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Archives of Orthopaedic and Trauma... Dec 2022Surgical training and biomechanical testing require models that realistically represent the in vivo injury condition. The aim of this work was to develop and test a...
INTRODUCTION
Surgical training and biomechanical testing require models that realistically represent the in vivo injury condition. The aim of this work was to develop and test a method for the generation of distal humerus fractures and olecranon fractures in human specimens, while preserving the soft tissue envelope.
METHODS
Twenty-one cadaveric upper extremity specimens (7 female, 14 male) were used. Two different experimental setups were developed, one to generate distal humerus fractures and one to generate olecranon fractures. Specimens were placed in a material testing machine and fractured with a predefined displacement. The force required for fracturing and the corresponding displacement were recorded and the induced energy was derived of the force-displacement graphs. After fracturing, CT imaging was performed and fractures were classified according to the AO classification.
RESULTS
Eleven distal humerus fractures and 10 olecranon fractures with intact soft tissue envelope could be created. Distal humerus fractures were classified as AO type C (n = 9) and as type B (n = 2), all olecranon fractures were classified as AO type B (n = 10). Distal humerus fractures required significantly more load than olecranon fractures (6077 N ± 1583 vs 4136 N ± 2368, p = 0.038) and absorbed more energy until fracture than olecranon fractures (17.8 J ± 9.1 vs 11.7 J ± 7.6, p = 0.11), while the displacement at fracture was similar (5.8 mm ± 1.6 vs 5.9 mm ± 3.1, p = 0.89).
CONCLUSION
The experimental setups are suitable for generating olecranon fractures and distal humerus fractures with intact soft tissue mantle for surgical training and biomechanical testing.
Topics: Male; Female; Humans; Olecranon Process; Humeral Fractures; Fracture Fixation, Internal; Elbow Joint; Humerus; Ulna Fractures; Treatment Outcome; Elbow Injuries
PubMed: 34973090
DOI: 10.1007/s00402-021-04286-0 -
Cirugia Y Cirujanos 2021The reconstruction of the proximal humerus is possible from the resection of the tumor and the placement of a prosthesis. In some cases, they do not meet the...
BACKGROUND
The reconstruction of the proximal humerus is possible from the resection of the tumor and the placement of a prosthesis. In some cases, they do not meet the anthropometric aspects of the patients.
OBJECTIVE
To determine the parameters to size the components of a humeral prosthesis and the development of a set, using design software.
METHOD
Forty patients were selected for prostheses, radiographs and CT scans were analyzed and statistical tests were applied to the measurements.
RESULTS
The length of the tumors was 8-20 cm. The minimum length of the humerus was 28 cm and 33 cm the maximum. Correlation was observed between the humerus and the tumor and the height of the patient with p = 0.93088 and p = 0.904564, respectively; humerus diameter, p = 0.2345. The set will include three components, diameter 6-10 mm, and length of 24, 26 and 28 cm. Three modular spacers with lengths of 6, 8.5 and 13 cm. Crowns 6.5 and 8.5 cm long, 1.3 cm in diameter and 5 mm nut.
CONCLUSION
With the development of the set, poorly calculated resections and adaptation to any humerus size can be resolved.
Topics: Bone Neoplasms; Humans; Humerus; Osteosarcoma; Prostheses and Implants; Prosthesis Design; Treatment Outcome
PubMed: 33498062
DOI: 10.24875/CIRU.20001695 -
PeerJ 2022The Plesiosauria (Sauropterygia) are secondary marine diapsids. They are the only tetrapods to have evolved hydrofoil fore- and hindflippers. Once this specialization of...
