Fractures of the proximal- and middle-thirds of the humeral shaft should be considered as fragility fractures

2020 ◽  
Vol 102-B (11) ◽  
pp. 1475-1483
Author(s):  
William M. Oliver ◽  
Henry K. C. Searle ◽  
Zhan Herr Ng ◽  
Neil R. L. Wickramasinghe ◽  
Samuel G. Molyneux ◽  
...  
Keyword(s):  
Fragility Fractures ◽  
Social Background ◽  
Bimodal Distribution ◽  
Injury Mechanism ◽  
Radial Nerve Palsy ◽  
Injury Characteristics ◽  
Fracture Location ◽  
Study Centre ◽  
Diaphyseal Fractures ◽  
Humeral Diaphysis

Aims The aim of this study was to determine the current incidence and epidemiology of humeral diaphyseal fractures. The secondary aim was to explore variation in patient and injury characteristics by fracture location within the humeral diaphysis. Methods Over ten years (2008 to 2017), all adult patients (aged ≥ 16 years) sustaining an acute fracture of the humeral diaphysis managed at the study centre were retrospectively identified from a trauma database. Patient age, sex, medical/social background, injury mechanism, fracture classification, and associated injuries were recorded and analyzed. Results A total of 900 fractures (typical 88.9%, n = 800/900; pathological 8.3%, n = 75/900; periprosthetic 2.8%, n = 25/900) were identified in 898 patients (mean age 57 years (16 to 97), 55.5% (n = 498/898) female). Overall fracture incidence was 12.6/100,000/year. For patients with a typical fracture (n = 798, mean age 56 years (16 to 96), 55.1% (n = 440/798) female), there was a bimodal distribution in men and unimodal distribution in older women (Type G). A fall from standing was the most common injury mechanism (72.6%, n = 581/800). The majority of fractures involved the middle-third of the diaphysis (47.6%, n = 381/800) followed by the proximal- (30.5%, n = 244/800) and distal-thirds (n = 175/800, 21.9%). In all, 18 injuries (2.3%) were open and a radial nerve palsy occurred in 6.7% (n = 53/795). Fractures involving the proximal- and middle-thirds were more likely to occur in older (p < 0.001), female patients (p < 0.001) with comorbidities (p < 0.001) after a fall from standing (p < 0.001). Proximal-third fractures were also more likely to occur in patients with alcohol excess (p = 0.003) and to be classified as AO-Orthopaedic Trauma Association type B or C injuries (p < 0.001). Conclusion This study updates the incidence and epidemiology of humeral diaphyseal fractures. Important differences in patient and injury characteristics were observed based upon fracture location. Injuries involving the proximal- and middle-thirds of the humeral diaphysis should be considered as fragility fractures. Cite this article: Bone Joint J 2020;102-B(11):1475–1483.

scholarly journals Epidemiology Of Proximal And Diaphyseal Humeral Fractures In Children: An Observational Study From The Swedish Fracture Register

2021 ◽  
Author(s):  
Sarah Daag Jacobsen ◽  
Richard Marsell ◽  
Olof Wolf ◽  
Yasmin D. Hailer
Keyword(s):  
Observational Study ◽  
Injury Mechanism ◽  
Humeral Fractures ◽  
Common Mechanism ◽  
Diaphyseal Fracture ◽  
Horse Riding ◽  
Fractures In Children ◽  
Surgical Methods ◽  
Fracture Register ◽  
Diaphyseal Fractures

