scholarly journals Digital analysis of external fixation area of proximal humerus fractures in elderly patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Baorui Xing ◽  
Yadi Zhang ◽  
Xiuxiu Hou ◽  
Yunmei Li ◽  
Guoliang Li ◽  
...  
Keyword(s):  
Humeral Head ◽  
3D Model ◽  
Proximal Humerus ◽  
Sagittal Plane ◽  
Axillary Nerve ◽  
Coronal Plane ◽  
Inferior Surface ◽  
Vertical Distance ◽  
Inferior Border ◽  
Superior Border

Abstract Introduction The purpose is based on anatomical basis, combined with three-dimensional measurement, to guide the clinical repositioning of proximal humeral fractures, select the appropriate pin entry point and angle, and simulate surgery. Methods 11 fresh cadaveric specimens were collected, the distance of the marked points around the shoulder joint was measured anatomically, and the vertical distance between the inferior border of the acromion and the superior border of the axillary nerve, the vertical distance between the apex of the humeral head and the superior border of the axillary nerve, the vertical distance between the inferior border of the acromion and the superior border of the anterior rotator humeral artery, and the vertical distance between the apex of the humeral head and the superior border of the anterior rotator humeral artery were marked on the 3D model based on the anatomical data to find the relative safety zone for pin placement. Results Contralateral data can be used to guide the repositioning and fixation of that side of the proximal humerus fracture, and uniform data cannot be used between male and female patients. For lateral pining, the distance of the inferior border of the acromion from the axillary nerve (5.90 ± 0.43) cm, range (5.3-6.9) cm, was selected for pining along the medial axis of the humeral head, close to the medial cervical cortex, and the pining angle was measured in the coronal plane (42.84 ± 2.45)°, range (37.02° ~ 46.31°), and in the sagittal plane (28.24 ± 2.25)°, range (19.22° ~ 28.51°). The pin was advanced laterally in front of the same level of the lateral approach point to form a cross-fixed support with the lateral pin, and the pin angle was measured in the coronal plane (36.14 ± 1.75)°, range (30.32° ~ 39.61°), and in the sagittal plane (28.64 ± 1.37)°, range (22.82° ~ 32.11°). Two pins were taken at the greater humeral tuberosity for fixation, with the proximal pin at an angle (159.26 ± 1.98) to the coronal surface of the humeral stem, range (155.79° ~ 165.08°), and the sagittal angle (161.76 ± 2.15)°, with the pin end between the superior surface of the humeral talus and the inferior surface of the humeral talus. The distal needle of the greater humeral tuberosity was parallel to the proximal approach trajectory, and the needle end was on the inferior surface of the humeral talus. Conclusion Based on the anatomical data, we can accurately identify the corresponding bony structures of the proximal humerus and mark the location of the pin on the 3D model for pin placement, which is simple and practical to meet the relevant individual parameters.

scholarly journals Digital Analysis of External Fixation Area of Proximal Humerus Fractures in Elderly Patients

2021 ◽  
Author(s):  
Yadi Zhang ◽  
Baorui Xing ◽  
Xiuxiu Hou ◽  
Yunmei Li ◽  
Guoliang Li ◽  
...  
Keyword(s):  
Humeral Head ◽  
3D Model ◽  
Proximal Humerus ◽  
Sagittal Plane ◽  
Axillary Nerve ◽  
Coronal Plane ◽  
Inferior Surface ◽  
Vertical Distance ◽  
Inferior Border ◽  
Superior Border