BACKGROUND
The Plesiosauria (Sauropterygia) are secondary marine diapsids. They are the only tetrapods to have evolved hydrofoil fore- and hindflippers. Once this specialization of locomotion had evolved, it remained essentially unchanged for 135 Ma. It is still controversial whether plesiosaurs flew underwater, rowed, or used a mixture of the two modes of locomotion. The long bones of Tetrapoda are functionally loaded by torsion, bending, compression, and tension during locomotion. Superposition of load cases shows that the bones are loaded mainly by compressive stresses. Therefore, it is possible to use finite element structure analysis (FESA) as a test environment for loading hypotheses. These include muscle reconstructions and muscle lines of action (LOA) when the goal is to obtain a homogeneous compressive stress distribution and to minimize bending in the model. Myological reconstruction revealed a muscle-powered flipper twisting mechanism. The flippers of plesiosaurs were twisted along the flipper length axis by extensors and flexors that originated from the humerus and femur as well as further distal locations.
METHODS
To investigate locomotion in plesiosaurs, the humerus and femur of a mounted skeleton of (Middle Jurassic Oxford Clay Formation from Britain) were analyzed using FE methods based on the concept of optimization of loading by compression. After limb muscle reconstructions including the flipper twisting muscles, LOA were derived for all humerus and femur muscles of by stretching cords along casts of the fore- and hindflippers of the mounted skeleton. LOA and muscle attachments were added to meshed volumetric models of the humerus and femur derived from micro-CT scans. Muscle forces were approximated by stochastic iteration and the compressive stress distribution for the two load cases, "downstroke" and "upstroke", for each bone were calculated by aiming at a homogeneous compressive stress distribution.
RESULTS
Humeral and femoral depressors and retractors, which drive underwater flight rather than rowing, were found to exert higher muscle forces than the elevators and protractors. Furthermore, extensors and flexors exert high muscle forces compared to Cheloniidae. This confirms a convergently evolved myological mechanism of flipper twisting in plesiosaurs and complements hydrodynamic studies that showed flipper twisting is critical for efficient plesiosaur underwater flight.
Topics: Finite Element Analysis; Femur; Humerus; Lower Extremity; Muscle, Skeletal; Muscle Strength
PubMed: 35677394
DOI: 10.7717/peerj.13342 -
BMC Musculoskeletal Disorders Sep 2022For patients with malignant limb tumors, salvage surgery can be achieved using endoprosthesis or biological reconstructions like allograft or autograft. In carefully... (Review)
Review
BACKGROUND
For patients with malignant limb tumors, salvage surgery can be achieved using endoprosthesis or biological reconstructions like allograft or autograft. In carefully selected patients, resected bone can be recycled after sterilization using methods like autoclaving, irradiation, pasteurization or freezing with liquid nitrogen. We evaluated the clinical outcome and complications of malignant limb tumors treated with intercalary resection and frozen autograft reconstruction.
METHODS
We reviewed 33 patients whose malignant bone tumors were treated by wide resection and reconstruction with recycling liquid nitrogen-treated autografts between 2006 and 2017. Limb function, bone union at the osteotomy site and complications were evaluated. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system.
RESULTS
The cohort comprised 16 males and 17 females, with a mean age of 35.4 years (14-76 years). The most common tumor was osteosarcoma (7 cases). Tumors were located in the humerus (5), ulna (1), femur (10) and tibia (17). The mean follow-up was 49.9 months (range 12-127 months). Of the 33 patients, 16 remained disease-free, and 3 were alive with disease. The mean size of the defect after tumor resection was 11.6 cm (range 6-25 cm). Bone union was achieved in 32 patients, with a mean union time of 8.8 months (range 4-18 months). Complications included 1 graft nonunion, 2 infections (1 superficial, 1 deep infection), 1 leg length discrepancy, 2 graft fractures and 3 local recurrences. The mean MSTS score was 87.2% (range 70-100%).
CONCLUSION
Liquid nitrogen-treated tumor-bearing autograft is an effective option for biological reconstruction after meta-/diaphyseal tumor resection of long bones. This method has excellent clinical outcomes and is especially recommended for patients with no severe osteolytic bone tumors.
Topics: Adult; Autografts; Bone Neoplasms; Bone Transplantation; Extremities; Female; Freezing; Humans; Humerus; Male; Nitrogen; Osteosarcoma; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome
PubMed: 36180843
DOI: 10.1186/s12891-022-05840-6 -
Anatomical Record (Hoboken, N.J. : 2007) Oct 2019Percutaneous osseointegrated (OI) prosthetic limb attachment holds promise for transhumeral amputees. Understanding humeral medullary morphology is necessary for...
