO). The aim of this cross-sectional study was to evaluate the outcomes of our less invasive technique using a modified anterolateral approach for treatment of proximal humerus fractures. Ten such operative procedures were performed in patients of varying age and with varied mechanism of injury from 2002-2011. All cases were conducted in an acute setting. There were no cases of infection and the functional outcome scores were good. This approach represents an alternative treatment for closed proximal humerus fracture but more extensive studies are needed.

KEY WORDS: Proximal humerus fracture, MIPO, less invasive,anterolateral approach.

Matched MeSH terms: Humeral Fractures

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

Anuar R, Gooi SG, Zulkiflee O

Malays Orthop J, 2015 Nov;9(3):71-74.

PMID: 28611917 MyJurnal DOI: 10.5704/MOJ.1511.019

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

Matched MeSH terms: Humeral Fractures

Fulltext Displaced supracondylar fracture of humerus in children--comparative study of the result of closed and open reduction

Yusof A, Razak M, Lim A

Med J Malaysia, 1998 Sep;53 Suppl A:52-8.

PMID: 10968183

The displaced supracondylar fracture of the humerus in children (Gartland type 3) is a most challenging injury to treat. There is controversy regarding the initial treatment either closed manipulation and splint immobilization or open reduction and internal fixation. This is a retrospective study comparing two groups of patients with displaced supracondylar fracture of the humerus (Gattland 3) treated in the Orthopaedic Unit, Universiti Kebangsaan Malaysia. The first group, 13 patients treated with closed reduction and splint immobilization and a second group, 15 patients treated with open reduction and internal fixation as initial definitive treatment. The results showed a high failure rate of closed reduction and splint immobilization. This was due to difficulty in reduction, loss of reduction post operatively or during follow-up. Open reduction and internal fixation was more advantages with reduced hospitalization time, fewer complications, more stable fixation and better anatomical reduction with minimal complications for type 3 supracondylar fracture of humerus. We would recommend that all Gartland 3 supracondylar fracture of the humerus be treated with open reduction and two K-wire fixation.

Matched MeSH terms: Humeral Fractures/surgery; Humeral Fractures/therapy*

Fulltext Supracondylar fractures of the humerus in children--an epidemiological study of 132 consecutive cases

Chai KK, Aik S, Sengupta S

Med J Malaysia, 2000 Sep;55 Suppl C:39-43.

PMID: 11200043

132 consecutive cases of supracondylar fractures of the humerus admitted between July, 1997 and February, 1999 were included in a prospective study. There were 93 boys and 39 girls. The age ranges from one to 14 years old. The non-dominant arm was more often injured. Ethnic Malay constituted the majority. Accidents mainly occurred at home with a peak between 4 pm and 8 pm. Majority was presented within 24 hours of injury. Type III fracture with distal fragment in extension predominated. Nerve injuries occurred in 9 cases in which median nerve was the most commonly affected. There was only one open fracture and it was complicated by absent radial pulse and median nerve injury.

Matched MeSH terms: Humeral Fractures/ethnology; Humeral Fractures/epidemiology*

Fulltext Supracondylar fractures of the humerus in children

Sengupta S

Med J Malaysia, 2000 Sep;55 Suppl C:1.

PMID: 11200034

Matched MeSH terms: Humeral Fractures/complications*; Humeral Fractures/epidemiology*

Lateral closing wedge supracondylar osteotomy of humerus for post-traumatic cubitus varus in children

Devnani AS

Injury, 1998 6 13;28(9-10):643-7.

