Cases reported "Humeral Fractures"

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1/20. Injuries of the axillary artery caused by fractures of the neck of the humerus.

    Three patients are presented in whom the axillary artery was injured in combination with a simple fracture of the neck of the humerus. The pathological anatomy, symptomatology, diagnosis and treatment of these lesions are discussed with reference to our own experience.
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2/20. Articular impingement in malunited fracture of the humeral head.

    We report on the case of a fracture of the humeral metaepiphysis, surgical neck, and greater tuberosity treated conservatively. Malunion of a fracture of the greater tuberosity developed an impingement on the glenoid surface, causing an articular locking in internal rotation that resolved with slight pressure and a painful "click." The impinging bone was removed arthroscopically. Its extreme posterior position required opening a second, novel portal close to the posterior edge of the acromion for instrument access. Complete removal of the impinging bone restored free internal rotation without signs of impingement on the glenoid surface. Passive motion was initiated immediately postoperatively, and active motion in a water pool was initiated after 2 weeks. After 1 year, the patient has no pain, has maintained complete range of motion, and experiences no limitations in daily or sports activities. The peculiar features of this case are the absence of soft tissue scar stiffness and deficiency of the rotator cuff, because malunion of the bone fragment to the posterior edge of the humeral head produced a mechanical block of internal rotation, and the arthroscopic treatment of the impingement through an atypical superoposterior portal, which has not been described in the literature before.
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3/20. Posterior dislocation of the shoulder associated with fracture of the humeral anatomical neck with 11-year follow-up after early open reduction and internal fixation.

    BACKGROUND:. The combination of posterior dislocation and fracture of the anatomical neck represents an extremely rare injury. methods:. A patient with posterior dislocation of the shoulder and ipsilateral fracture of the humeral anatomical neck was treated with open reduction and internal fixation with two Kirschner wires. He was followed up for 11 years. RESULTS:. The functional results were excellent, and X-ray and MRI investigations revealed the absence of avascular necrosis of the humeral head. CONCLUSION:. Early and accurate open reduction with minimal osteosynthesis resulted in excellent function of the injured shoulder without avascular necrosis.
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keywords = neck
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4/20. Combined olecranon osteotomy and posterior triceps splitting approach for complex fractures of the distal humerus.

    Complex fractures involving the intercondylar/supracondylar distal humerus with extension into the mid to proximal humeral shaft are difficult to manage through a single standard surgical approach. We present and review a technique that combines an olecranon osteotomy with a posterior triceps splitting approach to the humerus. This technique was used in two patients who presented with severe intercondylar fractures of the distal humerus and extension proximally to the midshaft of the humerus. The technique allowed extensive distal humerus exposure, including the supracondylar/intercondylar region, and excellent exposure of the humeral shaft proximally to the surgical neck.
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5/20. Intrathoracic humeral head fracture-dislocation.

    There are few cases in the medical literature documenting intrathoracic glenohumeral fracture-dislocations. A total of eight cases have been reported-two intrathoracic humerus dislocations with greater tuberosity fractures 1, 2 and six cases with intrathoracic fracture-dislocations in which the fracture involved the humeral neck. 3-8 With so few cases, treatment modalities vary, and no guidelines exist. patients in five of the reported cases underwent surgery, 1, 3-6 while the other three were treated nonoperatively. 2, 7, 8 We present a case of a middle-aged woman involved in a high-speed motor vehicle accident who sustained an intrathoracic humeral head fracture-dislocation and underwent operative treatment.
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6/20. axillary artery injury from humeral neck fracture: a rare but disabling traumatic event.

    axillary artery injury from blunt trauma to the shoulder is uncommon. Fracture of the neck of the humerus is a rare cause of injury to the axillary artery. Four cases of axillary artery thrombosis from humeral neck fracture are reported. Each of the first 2 patients presented with a pulseless and acutely ischemic limb after a trivial fall. A repair of the axillary artery with saphenous vein interposition graft was performed in the first patient. The extremity was salvaged, but a residual radial and ulnar neurologic deficit persisted. The second patient presented with a pulseless insensate upper extremity accompanied by motor loss. He underwent primary axillary artery repair. Still early in his postoperative course, he has had global brachial plexopathy and is undergoing intensive physical therapy. The third patient had a delayed presentation of brachial plexopathy and sympathetic reflex dystrophy. Arterial reconstruction was not required owing to excellent collateralization. The fourth patient presented with a cool pulseless extremity. His recovery is nearly complete after bypass of the axillary artery with a reversed saphenous vein graft. In addition, a review of the literature revealed 24 cases of axillary artery injury associated with humeral neck fracture. The mean age was 66.6 years. The most common mechanism of injury was a fall (79%). Thirteen patients (46%) presented with a neurologic deficit. Acute ischemia was present in 68%. physical examination predicted the arterial injury in all but 1 patient. The injured axillary artery was repaired in 26 cases. Revascularization by an interposition graft was the most common procedure. All grafts and reanastomoses were patent and led to limb salvage. Of 9 primary repairs, 3 amputations were performed. Although limb salvage rate was 89%, a good functional outcome was obtained in only half of the patients. A high index of suspicion is required for early diagnosis of axillary artery injury. Despite excellent results of vascular reconstruction, the outcome remains determined by the excessive neurologic morbidity. Recognition of the associated brachial plexus injury is essential to improve the functional outcome of this unusual arterial injury.
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7/20. Early intrathoracic migration of Kirschner wires used for percutaneous osteosynthesis of a two-part humeral neck fracture: a case report.