Percutaneous osseointegrated (OI) prosthetic limb attachment holds promise for transhumeral amputees. Understanding humeral medullary morphology is necessary for informed design of upper extremity OI systems, and is beneficial to the field of megaprosthetic reconstruction of the distal humerus where diaphyseal fixation is desired. The purpose of this study was to quantify the sex and laterality differences in humerus morphology, specifically over the diaphysis. Three-dimensional surface reconstructions of 58 pairs of cadaveric humeri (43 male, 15 female) were generated from CT data. Measures describing periosteal and medullary morphology were collected relative to an anatomic coordinate system. Sex and laterality differences in biomechanical length (BML) were observed (P ≤ 0.001 and 0.022, respectively). Head radius was larger in males than females (P ≤ 0.001). Retroversion was increased in right humeri relative to left (P ≤ 0.001). Canal orientation exhibited a conformational shift from anteversion to retroversion distally at approximately 65% BML. Right humeri exhibited larger medullary diameters than left in the 1st and 2nd principal directions (P ≤ 0.024). Males displayed larger diameter medullary canals proximally (P ≤ 0.029) and an increased rate of divergence of the endosteal cortex in the proximal diaphysis (P ≤ 0.009). Females exhibited higher canal aspect ratios at mid-shaft (P ≤ 0.014) and lower mean cortical thickness (P ≤ 0.001). Human humeral diaphysis morphology exhibits sex and laterality differences, which are dependent on position along the diaphysis. Understanding humeral morphology is necessary to achieve adequate primary stability and bone apposition in design of endoprosthetic stems for percutaneous OI implants, and distal humerus replacement. Anat Rec, 302:1709-1717, 2019. © 2019 The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association for Anatomy.
Topics: Adolescent; Adult; Arm; Artificial Limbs; Bone-Anchored Prosthesis; Cadaver; Female; Humans; Humerus; Imaging, Three-Dimensional; Male; Middle Aged; Prosthesis Design; Sex Factors; Shoulder Joint; Tomography, X-Ray Computed; Young Adult
PubMed: 30989818
DOI: 10.1002/ar.24138 -
Current Oncology (Toronto, Ont.) Mar 2023(1) Background: Some of the goals of orthopedic surgical oncology are saving limbs and function. The humerus is the third most frequent site in primary tumors and one of... (Observational Study)
Observational Study
(1) Background: Some of the goals of orthopedic surgical oncology are saving limbs and function. The humerus is the third most frequent site in primary tumors and one of the most involved sites for metastases. Prosthetic replacement with modular megaprosthesis is one of the treatment choices, but there are several types of complications, such as problems with function and pain. The aim of our study is to assess functional outcomes and shoulder instability in the reconstruction of proximal humerus metastases. (2) Methods: This is a retrospective observational study. Twenty-eight patients, with proximal humerus metastases, admitted to the department of Orthopaedics and Traumatology of our University Hospital between 2014 and 2022 were recruited. Each patient underwent resection and prosthetic replacement surgery with modular megaprosthesis. Clinical evaluation was assessed through MSTS score, WOSI index, and DASH score. (3) Results: Twenty patients were included in the study. Fairly good results, especially regarding pain, function, and emotional acceptance, were obtained in all three tests: DASH, MSTS, and WOSI. Patients who reported shoulder instability actually have worse outcomes than those who report having stable shoulders. In addition, patients with a resection >10 cm have worse outcomes than those who had a resection of 10 cm. No significant differences were found between the deltopectoral approach group and the lateral approach group. (4) Conclusions: Reconstructive surgery with megaprosthesis of the proximal humerus in patients with metastases can be considered a treatment option, especially in patients with pathological fractures or injuries with a high risk of fracture and good life expectancy. This study shows how this type of surgery affects instability, but in terms of functionality, pain, and patient satisfaction, it gives satisfactory results.