PMID: 9624344

Cubitus varus deformity following mal-union of a supracondylar fracture of the humerus in children causes no functional disability, but surgical correction is often requested to improve the appearance of the arm. Maintaining the correction after supracondylar osteotomy is a difficult aspect of the operative treatment and remains controversial. Nine children aged between 6 and 12 years (average 8 years and 11 months) underwent lateral closing wedge supracondylar osteotomy of the humerus, for deformity ranging between 10 and 20 degrees (average 13 degrees). The correction required ranged between 16 and 30 degrees (average 21 degrees). The osteotomy was internally fixed with a two hole marrow plate. At follow-up, which ranged between 3 months and 6 years (average 34 months), six patients were graded as good, two as satisfactory and one as a poor result. One patient had transient radial nerve palsy which recovered completely in 2 months. The patient who was graded poor had undercorrection of the deformity at the original operation. There was no incidence of loss of correction due to implant failure. Complete section of the bone to allow medial displacement of the distal fragment is recommended, thereby avoiding lateral bony prominence at the elbow.

Matched MeSH terms: Humeral Fractures/rehabilitation; Humeral Fractures/surgery*

Fulltext Crossed-pin versus lateral-pin fixation in pediatric supracondylar fractures

Shamsuddin SA, Penafort R, Sharaf I

Med J Malaysia, 2001 Dec;56 Suppl D:38-44.

PMID: 14569765 MyJurnal

A retrospective study was done on 56 patients treated with percutaneous pinning of displaced supracondylar fractures of the humerus in the Paediatrics Institute of Hospital Kuala Lumpur between November 1999 and October 2000, to ascertain whether there is any significance clinically in the stability of a crossed pinning medial compared with lateral pinning method. There was equal number of patients in each group (28 patients). The radiographs were evaluated for change in Baumann's angle and Lateral Humero-capitellar angle from immediate post-op until the last follow-up. The changes in the angles did not reveal any statistically significant difference in the ability to maintain reduction of the fractures. There were 3 instances of iatrogenic ulnar nerve injury in the crossed pinning group; the lateral pinning group had 1 case each of anterior interosseous nerve and radial nerve injury post operatively. No vascular injury was noted. Two cases of superficial pin tract infection were present in each group. The lateral percutaneous pinning technique of displaced supracondylar fractures of the humerus therefore offers a viable alternative to the crossed pinning group as it offers the same stability without the incipient risk of iatrogenic ulnar nerve injury.

Matched MeSH terms: Humeral Fractures/radiography; Humeral Fractures/surgery*

Fulltext Gradual reduction of supracondylar fracture of the humerus in children reporting late with a swollen elbow

Devnani AS

Singapore Med J, 2000 Sep;41(9):436-40.

PMID: 11193116

AIM: To study the outcome of gradual reduction by skin traction of supracondylar fracture of the humerus in children with swollen elbow, who seek treatment two days or longer after the injury.
METHOD: Fifteen children aged between 4 and 11 years (average 7 years 11 months), who had initially consulted a traditional practitioner, reported between 2 and 21 days (average 7.5) after the injury were treated by skin traction with the elbow kept straight and the forearm in position of comfort.
RESULTS: The average duration of stay in hospital was 14 days. All fractures healed; there was no incidence of myositis ossificans or neurovascular deficit. All patients had functional range of movements at the elbow within 6 months. Five patients developed cubitus varus deformity greater than 5 degrees, they were classified as poor result. Four out of these 5 patients had sought treatment after a delay of 7 days or longer. There were 9 good (60%), 1 fair (7%) and 5 poor (33%) results.
CONCLUSION: Gradual reduction by skin traction is safe. It is possible to achieve satisfactory reduction if the delay is up to 7 days. The results with regards to deformity and function were comparable with those obtained following open or closed Kirschner wire fixation.

Matched MeSH terms: Humeral Fractures/pathology; Humeral Fractures/therapy*

Fulltext Concomitant fat embolism syndrome and pulmonary embolism in a patient with patent foramen ovale

Dk Yeak R, Liew SK

Acta Orthop Traumatol Turc, 2020 Jul;54(4):465-468.

