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1.
L Naver J R Aalberg 《Archives of orthopaedic and traumatic surgery. Archiv für orthop?dische und Unfall-Chirurgie》1986,106(1):20-22
Twenty patients, 17 to 87 years of age, were treated with a dynamic brace for fractures of the humerus. The brace acts by compressing the soft tissues surrounding the fractured bone while the dependent arm of the ambulatory patient helps to pull the displaced bone fragments into normal relationship. As soon as the initial swelling and pain subsides the brace can be applied, usually within the first week. The brace permits early exercise of all the joints; it gives good comfort to the patient. There were two nonunions. Eighteen fractures healed with good anatomical and functional outcome. 相似文献
2.
Summary Twenty patients, 17 to 87 years of age, were treated with a dynamic brace for fractures of the humerus. The brace acts by compressing the soft tissues surrounding the fractured bone while the dependent arm of the ambulatory patient helps to pull the displaced bone fragments into normal relationship. As soon as the initial swelling and pain subsides the brace can be applied, usually within the first week. The brace permits early exercise of all the joints; it gives good comfort to the patient. There were two nonunions. Eighteen fractures healed with good anatomical and functional outcome.
Zusammenfassung Zwanzig Humerusfrakturen wurden in einer Prospektivstudie untersucht, um die Ergebnisse der funktionellen Behandlung zu beurteilen. Wir beschreiben einen einfachen Kunststoff-Fixationsapparat, der das weiche Gewebe um die Fraktur komprimiert und gleichzeitig ermöglicht, daß das Gewicht des hängenden Armes die Fraktur in die richtige Position ziehen kann. Der Apparat kann meist in einer Woche angepaßt werden und gibt darn Möglichkeit zu frühzeitiger aktiver Bewegungstherapie.相似文献
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The functional-conservative treatment of fractures of the humerus shaft is the most efficient method today. It is an uncomplicated and reliable method for outpatient therapy. In our opinion only second degree open fractures and vessel injuries are a contraindication. A few guidelines taken into consideration enable everybody to learn the handling of plaster brace in a short time period. All fractures we treated in this way showed an osseous fracture healing. 相似文献
4.
Jitendra Nath Pal Prahas Biswas Avik Roy Sunit Hazra Somnath Mahato 《Indian Journal of Orthopaedics》2015,49(4):408-417
Background:Functional brace application for isolated humeral shaft fracture persistently yields good results. Nonunion though uncommon involves usually the proximal third shaft fractures. Instead of polyethylene bivalve functional brace four plaster sleeves wrapped and molded with little more proximal extension expected to prevent nonunion of proximal third fractures. Periodic compressibility of the cast is likely to yield a better result. This can be applied on the 1st day of the presentation as an outpatient basis. Comprehensive objective scoring system befitting for fracture humeral shaft is a need.Results:The results were assessed using 100 point scoring system where union allotted 30 points and 60 points allotted for angulations (10), elbow motion (10), shoulder abduction (10), shortening (5), rotation (5), absence of infection (10), absence of nerve palsy during treatment (10). Remaining 10 points were allotted for five items with two points each. They were the absence of skin sore, absence of vascular problem, absence of reflex sympathetic dystrophy (RSD), recovery of paralyzed nerve during injury and recovery of paralyzed nerve during treatment. Results were considered excellent with 90 and above, good with 80–89, fair with 70–79 and poor below 70 point. Results at 6 months were excellent in 43.94% (n = 29), good in 42.42% (n = 28), fair in 9.1% (n = 6), poor in 4.55% (n = 3). Union took place in 98.48% (n = 65) with an average of 10.3 weeks (range 6–16 weeks). 87.5% (n = 7) paralyzed radial nerve recovered. All wounds healed. Four patients had transient skin problem. One patient with mid shaft fracture had nonunion due to the muscle interposition.Conclusion:Modified functional cast brace is one of the options in treatment for humeral shaft fractures as it can be applied on the 1st day of the presentation in most of the situations. Simple objective scoring system was useful particularly in uneducated patients. 相似文献
5.
