MyMedR

Fulltext Retrospective Review of Kirschner Wire Fixation andCasting for Displaced Lateral Condylar Fracture of theHumerus in Children

Gooi, S.G, Chee, E.K., Wong, C.L., Mohana, R., Khoo, E.H., Thevarajan, K.

Malays Orthop J, 2008;2(2):17-20.

MyJurnal

This study was conducted to assess the optimum period for Kirschner wire fixation and cast immobilization for displaced lateral condylar fracture of the humerus in children. We retrospectively reviewed 12 patients with displaced lateral condyle humerus fracture, ranging in age from 3-9 y, with injuries that occurred between Jan 2005 and Dec 2006. All patients were treated with two Kirschner wire fixation and elbow immobilization. In all except 2 patients, the Kirschner wires were maintained for 3 to 4 weeks. Mean time for union was 3.78 weeks and mean humeroulnar arch motion at last review was 138.7 degrees. Only one patient had a 5 degree increased carrying angle in valgus as compared to the non-injured side, and 50% had prominent scars > 4mm. We conclude that fracture union can be expected within three to four weeks for most children after open reduction and fixation with 2 Kirschner wires.

Matched MeSH terms: Humerus

Fulltext Nonunion of Lateral Humeral Condylar Fracture in A Child with Cubitus Varus

Sulaiman, A.R., Munajat, I., Mohd, E.F., Sharifudin, M.A.

Malays Orthop J, 2010;4(3):29-31.

MyJurnal

Patients with cubitus varus deformity secondary to malunited supracondylar fracture are at risk for lateral humeral condylar (LHC) fracture. This report describes a child presenting with preexisting malunion of supracondylar fracture presenting along with nonunion of a LHC fracture following a recent injury. The patient underwent resection osteotomy of the metaphyseal proximal fragment of the fracture surface, reduction of the displaced LHC fragment and screw fixation. This procedure corrected the cubitus varus and treated the nonunion of the lateral condyle thus avoiding a supracondylar osteotomy procedure. Treatment resulted in solid union, good range of motion and no avascular necrosis.

Matched MeSH terms: Humerus

Osteomyelitis in childhood -the natural history documented by radiographs

Singh, H.

Malaysian Journal of Paediatrics and Child Health, 2000;12(1):74-76.

MyJurnal

It is very rare indeed in the practice of children's orthopaedics today in Malaysia that the natural history of long bone osteomyelitis is seen. A case is presented where a shoulder abscess in a 3-year-old child developed into septic arthritis of the shoulder and subsequently chronic osteomyelitis of the adjacent humerus. The parents refused active surgical debridement and sequestrectomies. Three years later the child had regenerated a new humerus over the sequestra. Radiographs are presented illustrating the entire natural history of osteomyelitis with the regeneration of a new humerus.

Matched MeSH terms: Humerus

Fulltext Factors influencing functional outcome of Philos Plate fixation for proximal humerus fractures

Hazwan Ab. Wahid, Khairul Nizam bin Siron, Ahmad Zakiran

International Medical Journal Malaysia, 2017;16(11):42-42.

MyJurnal

Displaced and unstable proximal humerus fractures are difficult to treat
and they have high morbidity. The main goal is to achieve painless shoulder with full
recovery of the shoulder joint motion. Impingement syndrome is one of the commonest
postoperative complication. This study aim is to appreciate the functional outcomes of
Philos-plate fixation for proximal humerus fractures and to establish association with
high plate positioning with impingement syndrome of the shoulder after Philos-plate
fixation. (Copied from article).

Matched MeSH terms: Humerus

Fulltext Complex Proximal Humeral Fracture Fixation with PHILOS Plate using Minimal Invasive Percutaneous Plate Osteosynthesis (MIPPO) Technique: A Series of 30 Patients

Narayanan VL, Balasubramanian N

Malays Orthop J, 2018 Jul;12(2):20-24.

PMID: 30112124 DOI: 10.5704/MOJ.1807.004

Introduction: Proximal humerus fracture fixation using plate osteosynthesis depends on the quality of the bone, design of the fixation devices and intra-operative soft tissue dissection. This study evaluates the functional outcome of minimally invasive percutaneous plate osteosynthesis using locking compression plate in proximal humerus fracture treatment. Materials and Methods: The study was conducted on 30 patients with complex proximal humerus fractures treated by minimally invasive percutaneous plate osteosynthesis using locking compression plate (PHILOS). There were 21 males and 9 females. The average age of our study group was 58.8 years. All the patients were evaluated at six weeks, three months, four months, six months and 12 months following surgery. Results: All patients had fracture union at an average of 13.2 weeks. The mean DASH score at the follow-up was 8.69 (2.5 to 17.16), the average range of flexion was 143.83 degrees (100 to 170 degrees) and abduction was 121.49 degrees (90 to 160 degrees). We had superficial infection in three patients which resolved with a short course of antibiotics. There was excellent outcome in 26 patients, good and fair in two patients each. Conclusion: Proximal humerus fractures treated with minimally invasive percutaneous plate osteosynthesis using locking compression plate with minimal soft tissue dissection, provides good functional outcome and early return of shoulder function.

