External fixation in the treatment of shooting proximal humeral fracture with bone defect: A case report

Introduction. Shooting injuries of shoulder with destruction of proximal humerus are rare and severe orthopaedic injuries. Case Outline. A 74-year-old patient was wounded at close range by a shotgun. He was wounded in the left shoulder and suffered a massive defect of the proximal humerus and soft tissue. The neurocirculatory finding of the injury extremity was normal. After a short resuscitation, x-ray of the thorax and the left shoulder registered a complet destruction of humeral head. After the primary treatment of the wound under general endotracheal anesthesia, the shoulder was stabilized with an external fixator type Mitkovic, with convergent orientation of the pins, where two pins were placed in the neck of scapula and two in the humeral shaft, because the left scapular acromion was fractured by shotgun projectiles. Conclusion. After radical wound debridement, external fixation is the method of choice for shoulder stabilisation in shooting injury of shoulder with bone defect. If this is not possible, pins of the left external skeletal fixator should be placed into the coracoid process and acromion. The pins can be also placed into the humeral shaft, as done in the presented case, and by which a good stability of the injured proximal humerus, easy approach to the wound for bandaging and reconstructive surgery can be achieved.

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Fracture of Proximal Humerus & Shaft Managed With Closed Reduction & External Fixation by Joshi External Stabilisation System (Jess) – A Case Report

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v5i1.19057 ◽

2018 ◽

Vol 5 (1) ◽

pp. 54-58

Author(s):

Prakriti Raj Kandel ◽

Rajiv Baral ◽

Abhishek Kumar Thakur ◽

Gyaneshwar Prasad Singh ◽

Laxmi Pathak

Keyword(s):

External Fixation ◽

Closed Reduction ◽

Proximal Humerus ◽

Road Traffic ◽

Skin Grafting ◽

Shaft Fracture ◽

Left Shoulder ◽

Medical Sciences ◽

Lacerated Wound ◽

Fracture Of Proximal Humerus

We are presenting a case of proximal humerus& shaft fracture in a 50 year old female. She sustained injury on her left upper limb in a road traffic accident. It was managed with closed reduction & external fixation by Joshi External Stabilisation System (JESS). Lacerated wound over her left shoulder & arm region was managed with skin grafting. The post-operative period was uneventful. Journal of Universal College of Medical Sciences (2017) Vol.05 No.01 Issue 15, Page: 54-58

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Intramedullary Nailing for Pathological Fractures of the Proximal Humerus Caused by Multiple Myeloma: A Case Report and Literature Review

10.21203/rs.3.rs-308507/v1 ◽

2021 ◽

Author(s):

guoqiang xu ◽

gang wang ◽

xiaodong bai ◽

zhenyu liu ◽

xinjia wang ◽

...

Keyword(s):

Multiple Myeloma ◽

Proximal Humeral Fracture ◽

Pathological Fracture ◽

Proximal Humerus ◽

Combined Treatment ◽

Bone Destruction ◽

Humeral Fracture ◽

Whole Body ◽

Left Shoulder ◽

Im Nailing

Abstract Background: Multiple myeloma bone disease(MMBD) is indicative of multiple myeloma (MM), and it will reduce patient life quality. In addition to oncological, antineoplastic systemic therapy, surgical therapy in patients with MM represents an essential treatment pillar within the framework of supportive therapy measures and is the task of orthopedic tumor surgery. Nevertheless, there are few reports about applying intramedullary (IM) nailing in treating MM-induced proximal humeral fracture to prevent fixation loss. This paper aims to describe a case of pathological fracture of the proximal humerus caused by multiple myeloma effectively treated with IM nailing without removal of tumors and review the current literature.Case presentation: This study reported a 64-year-old male patient complaining of serious left shoulder pain and limited movement. X-ray films showed left proximal humeral fracture accompanying with osteoporosis and bone destruction. During the preoperative examinations, tumor markers, whole-body bone imaging and bone marrow biopsy were performed. The patient was finally diagnosed with multiple myeloma (IgAλ, IIIA/II). After the treatment of pathological fracture with IM nailing, the patient's function recovered and the pain was relieved rapidly. The visual analogue scale (VAS) reduced by 7 points to 2 points postoperatively compared with that preoperatively. Histopathological examination results presented plasma cell myeloma. Next, the patient received chemotherapy in the hematology department. Humeral fracture displayed good union in the 40-month follow-up, with complete healing of fracture, and the clinical outcome was still satisfactory.Conclusion: The pathological fracture of proximal humerus caused by multiple myeloma should be treated by surgery early. IM nail can be used for this kind of fracture without removal of tumors, bone cement augmentation for bone defect or local adjuvant therapy was also employed. Under the combined treatment, the proximal humerus fracture can eventually heal.