OBJECTIVE: To determine humeral diaphyseal fractures at risk for nonunion with functional brace treatment. DESIGN: Retrospective case series. SETTING: A single surgeon's practice. PATIENTS: Forty-nine of 52 consecutive patients treated nonoperatively for an isolated diaphyseal fracture of the humerus during a 6-year period were followed until either union and full or near-full restoration of shoulder and elbow motion, or until 6 months had passed, or until a reconstructive surgery was performed (average follow-up 14 months; range 2 to 50 months). INTERVENTION: Functional fracture brace. MAIN OUTCOME MEASUREMENTS: Radiographic and clinical union. RESULTS: Union was achieved in 44 of 49 patients (90%) with no more than 15-degree loss of shoulder or elbow motion in any patient. Four of 14 proximal-third fractures (29%), one of 22 middle-third fractures (4%), and none of the 13 distal-third fractures failed to heal. CONCLUSIONS: Proximal-third long oblique fractures may be at greater than average risk for nonunion after functional fracture bracing. LEVEL OF EVIDENCE: Level IV (case series). 相似文献
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It generally is agreed that fractures of the proximal tibia, when treated with intramedullary nails, are more likely to present technical difficulties and to be associated with an increased rate of complications. This study reports on 108 closed fractures located in the proximal third of the tibia that were treated with functional braces. Nonunion occurred in 2.7% of the patients; the final displacement and shortening averaged 20% and 3.5 mm, respectively. Eighty-eight percent of the fractures healed with less than 6 degrees of angular deformity. It seems that functional braces for closed fractures of the tibia, located in its proximal third, are a viable therapeutic approach that offers satisfactory clinical and radiographic results in a high percentage of instances. 相似文献
8.
Radial palsy in shaft fracture of the humerus 总被引:2,自引:0,他引:2
Ole B stman Georg Bakalim Seppo Vainionp Eero Wiippula Hannu P ti l Pentti Rokkanen 《Acta orthopaedica》1986,57(4):316-319
Fifty-nine patients with immediate and 16 with secondary radial nerve palsy complicating a fracture of the shaft of the humerus were reviewed. According to the preferences of the surgeon in charge, the palsy was treated either with early exploration of the radial nerve and internal fixation of the fracture or with initial expectance. Of the latter, 12 were later explored.
No useful recovery of motor function could be seen in 13/59 patients with immediate and in 2/16 patients with secondary palsy. In patients with immediate palsy treated by early exploration, there were 8/27 nonrecoveries. Among those treated with initial expectance, there were 5/32 nonrecoveries. For secondary palsy, these figures were 2/10 and 0/6, respectively.
No support emerged for routine early exploration. 相似文献
No useful recovery of motor function could be seen in 13/59 patients with immediate and in 2/16 patients with secondary palsy. In patients with immediate palsy treated by early exploration, there were 8/27 nonrecoveries. Among those treated with initial expectance, there were 5/32 nonrecoveries. For secondary palsy, these figures were 2/10 and 0/6, respectively.
No support emerged for routine early exploration. 相似文献
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The treatment of fractures of the humerus shaft is still controversial. The results of functional treatment (brace) are good, consolidation occurs in most cases within 8-10 weeks, slight malalignment can be accepted, and there is no risk of postoperative complications like osteitis, neurological iatrogenic disorders and technical errors. On the other hand a correct osteosynthesis allows painless functional postoperative treatment, the patient comfort is excellent and a selected group of patients might return to work faster. We present the results of plate fixation of humerus shaft fractures in 127 patients, operated from 1980 to 1988. 102 patients were clinically and radiologically controlled after 1 year: 85 patients (83.4%) presented an excellent or good result with complete functional recovery. 17 patients (16.6%) showed a limited range of motion in shoulder and/or elbow mostly due to other fractures of the same arm or to persistent neurological disorders (plexus or radial lesions). Postoperative complications included 2 postoperative radial palsies recovering completely within months, 5 failures of internal fixation due to technical errors, 2 pseudarthrosis and 4 postoperative infections, healed by reoperation and early removal of the implant with one exception (osteitis). We therefore conclude, that a correct plate fixation of humerus shaft fractures is an alternative to conservative treatment. The main advantage is better patient comfort and shorter disability for a selected group of patients. 相似文献
12.
