Humeral Plate Research Articles

Homologisation of the anterior articular plate in the wing base of Ephemeroptera and Odonatoptera

In the search for the sister group of modern Ephemerida, we used the evolutionary groundplan method to identify synapomorphies in wing articulation. The evolutionary approach is necessary because post-groundplan wing adaptations have obscured the phylogenetically informative higher-level synapomorphies in modern Ephemerida, Odonata and Neoptera. Protowing-level sclerites are recognisable fragments of the first limb-derived pleuron, arranged in eight rows above the pathways delivering blood to the eight principal wing veins. Each row includes three sclerites (proxalare, axalare and fulcalare) which articulate with the basivenale (wing blood sinus). Over the course of the pterygote evolutionary history, many row-sclerites have assembled into clusters, plates, or processes, the composition of which can be most clearly recognised by comparison with ancestral Paleozoic fossils. The extant orders Ephemerida and Odonata (Palaeoptera: Hydropalaeoptera) share a derived anterior articular plate (AAP) composed of four fused sclerites (two axalaria and two fulcalaria) belonging to the precostal and costal rows. This plate represents a complex and unique synapomorphy. In Neoptera, precostal and costal fulcalaria are fused to basivenalia to form a humeral plate, and axalaria are obscured by the tegula. Palaeoptera include two subdivisions, extant Hydropalaeoptera and extinct Palaeodictyopteroida.

Open Reduction and Internal Fixation of Proximal Humeral Fractures with Use of the Locking Proximal Humerus Plate

To The Editor: We read the article “Open Reduction and Internal Fixation of Proximal Humeral Fractures with Use of the Locking Proximal Humerus Plate. Results of a Prospective, Multicenter, Observational Study” (2009;91:1320-8), by Sudkamp et al., with interest. The authors have written yet another paper on the advantages and disadvantages of a locking proximal humeral plate and, while we have no doubt that the study was performed well, we believe that they sidestepped the real issue, which is who should be treated with these plates. They reported a mean Constant score of 70.6 one year after surgery in 187 patients …

잠김 압박 금속판을 이용한 근위 상완골 골절의 내고정술

Purpose: We assessed the radiographic and clinical results of one surgeon’s experience treating proximal humerus fractures with a locked proximal humeral plate. Materials and Methods: Twenty patients with unstable proximal humerus fractures were treated with a locking compression plate between February 2005 and September 2007. The average age of the patients was 60.6 years, and the average postoperative follow-up period was 22.3 months. The clinical results were evaluated using the Constant and DASH scores. The radiologic results were evaluated by the Paavolainen method, which measures the neck shaft angle and humeral head height. Results: At the last follow-up examination, the mean Constant score was 75.3 and 15 cases (75%) had excellent or good results; the mean DASH score was 16.4. The mean neck shaft angle was 137.1。 , and 19 cases (95%) had good results by the Paavolainen method. There was one delayed union, malunion, and screw loosening. Conclusion: The patients treated with a locking compression plate had relatively good clinical and radiologic results, and a low complication rate. Moreover, the patients could exercise earlier due to good reduction and initial stability. Treatment of unstable proximal humerus fractures with a locking compression plate is a reliable method.

Open Reduction and Internal Fixation of Proximal Humeral Fractures with Use of the Locking Proximal Humerus Plate

The treatment of unstable displaced proximal humeral fractures, especially in the elderly, remains controversial. The objective of the present prospective, multicenter, observational study was to evaluate the functional outcome and the complication rate after open reduction and internal fixation of proximal humeral fractures with use of a locking proximal humeral plate. One hundred and eighty-seven patients (mean age, 62.9 +/- 15.7 years) with an acute proximal humeral fracture were managed with open reduction and internal fixation with a locking proximal humeral plate. At the three-month, six-month, and one-year follow-up examinations, 165 (88%), 158 (84%), and 155 (83%) of the 187 patients were assessed with regard to pain, shoulder mobility, and strength. The Constant score was determined at each interval, and the Disabilities of the Arm, Shoulder and Hand (DASH) score was determined for the injured and contralateral extremities at the time of the one-year follow-up. Between three months and one year, the mean range of motion and the mean Constant score for the injured shoulders improved substantially. Twelve months after surgery, the mean Constant score for the injured side was 70.6 +/- 13.7 points, corresponding to 85.1% +/- 14.0% of the score for the contralateral side. The mean DASH score at the time of the one-year follow-up was 15.2 +/- 16.8 points. Sixty-two complications were encountered in fifty-two (34%) of 155 patients at the time of the one-year follow-up. Twenty-five complications (40%) were related to incorrect surgical technique and were present at the end of the operative procedure. The most common complication, noted in twenty-one (14%) of 155 patients, was intraoperative screw perforation of the humeral head. Twenty-nine patients (19%) had an unplanned second operation within twelve months after the fracture. Surgical treatment of displaced proximal humeral fractures with use of the locking proximal humeral plate that was evaluated in the present study can lead to a good functional outcome provided that the correct surgical technique is used. Because many of the complications were related to incorrect surgical technique, it behooves the treating surgeon to perform the operation correctly to avoid iatrogenic errors.