Abstract Background:The purpose is based on anatomical basis, combined with three-dimensional measurement, to guide the clinical repositioning of proximal humeral fractures, select the appropriate nail entry point and angle, and simulate surgery.Methods: 11 fresh cadaveric specimens were collected, the distance of the marked points around the shoulder joint was measured anatomically, and the vertical distance between the inferior border of the acromion and the superior border of the axillary nerve, the vertical distance between the apex of the humeral head and the superior border of the axillary nerve, the vertical distance between the inferior border of the acromion and the superior border of the anterior rotator humeral artery, and the vertical distance between the apex of the humeral head and the superior border of the anterior rotator humeral artery were marked on the 3D model based on the anatomical data to find the relative safety zone for nail placement.Results:Contralateral data can be used to guide the repositioning and fixation of that side of the proximal humerus fracture, and uniform data cannot be used between male and female patients. For lateral nailing, the distance of the inferior border of the acromion from the axillary nerve (5.90±0.43) cm, range (5.3-6.9) cm, was selected for nailing along the medial axis of the humeral head, close to the medial cervical cortex, and the nailing angle was measured in the coronal plane (42.84±2.45)°, range (37.02°~46.31°), and in the sagittal plane (28.24±2.25)°, range ( 19.22°~28.51°). The nail was advanced laterally in front of the same level of the lateral approach point to form a cross-fixed support with the lateral nail, and the nail angle was measured in the coronal plane (36.14±1.75)°, range (30.32°~39.61°), and in the sagittal plane (28.64±1.37)°, range (22.82°~32.11°). Two pins were taken at the greater humeral tuberosity for fixation, with the proximal pin at an angle (159.26±1.98) to the coronal surface of the humeral stem, range (155.79°~165.08°), and the sagittal angle (161.76±2.15)°, with the pin end between the superior surface of the humeral talus and the inferior surface of the humeral talus. The distal needle of the greater humeral tuberosity was parallel to the proximal approach trajectory, and the needle end was on the inferior surface of the humeral talus.Conclusion: Based on the anatomical data, we can accurately identify the corresponding bony structures of the proximal humerus and mark the location of the nail on the 3D model for nail placement, which is simple and practical to meet the relevant individual parameters.

scholarly journals SEVER INFERIOR HUMERAL HEAD SUBLUXATION FOR 3 MONTHS IN PROXIMAL HUMERUS FRACTURE DISLOCATION

2021 ◽  
Vol 9 (08) ◽  
pp. 870-873
Author(s):  
Emad M. Allehyani ◽  
Ahmed K. Alsarhani ◽  
Ahmed Alsyed
Keyword(s):  
Humeral Head ◽  
Proximal Humerus Fracture ◽  
Proximal Humerus ◽  
Axillary Nerve ◽  
Fracture Pattern ◽  
Humerus Fracture ◽  
Fracture Dislocation ◽  
Medical Illness ◽  
Patient Factors

Proximal humerus fracture is common fracture 4-6% of all fractures (1), third most common non vertebral fracture in elderly >65 years (2), affecting female more than males in ratios of 2:1.Approximately half (51%) of these fractures are displaced, the majority of which involve the surgical neck (77%). (3) Surgical treatment (mainly internal fixation or humeral head replacement) is being increasingly used (4).Management of each fracture is dependent of patient factors, fracture pattern, and complexity.Case scenario:33 years old female not known to has any medical illness, presented to the emergency department with right shoulder pain and inability to move it after motor cycle accident. X-rayshowed proximal humerusfracture dislocation Upon Post-operative follow up patient developed sever inferior humeral head subluxation, With intact axillary nerve sensation and motor exam.Discussion:proximal humerus fracture is common, fracture pattern and type, with patient factors will guide your management.proximal humerus fracture dislocation is more difficult and challenging to surgeon in managing such fracture, with inferior hemeral head subluxation is common can reach to 42% in the radiographic incidence among proximal humerus fracture.

A new classification of impacted proximal humerus fractures based on the morpho-volumetric evaluation of humeral head bone loss with a 3D model

2020 ◽  
Vol 29 (10) ◽  
pp. e374-e385 ◽  
Author(s):  
Raffaele Russo ◽  
Antonio Guastafierro ◽  
Giuseppe della Rotonda ◽  
Stefano Viglione ◽  
Michele Ciccarelli ◽  
...  
Keyword(s):  
Bone Loss ◽  
Humeral Head ◽  
3D Model ◽  
Proximal Humerus ◽  
Proximal Humerus Fractures ◽  
New Classification ◽  
Humerus Fractures

scholarly journals Change in the Distance From the Axillary Nerve to the Glenohumeral Joint With Shoulder External Rotation or Abduction Position

