Shintaro Yamane

Interlocking intramedullary nailing for nonunion of the proximal humerus with the Straight Nail System

Nonunion of the proximal humerus is a challenging problem. Since 1996, we have performed interlocking intramedullary nailing for the treatment of proximal humeral nonunions with the Straight Nail System and bone grafting. The objective of this study was to investigate the clinical outcomes of this procedure in patients with proximal humeral nonunion. We investigated 14 consecutive patients (mean age, 74.3 +/- 8.7 years). One patient was excluded because of associated brachial plexus palsy. All but 2 were initially treated conservatively. Range-of-motion exercises were started 1 week after the operation. The mean follow-up period was 37.8 months. Union was achieved in all cases without any evidence of malunion. All patients had improved range of motion of the shoulder and were satisfied with the surgical results. Mean flexion of the shoulder was 122 degrees +/- 14 degrees, and mean external rotation was 35 degrees +/- 10 degrees. Interlocking intramedullary nailing with the Straight Nail System and bone grafting offered a successful method of stable internal fixation in these complex proximal humeral nonunion cases.

Osteochondritis dissecans involving the trochlea of the humerus treated with transplantation of tissue-engineered cartilage: a case report.

Osteochondritis dissecans (OCD) of the elbow is typically located in the capitellum of the humerus in young teenagers. There are only a few reports of OCD in the trochlea of the humerus. The ideal goal of treatment for OCD lesions is to resurface the osteochondral defect with hyaline cartilage and to prevent the occurrence of osteoarthritis. Recently, to achieve this surgical goal, autologous chondrocyte implantations (ACIs) or tissue-engineered cartilage transplantations (TCTs) have been performed for OCD lesions of the knee and the ankle. We present a patient with OCD in the trochlea of the humerus who underwent TCT. To our knowledge, no such patient has previously been reported.

Association of the area of sensory disturbance with the area of suprascapular nerve palsy.

Purpose. To determine the association of the area of sensory disturbance with the area of suprascapular nerve (SSN) palsy in healthy volunteers and patients with SSN palsy. Methods. Five male and one female and healthy volunteers aged 23 to 44 (mean age, 32.2) years underwent an experiment of distal and proximal SSN block (at the spinoglenoid notch and suprascapular notch, respectively). A pinprick test was performed to determine pain sensation and the area of sensory disturbance. In addition, records of 21 male and 19 female patients aged 21 to 75 (mean, 54.1) years who underwent arthroscopic SSN release for SSN palsy were reviewed. The same pinprick test was performed. Results. After distal SSN block, 5 volunteers had a sensory deficit in the area below the scapular spine only, and one had no sensory deficit. After proximal SSN block, the sensory deficit spread to both lateral and medial sides above and below the scapular spine. In the 40 patients with SSN palsy, only 5 (12.5%) patients exhibited no sensory deficit above the scapular spine; 4 of them had ganglion cysts and one had entrapment of the nerve at the spinoglenoid notch. In 30 patients with palsy at the suprascapular notch, all had sensory deficit in the lateral side above the scapular spine. In 5 patients with ganglion and one patient with palsy at the spinoglenoid notch, sensory deficit was noted below (and not above) the scapular spine in all patients except for one. Conclusion. The area of sensory disturbance is associated with the area of SSN palsy.