Distal humeral plating of an intramedullary nail periprosthetic fracture using a miss-a-nail technique: a case report

The treatment of distal humeral periprosthetic fractures is not widely described in the literature. We present a difficult clinical scenario of a 72-year-old man who sustained a displaced distal humeral periprosthetic fracture about a Polarus Plus intramedullary nail. In this case, stable fixation was achieved using bicondylar Acumed Mayo congruent Plates using a miss-a-nail technique. Four months following the post operative period, the patient regained satisfactory range of movement with full function and no further complications up to 18 months post fixation. Treatment of such complex periprosthetic fractures is technically achievable and with potentially good results.

The magnification of digital radiographs in the trauma patient: Implications for templating

Introduction Digital radiographs are increasingly used for planning orthopaedic surgical procedures, despite the fact that they are frequently not calibrated to correct for magnification. The typical magnification of digital radiographs in the trauma patient has not yet been reported. The aims of this study were to assess the magnification of such radiographs, and to discuss if and when accurate calibration is required for trauma templating. Materials and methods The operative notes and postoperative radiographs of 227 trauma patients were obtained. Each patient had undergone one of the following procedures: hip hemiarthroplasty, femoral nailing, tibial nailing, ankle plating, humeral nailing, humeral plating, or forearm plating. The dimensions of the implants used were measured on the uncalibrated postoperative radiographs using the hospital's Picture Archiving and Communication System software. The actual dimensions of the orthopaedic implants were obtained from the operation notes, and these were compared with the radiographic measurements. The intraobserver and interobserver variability of the radiographic measurements was also assessed. Results The radiographic magnification was greatest for the femoral head, and most variable for the femoral shaft. The magnification was least for the forearm. In general the magnitude and variability of magnification was least at the peripheries. There was good correlation between the measured and actual dimensions of the implants. The intraobserver and interobserver variability between the radiographic measurements was extremely small. Conclusion Despite the ease and convenience of performing measurements on digital radiographs, these measurements are unreliable if the radiograph has not been calibrated. We believe that careful calibration of digital radiographs is essential for accurate templating in the trauma patient, although is less critical when templating the humeral canal, the tibial canal, the ankle and the forearm.

Internal fixation of proximal humeral fractures with locking proximal humeral plate (LPHP) in elderly patients with osteoporosis

BackgroundDifferent operative techniques used for treating displaced proximal humeral fractures could result in malunion, non-union, osteonecrosis of humeral head, loosening of screw and loss of reduction particularly in comminuted and osteoporotic fractures. Locking compression plate (LPHP) has been proposed for open reduction and internal fixation of these fractures and is associated with less complication rate.Materials and methodsWe prospectively assessed the functional outcome and the complications after an average follow-up of 24.9 months in 25 patients of proximal humeral fractures with osteoporosis. Mean age was 62 years. Using AO classification, 48% were type A and 52% type B.ResultsMean constant score was 80 points. According to constant score, 28% had excellent outcome, 64% had good functional outcome, and 8% had moderate outcome. When the results were related to grades of osteoporosis, grade IV osteoporotic fractures had highest average Constant–Murley score (83 points, range 78–88 points), followed by grade III osteoporotic fractures (80 points, range 71–92 points), followed by grade II osteoporotic fractures (78 points, range 66–88 points). Varus malalignment and subacromial impingement were observed in 8% patients. Loosening of implant and loss of reduction were observed in 4% patients. Superficial infection was observed in 4% patients.ConclusionsLocking compression plate (LPHP) is an advantageous implant in proximal humeral fractures due to angular stability, particularly in comminuted fractures and in osteoporotic bones in elderly patients, thus allowing early mobilization.

