INTRODUCTION: The cross Kirschner wire (K-wire) configuration in closed reduction and percutaneous pinning of paediatric supracondylar humeral fracture affords superior stability. However, medial pin placement presents a risk of iatrogenic ulnar nerve injury. This study describes, in step-by-step detail, another safe method of percutaneous medial pin insertion. METHODS: The technique involved placing the patient's arm in external rotation, with elbow flexed no more than 45° after closed reduction. The surgeon held the K-wire close to its sharp end to pass it percutaneously onto the medial epicondyle, then adjusted his grip toward the blunt end. After fluoroscopy check, the wire driver was engaged and an anteriorly directed force was applied to the distal humerus fragment using the thumb of the surgeon's free hand. The K-wire was inserted at a 45° angle to the longitudinal axis of the humerus shaft. Clinical notes and radiographs of patients who underwent surgery with this technique from 2006 to 2008 were reviewed. RESULTS: A total of 125 patients (84 boys, 41 girls) were included, with a mean age of 7.1 (range 2-14) years. Most injuries were left-sided (72.8%, n = 91, vs. right: 27.2%, n = 34). 72 (57.6%) patients had two-pin cross K-wire configuration, while 53 (42.4%) patients had an additional lateral pin inserted. No patient had postoperative ulnar neuropathy. There were no complications of non-union, malunion or infection. CONCLUSION This safe method of medial pin placement for surgical stabilisation of paediatric supracondylar humeral fractures is easily learnt and reproducible, and produces excellent results.
Adolescent ; Bone Nails ; Child ; Child, Preschool ; Female ; Fluoroscopy ; Fracture Fixation, Intramedullary ; methods ; Humans ; Humeral Fractures ; surgery ; Humerus ; injuries ; Iatrogenic Disease ; Male ; Pediatrics ; Radiography ; Retrospective Studies ; Ulnar Nerve

BACKGROUND: In 1951, Ardran reported that metastatic bone lesions could be detectable on plain radiography with 30% to 50% of decalcification. Authors performed experimental study for minimum level of decalcification to detect the osteolytic bone metastasis of long bone with recent technique of radiographs. METHODS: One pair of fibula and humerus from two cadavers was cut into specimen 1 inch in length. Distal half of specimen was dipped into hydrochloride (HCl) with 15 min interval. All 16 specimens were checked by film-type radiography (FR), computed radiography (CR), digital radiography (DR). To exclude inter-observer's variance, 3 radiologists evaluated images. Calcium amount before and after decalcification was measured and expressed in percentage of decalcification. RESULTS: Osteolytic changes were detectable with 11% to 16% of decalcification for fibula and 3% to 8% for humerus on plain radiography with FR, CR, and DR. CONCLUSIONS: Our study showed that minimum of 3% and maximum of 16% of decalcification is necessary when osteolytic metastatic bone lesions of long bone could be detected on plain radiography.
Cadaver ; Calcium ; Decalcification Technique ; Fibula ; Humerus ; Neoplasm Metastasis* ; Osteolysis ; Radiographic Image Enhancement ; Radiography*

The aim of the present study was to evaluate the degree of restoration of acromiohumeral distance of immediate postoperative period in patients who have rotator cuff repair surgery with large-to-massive rotator cuff tears and to find clinical and radiologic factors influencing this. Fifty four patients who had arthroscopic rotator cuff repair with available postoperative magnetic resonance images done within postoperative one week were included. Retrospective review of the medical data and radiologic images was done. It was revealed that acromiohumeral distance of immediate postoperative period was smaller in patients with larger sized rotator cuff tears, more retraction of the torn end and narrower preoperative acromiohumeral distance. The degree of inferior migration of the humeral head which could be obtained through the surgery alone was more in patients who have more difference between acromiohumeral distance measured on preoperative standing simple radiography and acromiohumeral distance measured on preoperative magnetic resonance image.
Acromion ; Humans ; Humeral Head ; Humerus ; Postoperative Period* ; Radiography ; Retrospective Studies ; Rotator Cuff* ; Shoulder ; Tears*

This report was designed to investigate a rare case that brachialis tear and hematoma caused by acute elbow posterior dislocation. We studied a 20-year-old male patient with right elbow joint pain after outstretched injury. Physical examination showed instability of hright elbow joint and simple radiography indicated a posterolateral dislocation of right elbow joint. Computed tomography taken after closed reduction using Parvin technique revealed a few small bone fragment located on posterior humerus capitulum. Magnetic resonance imaging showed complete tear of brachialis and anterior articular capsule with hematoma. The patient was managed with long arm splint and hinge brace for an elbow dislocation with brachialis rupture and hematoma. The elbow joint range of motion was recovered to be in a normal range, and pain was diminished. There are few reported cases of acute elbow posterior dislocation combined with brachialis rupture and hematoma. The patient showed good clinical outcome after conservative treatment.
Arm ; Braces ; Dislocations* ; Elbow Joint ; Elbow* ; Hematoma* ; Humans ; Humerus ; Joint Capsule ; Magnetic Resonance Imaging ; Male ; Physical Examination ; Radiography ; Range of Motion, Articular ; Reference Values ; Rupture ; Splints ; Young Adult

OBJECTIVETo study the radiologic and pathologic features of primary intermediate hemangioendothelioma of the bone.