Abstract Background: Most fractures in children are fractures of the upper extremity. Proximal and diaphyseal humeral fractures account for a minority of these fractures. To our knowledge, few previous reports address these fractures. This study aimed to describe the epidemiology and current treatment of proximal and diaphyseal humeral fractures by using the Swedish Fracture Register (SFR). Methods: In this nationwide observational study from the SFR we analysed data on patient characteristics, injury mechanism, fracture classification and treatment. We included patients aged <16 years at time of injury with proximal or diaphyseal humeral fracture registered in 2015-2019.Results: 1996 (1696 proximal and 300 diaphyseal) fractures were registered. Proximal fractures were more frequent in girls whereas diaphyseal fractures were more frequent in boys. The median age at fracture was 10 years in both fracture types but patient’s age was more widespread in diaphyseal fracture (IQR 5-13 compared to IQR 7-12 in proximal). In both sexes, the most registered injury mechanism was fall. Horse-riding was a common mechanism of injury in girls, whereas ice-skating and skiing were common mechanisms in boys. The majority of fractures were treated non-surgically (92% of proximal and 80% of diaphyseal fractures). The treatment method was not associated with the patient’s sex. Surgery was more often performed in adolescents. The most common surgical methods were K-wire and cerclage fixation in proximal fracture and intramedullary nailing in diaphyseal fracture.Conclusion: Following falls, we found sex-specific sport activities to cause most proximal and diaphyseal paediatric fractures. Further studies on prophylactic efforts in these activities are needed to investigate whether these fractures are preventable. The majority of the fractures were treated non-surgically, although surgical treatment increased with increasing age in both sexes.

scholarly journals AB0897 BIMODAL DISTRIBUTION OF VERTEBRAL FRAGILITY FRACTURES (VFF) IN A FRACTURE LIAISON SERVICE (FLS). RESULTS OF A COMPARATIVE ANALYSIS OF PATIENTS WITH VFF VERSUS THOSE WITH OTHER FRAGILITY FRACTURES (OFF).

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1752.1-1752
Author(s):  
B. Hernández-Cruz ◽  
F. J. Olmo Montes ◽  
M. J. Miranda García ◽  
M. D. Jimenez Moreno ◽  
M. A. Vázquez Gómez ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Lower Risk ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Fragility Fractures ◽  
Bimodal Distribution ◽  
Nonparametric Tests ◽  
University Hospital ◽  
Vertebral Compression Fractures ◽  
Risk Of Falls