Matched MeSH terms: Humerus

Fulltext Avulsion Fracture of Brachioradialis Muscle Origin: An Exceedingly Rare Entity: A Case Report

Behera G, Balaji G, Menon J, Sharma D, Komuravalli VK

Malays Orthop J, 2016 Jul;10(2):50-52.

PMID: 28435562 DOI: 10.5704/MOJ.1607.010

Avulsion fracture of the brachioradialis origin at its proximal attachment on the lateral supracondylar ridge of the distal humerus is exceedingly rare, and only two cases have been reported in the literature so far. In this article, we present a 38 years old patient who sustained a closed avulsion fracture of the lateral supracondylar ridge of left humerus at the proximal attachment of brachioradialis following a fall backwards on outstretched hand after being struck by a lorry from behind while riding on a two-wheeler (motorcycle). He was managed with above elbow plaster for four weeks followed by elbow and wrist mobilization. At final followup, the patient had painless full range elbow motion with good elbow flexion strength. The unique mechanism by which this avulasion fracture occurred is explained on the basis of the mode of injury, position of the limb and structure and function of the brachioradialis muscle.

Matched MeSH terms: Humerus

A Rare Case of a Distal Humerus Pathological Fracture from Klebsiella Pneumoniae Osteomyelitis: A Case Report

Chan MF, Kwek E

Malays Orthop J, 2020 Mar;14(1):81-83.

PMID: 32296487 DOI: 10.5704/MOJ.2003.013

Klebsiella pneumoniae is one of the leading causative organisms in pyogenic liver disease. It can cause disseminated infections, but rarely to bone, and rarely in healthy hosts. We report an unusual case of a distal humerus fracture from osteomyelitis secondary to dissemination in a non-immuno-compromised patient. The patient was surgically managed with external fixation and insertion of anti-biotic beads, in conjunction with medical therapy via culture direct antibiotics. This report highlights the diagnostic approach and treatment options for these atypical cases.

Matched MeSH terms: Humerus

Fulltext Moulded cement-prosthesis for osteosarcoma of the proximal humerus

Pan KL, Ong GB, Potukuchi AP

Med J Malaysia, 2006 Dec;61 Suppl B:55-7.

PMID: 17600994

We report a case of an 11-year-old boy with osteosarcoma of the proximal humerus treated with wide excision and reconstruction with a cement spacer-prosthesis. After seven years of follow-up, the patient is now almost a young adult. We present his current physical and functional status, which seems to defray the initial doubts regarding long-term problems when we chose this method of reconstruction.

Matched MeSH terms: Humerus*

Implantation metastasis in a 13-year-old girl: a case report

Singh C, Ibrahim S, Pang KS, Shanti S

J Orthop Surg (Hong Kong), 2003 Jun;11(1):94-6.

PMID: 12810979

We report a case of a 13-year-old girl with an osteosarcoma of the right humerus, which had been diagnosed as an aneurysmal bone cyst at our institution. She underwent curettage and bone grafting of the lesion, which resulted in implantation metastasis of the tumour to the ilium. She died 15 months after presentation owing to pulmonary metastases. This report highlights the possibility of metastasis occurring by direct implantation to a graft donor site. We strongly recommend that a biopsy be performed in cases of presumed benign lesions before proceeding with the definitive surgery.

Matched MeSH terms: Humerus/surgery*

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: Humerus/surgery*

Unusual origin of radial collateral artery noted in quadrangular space syndrome

Mohandas Rao KG, Bhat SM, Vollala VR

J Chin Med Assoc, 2006 Jun;69(6):276-7.

PMID: 16863014

In this paper, an unusual origin of the radial collateral artery of the arm is reported. The radial collateral artery in one of the cadavers dissected by us originated from the posterior circumflex humeral artery. The importance of this abnormal origin of the radial collateral artery from the posterior circumflex humeral artery in quadrangular space syndrome is discussed.

Matched MeSH terms: Humerus/blood supply

Late presentation of supracondylar fracture of the humerus in children

Devnani AS

Clin Orthop Relat Res, 2005 Feb.

