MyMedR

Fulltext Anomalous third head of biceps brachii muscle and its variant insertion compresses surrounding neurovascular structure: a rare case report

Zar Chi, T., Ahmad Ruzain, S., Mohammad Johari, I., Syed Baharom S. A. F.

Medicine & Health, 2017;12(2):368-374.

MyJurnal

Bisep brachii (BB) adalah salah satu otot yang mempunyai pelbagai variasi.
Terkini, kebanyakan maklumat adalah berkenaan variasi asal otot, namun terdapat
beberapa kes yang melaporkan variasi dalam sisipan BB. Dibentangkan di sini
kes BB otot yang mempunyai kedua-dua varian asal dan sisipan dalam otot yang
sama. Varian asal BB adalah panjang dan besar di kepala ketiga (10.2 cm lebar
dan 4.9 cm tebal) yang timbul dari pertengahan badan humerus. Lebih signifikan
lagi, bahagian tengah kepala meliputi dan menyembunyikan bahagian bawah
saraf median dan arteri brachial sebagai gerbang yang berterusan medially untuk
disisipkan ke epicondyle medial humerus. Dalam laporan ini, kami membincangkan
mekanisma yang mungkin untuk pemampatan neurovaskular oleh kepala ketiga
otot BB yang tidak normal dan perubahan BB dari asal dan sisipan. Memahami
perubahan ini adalah sangat penting dalam prosedur pembedahan di sekeliling
sendi siku dan lengan atas dan ia juga memberi ruang untuk diagnosis pembezaan
sindrom perangkap saraf

Matched MeSH terms: Humerus

Supratrochlear foramen of the humerus

Das S

Anat Sci Int, 2008 Jun;83(2):120; author reply 121.

PMID: 18507622 DOI: 10.1111/j.1447-073X.2008.00232.x

Matched MeSH terms: Humerus/anatomy & histology*

Variant course of posterior circumflex humeral artery associated with the abnormal origin of radial collateral artery: could it mimic the quadrangular space syndrome?

Mohandas Rao KG, Somayaji SN, Ashwini LS, Ravindra S, Abhinitha P, Rao A, et al.

Acta Med Iran, 2012;50(8):572-6.

PMID: 23109033

Variations in the origin of axillary artery branches are common. But, distinctly abnormal course of its posterior circumflex humeral branch is rare. We are reporting a case of posterior circumflex humeral artery (PCHA) originating from the axillary artery, passing through lower triangular space to reach the scapular region where it accompanied the axillary nerve and posterior circumflex humeral vein to pass around surgical neck of humerus, deep to the fibers of deltoid. Other variations observed in this specimen were the radial collateral artery arising from the PCHA, middle collateral artery arising directly from the brachial artery and absence of profunda brachii artery. PCHA forming a hair pin loop, traversing through lower triangular space instead of quadrangular space taking a long course is being reported for the first time. Further, the clinical and surgical importance of this case especially in relation with quadrangular space syndrome and relevant literature is discussed.

Matched MeSH terms: Humerus/blood supply*

The carrying angle: racial differences and relevance to inter-epicondylar distance of the humerus

Allouh MZ, Abu Ghaida JH, Jarrar AA, Khasawneh RR, Mustafa AG, Bashaireh KM

Folia Morphol (Warsz), 2016 02 26;75(3):388-392.

PMID: 26916201 DOI: 10.5603/FM.a2016.0007

The human carrying angle (CA) is a measure of the lateral deflection of the forearm from the arm. The importance of this angle emerges from its functional and clinical relevance. Previous studies have correlated this angle with different parameters including age, gender, and handedness. However, no reports have focused on race-dependent variations in CA or its relation to various components of the elbow joint. This study aimed to investigate the variations in CA with respect to race and inter-epicondylar distance (IED) of the humerus. The study included 457 Jordanian and 345 Malaysian volunteers with an age range of 18-21 years. All participants were right-hand dominant with no previous medical history in their upper limbs. Both CA and IED were measured by well-trained medical practitioners according to a well-established protocol. Regardless of race, CA was greater on the dominant side and in females. Furthermore, CA was significantly greater in Malaysian males compared to Jordanian males, and significantly smaller in Malaysian females compared to their Jordanian counterparts. Finally, CA significantly decreased with increasing IED in both races. This study supports effects of gender and handedness on the CA independent of race. However, CA also varies with race, and this variation is independent of age, gender, and handedness. The evaluation also revealed an inverse relationship between CA and IED. These findings indicate that multiple factors including race and IED should be considered during the examination and management of elbow fractures and epicondylar diseases.