Background:Fragility fractures (FF) represent a health problem and among them, the VFF. They have worse vital prognosis, are at greater risk of new FF, had higher comorbidity, with clinical manifestations in only 30%-40% of cases. One in 6 women and one in 12 adult males will have a VFF.Objectives:To analyze the clinical characteristics of FF patients attended in the FLS at Virgen Macarena University Hospital. Compare the sociodemographic and clinical characteristics of VFF patients with those with OFF.Methods:Design: Prospective cohort. Patients attended in the FLS from May 2018 to November 2019 in a protocolized manner (Openclinica®). Inclusion criteria: a clinical FF in the previous two years. Descriptive statistics: percentages and means with 25thand 75thpercentile. Inferential statistic by parametric and nonparametric tests. The project was approved by the Ethics Committee and patients signed consent to participate.Results:Data from 414 patients with a first FF are analyzed, 101 (25%) with VFF and 313 (76%) with OFF [188 (45%) hip, 66 (16%) distal radius, 32 (8%) humerus and 27 (6%) miscellaneous (pelvis, ribs, tibia)]. All VFFs analyzed had clinical symptoms and the number of fractured vertebrae was 2 (1-3). In 28 (37%) were FF of dorsal vertebrae, at 25 (33%) lumbar and 23 (30%) dorsal and lumbar. Comparative analysis showed differences in age VFF 71 (62-77) vs OFF 76 (66 – 83) years, p=0.0003. It highlighted a bimodal distribution according to age, with a peak incidence of 55 to 68 years and another between 75-80 years (Graph). Referral unit to FLS: VFF Rheumatology (42%) and/or Traumatology Emergency Room (44%) vs OFF Internal Medicine (45%) and General Traumatology Unit (38%), p=0.0001. There were also differences in the treatment with teriparatide (VFF 20% vs OFF 4%); zoledronate (VFF 6% vs OFF 3%) and alendronate (VFF 44% vs OFF 63%, p=0001); days of immobilization (VFF 30 (0 - 60) vs OFF 10 (0 - 30), p-0.01); they have greater independence to carry out activities of daily life (Barthel Scale) VFF 95(81 – 100) vs OFF 80 (60 – 95), p=0.00001; increased clamping force of hands 18 (12 - 20) vs 12 (8 - 18) mmHg, p=0.001, and lower risk of falls (J D Downton Scale) (VFF 43% vs OFF 60%, p=0,01). While the number of relevant comorbidities was higher in VFF 3 (1 - 5) vs OFF 2 (1 - 4) it was no statistical, p=0.3. The use of GCC was risky for VFF (n=13, 13%) vs OFF (n=17, 5%), p=0.01 and RR (95%CI) 2.3 (1.01 – 5.3) and not for other drugs (GnRH inhibitors, aromatase inhibitors or chemotherapy). No differences in sex were found (VFF 80%- vs OFF 80% women, p=0.9), previous FF history (9% vs 12%, p=0.2), secondary OP (16% vs 21%, p=0.1); percentage of patients with OP by femoral neck DEXA (VFF 35% vs 42%, p=0.2) or by lumbar spine DEXA (VFF 36% vs OFF 34%, p=0.8).Conclusion:VFF have a bimodal age-based distribution, usually occurring in younger patients, with a higher degree of independence and muscle strength and lower risk of falls, although they are associated with longer duration of immobilization, compared to OFF. In our cohort, VFFs affect 2 or more vertebrae and they are commonly treated with parenteral osteoporotic drugs. The use of glucocorticoids doubled the risk of developing a VFF, these findings are similar to those of others published cohorts.This project received a grant of the Ministry Health of the Junta de Andalucía Ref.PIN-0092-2016.Bibliography:[1]Gerdhem P. Best Practice & Research Clinical Rheumatology 27 (2013) 743–755[2]McCarty J,et al. Diagnosis and management for vertebral compression fractures. American Family of Physicians Jul1, 2016 Vol 94 No 1.Disclosure of Interests:Blanca Hernández-Cruz Speakers bureau: Abbvie, Lilly, Sanofi, BMS, STADA, Francisco Jesús Olmo Montes: None declared, Maria José Miranda García: None declared, María Dolores Jimenez Moreno: None declared, María Angeles Vázquez Gómez: None declared, Mercedes Giner García: None declared, Miguel Angel Colmenero Camacho: None declared, José Javier Pérez Venegas: None declared, María José Montoya García: None declared

scholarly journals Radial nerve palsy following closed unreamed nailing of the humeral diaphysis: A case report

2018 ◽  
Vol 4 (3) ◽  
Author(s):  
Sinopidis Chris ◽  
Bougiouklis Dimitrios ◽  
Gliatis John
Keyword(s):  
Case Report ◽  
Radial Nerve ◽  
Nerve Palsy ◽  
Radial Nerve Palsy ◽  
Unreamed Nailing ◽  
Humeral Diaphysis

Surgical vs. Nonsurgical Management for Humeral Shaft Fractures; Preference Among Orthopaedic Surgeons

2021 ◽  
Vol 23 (1) ◽  
pp. 21-26
Author(s):  
Tariq A. Kwaees ◽  
Nasri H. Zreik ◽  
Charalambos P. Charalambous
Keyword(s):  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Benefit Design ◽  
Electronic Survey ◽  
Humeral Shaft Fractures ◽  
Nonsurgical Management ◽  
Shaft Fractures ◽  
Diaphyseal Fractures