Hand ◽  
2016 ◽  
Vol 12 (4) ◽  
pp. 395-400 ◽  
Author(s):  
Juan Pablo Simone ◽  
Philipp N. Streubel ◽  
Joaquin Sanchez-Sotelo ◽  
Scott P. Steinmann ◽  
Julie E. Adams
Keyword(s):  
Humeral Head ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Axillary Nerve ◽  
Shoulder Abduction ◽  
Continuous Variables ◽  
Inferior Aspect ◽  
Fresh Frozen ◽  
The Mean ◽  
Inferior Border

Background: This study investigated whether axillary nerve (AN) distance to the inferior border of the humeral head and inferior glenoid would change while placing the glenohumeral joint in different degrees of external rotation and abduction. Methods: A standard deltopectoral approach was performed on 10 fresh-frozen cadaveric specimens. The distance between AN and the inferior border of the humeral head and inferior glenoid while placing the shoulder in 0°, 45°, and 90° of external rotation or abduction was measured. Continuous variables for changes in AN position were compared with paired 2-tailed Student t test. Results: The mean distance between the AN and the humeral head with the shoulder in 0°, 45°, and 90° of external rotation and 0° of abduction was 13.77 mm (SD 4.31), 13.99 mm (SD 4.12), and 16.28 mm (SD 5.40), respectively. The mean distance between the AN and glenoid with the shoulder in 0°, 45°, and 90° of external rotation was 16.33 mm (SD 3.60), 15.60 mm (SD 4.19), and 16.43 (SD 5.35), respectively. The mean distance between the AN and the humeral head with the shoulder in 0°, 45°, and 90° of abduction and 0° of external rotation was 13.76 mm (SD 4.31), 10.68 mm (SD 4.19), and 3.81 mm (SD 3.08), respectively. The mean distance between the AN and glenoid with the shoulder in 0°, 45°, and 90° of abduction was 16.33 mm (SD 3.60), 17.66 mm (SD 5.80), and 12.44 mm (SD 5.57), respectively. Conclusions: The AN position relative to the inferior aspect of the glenohumeral joint does not significantly change despite position of external rotation. Increasing shoulder abduction over 45° decreases the distance from the glenohumeral joint to the AN and should be avoided.

scholarly journals Establishing the appropriate position of proximal humerus locking plates: a cadaveric study of five plating systems and their anatomic reference measurements

2017 ◽  
Vol 10 (1) ◽  
pp. 40-44 ◽  
Author(s):  
Matthew A Butler ◽  
Aakash Chauhan ◽  
Gregory A Merrell ◽  
Jeffrey A Greenberg
Keyword(s):  
Humeral Head ◽  
First Generation ◽  
Second Generation ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Cadaveric Study ◽  
Locking Plates ◽  
Greater Tuberosity ◽  
Reference Measurements ◽  
Superior Border

Background The present study aimed to determine anatomic references for the placement of five proximal humerus locking plates. Methods Five proximal humerus locking-plate systems were placed on six human shoulder cadavers. Plates were positioned by fluoroscopic confirmation so that the inferior oblique screw was within 5 mm of the inferomedial cortex. Plate position was measured using the superior border of the pectoralis major tendon (PMT) to the bottom of the first slotted or nonlocking hole and top of the plate to the top of the greater tuberosity. The distance from the PMT insertion to the top of the humeral head was measured as a control. Results There was consistency within each plating system for both the distance from the PMT insertion to the first hole and the top of the plate to the greater tuberosity: Synthes first-generation [mean (SD) 13.7 mm (3.1 mm); 10 mm (1.3) mm], Synthes second-generation [28.2 mm (2.2 mm); 18.5 mm (2.7 mm)], Biomet OptiLock® [25.5 mm (2.7 mm); 18.7 mm (2 mm)], Stryker AxSOS® [5 mm (2.8 mm); 12.3 mm (3.3 mm)] and Acumed Polarus® [9.5 mm (1.8 mm); 14.8 mm (1.6 mm)]. Conclusions The present study provides measurements that improve the accuracy of plate positioning for five plating systems.