Matched MeSH terms: Humerus*

A new species of Kalophrynus with a unique male humeral spine from Peninsular Malaysia (Amphibia, Anura, Microhylidae)

Matsui M

Zoolog Sci, 2009 Aug;26(8):579-85.

PMID: 19719411 DOI: 10.2108/zsj.26.579

A new microhylid, Kalophrynus yongi, Is described from the Cameron Highlands of Peninsular Malaysia. Morphologically, the new species differs from all known congeners by having a very stout forelimb with a humeral spine in males. Acoustically, it resembles K. baluensis and K. heterochirus and sharply differs from K. interlineatus, K. pleurostigma, K. palmatissimus, and K. nubicola.

Matched MeSH terms: Humerus/anatomy & histology

Fulltext Wandering humeral head mimicking a breast mass

Tan GJS, Tan AGS, Peh WCG

Med J Malaysia, 2008 Jun;63(2):164-5.

PMID: 18942311

A 74-year-old woman was incidentally found to have a left breast mass. The mass could not be adequately compressed to be visualized on mammography. Ultrasonography showed a heavily-calcified rounded mass in the left axillary tail of the left breast. Chest radiograph confirmed that the mass was a migrated humeral head. Remotely-displaced fracture-dislocations of the humeral head are very rare and to our knowledge, displacement into the breast, clinically mimicking a breast mass, has not been previously described.

Matched MeSH terms: Humerus*

Fulltext Congenital humeroradial synostosis: a case report

Nema S, Vyas G, Sirsikar A, Bhoj PK

Malays Orthop J, 2012 Jun;6(SupplA):41-2.

PMID: 25279074 MyJurnal DOI: 10.5704/MOJ.1211.010

We present here a unique case of humeroradial synostosis. These anomalies are due to longitudinal failure of differentiation. Approximately 150 cases of humeroradial synostosis have been reported worldwide, the majority of which are familial in nature or associated with syndromes. The case presented here involves an infant aged 1½ months, born with bilateral humeroradial synostosis without familial or syndromic association. To the best of our knowledge, no such case has been reported in Asia.

Matched MeSH terms: Humerus

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: Humerus

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: Humerus

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

Santy JE, Kamal J, Abdul-Rashid AH, Ibrahim S

Malays Orthop J, 2015 Jul;9(2):13-16.

PMID: 28435603 MyJurnal DOI: 10.5704/MOJ.1507.006

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.

Matched MeSH terms: Humerus

Fulltext Separate Belly and Tendon of Flexor Digitorum Superficialis to the Fifth Digit

Rao M, Ashwini LS, Somayaji SN, Mishra S, Guru A, Rao A

Oman Med J, 2011 Nov;26(6):e027.

PMID: 28861181 DOI: 10.5001/omj.2011.120

Variation in the origin of long flexor tendons in the anterior compartment of forearm is common. During routine cadaveric dissection at Melaka Manipal Medical College (Manipal Campus), we observed a separate muscle belly and tendon of flexor digitorum superficialis (FDS) to the fifth digit in the right upper limb of a 60 year-old male cadaver. The anomalous muscle belly originated from the common flexor tendon from the medial epicondyle of the humerus and continued as a thin tendon at the middle of the forearm to get inserted into the middle phalanx of the fifth digit. This can be considered as a case of split flexor digitorum superficialis. Such muscle variations and knowledge of their frequency, appearance, and location can be helpful for surgeons.

Matched MeSH terms: Humerus

Fulltext Screw osteosynthesis of displaced lateral humeral condyle fractures in children: a mid-term review

Loke WP, Shukur MH, Yeap JK

Med J Malaysia, 2006 Feb;61 Suppl A:40-4.