PMID: 15685053

In children with delayed presentation of displaced supracondylar fractures, closed or open reduction with K-wire fixation risks complications. Gradually reducing the fracture with traction potentially reduces these risks. An unacceptable deformity can be corrected later by an osteotomy. This concept was used for 28 children, with an average age of 7 years 6 months, who presented after an average delay of 5.6 days. Their stay in the hospital was 14 days on average. At followup (average, 24 months), five children (18%) who had cubitus varus greater than 10 degrees had corrective osteotomy. There were no additional neurovascular injuries after treatment. The results are comparable with other methods of treatment.

Matched MeSH terms: Humerus/injuries*

Fulltext Cubitus Valgus with Tardy Ulnar Nerve Palsy - Is Anterior Transposition of the Ulnar Nerve Always Necessary? A Case Report

Anuar-Ramdhan IM, Remli R, Abdul-Rashid AH, Ibrahim S

Malays Orthop J, 2020 Jul;14(2):126-129.

PMID: 32983387 DOI: 10.5704/MOJ.2007.010

Tardy ulnar nerve palsy is a known complication of cubitus valgus. The options for treating the ulnar neuropathy include anterior nerve transposition or neurolysis. We report on an 11-year-old boy who had a tardy ulnar nerve palsy due to cubitus valgus resulting from a non-union of a lateral condyle fracture of the humerus. Anterior transposition of the ulnar nerve was not done after the closing wedge osteotomy of the distal humerus. The close wedge osteotomy relieved the tension on the nerve and not transposing the ulnar nerve anteriorly prevented an iatrogenic nerve injury. The patient had no restriction with activities of daily living at the six years follow-up although neurological recovery was incomplete.

Matched MeSH terms: Humerus

Fulltext Humeral Supracondylar Fractures in Children: A Novel Technique of Lateral External Fixation and Kirschner Wiring

Kow RY, Zamri AR, Ruben JK, Jamaluddin S, Mohd-Nazir MT

Malays Orthop J, 2016 Jul;10(2):41-46.

PMID: 28435560 MyJurnal DOI: 10.5704/MOJ.1607.008

Introduction: Supracondylar fracture of the humerus is the most common fracture around the elbow in children. Pinning with Kirschner wires (K-wires) after open or closed reduction is generally accepted as the primary treatment modality. However, it comes with the risk of persistent instability and if the K-wire is not inserted properly, it may cause displacement and varus deformity. We present our two-year experience with a new technique of lateral external fixation and K-wiring of the humeral supracondylar fracture. Materials and Methods: A total of seven children with irreducible Gartland Type III supracondylar humeral fracture were treated with closed reduction and lateral external fixation and lateral Kirschner wiring. Patients with ipsilateral radial or ulnar fracture, open fracture and presence of neurovascular impairment pre-operatively were excluded. All the patients were followed up at one, three and six weeks and three and six months. The final outcomes were assessed based on Flynn's criteria. Results: All the patients achieved satisfactory outcomes in terms of cosmetic and functional aspects. All patients except one (85.5%) regained excellent and good cosmetic and functional status. One patient (14.3%) sustained pin site infection which resolved with oral antibiotic (Checketts- Otterburn grade 2). There was no neurological deficit involving the ulnar nerve and radial nerve. Conclusion: The introduction of lateral external fixation and lateral percutaneous pinning provide a promising alternative method for the treatment of humeral supracondylar fracture. This study demonstrates that it has satisfactory cosmetic and functional outcomes with no increased risk of complications compared to percutaneous pinning.

Matched MeSH terms: Humerus

Fulltext Giant Chondrosarcoma of Proximal Humerus in an Adult Female Patient: A Case Report

Ng CK, Azuhairy A, Tan LH, Nordin A

Malays Orthop J, 2015 Jul;9(2):51-53.

PMID: 28435611 MyJurnal DOI: 10.5704/MOJ.1507.001

Chondrosarcoma is the third most common primary tumour of the bone, after myeloma and osteosarcoma. Most of the chondrosarcoma grow slowly and rarely metastasize, and they have an excellent prognosis after adequate surgery. However most of them are chemo or radio-resistant. We report a case of primary chondrosarcoma of proximal humerus in a 36-year-old female who presented with a six years history of left shoulder swelling and restricted range of motion. Trucut biopsy showed a well-differentiated chondrosarcoma. The patient underwent forequarter amputation of left upper limb and was started on chemotherapy following operation.

Matched MeSH terms: Humerus

Fulltext A Limb-Threatening Long Arterial Dissection Caused by Humerus Neck Fracture: A Case Report

Kurnaz R, Ikizler M, Ozbayburtlu M, Gunes T

Malays Orthop J, 2018 Mar;12(1):51-53.