METHODSFive cases of primary intermediate hemangioendothelioma of bone encountered in the past three years were enrolled into the study. The clinical, radiologic, pathologic and immunohistochemical features of the tumors were reviewed.

RESULTSThe patients included 3 children with Kaposiform hemangioendothelioma and 2 elderly with retiform hemangioendothelioma. Four of the cases affected long bones and the remaining case affected the clavicle. One case showed multifocal involvement of the humerus. Radiologically, the tumors showed borderline to low-grade bony destruction, with various degrees of cortical defect. Intralesional or perilesional bone formation was demonstrated in 4 cases and radial spicules were seen in 1 case. The histopathologic features of primary intermediate hemangioendothelioma of bone were similar to those of soft tissue, except for the presence of reactive bone formation. Immunohistochemically, the tumor cells were positive for CD31 (5/5), CD34 (5/5), vimentin (5/5) and smooth muscle actin (3/5) but negative for cytokeratin and epithelial membrane antigen.

CONCLUSIONSPrimary intermediate hemangioendothelioma of bone is a distinct entity and similar histologic classification applies as in its soft tissue counterparts. Comparison of the biologic behavior requires long-term follow-up studies.

Actins ; metabolism ; Antigens, CD34 ; metabolism ; Bone Neoplasms ; diagnostic imaging ; metabolism ; pathology ; Child ; Clavicle ; pathology ; Diagnosis, Differential ; Female ; Femur ; pathology ; Hemangioendothelioma ; diagnostic imaging ; metabolism ; pathology ; Hemangiosarcoma ; pathology ; Humans ; Humerus ; pathology ; Immunohistochemistry ; Infant ; Kasabach-Merritt Syndrome ; diagnostic imaging ; metabolism ; pathology ; Male ; Middle Aged ; Platelet Endothelial Cell Adhesion Molecule-1 ; metabolism ; Radiography ; Sarcoma, Kaposi ; diagnostic imaging ; metabolism ; pathology ; Vimentin ; metabolism

BACKGROUND: We conducted this radiographic study in the elderly population with proximal humeral fracture aiming to evaluate 1) the serial changes of neck-shaft angle after locking plate fixation and 2) find relationship between change in neck shaft angle and various factors such as age, fracture pattern, severity of osteoporosis, medial support and initial reduction angle. METHODS: Twenty-five patients who underwent surgical treatment for proximal humeral fracture with locking plate between September 2008 and August 2010 are included. True anteroposterior and axillary lateral radiographs were made postoperatively and at each follow-up visit. Measurement of neck shaft angle was done at immediate postoperative, 3 months postoperative and a final follow-up (average, 11 months; range, 8 to 17 months). Severity of osteoporosis was assessed using cortical thickness suggested by Tingart et al. RESULTS: The mean neck shaft angles were 133.6degrees (range, 100degrees to 116degrees) at immediate postoperative, 129.8degrees (range, 99degrees to 150degrees) at 3 months postoperative and 128.4degrees (range, 97degrees to 145degrees) at final follow-up. The mean loss in the neck-shaft angle in the first 3 months was 3.8degrees as compared to 1.3degrees in the period between 3 months and final follow-up. This was statistically significant (p = 0.002), indicating that most of the fall in neck shaft angle occurs in the first three months after surgery. Relationship between neck shaft angle change and age (p = 0.29), fracture pattern (p = 0.41), cortical thickness (p = 0.21), medial support (p = 0.63) and initial reduction accuracy (p = 0.65) are not statistically significant. CONCLUSIONS: The proximal humerus locking plate maintains reliable radiographic results even in the elderly population with proximal humerus fracture.
Aged ; Aged, 80 and over ; Analysis of Variance ; *Bone Plates ; Female ; Fracture Fixation, Internal/instrumentation/methods ; Humans ; Humerus/radiography/*surgery ; Male ; Shoulder Fractures/radiography/*surgery

BACKGROUND AND OBJECTIVEAfter chemotherapy was used to treat patients with malignant bone tumors in 1970s, amputation, which was the typical intervention in the 1980s, has been substituted with limb-sparing surgery. This article reported the surgical indications, operative methods, operative effects, and complications of prosthetic replacement of the proximal humerus after the resection of bone tumors.

