![]() The treatment of proximal humeral fractures by the use of Prévotnails is presented in this paper and some possible problems of the method are discussed. Fixation of subcapital humeral fractures by intramedullary pinning seems to provide sufficient stability without damaging the vascularity of the fracture fragments leaving intact in addition the soft tissues around the shoulder. Minimal exposure of the fracture area, indirect reduction techniques and a minimal but optimal biomechanical use of implants can help to avoid some of the possible (and partially iatrogenic) complications. Recent results from basic research emphasize the importance of sound tissue viability for undisturbed fracture healing and influence today's strategies in fracture management. A large spectrum of recommendations for the treatment of unstable subcapital fractures are known ranging from conservative treatment, open reduction and internal fixation using different implants to the primary prosthetic replacement of the humeral head. With respect to the fracture type and extent of displacement of the humeral head and the tuberosities the concepts for treatment remain controversial. Failure of internal fixation in Garden I and II fractures requires subsequent operative interventions A primary treatment plan of hip arthroplasty may be. Recognition of the appearance of subcapital hip fractures mimicking pathologic fractures and knowledge of the cause of this finding are important for prescribing appropriate treatment.Displaced subcapital fractures of the humerus are difficult to manage due to the specific anatomical and biological conditions in the proximal humerus. Minimally displaced and impacted left femoral subcapital neck fracture. This appearance is caused primarily by rotation of the fracture fragments, and the finding is accentuated by displacement. The radiographic appearance of subcapital fractures of the femoral neck unrelated to neoplasm is often similar to that of pathologic fractures. Especially, a displaced fracture of the subcapital femoral neck is known to cause many complications, such as AVN of the femoral head or nonunion. Study of the cadaveric femoral specimens showed that the radiographic appearance simulating a pathologic fracture was primarily caused by external rotation of the distal fracture fragment and was accentuated by displacement between fracture fragments. This finding occurred only with Garden stage III fractures (n = 7, 32% of Garden stage III fractures) or Garden stage IV fractures (n = 10, 24% of Garden stage IV fractures). Seventeen (17%) of the 100 subcapital fractures had a radiographic appearance similar to that of a pathologic fracture. Cadaveric femurs (n = 6) were fractured and studied radiographically. Fracture configuration was classified by using the Garden staging system. Preoperative radiographs were analyzed for the presence of findings suggesting a pathologic fracture. In the other patients, follow-up radiographs, clinical evaluation, and pathology reports were used to exclude neoplastic involvement. Review of intraoperative biopsy specimens, available in 69 patients, revealed no evidence of neoplasm in any case. In case of impacted fracture, we tried to disengage the fracture anatomically as much as possible using the Steinmann pin or bone hook via the joystick technique. Radiographs were available in 100 of these cases. Especially, a displaced fracture of the subcapital femoral neck is known to cause many complications. ![]() Our purpose was to determine the prevalence of this finding and the anatomic variations of fracture alignment that cause this appearance.Īll subcapital nonpathologic hip fractures (n = 111) that occurred at our institution during a 5-year period were reviewed. Occasionally, radiographs of the hip in these patients show a radiolucency in the superolateral, subcapital region of the femoral neck that mimics the features of a pathologic fracture. Subcapital fractures of the femoral neck are common in elderly persons who have osteoporosis.
0 Comments
Leave a Reply. |