Background. Determining trends in managing humeral shaft fractures may help identify variation in practice which might benefit design of clinical guidance. We aimed to determine the practice of members of the British Elbow and Shoulder Society (BESS) in managing humeral shaft fractures. Methods and materials. An electronic survey was sent to members of BESS. Questions related to preferred surgical and nonsurgical approaches for management of humeral shaft fractures. This was divided into management of proximal, middle and distal third diaphyseal fractures. Results. 91 fully completed responses were analysed. Nonsurgical management was preferred by 90.1% (n=82) for middle-third and 80.2 % (n=73) for proximal third fractures but there was an almost even split in favouring surgical (52.7%, n=48) and nonsurgical (42.8%, n=39) treatment for distal third fractures. There was great variation in how to deal with a humeral shaft fracture associated with radial nerve palsy with an almost equal divide between those favouring a surgical and nonsurgical approach for mid-shaft or distal third fractures. Conclusions. 1. The management preference for humeral shaft fractures amongst surgeons is highly variable. 2. This may be partly attributed to the sparsity of high-quality evidence. 3. Well-designed randomised trials or pro­spective cohort studies may help further guide management of these injuries.

scholarly journals Fractures of the Humeral Shaft with Primary Radial Nerve Palsy: Do Injury Mechanism, Fracture Type, or Treatment Influence Nerve Recovery?

2019 ◽  
Vol 8 (11) ◽  
pp. 1969 ◽  
Author(s):  
Roman C. Ostermann ◽  
Nikolaus W. Lang ◽  
Julian Joestl ◽  
Leo Pauzenberger ◽  
Thomas M. Tiefenboeck ◽  
...  
Keyword(s):  
Radial Nerve ◽  
Nerve Palsy ◽  
Injury Mechanism ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Fracture Type ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures ◽  
Nerve Recovery ◽  
Time To Onset

Adult humeral shaft fractures are associated with primary radial nerve palsy in up to 18% of cases. The purpose of this study was to assess the influence of injury mechanism, fracture type, and treatment on nerve recovery in patients with humeral shaft fractures and primary nerve palsy. Data of fifty patients (age—43.5 ± 21.3; female: male—1:1.8) with humeral shaft fractures and concomitant grade I–II primary radial nerve palsy, who underwent either open reduction and internal fixation (ORIF) or intramedullary nailing at an academic level I trauma center between 1994 and 2013, were evaluated. Factors potentially influencing the time to onset of recovery or full nerve recovery (injury mechanism, fracture type, fracture location and treatment) were analyzed in detail. Thirty patients were treated with ORIF and twenty patients with closed unreamed intramedullary nailing of the humeral shaft, respectively. The mean time to onset of recovery was 10.5 ± 3.4 weeks (2–17 weeks). Twenty-six (52%) patients reported significant clinical improvement within the first 12 weeks. Mean time to full recovery was 26.8 ± 8.9 weeks (4–52 weeks). Twenty-five (50%) patients regained full manual strength within the first six months following the injury. Forty-nine (98%) patients regained full manual strength within the first 52 weeks. Trauma mechanism, fracture type, fracture location, and treatment modality did not influence the time to onset of nerve recovery or time to full recovery following humeral shaft fractures with grade I–II primary radial nerve palsy.

scholarly journals Comparison of Fracture Location and Extent of Comminution in Isolated Scaphoid Fractures Versus Transscaphoid Fracture-Dislocations

Hand ◽  
2018 ◽  
Vol 15 (3) ◽  
pp. 384-387
Author(s):  
Thomas M. Suszynski ◽  
Oded Ben-Amotz ◽  
Jennifer S. Kargel ◽  
Robert Bass ◽  
Douglas M. Sammer
Keyword(s):  
Retrospective Review ◽  
Scaphoid Fracture ◽  
Injury Mechanism ◽  
Entire Length ◽  
Proximal Pole ◽  
Fracture Location ◽  
Scaphoid Fractures ◽  
Distal Pole ◽  
Fracture Dislocations ◽  
The Mean

