Left Humerus Research Articles

Bone labeling experiments and intraskeletal growth patterns in captive leopard geckos (Eublepharis macularius).

An understanding of the dynamics of bone growth is key to interpreting life-history parameters of vertebrates. In this study, we used fluorochrome labels in captive leopard geckos (Eublepharis macularius) to track bone growth and intraskeletal variability from embryonic to adult growth stages. Thirteen individuals were administered fluorochromes from pre-hatching to 4 years of age. The left tibia, fibula, femur, humerus, radius, and ulna were examined histologically and compared for differences in the number of labels within and between individuals at each sampled growth stage, and the amount of bone growth between labels was calculated. Results suggest that limb elements had differing growth rates; the fibula grew the fastest per day on average and the femur grew the slowest per day on average. All labels administered in ovo were still present in all limb elements in adults except for the tibia, suggesting growth marks are not lost in most elements and accurate calculations of growth rates could be performed in individuals up to 3 years old. All ex ovo labels were accounted for; however, when two fluorochromes were administered 3 weeks apart, the labels could not be differentiated from each other due to the new bone not being deposited at a quantifiable level. Overall, the tibia in leopard geckos is the least reliable limb bone to use for skeletochronology and the humerus, radius, and fibula preserve the longest growth record. This research highlights that, as in other extinct and extant animals, patterns of bone growth are not consistent across reptiles. This study adds to the growing body of knowledge on growth variability in reptiles.

Brody's abscess of the humerus is the cause of sepsis in a patient with coronavirus infection (COVID-19)

Purpose: To conduct a clinical and morphological analysis of the case of death as a result of sepsis, the cause of which was Brody's abscess.Material and methods. An analysis of the fatal outcome of a 54–year-old patient who occurred in a hospital of a medical organization where he received medical care for a disease – a new coronavirus infection. The complex of clinical, laboratory and instrumental diagnostic methods could not explain the progressive deterioration of the severity of the patient's condition and the onset of death.Results. During the autopsy, an abscess of the proximal epiphysis of the left humerus was found with the spread of the inflammatory process to the soft tissues of the breast, the parietal pleura with the development of purulent fibrinous pleurisy, left-sided pneumonia, purulent fibrinous pericarditis, hematogenous purulent meningitis.Conclusion. The authors of the article have established a causal cause of death from Brody's abscess, which makes it possible to expand the diagnostic search in the case of sepsis with an unclear primary focus.

High 18F-FDG Uptake in Phosphoglyceride Crystal Deposition Disease of the Humerus Mimicking Chondrosarcoma.

A 82-year-old man presented with left humerus pain. MRI revealed a lesion in the left humerus appearing hyperintense on T2WI and hyperintense on DWI. 18F-FDG PET/CT demonstrated high FDG uptake in the lesion. Surgical resection was performed under the preoperative diagnosis of chondrosarcoma. However, a histopathological analysis confirmed the diagnosis of phosphoglyceride crystal deposition disease (PGDD). PGDD is an extremely rare disease, and this is the first report of PGDD occurring in the humerus. Bone lesions showing high uptake of FDG are usually malignant lesions; however, it is important to consider the possibility of benign diseases such as PGDD.

Results of a large-scale humeri pair matching study.

During the analysis of a commingled human remains assemblage, pair-matching is often conducted as part of the inventory to inform the DNA sampling strategy and to calculate the minimum or most likely number of individuals. As commingled assemblages become larger, pair-matching becomes more difficult, and it is unknown whether accuracy declines. Therefore, a study to determine the accuracy rates of visual pair-matching for multiple observers was conducted on a large, commingled human assemblage. The sample consisted of 580 left and right humeri (n = 287 and n = 293, respectively) from the commingled remains of the USS Oklahoma, which were undergoing analysis at the Defense POW/MIA Accounting Agency. Five anthropologists completed this study, determining humeri pairs with varying degrees of confidence and non-pairs. The overall precision was 81.0% and ranged from 74.1% to 95.9% for participants, including all confidence levels. When considering only confident matches, the overall precision for all participants increased to 91.4%.

