Co-existing fractures of the proximal humerus and humeral shaft without shoulder dislocation – a rare injury

Multiple fractures of the humerus are a rare injury and usually associated with high-energy trauma. We report an unusual injury with co-existing fractures of the proximal humerus and humeral shaft without shoulder dislocation. We discuss our experience in the diagnosis and treatment of a 39-year-old man with co-existing fractures of proximal humerus and ipsilateral humeral shaft with radial nerve deficit. He was successfully managed with open reduction and fixation of the fractures. At follow-up 1 year after injury, he is back at work and has a good range of shoulder movements. The radial nerve injury is showing signs of recovery. In high-energy trauma to the shoulder, unusual fracture patterns with associated neurovascular deficits may be seen and this case report describes our experience with one such rare injury.     

锁定加压钢板治疗肱骨干骨折内固定术后骨不连

目的 探讨应用锁定加压钢板联合自体髂骨植骨的方法治疗肱骨干骨折内固定术后骨不连的效果。方法 2004年5月～2006年12月收治的手术后肱骨干骨折不愈合患者27例，其中20例采用二次手术取出原内固定物，重新行锁定加压钢板内固定，同时在不愈合部位行丰富的自体髂骨植骨。术后进行影像学观察和疗效评定。结果 20例患者均得到随访，随访时间为0．5～2．0年，均经二次手术后获得愈合，肩肘关节功能优良率为85％。结论 锁定加压钢板能够为骨折端提供早期的稳定性，减少局部血运的破坏，与自体髂骨植骨相结合是治疗肱骨干骨折内固定术后不愈合的一种有效方法。     

不同方法治疗肱骨干骨折疗效分析

目的探讨适合肱骨干骨折的手术治疗方法及并发症的预防措施。方法回顾分析手术治疗肱骨干骨折83例，根据手术方式不同，将其分为髓内钉、加压钢板和外固定架3组，临床观察结合X线评价骨折愈合，延迟愈合和不愈合作为判断临床疗效的标准。结果髓内钉组的骨折愈合率明显高于其他2组，并发症包括骨不连、关节僵硬和畸形愈合，发生率为18．1％，其中骨不连发生率为10．8％。结论髓内钉治疗肱骨干骨折的临床疗效优于加压钢板和外固定架，具有固定牢固、愈合快、并发症少等优点。     

非手术治疗并发血管神经损伤的肱骨髁上骨折

７例并发血管、神经损伤的肱骨髁上骨折，其中桡动脉搏动消失２例；桡动脉搏动减弱，甲床再充血时间延长，血循环不良１例；桡神经损伤３例；正中神经损伤１例。均经尺骨鹰嘴牵引非手术治疗达到良好复位，血管、神经伤恢复，无一例因血管、神经伤而引起其它并发症。     

肱骨远端全骺分离的诊断与治疗

自1998年1月—2002年1月我们诊治肱骨远端全骺分离21例，报告如下。     

Opposite-direction bilateral fracture dislocation of the shoulders after an electric shock

Injuries after an electric shock, such as dermal burns, motor and sensory nerve deficits, fractures and dislocations, are reported in the literature. Posterior dislocation of the shoulder after electric-shock is the common musculoskeletal injury. Bilateral dislocation, either anterior or posterior, is rarely seen and reported. We report a case of bilateral shoulder fracture dislocation in opposite directions following an electric-shock and discuss the mechanism, the diagnosis and the treatment.     

Radiological evaluation of bone growth in neonates born at gestational ages between 26 and 41 weeks: cross-sectional study

The length of the ossified part of the long bones of the upper (humerus) and lower limb (femur) as well as the axial length (that is, height) of the vertebral body of L1 were measured on a plain supine radiograph in 347 newborn babies (228 males, 119 females) with the gestational age (GA) from 26 to 41 weeks. All were admitted to the neonatal intensive care unit. Reasons for admission included hyaline membrane disease, meconium aspiration syndrome, neonatal asphyxia or transient tachypnea of the newborn. Patients with abnormal growth, gross anomalies, or who were the products of multiple births were excluded. The average weekly increment in the height of L1 for male infants born at GA varying from 26 to 41 weeks was 0.23 mm, for the humerus 1.82 mm and for the femur 2.35 mm. The corresponding data for females was 0.20 mm, 1.54 mm and 2.30 mm. The ratio of the height of L1 to body length progressively increased between 26 to 41 weeks. A growth spurt in L1 was noted for both sexes at 34 weeks of GA. Long bone growth was similar in male and female infants born before 36 weeks. However, the ratio of femur to body length in males increased after 36 weeks. The ratio of humerus to body length remained constant over the entire range of GA.     

Ball-thrower’s fracture of the humerus

A relatively rare case of ball-throwers fracture of the humerus is presented. Severe muscular action is an uncommon cause of humeral fractures but has been well documented in the orthopedic literature. To our knowledge, this fracture has not been described in the radiology literature, and awareness of this entity could preclude further unnecessary workup. The mechanism of injury and its typical radiographic appearance is described.     

带血管蒂尺桡骨上段骨膜瓣逆行转位的应用解剖

目的　为以骨间返血管或桡侧返血管为蒂的尺桡骨骨膜瓣逆行转位修复肱骨远段骨不连提供解剖学依据。方法　在 30侧成人上肢标本上观测了骨间返、桡侧返及桡侧副血管来源、走行、分布、吻合、血管外径、长度及与桡神经的关系。结果　骨间返动脉起于外上髁下 (6 5 1± 9 5 )mm ;起点外径 1(4 7± 0 2 )mm ;桡侧返动脉起于外上髁下 (6 3 7± 7 8)mm。起点外径 (2 1± 0 3)mm ;桡侧副动脉背侧支起于外上髁上 (10 4 5± 8 9)mm ,外径 (1 4 8± 0 2 2 )mm。三者吻合形式有三种“倒Y”、三点汇合、网状吻合。结论　以桡侧返、骨间返血管为蒂的尺桡骨骨膜瓣逆行转位修复肱骨远段不连具有可行性     

Treatment of displaced supracondylar humeral fractures among children: Crossed versus lateral pinning

This retrospective study evaluated different pinning configurations used in the treatment of displaced supracondylar humeral fractures among children, mainly regarding maintenance of fracture reduction and avoidance of complications. The fractures (41 type II and 67 type III) of 108 children (mean age 6.48 years) were treated by closed reduction and percutaneous pinning: 37 with crossed pins, 37 with two lateral pins and 34 with two lateral and one medial pin. Mean follow-up period was 7.4 months. Type III fractures fixed by two lateral pins were found significantly prone to postoperative instability, late complications and need for medial pin fixation. There was a significant relation between either delay to surgery or postoperative instability and occurrence of complications. Final outcome was significantly poorer in type III than in type II fractures. Fixation by two lateral pins only is not recommended for treating type III supracondylar humeral fractures, but could be used initially to fix severely unstable fractures to allow extension of the elbow before inserting a medial pin. Every effort should be made to avoid iatrogenic ulnar nerve injury while inserting the medial pin.