1/107. The spiral compression plate for proximal humeral shaft nonunion: a case report and description of a new technique.We present a case of humeral nonunion managed with a dynamic compression plate (DCP) contoured in a spiral fashion to preserve the deltoid muscle insertion. A forty-one-year-old woman sustained a closed proximal third humeral shaft fracture with an associated supraclavicular brachial plexus injury. She presented five months later with an atrophic nonunion of the proximal humeral shaft, inferior subluxation of the humeral head, and a resolving brachial plexopathy. Autogenous cancellous bone grafting and open reduction and internal fixation with a narrow DCP was performed. The deltoid muscle insertion was preserved by contouring the plate to fix the proximal humerus laterally over the greater tuberosity and anteriorly over the mid-humeral shaft. During the postoperative period, the humeral head reduced spontaneously. Five months after surgery, the fracture healed, and an excellent clinical result was achieved. We recommend the use of the spiral DCP for proximal shaft fractures and nonunions when preservation of the deltoid insertion is desirable.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
2/107. Endoscopic bone graft for delayed union and nonunion.Nonunion and delayed union are serious consequences in the treatment of fractures. Bone graft has been a mainstay of treatment for nonunion and delayed union. But with rapid development of the endoscopic procedure, bone grafting can be performed after curettage of fibrous tissue around the fracture gap and sclerotic fracture end under direct visual control of the endoscope. This technical note provides procedures for this technique.- - - - - - - - - - ranking = 5keywords = bone (Clic here for more details about this article) |
3/107. Heat-induced segmental necrosis after reaming of one humeral and two tibial fractures with a narrow medullary canal.In three cases referred to our clinic (a simple fracture of the humeral shaft, a simple, closed fracture, and a wedge fracture of the mid-third of the tibia), bone necrosis had resulted from excessive heat produced by reaming extremely narrow medullary cavities (5-5.5 mm diameter) with the 9 mm front-cutting reamer as part of a reamed nailing procedure. In any one case, different degrees of damage can occur from the metaphysis to the diaphysis. Based on the clinical course and the histological evaluation, we postulate that heat-induced damage can be divided into four degrees of severity (0-3): Grade 0: no damage; no devascularization, no heat-induced damage. Grade 1: The heat damaged zone is cut away during subsequent reaming, the only damage is devascularization. Grade 2: The damaged zones are not eliminated by subsequent reaming. The bone is devascularized and heat damaged. Grade 3: The entire cross section of the bone including the periosteum is devitalized by exposure to excessive heat. Depending on the severity of additional damage to the soft tissues, grave consequences are to be expected and further operations are unavoidable. The effects of heat-induced damage are particularly critical in the presence of infection (cases 2 and 3). The fundamental aspects and the extent of heat necrosis will be discussed. After discussion with the AO Technical Commission on the cause of heat-induced necrosis, we would recommend the following preventive measures: 1. preoperative measurement of the smallest diameter of the medullary cavity in two planes. 2. reaming with the standard instrumentation (9 mm) only if the medullary cavity has a diameter of at least 8 mm at its narrowest point. 3. Extremely narrow cavities should first be reamed manually or an alternative to nailing should be sought. 4. It is strongly recommended that only sharp reamers be used in such cases and blunt or damaged reamers replaced.- - - - - - - - - - ranking = 3keywords = bone (Clic here for more details about this article) |
4/107. CT imaging and three-dimensional reconstructions of shoulders with anterior glenohumeral instability.Glenohumeral instability is a common occurrence following anterior dislocation of the shoulder joint, particularly in young men. The bony abnormalities encountered in patients with glenohumeral instability can be difficult to detect with conventional radiography, even with special views. The aim of our study was to evaluate the bony abnormalities associated with glenohumeral instability using CT imaging with 3-D reconstruction images. We scanned 11 patients with glenohumeral instability, one with bilateral symptoms; 10 were male, one female, and their ages ranged from 18-66 years. Contiguous 3 mm axial slices of the glenohumeral joint were taken at 2 mm intervals using a Siemens Somatom CT scanner. In the 12 shoulders imaged, we identified four main abnormalities. A humeral-head defect or Hill-Sachs deformity was seen in 83% cases, fractures of the anterior glenoid rim in 50%, periosteal new bone formation secondary to capsular stripping in 42%, and loose bone fragments in 25%. Manipulation of the 3-D images enabled the abnormalities to be well seen in all cases, giving a graphic visualization of the joint, and only two 3-D images were needed to demonstrate all the necessary information. We feel that CT is the imaging modality most likely to show all the bone abnormalities associated with glenohumeral instability. These bony changes may lead to the correct inference of soft tissue abnormalities making more invasive examinations such as arthrography unnecessary.- - - - - - - - - - ranking = 3keywords = bone (Clic here for more details about this article) |
