We performed endoscopic bone grafting for eight patients of delayed union and nonunion which developed after femoral and humeral shaft fractures. The mean interval from initial intervention to endoscopic bone grafting was 7.3 months. Six patients of delayed union and nonunion healed at 4.1 months on average. Two patients had unsatisfactory healing and eventually underwent non-endoscopic revisional surgery. There was no intraoperative on postoperative complication. Endoscopic bone grafting can be a less invasive alternative, obtaining rapid bone union in cases of compromised healing of the diaphyseal fracture.
Adult ; Bone Transplantation* ; Case Report ; Endoscopy* ; Female ; Femoral Fractures/surgery* ; Femoral Fractures/radiography ; Femoral Fractures/physiopathology ; Human ; Humeral Fractures/surgery* ; Humeral Fractures/radiography ; Humeral Fractures/physiopathology ; Male ; Middle Age ; Time Factors ; Wound Healing*

OBJECTIVETo analyze the relationship between the degree of displacement and Baumann angle in pediatric supracondylar humeral fractures by using Excel, and to guide treatment for humeral fractures of children.

METHODSFrom July 2010 to July 2011,56 children with humeral supracondylar fractures were collected (34 boys and 22 girls, 15 patients with radial deviation and 41 patients with ulnar deviation,ranging in age from 3 to 14 years). The data of the patients about fracture displacement and the Baumann angle measured by MB-Ruler were input in Excel and then were analyzed to obtain data fitting curve.

RESULTSThere were close results between two methods, and the tangent of the radial deviation was more than tangent of ulnar deviation, which indicated that the influence of ulnar deviation was stronger than that of the radial deviation in pediatric supracondylar humeral fractures,so the correction should be paid attention to in clinic. When the radial deviation coefficient was less than -0.18 and ulnar deviation coefficient was more than 0.50,the Baumann angle would change to the reverse trend, so the angle range of Baumann in clinic should be between 65.70 and 96.77 degree. When the ulnar deviation factor was more than 0.15(including 0.15) and Baumann angle more than 82 degrees(including 82 degree), cubitus varus deformity occurred inevitably,so the practices and surgical reduction should be focused on in clinic.

CONCLUSIONAccording to data curves analysis results,the influence of ulnar deviation is stronger than that of the radial deviation in pediatric supracondylar humeral fractures. When the ulnar deviation factor is more than 0.15 (including 0.15), correction should be focused on in order to prevent cubitus varus deformity.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Humeral Fractures ; physiopathology ; therapy ; Male

OBJECTIVETo study the biomechanical characteristics of Ni-Ti shape-memory alloy-enclosed interlocking intramedular nail Ni-Ti En for clinical application.

METHODSSix transverse fractures were induced in 6 fresh humeral shafts and fixed with Ni-Ti En, plate, interlocking intramedullary nail, and Ender nail, respectively. The specimens then underwent stress analysis for comparison of the bending strength, twisting force, and flexibility.

RESULTSThe bending strength of Ni-Ti En was not significantly different from that of the plate and better than ender's nail; the twisting force of the interlocking intramedullary nail was comparable with the plate, but better than Ender nail.

CONCLUSIONNi-Ti Enpossess good biomechanical property to meet the demand of osteosynthesis, and its less stress protection, freedom of distant nail locking, flexibility and stable fixation may accelerate fracture healing.

Biomechanical Phenomena ; Bone Nails ; Fracture Fixation, Intramedullary ; instrumentation ; methods ; Humans ; Humeral Fractures ; physiopathology ; surgery ; Nickel ; Titanium

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Humeral Fractures ; surgery ; therapy ; Humerus ; physiopathology ; surgery ; Male

OBJECTIVESTo research the effects of supracondylar fractures of humerus treated by three different surgical methods.

METHODSThere were 103 patients with supracondylar fractures of humerus including 58 male and 45 female. The age was from 3 to 12 years old with the average of 7.4 years. To divide the cases into three groups by the operative approach in the humerus, the inside approach were in 37 cases (group A), the outside in 35 cases (group B) and the rear in 31 cases (group C). Comparing the reduction of the stretching and bending function of elbow joint and incidence of elbow varus.

