Percutaneous sclero-embolization is a minimally invasive treatment of varicocele that is feasible in children and adolescents. Most patients prefer this therapy, although it is not as safe as surgery. When open surgery is required, complete ligation of the whole vascular pedicle above the vas deferens offers excellent success.
The fracture avulsion of the greater tuberosity (GT) represents 2% of all humerus fractures, but the true incidence is likely to be higher, being challenging the initial diagnosis on radiograph. The fracture avulsion of the GT could have different treatments: nondisplaced or minimally displaced fractures are treated conservatively, whereas for displaced or comminuted fractures surgical treatment is preferred. The most important finding of this study is the employment of an all-arthroscopic transosseous augmented technique for the treatment of a displaced humeral GT fracture avulsion. This technique shows all the advantages of the transosseous fixation and arthroscopic approach.
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Background: Humeral shaft fractures account for 1% to 3% of all fractures and approximately 20% of all
fracture involving the humerus. The prevalence of non-union for diaphyseal humeral fractures has been
reported as 1% to 10% after non-surgical and 10% to 15% after surgical management. Various devices used
in treatment of humeral diaphyseal non-union are limited contact dynamic compression plates, locking
compression plate (LCP), wave plates, humerus interlocking nail (IMN), Ilizarov external fixators and bone
graft struts.
Case Description: A 68-year-old man reported a humeral shaft fracture on the left side, due to a simple fall.
It was reduced and fixed by IMN. He underwent clinical and radiological follow up. Three months after the
intervention, due to persistent pain and impaired function of the left shoulder, the nail was removed and a
cemented endoprosthesis was implanted. 3 years later, unsatisfied with the results, he came to our attention
and was diagnosed an atrophic non-union in the site of the previous humeral shaft fracture. Moreover, the
exams showed a rotator cuff insufficiency. It was decided to perform a single-stage intervention to achieve
two goals: cure the humeral shaft non-union and restore the function of the left shoulder. The cemented
endoprosthesis was removed, followed by an extensive curettage of the non-union site. A reverse prosthesis
was implanted, with an extra-long stem used to stabilize the non-union site, as it was an IMN. An allograft
was harvested from a cadaver femur and fixed with two metal cerclages. The patient underwent clinical and
radiological follow-up. Complete healing was achieved 8 months later.
Conclusion: Humeral shaft nonunion still represent a pathology that pose a serious problem to the surgeon.
A correct management should include an accurate pre-operative planning, to achieve the best result possible
for the patient.
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