Congenital Syphilis With Multiple Bone Fractures

We report a rare case of multiple fractures occurring in a 3-month-old boy with congenital syphilis (CS). His mother was diagnosed by a gynecologist with syphilis on a screening test before his birth. After birth, a serological panel revealed positive rapid plasma reagin and treponema pallidum hemagglutination assay test results. On the first visit, his left humerus was broken. Whole-body screening radiographs showed multiple fractures of both distal radii and the right first metatarsal. Immobilization was performed with a plastic splint, and callus formation of his humerus was seen after 3 weeks. CS cases have been increasing both in Japan and abroad in recent years. Orthopaedic surgeons should not forget the possibility of CS as a differential for fractures, especially in infants younger than 3 months born to syphilis-infected mothers.

Myrmecophaga tridactyla (Linnaeus, 1758) subfossils from Abismo Anhumas, Bonito/MS, Brazil: Morphology, isotopic habitat (δ13C, δ18O), radiocarbon dating, biogeography and human impact on the species conservation in Brazil

ABSTRACTMyrmecophaga tridactyla Linnaeus, 1758 is the largest extant anteater, being distributed in most biomes from southern Central America and northern South America. Herein, we analyzed cranial and postcranial elements of three partial skeletons of M. tridactyla found submerged in Abismo Anhumas cave (Bonito, Mato Grosso do Sul, Brazil). The bones collected were the skull (LEG 2598), left humerus (LEG 2601), ungueal phalanx (LEG 2602), and lumbar vertebrae (LEG 2599; LEG 2600). Radiocarbon dating and isotope analyses indicate that these animals lived between 360 and 560 cal a BP in an arboreal to open savanna habitat associated with the Cerrado, a Seasonal Dry Forest. Radiocarbon‐dated oxygen isotopes are possibly in agreement with dated oxygen isotopes found in stalagmites, suggesting a wet period between 442–364 cal a BP in the region. Finally, we created paleo‐species distribution models, which allowed the generation of a consensus map showing a historically stable area between 21 and 6 ka for this species. Currently, more than 50% of this area has been destroyed by human activity.

Optimising Emergency Care for Older Adults: A Case Study of the EDITH Service Following a Proximal Humerus Fracture

Abstract Background The Emergency Department in the Home (EDITH) service offers emergency Occupational Therapy and medical assessments to older adults at home, thus negating the need for hospital attendances. Mr X, an 86-year-old with vascular dementia and hypertension, sustained a left proximal humerus fracture from a fall. Following assessment in the ED, Mr X was deemed fit for discharge and was referred to EDITH for an acute functional assessment and clinical review. Methods Within 72 hours of discharge, Mr X was visited at home by an Occupational Therapist (OT) and an Advanced Nurse Practitioner (ANP). The OT conducted a home environment assessment, falls-risk screening, delirium screening, reviewed social supports, and performed a functional assessment. Education on one-handed dressing techniques and falls prevention was provided. The ANP conducted a clinical review, and reviewed Mr X’s medication and analgesia. Mr X had the support of his wife to assist with Activities of Daily Living (ADLs), functional mobility and medication management. Mr X’s son purchased assistive equipment recommended by the OT, to enhance home safety. Referrals were made to the local memory support service, a Physiotherapist, and his Public Health Nurse to organise formal care supports. Results Mr X remained at home with support from his wife, primary care services, and virtual EDITH follow-up. Mr X had a scheduled review at the fracture clinic following his ED attendance. Conclusion Emergency care practitioners play a crucial role in addressing acute functional and clinical changes in older adults attending the ED. Supported ED discharges and service integration during the acute phase can prevent hospital admissions. Collaboration between emergency medicine and primary care is essential for addressing acute medical needs and long-term functional outcomes. With adequate social support and timely services, older adults can recover successfully at home.