RESULTSAll patients were followed-up for 1.5 to 8 years after operation with the average of 32 months. The reduction of stretching and bending function of elbow joint occurrenced in 6 cases in group A, 6 cases in group B and 25 cases in group C, the incidenc of group C were obvious more than group A and B (P < 0.01). The elbow varus occurred in 8 cases in group A, 17 cases in group B and 7 cases in group C, the incidence of group B were obviously more than group A and C (P < 0.05).

CONCLUSIONThere are different effects between three kinds of operative approaches in the humerus. The incidence of outside group is higher on the varus of elbow. The incidence of rear group is higher on the ability of elbow joint stretching and bending. The effect of inside group is sure on the operative approach in the humerus.

Child ; Child, Preschool ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; physiopathology ; surgery ; Humerus ; injuries ; physiopathology ; surgery ; Male

Adolescent ; Adult ; Aged ; Child ; External Fixators ; Female ; Humans ; Humeral Fractures ; physiopathology ; therapy ; Humerus ; injuries ; physiopathology ; Male ; Middle Aged ; Musculoskeletal Manipulations

Fracture of bilateral capitulum humeri is a very rare injury. We present a case of a 38-year-old woman, affected by a shear fracture of bilateral capitellum after a motorcycle accident. Intervention was carried out through a lateral approach on both sides and direct fixation of the fragment with headless screws. Consolidation was achieved and no signs of avascular necrosis occurred at 24 months of follow-up. The patient returned to her previous activities with no functional limitations. To the best of our knowledge, only four cases are reported describing different types of treatment and postoperative period of cast immobilization. According to our review of the literature regarding capitellar fractures, we preferred an immediate postoperative rehabilitation of the elbow, following the stable osteosynthesis.
Adult ; Collateral Ligaments ; injuries ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; physiopathology ; rehabilitation ; surgery ; Range of Motion, Articular

OBJECTIVETo explore the clinical efficacy of self-made Kirschner wire hook in the treatment of severely displaced proximal humerus fractures in children.

METHODSFrom January 2007 to February 2012,35 children with severely displaced proximal humerus fractures were treated with self-made Kirschner wire hook fixation,including 25 boys and 10 girls with an average age of 13.2 years old ranging from 5 to 17. The duration from injury to operation was 1 to 10 days with an average of 4.5 days. Preoperative diagnoses were confirmed by X-ray films as type III in 26 cases and type IV in 9 according to the Neer-Horwitz classification of the proximal humerus fractures. All fractures were close fracture without nerve or vascular injuries. Anatomical reduction was achieved by open reduction and the fractures were fixed by self-made Kirschner wire hook. Intra-operative and postoperative complications, postoperative radiographic examination, upper extremity length and range of shoulder motion were observed and recorded. Neer score system was used to evaluate shoulder function.

RESULTSAll patients were followed up from 6 to 18 months with an average of 12.1 months. The mean Neer score of the injured side was 94.2 +/- 4.8 (ranged, 84 to 99), 30 patients got an excellent result and 5 good according to the Neer scores. The X-ray showed all the fractures healed without shortening deformity or epiphyseal arrest at early stage. There were no complications related to the implant including loosening or breakage of the self-made Kirschner wire hook. The range of shoulder motion in the injuried side was similar to the normal side, except in abductor lift. All the patients could participate in normal physical activities.

CONCLUSIONThe method of open reduction and fixed with self-made Kirschner wire hook is a safe,effective,convenient treatment for severely displaced proximal humeral fractures in children.

Adolescent ; Bone Wires ; Child ; Child, Preschool ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; physiopathology ; surgery ; Male ; Range of Motion, Articular

OBJECTIVETo investigate the therapeutic efficacy of bone-setting manipulative reduction and small splint fixation combined with micro-movement theory exercise for treatment of humeral shaft fractures.

METHODSFrom March 2011 to February 2014, 64 cases of humeral shaft fractures were treated by bone-setting manipulative reduction and small splint fixation including 28 males and 36 females with an average age of 38.1 years old ranging from 22 to 67 years old. According to the classification of AO/OTA, there were 10 cases of type A1, 12 cases of type A2,11 cases of type A3,10 cases of type B1,12 cases of type B2, 7 cases of type B3, 2 cases of type C1, 1 case of type C2, 1 case of type C3. After close reduction early functional exercise performed according to micro-movement theory. All patients had no other parts of the fractures, neurovascular injury, and serious medical problems. Patients were followed up for fracture healing, shoulder and elbow joint function recovery, and curative effect.