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Ipsilateral fractures of both the proximal and distal humerus; the ‘floating arm injury’ in children

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210643 ◽

2021 ◽

Vol 7 (2) ◽

pp. 424

Author(s):

Paragjyoti Gogoi ◽

Aditi Das ◽

Arijit Dhar ◽

Rajdeep Roy

Keyword(s):

Shoulder Joint ◽

Clavicle Fracture ◽

Humeral Fracture ◽

Distal Humerus ◽

Coracoid Process ◽

Wound Debridement ◽

Wire Fixation ◽

Fall From Height ◽

Humerus Fractures ◽

Distal Fracture

<p>Proximal humerus fractures are usually associated with other injuries in and around the shoulder joint like clavicle fracture, acromion process fracture, coracoid process fracture, and dislocation of the shoulder joint or acromion-clavicular joint. Similarly, distal humerus fractures are normally associated with fractures of olecranon, radial head or dislocation of the elbow joint itself. However, simultaneous fracture of both the ends of humerus is rarely encountered. Literature search does reveal only a few cases of such type. This variety is also termed as floating arm. We are presenting here two cases of fracture of both the proximal and distal end of same humerus following fall from height, one of which the proximal humeral fracture was Gustillo-Anderson type II open fracture. The patient was managed by wound debridement and open reduction and fixation of the proximal fracture followed by closed manipulation and K wire fixation of the distal fracture. The second case was also managed by closed reduction and K wire fixation of both the fractures. </p>

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Intramedullary Nailing for Pathological Fractures of the Proximal Humerus caused by Multiple Myeloma: A Case Report and Literature Review

10.21203/rs.3.rs-308507/v2 ◽

2021 ◽

Author(s):

guoqiang xu ◽

gang wang ◽

xiaodong bai ◽

zhenyu liu ◽

xinjia wang ◽

...

Keyword(s):

Multiple Myeloma ◽

Proximal Humeral Fracture ◽

Pathological Fracture ◽

Proximal Humerus ◽

Combined Treatment ◽

Bone Destruction ◽

Humeral Fracture ◽

Whole Body ◽

Left Shoulder ◽

Im Nailing

Abstract BackgroundMultiple myeloma bone disease(MMBD) is indicative of multiple myeloma (MM), and it will reduce patient life quality. In addition to oncological, antineoplastic systemic therapy, surgical therapy in patients with MM represents an essential treatment pillar within the framework of supportive therapy measures and is the task of orthopedic tumor surgery. Nevertheless, there are few reports about applying intramedullary (IM) nailing in treating MM-induced proximal humeral fracture to prevent fixation loss. This paper aims to describe a case of pathological fracture of the proximal humerus caused by multiple myeloma effectively treated with IM nailing without removal of tumors and review the current literature.Case presentationThis study reported a 64-year-old male patient complaining of serious left shoulder pain and limited movement. X-ray films showed left proximal humeral fracture accompanying with osteoporosis and bone destruction. During the preoperative examinations, tumor markers, whole-body bone imaging and bone marrow biopsy were performed. The patient was finally diagnosed with multiple myeloma (IgAλ, IIIA/II). After the treatment of pathological fracture with IM nailing, the patient's function recovered and the pain was relieved rapidly. The visual analogue scale (VAS) reduced by 7 points to 2 points postoperatively compared with that preoperatively. Histopathological examination results presented plasma cell myeloma. Next, the patient received chemotherapy in the hematology department. Humeral fracture displayed good union in the 40-month follow-up, with complete healing of fracture, and the clinical outcome was still satisfactory.ConclusionThe pathological fracture of proximal humerus caused by multiple myeloma should be treated by surgery early. IM nail can be used for this kind of fracture without removal of tumors, bone cement augmentation for bone defect or local adjuvant therapy was also employed. Under the combined treatment, the proximal humerus fracture can eventually heal.