Topics: Humans; Shoulder; Shoulder Joint; Joint Instability; Bone Neoplasms; Treatment Outcome; Humerus; Pain
PubMed: 37185385
DOI: 10.3390/curroncol30040272 -
Joint Diseases and Related Surgery 2022In this case series, we aimed to evaluate the clinical and radiographic outcomes of the patients with infrafossal fracture of the humerus and to evaluate the upper...
OBJECTIVES
In this case series, we aimed to evaluate the clinical and radiographic outcomes of the patients with infrafossal fracture of the humerus and to evaluate the upper extremity and elbow function with the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire.
PATIENTS AND METHODS
Between January 2005 and July 2020, the clinical data and radiographs of 2,443 children who were treated due to distal humerus fracture were retrospectively analyzed. A total of six patients (5 males, 1 female; mean age: 6.7±2.6 years, range, 3 to 11 years) treated due to an infrafossal fracture of the humerus were included. Radiographic measurements, such as Baumann's angle, lateral capitellohumeral angle, and carrying angle of the elbow, were performed. At the final follow-up, elbow joint range of motion (ROM) was measured, functional scores of the elbow and upper extremity were assessed. Complications were also recorded.
RESULTS
The mean follow-up was 62.8±47.4 (range, 20 to 140) months. Two patients underwent open and three underwent closed reduction and internal fixation by different surgeons. One of the patients was treated with a long-arm cast. There was no major elbow ROM limitation. There was no significant deterioration in the lateral capitellohumeral and elbow carrying angles of the patients. Baumann's angle was normal for all the patients; however, it could not be measured in two patients, as their epiphyses were closed. Four patients had an excellent MEPS and two patients a good MEPS. The QuickDASH scores were low in all patients. There were two patients with cubitus varus who were treated surgically using lateral closing-wedge corrective osteotomy.
CONCLUSION
Infrafossal fracture of the humerus is a fracture type which is different from supracondylar and transcondylar fractures and has not been previously reported in the literature. Despite the cubitus varus developed in two of our patients, functionally satisfactory results were achieved in all patients at the end of the treatment. Due to the risk of developing cubitus varus, patients with infrafossal fracture of the humerus should be followed closely until the end of adolescence. Although the current study is very limited in terms of being a guide for the treatment, it may contribute to the literature in terms of defining a new fracture subtype.
Topics: Male; Adolescent; Child; Humans; Female; Child, Preschool; Humeral Fractures; Joint Deformities, Acquired; Retrospective Studies; Follow-Up Studies; Treatment Outcome; Humerus
PubMed: 36345194
DOI: 10.52312/jdrs.2022.717 -
BMC Musculoskeletal Disorders Jan 2022Posttraumatic shoulder stiffness remains a problem after proximal humerus fracture (PHF) despite good healing rates. The aim of this pilot study was to determine whether...
Functional outcomes before and after implant removal in patients with posttraumatic shoulder stiffness and healed proximal humerus fractures: does implant material (PEEK vs. titanium) have an impact? - a pilot study.
BACKGROUND
Posttraumatic shoulder stiffness remains a problem after proximal humerus fracture (PHF) despite good healing rates. The aim of this pilot study was to determine whether the implant material and overlying soft tissue have an effect on shoulder range of motion (ROM) before and after implant removal (IR).
METHODS
16 patients (mean age 55.2 ± 15.3 (SD) years; 62.5% female) were included who underwent operative treatment with locking plates of either carbon fiber reinforced Polyetheretherketone (PEEK) (PEEKPower® humeral fracture plate, Arthrex, Naples, Florida, USA, n = 8) or titanium alloy (Ti) (Philos®, DePuy Synthes, Johnson & Johnson Medical, Raynham, Massachusetts, USA, n = 8) for PHF. All patients presented with a limited ROM and persistent pain in everyday life after the fracture had healed, whereupon IR was indicated. ROM before and after IR were compared as well as the Constant Score (CS) and the CS compared to the contralateral shoulder (%CS) 1 year after IR.