METHODSFrom April 2004 and December 2008, prosthetic replacement was performed in 18 patients with proximal humerus tumors, including 7 patients with osteosarcoma, 5 patients with chondrosarcoma, 3 patients with giant cell tumor (GCT) of the bone, 1 patient with GCT of the bone combined with an aneurysmal bone cyst, and 1 patient with metastatic bone tumors. Using the Enneking staging system, 7 osteosarcomas and 3 chondrosarcomas were at stage Ib, and 3 GCTs and 2 chondrosarcomas were at stage Ib. The patient with metastatic bone tumors reported severe pain.

RESULTSThe follow-up ranged 5-61 months (mean, 29 months) and showed that 1 patient with osteosarcoma died 19 months after surgery. Local recurrence presented in 1 patient with GCT, 1 patient had inner infection in the area of surgery, and 2 patients had shoulder subluxation after the operation. There was no prosthetic loosening in any patient. The abduction angle of the shoulder was 8 degrees-35 degrees, and circumgyrate angle was 18 degrees-25 degrees, with flexion 35 degrees-90 degrees and extension 25 degrees-42 degrees. According to the functional score developed by the International Society of Limb Salvage, scores ranged between 18 and 29 points, with an average of 24 points.

CONCLUSIONSThe prosthesis replacement for the patients with bone tumors in the proximal humerus is an appropriate procedure with satisfactory therapeutic outcomes; however, many complications should be noted and long-term therapeutic effect needs further investigations.

Adolescent ; Adult ; Arthroplasty, Replacement ; Bone Neoplasms ; diagnostic imaging ; pathology ; surgery ; Chondrosarcoma ; diagnostic imaging ; pathology ; surgery ; Female ; Follow-Up Studies ; Giant Cell Tumor of Bone ; diagnostic imaging ; pathology ; surgery ; Humans ; Humerus ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Osteosarcoma ; diagnostic imaging ; pathology ; secondary ; surgery ; Prosthesis Implantation ; Radiography ; Range of Motion, Articular ; Young Adult

A extragonadal malignant teratoma of the extremity is a rare pheonemenon. We describe a extremely rare case of malignant teratoma of the left proximal humerus in a 14-yr-old female. Radiologic evaluations, including magnetic resonance imaging, suggested a malignant bone tumor, but a pathological examination revealed an immature bony teratoma. Bone scintigraphy and positron emission tomography computed tomography scan showed increased uptake of proximal humerus but no other abnormal lesion.
Adolescent ; Bone Neoplasms/*diagnosis/pathology/radiography ; Female ; Humans ; *Humerus/radiography ; Magnetic Resonance Imaging ; Positron-Emission Tomography ; Teratoma/*diagnosis/pathology/radiography ; Tomography, X-Ray Computed

OBJECTIVETo study the clinicopathologic and radiologic features of dedifferentiated chondrosarcoma, focusing on its diagnosis and differential diagnosis.

METHODClinical, radiological and pathologic findings of 14 cases of dedifferentiated chondrosarcoma (including biopsy and surgical specimens) were analyzed by hematoxylin and eosin stained sections and immunohistochemistry.

RESULTSThe mean age of patients was 52 years. The male-to-female ratio was 9:5. The most common sites of involvement were pelvis, femur and humerus, similar to the conventional chondrosarcoma. Radiologically, they were malignant tumors with dimorphic pattern. Grossly, central chondrosarcomas were more common than those of the peripheral. An essential histological feature of dedifferentiated chondrosarcoma was an abrupt interface between the low-grade cartilaginous tumor and high-grade anaplastic sarcoma. The most common dedifferentiated components were osteosarcoma, malignant fibrous histocytoma and fibrosarcoma. False negative diagnosis and erroneous diagnosis were frequent when only one-time biopsy was available.

CONCLUSIONSDedifferentiated chondrosarcoma is a rare subtype of chondrosarcoma with poor prognosis, which has different features of clinical manifestation, imaging features and pathological characteristics, compared to conventional chondrosarcoma and chondroblastic osteosarcoma.

Adult ; Aged ; Bone Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; surgery ; Cell Differentiation ; Chondrosarcoma ; diagnostic imaging ; drug therapy ; pathology ; surgery ; Chondrosarcoma, Mesenchymal ; pathology ; Diagnosis, Differential ; Female ; Femoral Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; surgery ; Follow-Up Studies ; Humans ; Humerus ; pathology ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Osteosarcoma ; pathology ; Pelvic Bones ; pathology ; Radiography ; Vimentin ; metabolism ; Young Adult

Albendazole ; therapeutic use ; Anthelmintics ; therapeutic use ; Bone Diseases, Infectious ; diagnostic imaging ; pathology ; therapy ; Bone Plates ; Curettage ; Echinococcosis ; diagnostic imaging ; drug therapy ; pathology ; Humans ; Humerus ; parasitology ; surgery ; Male ; Middle Aged ; Radiography