Percutaneous Humeral Plating of Fractures of the Proximal Humerus: Results of a Prospective Multicenter Clinical Trial

To evaluate the safety and functional outcome of a recently described surgical technique of percutaneous plating for proximal humerus fractures. Prospective clinical trial. : Two urban Level 1 university trauma centers. From February 2002 to December 2003, 34 consecutive patients underwent surgery by 5 trauma surgeons from 2 teaching hospitals. Twenty-seven patients had 1-year follow-up. The technique involved 2 minimal incisions with a lateral deltoid split and a more distal shaft incision. A proximal humerus-specific locking plate was implemented. DASH (disabilities of the arm, shoulder, and hand) and Constant-Murley evaluation scores were used for functional evaluation. The presence of complications was noted. Specifically, there were no axillary nerve injury injuries and no loss of reduction. The average Constant score at 1 year was 82 and the DASH score was 26. This study demonstrated that the functional outcome results correspond to a normal age-adjusted score signifying an acceptable result.

Proximal Humeral Epiphyseal Plate Fracture in a Collegiate Track and Field Decathlete: A Case Study

To present the case of an 18-year-old collegiate decathlete with a Salter-Harris type I epiphyseal plate fracture of the proximal humerus. A collegiate decathlete was playing flag football and fell on an outstretched arm. He was taken to the emergency room and diagnosed with a type I epiphyseal plate fracture. AC sprain, dislocation or subluxation, rotator cuff tear, labral tear. Active and passive range of motion exercises were completed after two days of immobilization. He then started strengthening exercises and returned to competitive activity in 10 weeks. Proximal humeral epiphyseal plate fractures are uncommon injuries, especially in athletes over the age of 15. If an accurate diagnosis is made, an appropriate conservative rehabilitation program can be implemented to safely return an athlete to participation without permanent deformity following a type I Salter-Harris fracture.

Comparative morphological assessment and phylogenetic significance of the wing base articulation in Psylloidea (Insecta, Hemiptera, Sternorrhyncha)

The wing articulation sclerites, as well as wing base environment, of phylogenetically distant Psylloidea taxa were examined by optical and electron microscopy in order to estimate the phylogenetic significance of observed morphological patterns. The basiradial bridge is strongly developed and links the fused humeral plate, basisubcostale, basiradiale and second axillary sclerite to the fused veins R + M + Cu. The proximal median plate has a vertical orientation, which may have a role in moving the wing forward and backward. The weak sclerotization posteriad of the second axillary sclerite and anteriad to the third axillary sclerite facilitates the backward movement of the wing. The horizontal hinge (= basal hinge), the vertical hinge and the torsional hinge are the most important fold- and flexion-lines for the mobility of the wing, whereas humeral folds and the anterior axillary fold-line play a minor role. The basalare presents two horns or processes that are autapomorphic traits for the superfamily Psylloidea. The monophyly of Psylloidea is also supported by the absence of the subalare, of the median notal wing process and of the anterior arm of the third axillary sclerite (lacking articulation with second axillary sclerite). Major interspecific variations are observed in tegula, first axillary sclerite and basalare shape and size. The second distal median plate is absent in Homotoma ficus (Homotomidae) and Glycaspis brimblecombei (Spondyliaspidinae), whereas it is present in Calophya schini (Calophyidae) and Psylla buxi (Psyllinae/Arytaininae); the presence of this sclerite could be a synapomorphy linking Calophyidae and the “psyllid assemblage”.

Clinical research on proximal humeral fractures treated by locking proximal humeral plate

To evaluate the indications and clinical results of displaced proximal humeral fractures treated by locking proximal humeral plate (LPHP). From September 2004 to March 2006, 75 patients which were treated by open reduction and internal fixation with LPHP were available to follow-up, with an average time of 17 months (12 - 30 months). There were 60 fresh fractures and 15 delayed fractures. The range of motion, muscle strength, visual analogue scale (VAS) for pain, American shoulder and elbow surgeon (ASES) score, Constant-Murley, University of California, Los Angeles (UCLA) scoring system and simple shoulder test (SST) for function evaluation were all recorded. The average forward flexion was (147.3 +/- 17.7) degrees , external rotation was (30.5 +/- 16.2) degrees and internal rotation was to T9. The mean ASES was 86.7 +/- 12.7, Constant-Murley was 87.4 +/- 10.5, UCLA was 30.1 +/- 4.2. The total good or excellent rate was 89.3%. Compare with fresh fractures, the delayed group showed significant less forward flexion and ASES (P = 0.021 and 0.036 respectively). In 9 patients with late complications, there were significant differences regarding ASES, UCLA scoring system and Constant-Murley compared with patients without any complication. With strict indication control and appropriate surgical technique, satisfactory results can be expected for the displaced proximal humeral fractures treated with locking proximal humeral plates.