RESULTSAll patients were followed up from 10 to 12 months with an average of 10.3 months. Of them, 2 cases had a small amount of callus growth at 3 months after close reduction, so instead of operation; 2 cases appeared radial nerve symptoms after close reduction ,so instead of operation. Other patients were osseous healing, the time was 8 to 12 weeks with an average of 10.2 weeks. After osseous healing, according to Constant-Murley score system ,the average score was (93.5 ± 3.2) points, the result was excellent in 29 cases, good in 29 cases, fair in 6 cases, excellent and good rate was 90.3%; according to the Mayo score system, the average score was (93.7 ± 4.2) points, the result was excellent in 35 cases, good in 23 cases, fair in 6 cases, excellent and good rate was 91.9%.

CONCLUSIONBone-setting manipulative reduction and small splint fixation combined with micromovement theory exercise for treatment of humeral shaft fractures has advantage of positive effect, easy and inexpensive method, the treatment has relevant scientific basis and practical value, it can effectively reduce complications, promote patients early recovery.

Adult ; Aged ; Exercise Therapy ; Female ; Fracture Healing ; Humans ; Humeral Fractures ; physiopathology ; therapy ; Male ; Manipulation, Orthopedic ; methods ; Middle Aged ; Movement ; Splints

OBJECTIVETo compare therapeutic effects of three fixation methods with three Kirschner wires,and to find the best fixation method.

METHODSFrom July 2008 to May 2009, 60 patients with humeral supracondylar fractures were treated. Among patients in Group A, 11 patients were male and 9 patients were female, ranging from 2 to 13 years old,with an average of (5.4 +/- 0.5)years;all the patients in Group A were fresh closed fractures without nerve and blood vessel injuries, 13 patients were type II and 7 patients were type III according to Gartland classification; and all the patients in Group A were treated by three Kirschner wires fixation with the third Kirschner different wire fixed through radial edge of coronoid fossa. Among patients in Group B, 13 patients were male and 7 patients were female,ranging from 2 to 11 years old, with an average of (6.1 +/- 0.4) years; all the patients in Group B were fresh closed fractures without blood vessel injuries, 11 patients were type II and 9 patients were type III according to Gartland classification, 2 patients had ulnar nerve injuries before treatment; and all the patients in Group B were treated by three Kirschner wires fixation with the third Kirschner different wire fixed through ulnar edge of coronoid fossa. Among patients in Group C, 8 patients were male and 12 patients were female, ranging from 3 to 14 years old, with an average of (7.4 +/- 0.6) years; all the patients in Group C were closed fresh fractures without blood vessel injuries, 7 patients were type II and 13 patients were type III according to Gartland classification, 2 patients had radial nerve injuries before treatment; and all the patients in Group C were treated by three Kirschner wires fixation with the third Kirschner different wire fixed through middle of coronoid fossa. After 1 year of treatment,the Carrying and Baumann angles were measured on the X-ray of all patients in the three groups, and the motion range of elbow joint was observed. The Flynn evaluation criteria were used to compare therapeutic effects among the three groups.

RESULTSAll the patients were followed up. The function loss of elbow joint were (14.04 +/- 3.25) degrees in Group A, (13.14 +/- 2.34) degrees in Group B, and (9.25 +/- 2.56) degrees in Group C. Changes of Carrying angle were (7.64 +/- 1.78) degrees in Group A; (7.38 +/- 1.68) degrees in Group B, and (5.27 +/- 1.13) degrees in Group C. Changes of Baumann angle were (28.55 +/- 3.23) degrees in Group A, (27.55 +/- 2.23) degrees in Group B, (21.45 +/- 1.73) degrees in Group C. According to Flynn criteria, there were 11 patients got excellent result, 4 good and 5 poor in Group A; in Group B, 12 patients got excellent result, 3 good and 5 poor; in Group C, 11 patients got excellent result, 6 good and 3 poor. The therapeutic effects of Group C was better than those of Group A and Group B.

CONCLUSIONThere are different effects among three kinds of operative approaches for the humerus supracondylar fractures. The fixation method with one Kirschner wire through middle part of coronoid fossa is better than the other two fixation methods.

Adolescent ; Bone Wires ; Case-Control Studies ; Child ; Child, Preschool ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; physiopathology ; surgery ; Male