Issue 65


May/June 2004 65_front.jpg

In this issue:

  • Close to the Bone - Surgeons and Chefs
  • Measuring the X-Ray - Problems and Solutions
  • The COA Web Site - Request for Input

    -

-
-
-
-
-



Themes - Role of Prosthetic Replacement for Proximal Humerus Fractures PDF Print E-mail

Role of Prosthetic Replacement for Proximal Humerus Fractures

Robert G. McCormack M.D. FRCSC
Assistant Professor
University of British Columbia
New Westminster, BC

Damian Musso M.D.
Orthopaedic Fellow
University of British Columbia

Complex fractures of the proximal humerus remain one of the most challenging problems in orthopaedic surgery. There is a significant complication rate, irrespective of how they are managed, and a paucity of data to support one treatment modality over another. Perhaps more than any other injury, the fracture personality is the key to determining treatment. Several factors need to be considered, including patient demands and co-morbidities, the fracture pattern, bone quality, soft tissue status and surgeon experience. The average age for proximal humerus fracture is 66 years old and there is a trend for fracture complexity to increase with age. Superimposed on this, almost all patients that fracture the proximal humerus over age 40 have osteopenia, which makes standard ORIF more challenging.

Last Updated on Wednesday, 21 March 2007 11:38
Read more...
 
Measuring the X-Ray: Problems and Solutions PDF Print E-mail

Measuring the X-Ray: Problems and Solutions

T. Derek V. Cooke, M.D., MB, BChir, FRCSC
Allan Scudamore, PhD
Kingston, ON

The value of radiographs (X-rays) in musculoskeletal care is beyond dispute, yet the time-honoured technology is cumbersome in terms of film processing, handling, storage and retrieval. Fortunately, digital imaging methods now promise greater convenience and lower costs in the long-term. Currently there are two options: Computer Radiography (CR) using radiosensitive phosphor screens read by laser scanners, and Direct Radiography (DR) where image capture is immediate via sensors hard-wired to the computer. These systems, despite their high capital costs for conversion, are being adopted by many institutions. A central feature of them is PACS (Picture Archiving Computer Systems) which manage the data storage and retrieval networks. Apart from the better logistics afforded by these systems, digital images have a range of clinical advantages including better image quality (sharpness, contrast, magnification etc.) and facilitation of metric imaging.

Last Updated on Wednesday, 21 March 2007 11:37
Read more...
 
Themes - The Role of Locking Plates in the Treatment of Proximal Humerus Fractures PDF Print E-mail

The Role of Locking Plates in the Treatment of Proximal Humerus Fractures

Tousief Hussain, M.D., BSC, FRCSC
Saskatoon, SK

Proximal humerus fractures represent one of the most common fractures in the elderly. They account for 10% of all fractures in patients over the age of 65 years and are the third most common fracture in the elderly1,2. Seventy-five percent of these fractures occur in patients > 60 years of age3. The management of these fractures can be a significant challenge especially in the presence of osteoporosis and multiple fracture segments. Treatment options include conservative therapy, fixation, and arthroplasty. A good outcome can be regarded as pain free abduction and elevation of ≈ 90, external rotation of ≈ 25, and an internal rotation good enough to touch the L1 vertebra4.

Last Updated on Wednesday, 21 March 2007 11:39
Read more...
 
Themes - Introduction - Treatment Options For Displaced Proximal Humeral Fractures PDF Print E-mail
Treatment Options For Displaced Proximal Humeral Fractures

Displaced proximal humeral fractures can lead to significant sequelae if not treated properly. Controversy has existed as to whether these injuries should be treated with or without surgery and if treated surgically with internal fixation or arthroplasty. The dramatic outcomes of surgical treatment have led to increasing use of various treatment alternatives. Each treatment alternative has included a fair proportion of failures, which have required revision. These failures and the increasing demand for normal function have lead to increasing debate as to the most appropriate procedure. Our themes section will discuss this important issue in detail.

Last Updated on Wednesday, 21 March 2007 11:37
 
Themes - Percutaneous Pinning of Proximal Humerus Fractures PDF Print E-mail

Percutaneous Pinning of Proximal Humerus Fractures

Edward J. Harvey M.D., MSc, FRCSC
Montreal, QC

 

The myriad of treatment protocols for the proximal humerus fracture means only one thing - this fracture is probably inadequately treated by all modalities1. Percutaneous pinning is possible in almost all fractures of the proximal humerus. Certain steps must be taken in order to ensure the success of the fixation. Bouquet fixation, or the use of flexible nailing systems, are possible choices but these have been associated with frequent complications. A systematic approach (similar to that of Jaberg et al2) to both the reduction of the fracture through stab incisions and the placement of 2.5 mm wires will maximize chances of success. The implant of choice is the 2.5 mm terminally threaded k-wire (easily obtainable from the AO small external fixators set). harvey fig1a.jpg
Figure 1a Typical axillary view of comminuted proximal humerus fracture in a 65 year old male. Mechanism of injury was a fall from 2nd floor roof.

 

Last Updated on Wednesday, 21 March 2007 11:38
Read more...
 
<< Start < Prev 1 2 3 4 Next > End >>

Page 1 of 4