Humeral Shaft Split Fracture Around Proximal Humeral Locking Plates: A Report of Two Cases

Locking plates increasingly are being used in the treatment of osteoporotic fractures. Such devices provide multiple fixed- angle anchorage points and improve fracture fixation stability in weak bone. We report two cases of early proximal humeral fracture fixation failure in osteoporotic bone by humeral shaft "fissure" or split fracture after open reduction and internal fixation with locking proximal humeral plates and screws. Each patient failed early in the postoperative period and was revised to fixation with compression plating techniques, with uneventful union.

Two-Part Surgical Neck Fractures of the Proximal Part of the Humerus<sbt aid="1049903">A Biomechanical Evaluation of Two Fixation Techniques</sbt>

Successful internal fixation of fractures of the surgical neck of the humerus can be difficult to achieve because of osteopenia of the proximal aspect of the humerus. The purpose of this study was to compare the biomechanical stability of a proximal humeral intramedullary nail and a locking plate for the treatment of a comminuted two-part fracture of the surgical neck in a human cadaver model. Twenty-four cadaveric humeri were instrumented with use of either a titanium proximal humeral nail (PHN) or a 3.5-mm locking compression plate for the proximal part of the humerus (LCP-PH). The specimens were matched by bone mineral density and were separated into four experimental groups with six humeri in each: PHN bending, LCP-PH bending, PHN torsion, or LCP-PH torsion. Comminuted fractures of the surgical neck were simulated by excising a 10-mm wedge of bone. Bending specimens were cyclically loaded from 0 to 7.5 Nm of varus bending moment at the fracture site. Torsion specimens were cyclically loaded to +/-2 Nm of axial torque. The mean and maximum displacement in bending, mean and maximum angular rotation in torsion, and stiffness of the bone-implant constructs were compared. In bending, the LCP-PH group demonstrated significantly less mean displacement of the distal fragment than did the PHN group over 5000 cycles (p = 0.002). In torsion, the LCP-PH group demonstrated significantly less mean angular rotation than did the PHN group over 5000 cycles (p = 0.04). A significant number of specimens in the PHN group failed prior to reaching 5000 cycles (p = 0.04). The LCP-PH implant created a significantly stiffer bone-implant construct than did the PHN implant (p = 0.007). The LCP proximal humeral plate demonstrated superior biomechanical characteristics compared with the proximal humeral nail when tested cyclically in both cantilevered varus bending and torsion. The rate of early failure of the proximal humeral nail could reflect the high moment transmitted to the locking proximal screw-bone interface in this implant. The high failure rate in torsion of the proximal humeral nail-bone construct is concerning, and, with relatively osteoporotic bone and early motion, the results could be poor.

Management of Cubitus Varus and Valgus

Many types of osteotomy have been proposed for the treatment of cubitus varus and valgus, but they have limitations, such as poor internal fixation, residual protrusion of the lateral or medial condyle, technical difficulty, the need for long-term immobilization, a risk of neurovascular injury, and patient discomfort. We reviewed the results of a simple step-cut translation osteotomy that overcomes these limitations. Between 1993 and 2002, we treated nineteen cases of cubitus varus and thirteen cases of cubitus valgus with use of a simple step-cut translation osteotomy and fixation with a Y-shaped humeral plate. After surgery, the patients were observed closely for more than one year. We compared preoperative and postoperative humerus-elbow-wrist angles, ranges of motion, and lateral or medial prominence indices for all patients. The results were evaluated according to the modified criteria of Oppenheim et al. The presence of tardy ulnar nerve palsy and its duration, and postoperative lazy-s deformity or unsightly scarring, were also noted. There were twenty-six excellent and six good results. In the nineteen patients with cubitus varus, the average amount of correction of the humerus-elbow-wrist angle was 26.0 degrees , to a mean postoperative angle of 8.6 degrees , and the average increase in the lateral prominence index was 8.2%. In the thirteen patients with cubitus valgus, the average correction in the humerus-elbow-wrist angle was 27.6 degrees , resulting in a final angle of 9.1 degrees , and the average increase in the medial prominence index was 11.9%. In all patients, the desired range of motion, good alignment, and complete union of the bone were achieved. Step-cut translation osteotomy, with a wedge-shaped osteotomized surface, fixed with a Y-shaped humeral plate is a relatively simple procedure resulting in very firm fixation that allows early movement of the joint with good clinical results.