The Kaplan Fibers of the Iliotibial Band Can Be Identified on Routine Knee Magnetic Resonance Imaging

2019 ◽  
Vol 47 (12) ◽  
pp. 2895-2903 ◽  
Author(s):  
Lachlan Batty ◽  
Jerome Murgier ◽  
Richard O’Sullivan ◽  
Kate E. Webster ◽  
Julian A. Feller ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Sagittal Plane ◽  
Interobserver Reliability ◽  
Joint Line ◽  
Coronal Plane ◽  
Iliotibial Band ◽  
Resonance Imaging ◽  
Lateral Gastrocnemius ◽  
The Mean

Background: The Kaplan fibers (KFs) of the iliotibial band have been suggested to play a role in anterolateral rotational instability of the knee, particularly in the setting of an anterior cruciate ligament (ACL) rupture. Description of the normal magnetic resonance imaging (MRI) anatomy of the KFs may facilitate subsequent investigation into the MRI signs of injury. Purpose: To assess if the KF complex can be identified on 3-T MRI using standard knee protocols. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: 3-T MRI scans of 50 ACL-intact knees were reviewed independently by a musculoskeletal radiologist and 2 orthopaedic surgeons. Identification of the KFs was based on radiological diagnostic criteria developed a priori. Identification of the KFs in the sagittal, coronal, and axial planes was recorded. Interobserver reliability was assessed using the Kappa statistic. Detailed anatomy including distance to the joint line and relationship to adjacent structures was recorded. Results: The mean patient age was 43 years (range, 15-81 years), 58% were male, and 50% were right knees. The KFs were identified by at least 2 reviewers on the sagittal images in 96% of cases, on the axial images in 76% of cases, and on the coronal images in 4% of cases. The mean distance from the KF distal femoral insertion to the lateral joint line was 50.1 mm (SD, 6.6 mm) and the mean distance to the lateral gastrocnemius tendon origin was 10.8 mm (SD, 8.6 mm). The KFs were consistently identified immediately anterior to the superior lateral geniculate artery on sagittal imaging. Interobserver reliability for identification was best in the sagittal plane (Kappa 0.5) and worst in the coronal plane (Kappa 0.1). Conclusion: The KF complex can be identified on routine MRI sequences in the ACL-intact knee; however, there is low to moderate interobserver reliability. Imaging in the sagittal plane had the highest rate of identification and the coronal plane the lowest. There is a consistent relationship between the most distal KF femoral attachment and the lateral joint line, lateral gastrocnemius tendon, and superior lateral geniculate artery.

scholarly journals The Natural History of Progression in Adult Spinal Deformity: A Radiographic Analysis

2019 ◽  
Vol 10 (3) ◽  
pp. 272-279 ◽  
Author(s):  
Sayf S. A. Faraj ◽  
Niek te Hennepe ◽  
Miranda L. van Hooff ◽  
Martin Pouw ◽  
Marinus de Kleuver ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Cobb Angle ◽  
Spinal Deformity ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Coronal Plane ◽  
Historical Cohort ◽  
Curve Magnitude ◽  
Nonsurgical Patients

Study Design: Historical cohort study. Objective: To evaluate progression in the coronal and sagittal planes in nonsurgical patients with adult spinal deformity (ASD). Methods: A retrospective analysis of nonsurgical ASD patients between 2005 and 2017 was performed. Magnitude of the coronal and sagittal planes were compared on the day of presentation and at most recent follow-up. Previous reported prognostic factors for progression in the coronal plane, including the direction of scoliosis, curve magnitude, and the position of the intercrest line (passing through L4 or L5 vertebra), were studied. Results: Fifty-eight patients were included with a mean follow-up of 59.8 ± 34.5 months. Progression in the coronal plane was seen in 72% of patients. Mean Cobb angle on the day of presentation and most recent follow-up was 37.2 ± 14.6° and 40.8° ± 16.5°, respectively. No significant differences were found in curve progression in left- versus right-sided scoliosis (3.3 ± 7.1 vs 3.7 ± 5.4, P = .81), Cobb angle <30° versus ≥30° (2.6 ± 5.0 vs 4.3 ± 6.5, P = .30), or when the intercrest line passed through L4 rather than L5 vertebra (3.4 ± 5.0° vs 3.8 ± 7.1°, P = .79). No significant differences were found in the sagittal plane between presentation and most recent follow-up. Conclusions: This is the first study that describes progression in the coronal and sagittal planes in nonsurgical patients with ASD. Previous reported prognostic factors were not confirmed as truly relevant. Although progression appears to occur, large variation exists and these results may not be directly applicable to the individual patient.