PMID: 32812879 DOI: 10.5152/j.aott.2020.20035

We present a rare case of a patient with concurrent fat embolism and pulmonary embolism, in a closed femur fracture with patent foramen ovale (PFO). A 24-year-old man was involved in a motor vehicle accident with a closed left midshaft femur fracture. He developed fat embolism syndrome (FES) on day 3 of admission, and plating was performed. The D-dimer concentration was also high, which raised the suspicion of pulmonary artery embolism. Computed tomography pulmonary angiography (CTPA) revealed right inferior lobar pulmonary artery embolism and FES. A transthoracic echocardiogram (TEE) was performed, which showed a PFO. The presence of a PFO in patients with pulmonary embolism increases the risk of systemic embolism. Therefore, we recommend the routine echocardiogram for patients with pulmonary embolism to exclude any cardiac defect in causing right-to-left shunts, which predisposes the patient to paradoxical embolism.

Matched MeSH terms: Humeral Fractures/diagnosis; Humeral Fractures/therapy

An elbow dislocation in a child with missed medial epicondyle fracture and late ulnar nerve palsy

Haflah NH, Ibrahim S, Sapuan J, Abdullah S

J Pediatr Orthop B, 2010 Sep;19(5):459-61.

PMID: 20555271 DOI: 10.1097/BPB.0b013e32833b6032

Elbow dislocations associated with a medial epicondyle fracture and ulnar nerve palsy are uncommon injuries. We present the case of an 11-year-old girl with an elbow dislocation treated by closed manual reduction. The medial epicondyle fracture was missed initially until she developed an ulnar nerve palsy 2 months later. Intraoperatively we discovered the bony epicondyle piercing the joint capsule and compressing the ulnar nerve. Removal of the bony fragment relieved her symptoms and she returned to normal activities at 1 year follow-up. We would like to highlight this rare occurrence and present the detailed history and management of this case.

Matched MeSH terms: Humeral Fractures/complications; Humeral Fractures/diagnosis*

Fulltext Is A New Combination of Tendon Transfers For Radial Nerve Palsy (RNP) Needed?

Ramdhan I, Nawfar S, Paiman M

Malays Orthop J, 2014 Mar;8(1):75-8.

PMID: 25347622 MyJurnal DOI: 10.5704/MOJ.1403.006

Radial nerve palsy following traumatic humeral diaphyseal fractures occurs uncommonly. Most recover with good outcome. However the cases with poor outcome or recovery will have tendon transfers to regain the lost functions. Various tendon transfer methods and choices are available in literatures citing acceptable to good results. We report a case of radial nerve transection secondary to a closed traumatic diaphyseal fracture of the humerus which did not improve despite the repair. As many conventional technique produce asynergistic muscle action with secondary post-transfer deformity, thus we had resorted to tendon transfer procedure using an unconventional donor and recipient tendons yielding good results. This new combination of tendon transfers was invented involves better dynamic correlation of synergistic muscles action and produces good outcome and hand function.

Matched MeSH terms: Humeral Fractures

Fulltext Plate osteosynthesis of the humerus shaft fracture an its association with radial nerve injury--a retrospective study in Melaka General Hospital

Lim KE, Yap CK, Ong SC, Aminuddin

Med J Malaysia, 2001 Jun;56 Suppl C:8-12.

PMID: 11814257

Over a seven-year period, 170 cases of humerus fractures were plated in Hospital Melaka. Of these, 131 cases were successfully traced for this study. Besides looking at fracture epidemiology, its relationship with radial nerve injury was examined. The incidence of post-traumatic wrist drop in closed and compound fractures were 14.9% and 35.3% respectively. In relation to the site of fracture, lower third fracture had the highest incidence of wrist drop (29%). The recovery from post-traumatic wrist drop was 83%. The average duration taken for recovery was 11.8 weeks. The incidence of post-operative wrist drop was high at 17.6% but all recovered during follow-up.

Matched MeSH terms: Humeral Fractures/complications*; Humeral Fractures/epidemiology; Humeral Fractures/surgery*

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