NONPROSTHETIC MANAGEMENT OF PROXIMAL HUMERAL FRACTURES

Many proximal humeral fractures can be treated without the need for hemiarthroplasty. Treatment choice is affected by fracture location and pattern, as well as by patient factors including age, activity level, quality of bone, and ability to comply with a regimen of therapy. Successful diagnosis and treatment of proximal humeral fractures is dependent on good-quality radiographs, but in some cases, intraoperative assessment of the fracture pattern is required for a complete and accurate diagnosis of the fracture pattern and severity. A discussion of nonsurgical and surgical treatment options and techniques needed to achieve anatomic reduction and stable fixation is important.

Design and validation of a surrogate humerus for biomechanical testing

At present biomechanical testing of fracture plating strategies is conducted using animal or cadaveric whole bone models. This may introduce experimental error into these studies. This communication summarises the design and validation of a novel bone and fibre-reinforced plastic construct conceived to minimise intra-experimental error. A tubular surrogate humerus was produced with dimension and strength matched to that of the human humerus. Bone inserts placed into the wall of the tube allow for the fixation of the plates with bone screws. Three-point bending tests of the flexural rigidity of the surrogate humerus (EI=100.1 (SD 6.0) Nm 2) showed it to be comparable to the human humerus. Further, pull-out tests of the screws showed that the bone slots adequately mimicked the whole bone scenario. This testing construct will be used for a comparative study of humeral plating techniques.

長管骨の成長板軟骨における軟骨組織の吸収に関する微細構造学的研究

長管骨の成長板軟骨における軟骨組織の吸収に関する微細構造学的研究

Structural and histochemical study of the effect of 1,25-dihydroxyvitamin D3 on long-bone growth center in suckling mice.

The in vivo effects of 1 alpha,25-dihydroxyvitamin D3 [1,25(OH)2D3] on cellular structure and response, matrix metachromasia and mineralization have been studied in the epiphysis and growth plate of humeri in normal neonatal mice. A relatively low dose of the metabolite, 50 ng/kg body weight, significantly increased the overall size of humeral growth plate, the zone of proliferating cells and that of hypertrophic chondrocytes. The response of the tissue to the metabolite changed with the increase in dose administered so that it was only the zone of proliferation that still showed increases in size in comparison to untreated controls. 1,25 (OH)2D3 led to an increase in the metachromatic reaction of the cartilage matrix in the chondroblastic zone, and to marked increase in matrix mineralization in the hypertrophic zone. Qualitative changes were also noted in the structure of chondroblasts and hypertrophic chondrocytes. 1,25(OH)2D3 affected the osteoblastic and osteocytic populations of cells along the metaphysis and diaphysis of the humerus. High doses of 1,25(OH)2D3 brought about distinct atrophic changes in the above cells. Chondrocytes in the epiphysis were found to synthesize type I collagen and fibronectin. These findings indicate that excessive doses of 1,25(OH)2D3 in an intact growing animal affect the normal differentiative pathway of prechondroblasts and thereby affect long bone development.

Subperiosteal segmental resection and insertion of a fibula graft in the treatment of solitary bone cysts of the humerus.

Twenty-six consecutive cases of solitary bone cysts of the humerus were treated by a special operative procedure of subposteriosteal segmental resection and subsequent insertion of a fibula graft. During a mean follow-up period of 4 years, 23 cases showed complete recovery. In two cases minute residual cysts were detected directly below the epiphyseal plate but not, however, necessitating further therapy. In one case only, an 11-year-old girl, not all of the cystic tissue had been removed from the proximal humeral growth plate. This remaining cyst was later excised after the fibula graft had taken and the defect filled with bone chips from the iliac crest.

Observations on the growth of the normal male mouse.

The pattern of body weight gain, the longitudinal growth of the humerus and the changes in the width of its proximal growth plate were determined in normal ICR male mice. The respective growth rates were calculated and compared throughout the animals' first year of life. It was found that the overall growth period can be divided into four phases which differ markedly in their growth rate. Whereas skeletal maturation is reached at the age of 20 weeks, the animals' body weight continues to increase up to the end of the 52nd week. The humeral growth plate retains its existence and function until old age is reached, i.e. 15 months. During the period of highest growth activity extending between weanling and sexual maturation, the growth velocities of the various parameters do no coincide.