OBJECTIVE: To assess which fractures of the humeral diaphysis are prone to nonunion after functional bracing by analyzing patients that present for treatment of nonunion after brace treatment. METHODS: Thirty-two patients treated operatively for a nonunion of the diaphyseal humerus after functional brace treatment were analyzed with respect to the location and the pattern of the original fracture. There were 21 women and 11 men with an average age of 53 years (range 23-84 years). RESULTS: The fracture involved the proximal third of the diaphysis in 17 patients, the middle third in 14 patients, and the distal third in 1 patient. The pattern of the fracture was oblique or spiral in 27 patients with a butterfly fragment in 11 of those patients. Only four patients had a transverse fracture. Operative fixation ultimately achieved union in all 32 patients, but a second procedure was necessary for loosening of fixation or persistent nonunion in 3 older-aged patients. The functional results were good or excellent in all 32 patients. CONCLUSIONS: Compared with the epidemiology of acute diaphyseal humerus fractures, nonunions after functional bracing are more likely to follow spiral/oblique fractures that involve the mid- or proximal-third of the diaphysis. Operative treatment can gain union and improve arm function. 相似文献
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Background
Acute Achilles tendon (AT) rupture management remains debatable but non-operative functional regimes are beginning to gain popularity. The aim of this study was to identify predictors of functional outcome in patients with AT ruptures treated non-operatively with an immediate weight bearing functional regime in an orthosis.Methods
Analysis of prospectively gathered data from a local database of all patients treated non-operatively at our institution with an AT rupture was performed. For inclusion in the study patients required a completed Achilles Tendon Rupture Score (ATRS) at a minimum of 6 months post injury. The ATRS score was correlated against age, gender, time following rupture, duration (8 or 11 weeks) of treatment in a functional orthoses and complications were recorded.Results
236 patients of average age 49.5 years were included. The mean ATRS on completion of rehabilitation was 74 points. The mean ATRS was significantly lower in the 37 females (65.8) as compared to the 199 males (75.6) (p = 0.013). Age inversely affected ATRS with a Pearsons correlation of ?0.2. There was no significant difference in the ATRS score when comparing the two different treatment regime durations. There were 12 episodes of VTE and 4 episodes of re-rupture. The ATRS does not change significantly after 6 months following rupture treatment completion.Conclusion
Patients with AT ruptures treated non-operatively with a functional rehabilitation regime demonstrate comparable function to other non-surgical regimes with low re-rupture rates. Increasing age and female gender demonstrate inferior functional outcomes.Clinical relevance
Females and increasing age predict poorer functional outcome in acute Achilles tendon ruptures managed in a dynamic full-weight bearing treatment regime. 相似文献15.
肱骨近端是上肢骨折的好发部位之一。随着工伤、交通事故等高能量致伤因素的增加,其发病率不断上升,且骨折类型呈现新的特点,尤其是我国已进入老龄化社会,老年性肱骨近端骨折大多为严重、复杂、粉碎的关节内骨折。如何正确治疗,这对于临床更是一个新的课题。目前,全国各地医生根据自己对该骨折的认识、知识更新的程度、是否受到良好的训练。 相似文献
16.
Three cases of dislocation of the shoulder and ipsilateral fracture of the shaft of the humerus are reported. The literature is reviewed. It is suggested that X-ray films should be taken of the shoulder and elbow in all patients with fractures of the shaft of the humerus. 相似文献
17.
J. S. Butler R. T. Dolan M. Burbridge C. J. Hurson J. M. O’Byrne D. McCormack K. Synnott A. R. Poynton 《European spine journal》2010,19(10):1635-1642
Odontoid fractures currently account for 9–15% of all adult cervical spine fractures, with type II fractures accounting for
the majority of these injuries. Despite recent advances in internal fixation techniques, the management of type II fractures
still remains controversial with advocates still supporting non-rigid immobilization as the definitive treatment of these
injuries. At the NSIU, over an 11-year period between 1 July 1996 and 30 June 2006, 66 patients (n = 66) were treated by external immobilization for type II odontoid fractures. The medical records, radiographs and CT scans
of all patients identified were reviewed. Clinical follow-up evaluation was performed using the Cervical Spine Outcomes Questionnaire
(CSOQ). The objectives of this study were to evaluate the long-term functional outcome of patients suffering isolated type
II odontoid fractures managed non-operatively and to correlate patient age and device type with clinical and functional outcome.