Cadaver Study on Variation of Nutrient Foramina of Adult Human Humeri in Bangladeshi Population

The nutrient foramen is an opening in the bone shaft which allows passage to the blood vessels of the modularly cavity of a bone for its nourishment and growth. Nutrient artery is the major source of blood supply to bone and it plays an important role in healing of fracture and trauma and is also important for bone grafting. This cross-sectional, descriptive cadaver based study aims to determine the presence, direction, common location, position and number of nutrient foramen of adult human humerus in a Bangladeshi population. One hundred samples (43 on right and 57 on left) were selected through the purposive sampling technique which was carried out in the Department of Anatomy, Mymensingh Medical College, Bangladesh, from July 2021 to June 2022. Any damaged, unossified bones or fractured bones were excluded. The presence of nutrient foramina was observed in the shaft of the humeri. Data were recorded and tabulated to analyze using Microsoft Excel and SPSS software. Nutrient foramina was found in all the samples on both sides. So nutrient foramina present on the right side was 100% and on the left side was 100%. The direction of nutrient foramina towards the elbow joint was found in all the samples of both sides. Among 43 right humeri, 37(75.51%) have single-nutrient foramen and 06(24.49%) have double-nutrient foramina. Among 57 left humeri, 53(92.98%) have single nutrient foramen, 03(5.27%) have double nutrient foramina and 01(1.75%) has triple nutrient foramina. In case of location of nutrient foramina, among 49 right nutrient foramina, 45(91.84%) were found on the anteromedial surface, 02(4.08%) were found on the anterolateral surface and 02(4.08%) were on the posterior surface of the shaft of the humerus. In case of 62 left nutrient foramina, 57(91.94%) were found on the anteromedial surface and 05(8.06%) were found on the posterior surface of the shaft of the humerus. In case of position of nutrient foramina, among 49 right nutrient foramina, 01(2.04%) was found on the upper third, 46(93.88%) on the middle third and 02(4.08%) on the lower third of the shaft of the humerus. In case of 62 left nutrient foramina, 01(1.60%) was on the upper third, 57(91.95%) were on the middle third and 04(6.45%) were on the lower third of the shaft of the humerus. CBMJ 2024 July: vol. 13 no. 02 P: 176-182

A left humerus fracture-induced Takotsubo syndrome

A left humerus fracture-induced Takotsubo syndrome

Evaluation of Shoulder Risk Factors in the Repetitive Task of Slaughterhouse

Repetitive movements and the speed of upper limbs increase the risk of musculoskeletal disorders. This study aimed to analyse the risk of shoulder injuries in repetitive tasks by evaluating the humerus angle, angular velocity, and angular acceleration during simulated chicken wing cutting. The study was conducted in a laboratory simulating a real environment. Thirty-six healthy right-handed volunteers were assessed using an electromagnetic tracking device, TrakSTAR, integrated with MotionMonitor™ (Innovative Sports Training, Inc. Chicago, IL) and software to collect 3-D kinematic data developed in the research centre. The equipment measured the angles performed by the upper limbs during the entire movement. The humerus angles were automatically transformed into angular velocity (°·s−1) and angular acceleration (°·s−2). Maximum angular velocities were 27.39°·s−1 (men, right humerus) and 22.39°·s−1 (women, left humerus), both below the safe limit. Maximum accelerations were 25.32°·s−2 (men, left side) and 28.94°·s−2 (women, left side); safety values for these accelerations are not established. Monotony is a risk factor, especially for the dominant side. Future studies should evaluate risk factors simultaneously in repetitive tasks. Repetitiveness exceeds the safe limit according to the OCRA method.

Alcohol intake during pregnancy reduces offspring bone epiphyseal growth plate chondrocyte proliferation through transforming growth factor β-1 inhibition in the Sprague Dawley rat humerus.