5/107. Free vascularized fibula grafts in surgery of the upper limb.Twenty patients with intractable diseases in the upper extremity were treated using free vascularized fibula grafts. There were 13 men and seven women. Three patients had traumatic bone defects, five had post-traumatic nonunions, two had congenital pseudoarthroses, seven had defects after tumor resection, and three had other lesions. The reconstructed sites were the humerus in two patients, the radius and/or ulna in 17, and the metacarpal and phalangeal bones in one. The length of the bone defect ranged from 3 to 18 cm (mean: 8.4 cm). Follow-up periods ranged from 6 to 204 months. No patient required additional bone grafts. The mean period required to obtain radiographic bone union was 4.4 months. There were no cases with fractures of the grafted bone, but malunion occurred in four cases. The vascularized fibula graft is indicated in patients with large bone defects or intractable nonunions in the humerus, radius, and/or ulna.- - - - - - - - - - ranking = 7keywords = bone (Clic here for more details about this article) |
6/107. myxoma of the humerus: an exceptional site of origin.myxoma of bone, outside of the jaws, is exceptional. We present such a tumor in the humerus and discuss the criteria for the diagnosis of myxoma.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
7/107. Endoscopic bone graft for delayed union and nonunion.We performed endoscopic bone grafting for eight patients of delayed union and nonunion which developed after femoral and humeral shaft fractures. The mean interval from initial intervention to endoscopic bone grafting was 7.3 months. Six patients of delayed union and nonunion healed at 4.1 months on average. Two patients had unsatisfactory healing and eventually underwent non-endoscopic revisional surgery. There was no intraoperative on postoperative complication. Endoscopic bone grafting can be a less invasive alternative, obtaining rapid bone union in cases of compromised healing of the diaphyseal fracture.- - - - - - - - - - ranking = 8keywords = bone (Clic here for more details about this article) |
8/107. The application of arthroscopic principles to bone grafting of delayed union of long bone fractures.The purpose of this study was to explore the potential of applying arthroscopic techniques to autogenous bone grafting of long bone fracture delayed union. There were 9 patients in this initial series, including 4 patients (average age, 37 years) with humeral lesions and 5 patients (average age, 25 years) with tibial fractures. There were 6 men and 3 women. Techniques customarily employed in arthroscopy were used to visualize, expose, and deliver the onlay cancellous bone grafts. Bony union occurred in all but 1 patient in an average of 4 months. This patient had a fibrous union and sustained a reinjury that led to successful repeat open bone graft surgery. The arthroscopic approach for bone grafting of certain long bone delayed union appears to be a safe and effective procedure. The procedure is best suited for patients with mechanically stabilized fragments, and it lends itself to those with overlying skin or soft tissue compromise. There are some relative contraindications: grossly unstable fragments, severe malunion, and/or infection.- - - - - - - - - - ranking = 14keywords = bone (Clic here for more details about this article) |
9/107. Keyhole defect production in tubular bone.Fracture characteristics, reported primarily for the cranium, are valuable indicators of bullet direction. A bullet striking the vault tangentially produces an irregular opening, termed a "keyhole defect." with the circular portion of the defect being the initial point of impact. Identifying this feature in tubular bone (long bone) can also demonstrate bullet direction and the position of the bone at the time of the shooting. This case study involving a tangential shot (i.e., a keyhole fracture) to the humerus demonstrates some of the same fracture mechanics seen in the cranium.- - - - - - - - - - ranking = 7keywords = bone (Clic here for more details about this article) |
10/107. Development of a solitary bone cyst--a report of a case suggesting its pathogenesis.The origin and natural course of solitary bone cysts (SBC) still remain controversial. knowledge of the process of cyst formation and enlargement would be helpful for investigating its pathogenesis. Only two papers have described a radiodense nidus of the diaphysis as a precursor. Their cases were unique in that the initial lesions were in the diaphysis and that the cysts did not abut onto the epiphyseal line. This study reports a case in a patient with a tiny erosive lesion in the endosteal surface of the humeral metaphysis, which developed expansively into a typical large cyst over 6 years. Serial roentgenograms taken every year demonstrated the process of cyst enlargement. This is the first longitudinal study of a case with SBC documented from its onset.- - - - - - - - - - ranking = 5keywords = bone (Clic here for more details about this article) |
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