PMID: 17042228

Displaced humeral condyle fractures in children are traditionally fixed with smooth Kirschner wire at the expense of a risk of secondary displacement following removal of wire. Screw fixation of such fractures has recently been advocated as it provides stable fixation. We have been using screw osteosynthesis for treatment of displaced lateral humeral condyle fractures in children in our institution since the turn of this century. This study provides a midterm review of treatment of such injuries with special regards to growth disturbances after screw osteosynthesis and to assess rate of union with a view to formulate guidelines for screw removal. We review the outcomes of screw osteosynthesis for displaced lateral condyle fracture of the humerus (19 Milch type-1 and 15 Milch type-II) in 34 children treated in our institution from January 2000 to March 2004. The average age of the patients was 6.1 years. The average follow up was 24.5 months. Screw osteosynthesis led to union (average 6.9 weeks) in all patients with excellent results in 28 patients. Growth disturbances in the form of lateral condyle overgrowth (2 patients), valgus deformity secondary to lateral condyle avascular necrosis (2 patients) and fishtail deformity ((3 patients) were recognized. The implants should not be removed until fracture union is established. Screw osteosynthesis of the lateral humeral condyle fracture prevents secondary fracture redisplacement and lateral condyle overgrowth is probably related to hyperemic response to metaphyseal fixation and early removal of implant before radiological union.

Matched MeSH terms: Humerus/injuries; Humerus/surgery*

Fulltext Forequarter amputation of the upper extremity for musculoskeletal tumors: posterior approach revisited

Faisham WI, Zulmi W, Nor Azman MZ, Rhendra Hardy MZ

Med J Malaysia, 2006 Feb;61 Suppl A:57-61.

PMID: 17042232

Forequarter amputation entails surgical removal of entire upper extremity, scapula and clavicle. Several techniques of forequarter amputation have been described. The anterior approach has been the preferred technique of exploration of axillary vessels and brachial plexus. The posterior approach has been condemned to be unreliable and dangerous for most large tumor of the scapula and suprascapular area. We describe a surgical technique using posterior approach of exploration of major vessels for forequarter amputation of upper extremity in eight patients who presented with humeral-scapular tumor. There were six patients with osteosarcoma: three with tumor recurrent and three chemotherapy recalcitrant tumors with vessels involvement. One patient had massive fungating squamous cell carcinoma and another had recurrent rhabdomyosarcoma. Four patients had fungating ulcer and six patients had multiple pulmonary metastases at the time of surgery. The mean estimated blood transfusion was 900 ml (range 0-1600 ml) and two patients did not require transfusion. The duration of surgery ranged 2.5-6.0 hours (mean 3.8 hours). Two patients with known pulmonary metastases required post-operative intensive care monitoring. The mean duration of survival was 5.8 months. The posterior approach of exploring major vessels for forequarter amputation of upper extremity with musculoskeletal tumor is safe and reliable.

Matched MeSH terms: Humerus/pathology; Humerus/surgery

Fulltext Simple approach to the management of aseptic non-union of the shaft of long bones

Devnani AS

Singapore Med J, 2001 Jan;42(1):20-5.

PMID: 11361233

Internal fixation with a plate in the management of non-union for shaft of long bones has been condemned but the review of the literature does not provide such unequivocal evidence. Also there are certain situations where it is either technically not feasible or contraindicated to do closed intramedullary nailing. This study was done to see the outcome of plate-fixation for the treatment of non-union of the shaft of long bones.

Matched MeSH terms: Humerus/injuries; Humerus/surgery

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: Humerus

a case with massive metastases to bone and soft tissues of arm

Lopez CG, Ganesan S, Dutt AK, Omar bin Din

Med J Malaya, 1969 Dec;24(2):154-7.

PMID: 4244143

Matched MeSH terms: Humerus

Modified French Osteotomy for Humeroradial Synostosis in a Child with Multiple Synostoses Syndrome: A Case Report

Sahdi H, Rasit AH, Khoo CS, Bojeng A, Nur-Alyana BA

Malays Orthop J, 2019 Jul;13(2):52-55.

PMID: 31467654 DOI: 10.5704/MOJ.1907.011

Congenital humeroradial synostosis can occur as an isolated clinical entity or as part of a syndrome. Bilateral elbow fixed flexion deformity is very incapacitating and challenging to treat. Here we present the case of a boy with fixed flexion deformity of both elbows due bilateral humeroradial synostosis. Other characteristic features of multiple synostoses syndrome were also present in this child, his elder brother and mother. We elected to improve the position of the right elbow by adapting the modified French osteotomy described by Bellemore et al.