The addition of a conjunctival flap to a posterior lamella auricular cartilage graft: A technique to avoid corneal complications

2021 ◽  
pp. 112067212199891
Author(s):  
Constanza Barrancos ◽  
Ignacio García-Cruz ◽  
Beatriz Ventas-Ayala ◽  
Marco Sales-Sanz
Keyword(s):  
Donor Site ◽  
Lower Eyelid ◽  
Cartilage Graft ◽  
Auricular Cartilage ◽  
Inferior Margin ◽  
Conjunctival Flap ◽  
Absorbable Sutures ◽  
Inferior Border ◽  
Superior Portion ◽  
Superior Border

Purpose: To present the benefits of the addition of a conjunctival flap when correcting lower eyelid retraction using an auricular cartilage graft. Methods: An auricular cartilage graft was obtained either from the concha o the scaphoid fossa. When preparing the receiving bed, the conjunctival incision was made 2 mm below the inferior margin of the lower eyelid tarsus, therefore, a conjunctival flap arising from the inferior border of the tarsus was obtained. The cartilage graft was placed in the lower eyelid. The inferior border of the graft was sutured to the retractors and conjunctiva using absorbable sutures. The superior border was sutured to the inferior tarsus, so that de conjunctival flap covered the superior portion of the graft. Results: Fourteen patients underwent the surgical technique. No corneal complications were observed in the early or late postoperative period. Donor site complications were not encountered. Conclusions: The confection of a conjunctival flap that lines the superior portion of an auricular cartilage graft in the lower eyelid provides protection against corneal postoperative complications until the graft is epithelized.

Stress Study of Removable Partial Denture with Attachments Using Finite Element Analysis

2014 ◽  
Vol 658 ◽  
pp. 389-394
Author(s):  
Oana Cella Andrei ◽  
Livia Alice Tanasescu ◽  
Ruxandra Margarit ◽  
Mircea Horia Tierean
Keyword(s):  
3D Model ◽  
Sagittal Plane ◽  
Simulation Software ◽  
Von Mises Stress ◽  
Removable Partial Denture ◽  
Maximum Displacement ◽  
Partial Denture ◽  
Rotational Movement ◽  
Anterior Teeth ◽  
First Case

The paper presents the study of the stresses and the displacements that appear in different areas of the removable partial denture (RPD) with extracoronal attachments under occlusal loading, using FEA. The first step was to create the 3D model of a RPD with ball attachments in case of a class I Kennedy edentulous patient with all six anterior teeth as abutments. All materials were considered homogeneous, isotropic and having linear elasticity. There were assumed two types of constraints: in the first one the model is fixed under the action of the mastication forces; in the second one the rotational movement of the denture’s saddles in the sagittal plane was simulated, towards the edentulous ridge. In the first case, the 3D model and FEA were developed using Autodesk Inventor 2013 software. In the second case, the FEA was done using Autodesk Algor Simulation software. The loading of the model was symmetrically applied, considering the magnitude of the tangential and normal oral forces determined by Las Casas et al. These forces were applied to all the PM1, PM2, M1 and M2 pairs. Each loading case was analysed separately. The results of the two constrain situations are presented graphically, comparatively and show that the amount of the saddle displacement depends on the application area of the mastication force. Maximum displacement was computed at the application of the mastication forces on the M2 and decreases as the force is applied more mesial. The amount of the major connector’s deformation is very little influenced by the site of the force. The largest displacement of the denture was recorded at the distal end of the saddle, with values ​​that depend on the site of the forces. The existence of the rotational movement of the denture’s free end saddles in the sagittal plane, towards the edentulous ridge, changes the values ​​of accumulated stresses in denture during mastication and its Von Mises stress peaks. This analysis can be use to establish the principles of planning and designing the RPD with ball attachments having in mind to minimize the number of repairs caused by fractures of the components.

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