Of the 66 patients, there were 42 males and 24 females (M:F = 1.75:1) managed non-operatively for type II odontoid fractures.
The mean follow-up time was 66 months. Advancing age was highly correlated with poorer long-term functional outcomes when
assessing neck pain (r = 0.19, P = 0.1219), shoulder and arm pain (r = 0.41, P = 0.0007), physical symptoms (r = 0.25, P = 0.472), functional disability (r = 0.24, P = 0.0476) and psychological distress (r = 0.41, P = 0.0007). Patients >65 years displayed a higher rate of pseudoarthrosis (21.43 vs. 1.92%) and established non-union (7.14
vs. 0%) than patients <65 years. The non-operative management of type II odontoid fractures is an effective and satisfactory
method of treating type II odontoid fractures, particularly those of a stable nature. However, patients of advancing age have
been demonstrated to have significantly poorer functional outcomes in the long term. This may be linked to higher rates of
non-union. 相似文献
18.
《中华手外科杂志》2005,21(5)
肱骨近端是上肢骨折的好发部位之一.随着工伤、交通事故等高能量致伤因素的增加,其发病率不断上升,且骨折类型呈现新的特点,尤其是我国已进入老龄化社会,老年性肱骨近端骨折大多为严重、复杂、粉碎的关节内骨折.如何正确治疗,这对于临床更是一个新的课题.目前,全国各地医生根据自己对该骨折的认识、知识更新的程度、是否受到良好的训练,在治疗上采用了保守,闭合或开放复位,克氏针张力带钢丝,各种传统的钢板,肱骨近端锁定加压钢板(locking proximal humeral plate,LPHP)以及人工肱骨头置换等多种术式,疗效不一,众说纷纭。面对众多的治疗方法,有时临床医生感到不知所措,为了引起广大临床工作者对肱骨近端骨折治疗的重视,加强其临床与基础研究,为临床工作者提供百花齐放学术争端的良好平台,本刊组织了4篇专题论著,旨在抛砖引玉,欢迎同道积极参与讨论. 相似文献
19.
目的探讨弹性髓内钉治疗儿童肱骨干骨折的临床效果。方法对37例肱骨干骨折(经手法复位不满意或手法复位石膏固定后再移位)患儿采取闭合复位、小切口弹性髓内钉内固定治疗。除2例因手法复位失败采用有限切开复位外,其余均采用闭合复位。分别于术后3、6、12个月对患儿肩、肘关节功能进行评分。结果 37例均获随访,时间6~24个月,2例因钉尾过长或折弯致肱骨进针点疼痛和钉尾刺激反应,拔钉后症状消失。骨折全部骨性愈合,愈合时间3~6个月。均无感染、短缩、旋转畸形以及骨骺、神经损伤等并发症发生。采用Constant和Murley肩关节评分系统、Mayo肘关节功能评分系统评价疗效,术后12个月疗效:优20例,良15例,可2例,优良率为94.59%。结论弹性髓内钉内固定治疗儿童肱骨干骨折创伤小,可早期活动,愈合快,并发症少。 相似文献
20.
Treatment of supracondylar fracture of the humerus in children by skeletal traction in a brace 总被引:5,自引:0,他引:5
Matsuzaki K Nakatani N Harada M Tamaki T 《The Journal of bone and joint surgery. British volume》2004,86(2):232-238
In 1980, we developed a specially designed brace for treating supracondylar fractures of the humerus in children, along with an easy and safe technique of reduction by skeletal traction. This method, which takes into consideration only the medial tilting and anterior angulation of the distal fragment, achieves complete reduction, ignoring any lateral, posterior and minor rotational displacements of the fragment. Skeletal traction is applied through a screw inserted into the olecranon and the angulation at the fracture site is reduced regardless of the anatomical position without manipulation. We treated 193 children with displaced supracondylar fractures of the humerus using this method between 1980 and 2001. Only four children (2%) developed cubitus varus. The majority obtained an excellent range of movement at the elbow; one had a 25 degree limitation of flexion. This technique is an effective and easy method of treating supracondylar fractures of the humerus in children. 相似文献