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A 60-year-old woman with chronic atraumatic shoulder pain underwent arthroscopic biceps tenodesis. Upon presenting to the physical therapy clinic 7 days following surgery, she reported constant pain. Following the examination, the physical therapist reviewed the patient's postoperative radiographs and noted a comminuted but minimally displaced fracture of the right proximal humeral metaphysis. J Orthop Sports Phys Ther 2020;50(11):649. doi:10.2519/jospt.2020.9497.

Objectives: We evaluated the results of a new technique developed for aneurysmal bone cysts centrally located in the proximal humeral metaphysis leading to widespread destruction.Methods: The study included seven patients (5 boys, 2 girls; mean age 12.8 years; range 9 to 15 years) who were treated with cortical collapsing and massive fibular autograft for centrally located aneurysmal bone cysts in the proximal humeral metaphysis leading to widespread destruction. All the patients had type II and active tumors according to the criteria of Capanna et al. and Campanacci et al., respectively. Final evaluations included six patients because one patient was lost to follow-up. The mean follow-up period was 49 months (range 12 to 105 months).Results: No complications were seen in the early postoperative period. Radiographic examination showed partial recurrence in two patients; of whom, one patient underwent curettage and bone grafting in the postoperative second year because of pain and discomfort. No deformity was observed. One patient developed shortening of 0.5 cm. Radiographically, all the patients exhibited metaphyseal remodelling one year after surgery. Function of the shoulder joint was near-normal in all the patients.Conclusion: In this technique, cortical collapsing reduces the amount of bone graft used, and massive fibular strut grafting provides structural support to prevent deformities., Amaç: Bu çalışmada, humerus proksimal metafizine santral olarak yerleşmiş, geniş destrüksiyon yapmış anevrizmal kemik kistleri için geliştirdiğimiz yeni bir tekniğin sonuçları değerlendirildi.Çalışma planı: Humerus proksimal metafizinde santral olarak gelişen ve geniş destrüksiyona neden olan, klinik ve radyografik olarak anevrizmal kemik kisti tanısı konan yedi hasta (5 erkek, 2 kız; ort. yaş 12.8; dağılım 9-15) kortikal çöktürme ve fibuladan alınan masif otogreft ile tedavi edildi. Tüm olgularda Capanna ve ark.nın sınıflandırmasına göre tip II, Campanacci ve ark.nın sınıflandırmasına göre aktif tümör vardı. Bir olgu takipten çıktığı için çalışma dışı bırakıldı. Hastaların ortalama takip süresi 49 ay (dağılım 12-105 ay) idi.Sonuçlar: Ameliyat sonrası erken dönemde hiçbir olguda komplikasyon görülmedi. Radyografik değerlendirmede iki olguda kısmi nüks saptandı; bu olgulardan birine, ağrı yakınması nedeniyle ameliyat sonrası ikinci yılda küretaj ve greftleme uygulandı. Olgularda deformite izlenmedi. Sadece bir olguda 0.5 cm’lik kısalık saptandı. Ameliyattan yaklaşık bir yıl sonra metafizer bölgenin anatomik görünümde yeniden şekillendiği gözlendi. Tüm olgularda omuz eklem fonksiyonu normale yakın bulundu.Çıkarımlar: Uyguladığımız teknikte, kortikal çöktürme ile greft ihtiyacı azalmakta, fibular greft de yapısal destek oluşturarak deformite oluşumunu engellemektedir.

Each generation of total shoulder arthroplasy has improved on the previous. The newest humeral component innovation is shortening the humeral component or eliminating the stem entirely to rely on stemless fixation in the humeral metaphysis. This offers theoretical advantages of preserved bone stock, less stress shielding, eliminating the diaphyseal stress riser, ease of stem removal at revision, and humeral head placement independent from the humeral shaft axis. There are a number of short term cohorts that have shown low complication rates and outcomes similar to previous generations of stemmed humeral components. Longer term and better designed studies are needed in order for short stems and stemless components to become the standard of care.

Segmental bone loss associated with high-energy trauma is a challenging problem for the physician. In majority of the cases, autogenous bone graft can be used successfully; however, reimplantation of extruded fragments has the benefits of maintaining skeletal length and avoiding the morbidity of the autogenous bone harvest. We report the case of a 17-year-old boy that had an open fracture of his left arm with an extruded fragment of 8 cm, which was successfully reimplanted.

A fracture separation of the distal humeral epiphysis, a rare injury can result in an extensive periosteal new bone formation around the humeral metaphysis due to extensive periosteal stripping, if an early and appropriate diagnosis is not established. A case with a rapid bone formation after such an injury is presented.

Summary: A review was carried out on nine children who were diagnosed and treated for septic arthritis of the glenohumeral joint at the University of California, San Diego affiliated hospitals. Eight of the nine patients were under 18 months of age at the time of diagnosis. Three patients had a history of antecedent trauma, and four had a previous or concurrent source of infection. The longest delay between the onset of symptoms and diagnosis was 30 days with the majority being diagnosed within 4 days of onset. Laboratory findings revealed a mean white blood cell count of 17,400 and a mean temperature of 39.3°C. The sedimentation rate was always greater than 30 mm and averaged nearly 60 mm in these nine patients. Joint cultures were positive for a variety of organisms. Early radiographic findings often demonstrated widening of the joint space. Associated osteomyelitis of the proximal humerus was present in five of nine patients. Once the diagnosis has been established by aspiration, we recommend arthrotomy. Important aspects of the surgery include drainage of the joint and bicipital recess, and drilling of the proximal humeral metaphysis to rule out osteomyelitis or to more adequately decompress the bone.

— An analysis of the anatomic location of 314 canine osteosarcomas revealed that the distal metaphysis of the radius was the most frequent site (23 per cent) and the proxinial humeral metaphysis (19 per cent) the next most frequent one. None involved the proximal end of the radius and only one the distal end of the humerus. Resume— Une analyse du siege anatomique de 314 osteosarcomes chez le chien montre que l'extre mite distale de la diaphyse du radius etait la plus frequemment 23% apres venait l'extremite proximale attente de la diaphyse humerale 19%. Aucuns n'impliquaient l'extremite proxnulle du radius; et seulement un cas l'extremite distale de l'humerus. Zusammenfassung— Eine Analyse der anatomisch bevorzugten Lokalisation der Osteosarkome bei 314 Hunden envies, dass die distale Metaphyse des Radius am haufigsten befallen war (23% der Falle) und dass die proximale Metaphyse die nachst haufige Stelle war (19% der Falle). Das proximale Ende des Radius war nie befallen und das distale Ende des Humerus nur einmal.