RESULTS
In group PEEK, elevation was 116.3° ± 19.2° pre- and 129.4° ± 23.7° post-IR (p = 0.027). External rotation was 35.0° ± 7.6° pre- and 50.6° ± 21.8° post-IR (p = 0.041). External rotation with the humerus abducted 90° was 38.8° ± 18.1° pre- and 52.5° ± 25.5° post-IR (p = 0.024). In group Ti, elevation was 110.0° ± 34.6° pre- and 133.8° ± 31.1° post-IR (p = 0.011). External rotation with the humerus at rest was 33.8° ± 23.1° pre- and 48.8° ± 18.7° post-IR (p = 0.048). External rotation with the humerus abducted 90° was 40.0° ± 31.6° pre- and 52.5° ± 22.5° post-IR (p = 0.011). Comparison of the two implant materials showed no significant difference. The overall CS was 90.3 ± 8.8, the %CS was 91.8% ± 14.7%.
CONCLUSION
There was no significant difference in ROM, CS and %CS with respect to plate materials, although lower cell adhesion is reported for the hydrophobic PEEK. However, all patients showed improved functional outcomes after IR in this pilot study. In patients with shoulder stiffness following locked plating for PHF, implants should be removed and open arthrolysis should be performed, independently from the hardware material.
LEVEL OF EVIDENCE
II.
Topics: Adult; Aged; Benzophenones; Bone Plates; Female; Fracture Fixation, Internal; Humans; Humerus; Male; Middle Aged; Pilot Projects; Polymers; Retrospective Studies; Shoulder; Shoulder Fractures; Titanium; Treatment Outcome
PubMed: 35086539
DOI: 10.1186/s12891-022-05061-x -
Clinical Medicine & Research Jun 2023Humeral fractures in arm wrestling are rarely reported entities in the orthopedic literature and can present with significant pain and debilitation. These injuries are... (Review)
Review
Humeral fractures in arm wrestling are rarely reported entities in the orthopedic literature and can present with significant pain and debilitation. These injuries are even more uncommon in female practitioners of the sport. Rotational forces applied to the humerus during competition can result in the transmission of stress into the distal part of the humerus, thereby causing a spiral fracture. Common complications that can arise from such an injury can include radial nerve palsy and butterfly fragments of the humerus. These can occur in arm wrestling and can present with prominent pain, weakness, and functional impairment. Treatment often varies according to the presenting case and are often operative in cases with displaced fractures, and non-operative in those of nondisplaced fractures. Prognostic outcomes are often favorable and uneventful. In this article, we explore a distal humeral fracture in a female arm wrestler and discuss the mechanism, presentation, and management of such an injury, based on a thorough yet concise review of literature.
Topics: Humans; Female; Arm; Humeral Fractures; Humerus; Radial Neuropathy; Patient-Centered Care; Retrospective Studies
PubMed: 37407215
DOI: 10.3121/cmr.2023.1787 -
The Iowa Orthopaedic Journal 2004Seven patients underwent 9 ulnohumeral arthroplasties for degenerative arthritis of the elbow. At mean follow-up of 26 months, 5 elbows were pain free; two continued to...
Seven patients underwent 9 ulnohumeral arthroplasties for degenerative arthritis of the elbow. At mean follow-up of 26 months, 5 elbows were pain free; two continued to cause mild pain and one to cause moderate pain. Extension improved from 22 degrees+/-8 degrees preoperatively to 12 degrees+/-9 degrees postoperatively (p=0.02); the average correction was 10 degrees+/-10 degrees. Flexion improved from 122 degrees+/-8 degrees to 133 degrees +/- 8 degrees (p=0.02); the average correction was 11 degrees+/-11 degrees. One patient had a late supracondylar humerus fracture which healed well with open reduction and internal fixation. Overall, we believe that ulnohumeral arthroplasty is relatively safe and easy to perform. Our patients did have modest improvements in range of motion, but complete relief of pain occurred in only about two thirds of the patients.
Topics: Adult; Aged; Arthroplasty; Elbow Joint; Female; Humans; Humerus; Male; Middle Aged; Osteoarthritis; Radiography; Range of Motion, Articular; Ulna
PubMed: 15296206
DOI: No ID Found