Intrauterine alcohol exposure delays bone maturation and intensifies osteoporosis and fracture risk. As most studies emphasize the neurological aspects of intrauterine alcohol exposure, there is a lack of research on the implications pertaining to osseous tissue. Previous studies investigated these effects in fetuses, with limited studies on postnatal life. Postnatal studies are crucial since peak bone growth occurs during adolescence. This study aimed at assessing the effects of prenatal alcohol exposure on the humerus proximal and distal growth plate chondrocytes in 3-week-old rats. Sprague Dawley rats (n=9) were assigned to either the ethanol group (n=3), saline (n=3), and untreated (n=3) group and time-mated. Once pregnant, as confirmed by the presence of a copulation plug, the former 2 groups were treated with 0.015 ml/g of 25.2% ethanol and 0.9% saline. The untreated group received no treatment. The left humeri belonging to 6 pups per group were used. Serial sections were cut with a microtome at 5 μm thickness. These sections were stained with haematoxylin and eosin for assessment of normal morphology or immunolabeled with anti-Ki-67 and transforming growth factor β-1 (TGFβ-1) antibody. Prenatal alcohol exposure adversely effected the growth plate sizes and the number of cells in the proliferative zone. Fewer TGFβ-1 immunopositive and proliferative chondrocytes were found using the anti-Ki-67 antibody. This may explain the growth retardation in offspring exposed to gestational alcohol, showing that gestational alcohol exposure inhibits cell proliferation, aiding the diminished stature.

Distal Humerus Physeal Separation in Young Children: A Frequently Missed Diagnosis

A 2-year-old child fell and landed on the left hand. Post-trauma, he developed swelling over his left elbow and refused to move the left elbow. He was brought to the emergency department and initially diagnosed with left elbow dislocation. A careful study of the plain radiograph of the left elbow showed left distal humerus physeal separation. A gentle closed manipulative reduction was attempted under sedation but failed to achieve good alignment. The child was put under general anaesthesia, where an elbow arthrogram was performed and closed manipulative and percutaneous pinning was done. The child regained full elbow range of motion at 4 months post-injury. At 1 year follow-up, there was no deformity noted. Distal humerus physeal separation is a relatively uncommon presentation and frequently missed diagnosis due to the

Three-dimensional measurement of humeral retroversion on a large academic cadaveric database

BackgroundThe Humeral retroversion angle (HRA) has been described in the literature as the orientation of the humeral head compared with the epicondylar axis of the distal humerus. HRA is a crucial measurement for designing shoulder prostheses and surgical technique, and is often noted to range from 25° to 35° in healthy adults. However, a wide range of individual variability has been reported in literature, with reported values ranging from −6° to 74°. Various imaging modalities including X-rays, computed tomography scans, and magnetic resonance imaging have historically been used to measure this angle, but conventional 2-dimensional technologies may result in inaccuracy and variability in angular measurements. Therefore, recent studies have focused on using 3-dimensional (3D) modalities to measure HRA. These studies have shown promising results regarding accuracy and clinical significance, although most have only included a small number of subjects and have not procured conclusive findings. This study aims to measure the HRA in a large sample of subjects using 3D imaging to establish measurements for the general population. MethodsWe examined the right and left cadaveric humerus from 559 individuals (146 females and 413 males). All of the humeri underwent computed tomography scan and surface models generated. 3D landmarks were automatically calculated on each 3D bone using custom-written software in C++. Those landmarks were used to calculate (1) HRA as the angle between the epicondylar axis and the humeral neck axis and (2) humeral proximal neck angle (HPNA) as the angle between the humeral neck axis and the anatomical axis. Descriptive statistics of both HRA and HPNA was analyzed using JMP Pro statistical software version 15.2.0. ResultsThe HPNA was found to be 137.7° ± 1.04° for males and 136.34° ± 1.4° for females with a 95% confidence interval. HRA was found to be 39.89° ± 12.77° for males and 38.89° ± 3.15° for females with a 95% confidence interval. Results of analysis of variance revealed that males had a statistically significant larger HRA than females (P < .001). ConclusionOur study suggests using a standardized measurement for the HRA, which we believe may improve operative outcomes. However, future prospective trials are required to validate our results in a clinical setting.