Matched MeSH terms: Humerus

Fulltext Cubitus Valgus with Tardy Ulnar Nerve Palsy - Functional Outcome of Milch Osteotomy without Anterior Transposition of Ulnar Nerve

Gupta RK, Khiyani R, Majumdar KP, Potalia R

Malays Orthop J, 2020 Jul;14(2):120-125.

PMID: 32983386 DOI: 10.5704/MOJ.2007.021

Introduction: To assess the results of Milch osteotomy in terms of deformity correction and functional outcome in the absence of ulnar nerve transposition.

Material and Methods: Nine patients with cubitus valgus deformity greater than 20° with tardy ulnar nerve palsy (TUNP) operated between 2012 and 2017 were evaluated. Correction by Milch osteotomy and fixation was done in each case, without osteosynthesis of the non-union lateral condyle humerus or transposition of the ulnar nerve. At one year post-operatively, carrying angle, elbow function (Mayo Elbow Performance Score) and ulnar nerve symptoms were assessed.

Results: The mean carrying angle pre-operatively was 30.8° on the affected side which improved to a mean of 8.3° postoperatively with an average correction of 22.5°. The mean elbow flexion pre-operatively was 129.4° which improved to 133.3° post-operatively. The mean preoperative MEP score was 76.7 which improved to a mean of 92.2 post-operatively (p < 0.01). TUNP recovered completely in all the patients.

Conclusion: Milch osteotomy is an effective procedure for cubitus valgus deformity correction and its associated tardy ulnar nerve palsy without a decrease in elbow ROM. Correction of even severe valgus deformities without concurrent anterior transposition of the ulnar nerve is likely to improve ulnar nerve symptoms.

Matched MeSH terms: Humerus

Fulltext Biomechanical Analysis of Crossed Pinning Construct in Supracondylar Fracture of Humerus: Does the Point of Crossing Matter?

Hanim A, Wafiuddin M, Azfar MA, Awang MS, Nik Abdul Adel NA

Cureus, 2021 Mar 22;13(3):e14043.

PMID: 33898129 DOI: 10.7759/cureus.14043

Introduction This appears to be the first biomechanical study that compares the stability of various locations of the crossing points in crossed pinning Kirschner wiring (K-wire) construct in treating pediatric supracondylar humerus fracture (SCHF). Additionally, this study compared the biomechanical stability between crossed pinning K-wire construct and the three-lateral divergent K-wire construct. Methods For the study purpose, 30 synthetic humerus bones were osteotomised at mid-olecranon fossa, anatomically reduced, and pinned using two 1.6-millimeter K-wires in five different constructs. A total of six samples were prepared for each construct and tested for extension, flexion, valgus, varus, internal rotation, and external rotation forces. Results As for crossed pinning K-wire construct, the center crossing point emerged as the stiffest construct in both linear and rotational forces, in comparison to the lateral crossing point, superior crossing, and medial crossing point Conclusion Based on this analysis, it is highly recommended that, if the crossed pinning construct is selected to treat supracondylar humerus fracture, the surgeon should aim for center crossing point as it is the most stable construct. Nevertheless, if lateral and superior crossing points are obtained during the initial attempt of fixation, the fixation may be accepted without revising the K-wire as the stability of these two constructs are comparable and portrayed no significant difference when compared to that of the center crossing point. Additionally, it is essential to avoid the medial crossing point as it is significantly less stable in terms of rotational force when compared to the center crossing point.

Matched MeSH terms: Humerus

Fulltext PHILOS Plate as a Fixation of Proximal Humeral Fracture: A Revisit

Mohd Shaffid Md Shariff, Hanizah Ngadiron, Firdaus Hayati, Nornazirah Azizan, Affirul Chairil Ariffin

Borneo Journal of Medical Sciences, 2019;13(2):39-43.

MyJurnal

Fracture is common after trauma. Proximal humeral fracture can occur in the elderly after fall and in youngsters after motor vehicle accidents (MVA) and sport injuries. A 37-year-old man was admitted with a fracture of his left proximal humerus following an MVA. He sustained a 3-part fracture and treated surgically using a PHILOS plate. There are few options in managing proximal humerus fracture ranging from conservative to surgical intervention based on its severity. We reminiscent the usage of PHILOS plate as a mode of treatment of such fracture.

Matched MeSH terms: Humerus

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