    We present an unusual case of early migration of three Kirschner wires used for percutaneous osteosynthesis of a two-part humeral neck fracture, causing hemothorax. An 85-year-old woman was admitted to the emergency room after casual accident. She was found to have suffered a two-part fracture of the surgical neck of the right humerus. The humeral fracture was treated by closed reduction and percutaneous osteosynthesis with three threaded Kirschner wires, which were bent subcutaneously. Ten days after the accident the patient presented with dyspnea and laterocervical pain. Plain x-rays and complementary CT demonstrated intrathoracic migration of the three Kirschner wires with hemothorax. Two of the wires were seen under the right clavicle and adjacent to the C7 vertebra. The third wire reached the lateral chest wall. Immediate surgery was performed, with withdrawal of the wires and placement of a drainage tube. The patient had an uneventful recovery after surgery. The humeral fracture resulted in a nonunion, which was well tolerated by the patient and was left untreated. The use of Kirschner wires for osteosynthesis of proximal humeral fractures may cause significant thoracic morbidity, even if various prophylactic measures, including the use of threaded wires, subcutaneous bending, and close radiographic follow-up, are adopted. The use of Kirschner wires should anyway be restricted to carefully selected cases, in order to avoid major complications.
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ranking = 1.2
keywords = neck
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8/20. Iatrogenic axillary artery injury from humeral neck fracture repair. A rare and unusual event in which and aggressive strategy was mandatory to save a child limb.

    Humeral neck fracture is rarely associated with injury of the nearby axillary artery and in the English literature only 29 such cases have been reported. An injury of the distal axillary artery secondary to reduction and fixation of a humeral neck fracture is a very rare and unusual complication, to the best of our knowledge has never been reported in literature. In this paper we report the case of entrapment of the distal axillary artery in the humerus rhyme fracture in a 9-year-old child who suffered a nighttime car-accident with her father. At admission, the child presented a left humeral neck fracture with no other lesions and no neurologic problems in her limb; peripheral pulses present in her left hand at palpation. After closed reduction and pinning of the fracture with 2 K-wires, the left upper limb became ischemic and pulseless and the child was transferred at our Institution for diagnosis and treatment. In this paper we discuss the treatment to be adopted in this very unusual situation.
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ranking = 1.4
keywords = neck
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9/20. Arthroscopic treatment of acute traumatic posterior glenohumeral dislocation and anatomic neck fracture.

    We describe a simple method of arthroscopic-assisted reduction of a posterior fracture dislocation of the proximal humerus, the principle of which could be used as a method of reduction for all fracture dislocations of the proximal humerus for which percutaneous reduction is beneficial. With the patient in the beach-chair position and using a posterior portal 2 cm medial and 2 cm inferior to the posterolateral corner of the acromion on the medial edge of the displaced head, a 4.5-mm blunt trocar is introduced, directed medial to the head fragment toward the posterior lateral scapular neck, translating the distal tip laterally to enter the shoulder joint. The trocar is then redirected medially onto the articular surface of the glenoid and the head is levered into the joint atraumatically. The standard technique of percutaneous reduction of the proximal humerus follows. Arthroscopic evaluation of the shoulder with gravity-assisted flow is performed to improve the articular reduction and document any associated capsular, ligamentous, labral, or tendon damage. Similarly, anterior fracture dislocations can be reduced atraumatically using lateral and anterior portals, after which percutaneous reduction could be effective when indicated.
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keywords = neck
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10/20. Experience on fracture dislocation of the humeral head. A report of two cases.

    Two cases of anterior-inferior fracture dislocations through the anatomical humeral neck combined with avulsion of the greater tuberosity are reviewed. The management, complications and results are analyzed.
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