Peripheral Nerve Stimulation for Arm Pain in an Adolescent Girl with Ewing Sarcoma as Bridge Therapy to Chemotherapy: A Case Report

BACKGROUND: Cancer commonly presents discomfort from abnormal cell growth in healthy tissue and is often inadequately managed. Peripheral nerve stimulation (PNS), mainly for non-cancer chronic pain, has emerged as a minimally invasive option for neuropathic cancer-related pain when conventional methods fail. Limited research, primarily in adults, has focused on PNS in the non-oncological population. CASE REPORT: A 14-year-old adolescent girl with a history of obesity, diabetes, and Ewing sarcoma in her left proximal humerus experienced severe pain, initially rated at 10/10. After undergoing ultrasound-guided left suprascapular PNS as a 60-day bridge therapy to chemotherapy, her pain improved to 3/10 at lead removal and remained at 4/10 at 3 months postremoval. CONCLUSION: PNS is a promising and less invasive neuromodulation approach for managing tumor-related bone pain. Our case study illustrates the effectiveness of PNS placement for significant pain reduction, although limitations, such as delayed response and the need for further randomized-controlled studies, are acknowledged. KEY WORDS: Neuromodulation, peripheral nerve stimulation, Ewing sarcoma, arm pain, bone pain, chemotherapy, teen, adolescent

A Study on Diaphyseal Nutrient Foramen of Humerus

Objective: The aim of this study is to provide detailed data about the nutrient foramen (NF) of the humerus, the entry point of the nutrient artery, used in order to avoid damaging the nutrient artery, which has an important role in the nutrition of the humerus, during surgical approaches to the humeral diaphysis. Methods: This study was performed on 113 (58 right, 55 left) humeri. The number, direction, location, position, size and foraminal index of the nutrient foramina (NFs) were evaluated. In addition, total length of the humerus and distance between NF and proximal end of the humerus were measured. Results: One NF was observed on 86 of 113 (76.11%) humeri, two NFs on 17 of 113 (15.05%) humeri, 3 NFs on the one right sided humerus and no NF was observed on 9 of 113 (7.96%) humeri. While 122 (99.19%) of all NFs were directed distally, one (0.81%) NF was directed horizontally. Eighty-six (69.92%) NFs were located on the anteromedial surface, while 18 (14.63%) NFs were found to be located on the medial border, 12 (9.76%) NFs on the posterior surface, 4 (3.25%) NFs on the anterolateral surface and 3 (2.44%) NFs on the lateral border. 20G sized NF was detected on 50 of 123 (40.65%) NFs. 14G and 16G sized NFs were not detected. 5 (4.07%) NFs were located on the proximal 1/3, 113 (91.86%) NFs were located on middle 1/3 and 5 (4.07%) NFs were located on distal 1/3 of the humerus. The mean values of total length of the humerus, distance between NF and proximal end of the humerus and foraminal index were found out to be 301.68±20.61 mm, 166.70±32.50 mm and 55.33±9.48%, respectively. Conclusion: It is found out that there is usually one NF on the humerus and that this foramen is directed distally, localized on the anteromedial surface and the middle 1/3 of the humerus and sized at 20G. And also, we observed horizontally directed NF on the humerus. To our knowledge, there is no study which observed horizontally directed NF. There may be differences between populations about the morphology and morphometry of NF. Therefore, being aware for the morphology, morphometry and variations of the NF is important for the orthopaedic surgeons in surgeries such as fracture repairing and vascularized bone graft in order to avoid damaging the nutrient arteries.

Primary Small Cell Carcinoma of Hypopharynx-A Case Report of a Rare Tumor from a Tertiary Care Hospital in India

Introduction. Primary hypopharynx involvement of small cell carcinoma is very rare and very few cases have been reported in the texts. Here, we report a case of primary small cell carcinoma of hypopharynx with metastases to left humerus in a female patient of north india. Case Report. A 54 year old woman presented with a 4month history of shortness of breath and neck swelling in the left side. Fibreoptic laryngoscopy and biopsy revealed small cell carcinoma of the hypopharynx. Discussion. Small cell carcinoma of the hypopharynx still does not have any clear modality of treatment due to being a rare entity. Systemic chemotherapy and radiotherapy should be preferred over other treatment modalities.

