Humeral diaphyseal fractures
Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth in Musculoskeletal Trauma in the Elderly, 2016
The patient is positioned supine on a radiolucent table with image intensification coming from the contralateral side.32 A narrow 4.5 mm locking compression plate is selected, typically one to two holes longer than for an open technique, and placed over the skin of the anterior arm. The proximal and distal surgical windows are marked; the proximal window is a 3–4 cm incision with a deltopectoral approach, and the distal window is a direct anterior approach to the distal diaphyseal humerus. The biceps muscle is retracted medially and the brachialis muscle is divided longitudinally to expose the anterior cortex of the distal humerus, using caution as the musculocutaneous nerve emerges on the anteromedial aspect of the brachialis. A periosteal elevator is used to create a sub-brachialis extraperiosteal tunnel by blunt dissection. The plate is inserted from the proximal window, through the sub-brachialis tunnel on the anterior aspect of the humerus, taking care to identify and protect the radial nerve in the distal window. A locking tower can be attached proximally to help maneuver the plate. After the proximal fragment is fixed to the plate, the fracture can be reduced indirectly. Screws are then inserted through the plate, which bridges the fracture. Alternatively, some surgeons apply a temporary external fixator at the beginning of the procedure to reduce the fracture and remove it after the plate is secured to bone (Figure 22.11c).
Pediatric Orthopedic Trauma: Upper Extremity Fractures
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
Permanent vascular injury is seen in less than 1% of supracondylar humerus fractures. The brachial artery is protected by the brachialis muscle but if the muscle is torn, the anterior spike of proximal fracture fragment can occlude flow. The artery can also rarely become entrapped within the fracture site upon reduction of the fracture. If this occurs, oftentimes the median nerve is also entrapped necessitating open reduction of the fracture with removal of the neurovascular structures from the fracture site. The management of supracondylar humerus fractures with an absent radial pulse is closed reduction after general anesthesia. If circulation returns the fracture is pinned, splinted, and observed. If following the reduction the limb is truly dysvascular then arterial exploration is indicated. If the hand is perfused but the radial pulse does not return, this is observed as this is typically the result of vasospasm and collateral flow to the arm is abundant.
Upper limb
Aida Lai in Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Attachments of brachialis muscle– origin: ant. humerus– insertion: tuberosity of ulna– nerve SS: musculocutaneous n. (C5–7)– function: flex elbow
The reanimation of the elbow functions in avulsive injuries of the upper brachial plexus using the medial cord transfer: nuances of the technique and update
Published in Neurological Research, 2023
Stefano Ferraresi, Elisabetta Basso, Lorenzo Maistrello, Piero Di Pasquale
It was only in the ‘nerve transfer era’, initiated by Oberlin, that upper plexus injuries definitely improved their final outcome. Despite the good results obtained worldwide, the Oberlin’s technique is not free from limitations: it is a terminal surgery: the recipient nerve cannot be prepared further distally. Therefore, in case of failure caused by rupture of the fragile nerve suture, the identification of the recipient fascicle is rendered extremely difficult by scar tissue and the success of a second attempt will be unpredictable.only the biceps is reinnervated [22]. To add the brachialis muscle, a separate transfer of one fascicle from the median nerve to the brachialis nerve branch must be associated [23].in avulsive injury of C5 and C6, when a weak biceps (M1/M2) is sustained by C7, the Oberlin procedure would entail the interruption of this function.rarely, the interruption of a motor fascicle from the ulnar nerve can cause an imbalance between intrinsic and extrinsic muscle of the hand. This may be due to a loss of function but also to a spastic irritation, and this causes a typical hand posture characterized by metacarpophalangeal flexion with proximal and distal interphalangeal joint extension, called ‘intrinsic plus hand’. We had one case and it is a very disturbing condition.
Spastic muscle stiffness evaluated using ultrasound elastography and evoked electromyogram in patients following severe traumatic brain injury: an observational study
Published in Brain Injury, 2022
Jun Matsumoto-Miyazaki, Shogo Sawamura, Yumiko Nishibu, Maki Okada, Yuka Ikegame, Yoshitaka Asano, Hirohito Yano, Jun Shinoda
Some limitations of the current study’s results warrant discussion. First, only a relatively small number of subjects from a single center had been included herein. Second, different muscles were assessed for US SWE (BBM) and F-wave measurements (APB). Third, clinical spastic severity using MAS and MTS of elbow flexor muscle could have been influenced by the degeneration of other soft tissues around elbow joints, such as the brachialis muscle, brachioradialis muscle, and skin and ligaments, and not only BBM, in which the US was performed. Therefore, more muscles may need to be observed using US to determine variables not significant in the present study, such as the relationship between SWS and F wave. Fourth, patients who could not maintain 90° elbow joint flexion due to severe muscle overactivity were excluded. Thus, the relationship between SWS and F wave and between SWS and clinical findings in patients with more severe spastic muscle overactivity remains unclear. Fifth, intra-assessor reliability was measured using US data within only 1 day in order to reduce participant burden. However, high reliability can be expected based on previous reports on spasticity in stroke patients (24).
A metabolic energy expenditure model with a continuous first derivative and its application to predictive simulations of gait
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2018
Anne D. Koelewijn, Eva Dorschky, Antonie J. van den Bogert
An arm, rotating around a single joint, controlled by two muscles, performs a reaching task in the horizontal plane. The task is to move 90 degrees and back in five seconds. Figure 2 shows the arm at θ = 90 degrees. The two muscles are Hill-type muscles, with a contractile element with activation and contraction dynamics, a series elastic element, and a parallel elastic element, both modeled as nonlinear springs. Their properties were similar to muscle properties of a Brachialis muscle (Breteler et al. 1999) (Table 1).
Related Knowledge Centers
- Arm
- Musculocutaneous Nerve
- Radial Nerve
- Skeletal Muscle
- Elbow
- Humerus
- Biceps
- Cubital Fossa
- Tuberosity of The Ulna
- Anatomical Terms of Muscle