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Double plating for long-standing nonunion of the humeral shaft complicated with metaphyseal bone defect and deformity: A case report

Trauma Case Reports ◽

10.1016/j.tcr.2021.100448 ◽

2021 ◽

Vol 32 ◽

pp. 100448

Author(s):

Natsumi Saka ◽

Gen Sasaki ◽

Yoshinobu Watanabe ◽

Hirotaka Kawano

Keyword(s):

Case Report ◽

Bone Defect ◽

Humeral Shaft ◽

Metaphyseal Bone ◽

Double Plating

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Combined Ipsilateral Humeral Shaft and Galeazzi Fractures Creating a Floating Elbow Variant

Case Reports in Orthopedics ◽

10.1155/2018/7430297 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Patrick Lee ◽

Allison Z. Piatek ◽

Michael J. DeRogatis ◽

Paul S. Issack

Keyword(s):

Internal Fixation ◽

Range Of Motion ◽

Open Reduction ◽

Humeral Fracture ◽

Humeral Shaft ◽

Proximal Ulna ◽

Elbow Injury ◽

Anatomic Reduction ◽

Elbow Injuries ◽

Floating Elbow

“Floating elbow” injuries of the arm traditionally represent a combination of humeral shaft and forearm fractures which require anatomic rigid open reduction and internal fixation of all fractures to allow for early range of motion exercises of the elbow. There are published variants of the floating elbow injury which include ipsilateral diaphyseal humeral fracture, proximal ulna fracture with proximal radioulnar joint disruption, and ipsilateral diaphyseal humeral fracture with elbow dislocation and both bones forearm fracture. We present the case of a 21-year-old woman whose left arm became caught between the side of a waterslide and adjacent rocks at a park. She sustained a torsional and axial loading injury to her left upper extremity resulting in ipsilateral humeral shaft and Galeazzi fractures. The combination of ipsilateral humeral shaft and Galeazzi fractures resulted in a rare floating elbow variant. Prompt open reduction and internal fixation of both fractures and early range of motion of the elbow and wrist resulted in an excellent clinical and radiographic result. Floating elbow injuries and their variants should be promptly recognized as early anatomic reduction, and rigid internal fixation can allow for good elbow function with minimization of stiffness.

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Beware the rebound effect: regional anesthesia increases opioid utilization after humerus fracture surgery

Shoulder & Elbow ◽

10.1177/17585732211048117 ◽

2021 ◽

pp. 175857322110481

Author(s):

Daniel J. Cunningham ◽

Micaela A. LaRose ◽

Gloria X. Zhang ◽

Ariana R. Paniagua ◽

Christopher S. Klifto ◽

...

Keyword(s):

Regional Anesthesia ◽

Proximal Humerus ◽

Rebound Effect ◽

Shaft Fracture ◽

Humeral Shaft Fracture ◽

Opioid Consumption ◽

Humeral Shaft ◽

Patients Âgés ◽

The Impact ◽

Fracture Surgery

Introduction Regional anesthesia (RA) is used reduce pain in proximal humerus and humeral shaft fracture surgery. The study hypothesis was that RA would decrease opioid demand in patients undergoing fracture surgery. Materials and methods Opioid demand was recorded in all patients ages 18 and older undergoing proximal humerus or humeral shaft fracture surgery at a single, Level I trauma center from 7/2013 – 7/2018 (n = 380 patients). Inpatient opioid consumption from 0–24, 24–48, and 48–72 h and outpatient opioid demand from 1-month pre-operative to 90-days post-operative were converted to oxycodone 5-mg equivalents (OE's). Unadjusted and adjusted models were constructed to evaluate the impact of RA and other factors on opioid utilization. Results Adjusted models demonstrated increases in inpatient opioid consumption in patients with RA (6.8 estimated OE's without RA vs 8.8 estimated OE's with RA from 0–24 h post-op; 10 vs 13.7 from 24–48 h post-op; and 8.7 vs 11.6 from 48–72 h post-op; all p < 0.05). Estimated cumulative outpatient opioid demand was significantly higher in patients with RA at all timepoints. Discussion In proximal humerus and humeral shaft fracture surgery, RA was associated with increased inpatient and outpatient opioid demand after adjusting for baseline patient and treatment characteristics.

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