Background: Isolated scaphoid fractures (ISFs) are common, whereas transscaphoid fracture-dislocations (TSFDs) are not. Scaphoid fracture location and the extent of comminution are factors that affect treatment and outcome. The purpose of this study is to compare the radiographic characteristics of ISFs with TSFDs associated with greater arc injury. Methods: This study is a retrospective review of all ISFs and TSFDs that presented to our institution during a 5-year period. Fracture location (along the long axis of the scaphoid) was calculated by dividing the distance from the proximal pole to the fracture by the entire length of the scaphoid. The extent of comminution was measured in millimeters along the mid-axis of the scaphoid and divided by the entire length of the scaphoid. Results: One-hundred thirty-eight scaphoid fractures in 137 patients were identified. One-hundred twelve fractures (81%) were ISFs, and 26 (19%) were associated with a TSFD. The mean fracture location was more proximal in TSFDs than in ISFs. However, fractures occurred in the distal third of the scaphoid in 12% of ISFs compared with 0% of TSFDs. Nine percent of ISFs demonstrated comminution as compared with 12% of TSFDs. Extent of comminution was 16% and 28% for ISFs and TSFDs, respectively. Conclusion: Scaphoid fractures associated with greater arc injuries are located more proximally and are more comminuted than ISFs, and distal pole fractures rarely occur in the setting of TSFDs. The increased incidence and extent of comminution in TSFDs may be suggestive of a higher energy injury mechanism.

The Social Origins and Provenance of the English Bishops during the Reign of Edward II

1959 ◽  
Vol 9 ◽  
pp. 51-79
Author(s):  
K. Edwards
Keyword(s):  
Middle Ages ◽  
Social Background ◽  
Early Career ◽  
The Political ◽  
Social Origins ◽  
Political Activities ◽  
Edward Ii ◽  
The Social ◽  
Complete Study ◽  
History Of

During the last twenty or twenty-five years medieval historians have been much interested in the composition of the English episcopate. A number of studies of it have been published on periods ranging from the eleventh to the fifteenth and early sixteenth centuries. A further paper might well seem superfluous. My reason for offering one is that most previous writers have concentrated on analysing the professional circles from which the bishops were drawn, and suggesting the influences which their early careers as royal clerks, university masters and students, secular or regular clergy, may have had on their later work as bishops. They have shown comparatively little interest in their social background and provenance, except for those bishops who belonged to magnate families. Some years ago, when working on the political activities of Edward II's bishops, it seemed to me that social origins, family connexions and provenance might in a number of cases have had at least as much influence on a bishop's attitude to politics as his early career. I there fore collected information about the origins and provenance of these bishops. I now think that a rather more careful and complete study of this subject might throw further light not only on the political history of the reign, but on other problems connected with the character and work of the English episcopate. There is a general impression that in England in the later middle ages the bishops' ties with their dioceses were becoming less close, and that they were normally spending less time in diocesan work than their predecessors in the thirteenth century.

Childhood Intelligence Predicts Adult Trait Openness

2016 ◽  
Vol 37 (2) ◽  
pp. 105-111 ◽  
Author(s):  
Adrian Furnham ◽  
Helen Cheng
Keyword(s):  
Structural Equation Modeling ◽  
Structural Equation ◽  
Social Background ◽  
Study Data ◽  
Equation Modeling ◽  
Direct Effects ◽  
Data Set ◽  
National Child Development Study ◽  
Nationally Representative ◽  
The Uk

Abstract. This study used a longitudinal data set of 5,672 adults followed for 50 years to determine the factors that influence adult trait Openness-to-Experience. In a large, nationally representative sample in the UK (the National Child Development Study), data were collected at birth, in childhood (age 11), adolescence (age 16), and adulthood (ages 33, 42, and 50) to examine the effects of family social background, childhood intelligence, school motivation during adolescence, education, and occupation on the personality trait Openness assessed at age 50 years. Structural equation modeling showed that parental social status, childhood intelligence, school motivation, education, and occupation all had modest, but direct, effects on trait Openness, among which childhood intelligence was the strongest predictor. Gender was not significantly associated with trait Openness. Limitations and implications of the study are discussed.

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