Close Reduction of Supracondylar fracture of humerus in children by Gravity Method

Objective: To evaluate the outcomes of employing a new technique, the gravity method, for the closed reduction of supracondylar humerus fractures (Gartland’s type II and III) in pediatric patients treated at the Trauma Center of Aziz Bhatti Shaheed Hospital Gujrat. Methodology: This descriptive cross-sectional study was conducted at Aziz Bhatti Shaheed Hospital's Trauma Center from August 2022 to April 2023. Children under 12 years old, presenting within 48 hours of injury with closed supracondylar humerus fractures (Gartland’s Extension type II and III), were included. All patients underwent closed reduction and percutaneous pinning. Data analysis was performed using SPSS, employing means and standard deviations for quantitative variables, and frequency and percentage for qualitative variables. Results: The mean age was 5.5 years (±1.5). Among 65 patients, there were 45 males and 20 females, with a male-to-female ratio of 1:0.4. The right humerus was affected in 28 patients (43%), while the left humerus was affected in 37 patients (57%). The gravity method successfully reduced 90% of fractures without the need for an assistant surgeon, resulting in a zero percent incidence of iatrogenic neurovascular injury. The average surgical duration was 20 minutes (ranging from 16 to 24 minutes), with an average of 7 images captured using the image intensifier. In cases where the gravity method failed, alternative closed reduction methods were employed for 10% of fractures; no open reduction was necessary. Conclusion: The gravity method demonstrates safety and efficacy by providing accurate traction for reducing displaced supracondylar fractures without causing damage to the overlying skin or neurovascular structures around the elbow. Its applicability is particularly noteworthy in settings with a shortage of trained medical personnel and limited expertise in managing neurovascular complications.

Osteochondroma of the distal humerus: A rare location

Osteochondroma of the medial condyle of the humerus is rare; hence, diagnosis can be challenging as it may be confused with other causes of swelling around the elbow joint. This can lead to compression of neurovascular structure. We present a case of left medial condyle humerus osteochondroma with ulnar nerve involvement and conduct a literature review of this rare condition. A 25-year-old male patient presented with swelling around the left elbow joint for 1 year and tingling and numbness along ulnar nerve distribution for the last 3 months. He underwent an X-ray, magnetic resonance imaging, electromyography, and nerve conduction velocity that confirmed the diagnosis of an osteochondroma with ulnar nerve involvement. An excisional biopsy was subsequently done. In conclusion, the case is an atypical location of osteochondroma. The history, clinical presentation, diagnostic imaging, and management outlined may help in the early identification and management of this rare but complicated condition.

An Unusual Case of Brachial Artery Thrombosis in a Neonate Following Humerus fracture at Birth

A female infant of a diabetic mother born through LSCS at 39 weeks of gestation with a birth weight of 2908 grams was noted to have a paucity of movement of the left upper limb soon after birth. The extremity was pale, had markedly deranged perfusion, and was cold to touch with absent brachial, radial, and ulnar arterial pulsations. There was a swelling noted over the middle of the left arm, which was tender and associated with crepitus suspicious of a fracture. The right upper limb and lower limbs were normal. An urgent X-ray of the left upper limb showed a displaced fracture of the left humerus fracture and the Doppler study revealed absent flow in the brachial artery distal to the fracture site without thrombus. Urgent close reduction of the fracture following which the doppler showed a thrombus in the brachial artery extending up to its bifurcation. The thrombosis was managed medically with low molecular weight heparin and aspirin. There was a gradual improvement of limb perfusion with normalcy achieved on day 3 of life with no residual complications even on follow-up. The workup of neonatal thrombosis, its immediate management and current evidence for the same have been discussed in detail.

Induced Membrane Technique Combined with Surgical Lengthening of an Humerus Defect Secondary to Chronic Osteomyelitis: Case Report

Surgical management of long bone defects remains a considerable challenge for orthopedic surgeons, particularly in septic conditions. We present the case of an 8-year-old girl with a history of chronic osteomyelitis in the left humerus, referred to us following a pathologic fracture, initially managed with humeral osteosynthesis and grafting. Subsequently, the induced membrane technique was employed for pseudarthrosis after a recurrent fracture. Following consolidation, significant humeral shortening was observed, necessitating surgical lengthening using an external fixator, resulting in a satisfactory final outcome.