PMID: 29725515 DOI: 10.5704/MOJ.1803.012

Proximal humerus fracture is a common arm trauma and rarely occurs with vascular injury which however is a serious complication. In this case report, we present a long segment dissection of the axillary and brachial arteries as a rare complication due to fragmented proximal humerus fracture and shoulder dislocation. An 80-year old female patient was seen at the emergency department. Radiograph examination has revealed a fragmented proximal humerus fracture besides dislocation of the head of humerus towards the axillary area. On vascular examination, acute arterial occlusion such as absence of radial and ulnar pulses were observed in her left hand. The patient was immediately taken to the operating room. The dissection included the entire segment approximately 20cm between the distal subclavian artery and the distal brachial artery. This injured segment was removed and a 6mm Polytetrafluroethylene (PTFE) graft with rings was interpositoned between subclavian and brachial arteries. This case is a rarity because of such a significant complication after a small injury. Axillary artery injuries caused by humeral neck fractures are rare but should not be missed by the physician.

Matched MeSH terms: Humerus

Fulltext Bilateral Asymmetrical Fracture Dislocation of Shoulder with Rare Combination of Injuries after Epileptic Seizure: A Case Report

Sharma A, Jindal S, Narula MS, Garg S, Sethi A

Malays Orthop J, 2017 Mar;11(1):74-76.

PMID: 28435581 DOI: 10.5704/MOJ.1703.011

The incidence of bilateral gleno-humeral joint dislocation is rare, is almost always posterior and is usually caused by sports injuries, epileptic seizures, electrical shock, or electroconvulsive therapy. Bilateral fracture-dislocation is even rarer, with a few cases reported in the literature. We report an unusual case with dislocation of the both glenohumeral joints in opposite direction after a seizure episode, with fracture of greater tuberosity on one side and of the lesser tuberosity on the contralateral side. Although there have been a few reports of bilateral asymmetric fracture dislocations of the shoulder in the past, an injury pattern resembling our case has, to the best of our knowledge, not been described in the literature so far. This report includes a detailed discussion regarding the mechanism of injury in a case of asymmetrical dislocation following a seizure episode. At final follow-up, the patient had healed fractures, painless near normal range of motion with no redislocations.

Matched MeSH terms: Humerus

Syringomyelic neuropathic ulcer of the elbow: treatment with an external fixator

Yeap JS, Wallace AL

J Shoulder Elbow Surg, 2003 Sep-Oct;12(5):506-9.

PMID: 14564278 DOI: 10.1016/S1058-2746(03)00168-X

Matched MeSH terms: Humerus/surgery

Growth patterns of the humeral and femur length in a multiethnic population

Raman S, Teoh T, Nagaraj S

Int J Gynaecol Obstet, 1996 Aug;54(2):143-7.

PMID: 9236312

OBJECTIVES: To study whether there are any differences in growth of the femoral and humeral length between the three major ethnic groups in Malaysia viz Malays, Chinese and Indians. The effect on fetal growth by gender of the baby and parity of the mother was also studied.

METHODS: The setting was the University of Kuala Lumpur. Thirty-four Malay, 35 Chinese and 34 Indian normal pregnant middle-class women were studied longitudinally by monthly ultrasound scans for 18 to 38 weeks of gestation. The data were subjected to regression analysis; the quadratic curve was found to be the most adequate. Dummy variables were used to determine any effects by gender, parity as well as ethnicity on the length of limb growth. There was no difference in birth weights of the three ethnic groups studied, nor in gender or parity.

RESULTS: There were found to be significant differences in limb lengths of the Indians (longer) when compared with the Malays and Chinese. Parity seems to affect only Indians in whom the multiparous fetuses have shorter limb lengths than the primaparous. There appears to be no effect by gender.

CONCLUSION: There appear to be definite differences in growth of limb length between the different Malaysian ethnic groups and this should be taken into account when growth charts are used and when fetal weight formulas are calculated using limb lengths. The limitation of this study was that the numbers of subjects studied were small. Larger studies will be able to confirm or refute the findings.

Matched MeSH terms: Humerus/growth & development*

Fulltext Early complication following long bone reconstruction using vascularised fibula graft

Imran Y, Zulmi W, Halim AS

Med J Malaysia, 2004 Dec;59 Suppl F:35-8.

PMID: 15941158

Long bone reconstruction using vascularized fibula graft is becoming more popular despite the difficulties and its post-operative complications. We reviewed our early experience dealing with vascularized fibula graft for the management of massive long bone defect. Thirteen patients had undergone long bone reconstruction using vascularized fibula graft. Early complications that had been encountered include superficial wound infection (23%), transient common peroneal nerve palsy (23%), stage 1 bed sore (7.7%), anastomotic venous thrombosis (30.8%), DIVC (15.4%), flap loss and amputation (7.7%), and reactive psychiatric problem (7.7%). The early complications following this procedure are comparable with other major orthopaedic surgery and most of them are minor and treatable. The complication rates are also comparable with similar surgery done elsewhere.

Matched MeSH terms: Humerus/surgery

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