A research report submitted to the Faculty of Health Sciences, the University of Witwatersrand in partial fulfilment of the requirements for the Degree of Master of Medicine in the branch of Orthopaedic Surgery. Johannesburg, 2017 / Study design: This is a prospective clinical audit of patient data. Objectives: to determine the clinical outcomes in patients who have undergone hemiarthroplasty surgery of the shoulder. Background: Hemiarthroplasty of the shoulder involves the replacement of the humeral head in patients with fractures of the proximal humerus deemed too severe to fix. It is done routinely at Helen Joseph Hospital. Methods: Our study cohort consisted of 32 patients who had undergone hemiarthroplasty surgery for proximal humerus fractures over a period of four years from 2009 to 2013. All patients were assessed for the following: • The amount of pain they are experiencing in the operated shoulder • Whether their pain post fracture resolved with the surgery • How their activities of daily living are affected • Any functional impairment they are experiencing in the operated shoulder The data that was obtained from the patients included age, gender, Disabilities of Arm, Shoulder and Hand (DASH) score1 and range of motion of both the operated shoulder and the unoperated shoulder. Data was first captured using Microsoft Excel and then Stata 13.0 was used to perform the analysis. Results: Of the 32 patients that participated in the study, there were 12 males and 20 females. The mean age of the patients was 70.5 years (range 51 – 84 years). The mean DASH score was 36.9 (range 18.3 – 53.3). The DASH scores were positively correlated with the ages of the patients. The active range of motion of the operated shoulder was compared to the opposite shoulder in each patient. The range of motion was assessed according to flexion, extension, abduction, internal rotation and external rotation. In each of the 5 movements, the degree of movement in the operated shoulder was less than in the opposite shoulder, which had not been previously operated on. These differences were statistically significant p <0.001. Conclusion: Hemiarthroplasty remains a viable option for the treatment of patients with proximal humerus fractures that are deemed too severe to repair. It provides good pain relief to patients, but the function of the operated shoulder is less than it was pre-injury. / MT2017

The term scapulohumeral rhythm is commonly used to describe the two dimensional rotation of the scapula accompanying motion of the arm. Despite the development of a variety of measurement techniques, including radiography, goniometry and three dimensional digitisation, the complete three dimensional kinematics of the scapula have never been presented. Nor have the effects of arm motions outside elevation in the coronal, sagittal or scapula planes been considered. Employing the Isotrak®" electromagnetic measurement system, this study has developed and validated a new method to simultaneously measure the three dimensional kinematics of the scapula and humerus. Euler angle rotations of the· scapu·lawere defined in a sequence approximately analogous to clinical definitions. For the first time, the three dimensional displacements of the scapula have also been determined. 950/0 confidence intervals for lateral rotation of the scapula during humeral elevation in the coronal plane have been calculated at under 4°, Significantly smaller than those presented by previous authors. A mathematical model of three dimensional scapulohumeral kinematics has been developed, capable of predicting the position and orientation of the scapula for a given orientation of the humerus over a wide range of humeral motion. Using this model system, the effects of humeral azimuth, elevation and rotation on the kinematics of the scapula have been investigated. Humeral elevation was seen to have the largest effect, causing the scapula to rotate laterally, retract and tip backwards. Humeral azimuth. has no noticeable effect on the lateral rotation of the scapula, although it causes the scapula to retract, and to tip backwards slightly. Rotation of the humerus has littre effect on the kinematics of the scapula. However, when approaching maximal internal rotation, the ligaments around the glenohumeral joint impose a kinematic constraint on the scapula, resulting in elevation of the scapula upon the thoracic cage.

Thesis (M.S.)--California Polytechnic State University, 2010. / Title from PDF title page; viewed on March 18, 2010. Major professor: Hazelwood, Scott, Ph.D. "Presented to the faculty of California Polytechnic State University, San Luis Obispo." "In partial fulfillment of the requirements for the degree [of] Master of Science in Biomedical Engineering." "February 2010." Includes bibliographical references (p. 87-89).

Visual and metric analysis both provide accepted methods for sex determination in humans. Visual ascertainment uses differing morphological traits in males and females to establish sex. Researchers have continually sought accurate methods of sexing long bones when skulls or pelves are absent or fragmented. These long bone elements may not have sexually distinct characteristics, but tend to survive in the field quite well. Metric analysis depends on size dimorphism between males and females to correctly assign sex. Metric methods fail where the sexes overlap or when skeletal elements cannot be assigned to their correct biological population. Under these conditions, visual ascertainment is extremely useful. It relies on descriptive features, not size, to interpret the shape variations between male and female elements. For example, physiological soft tissue variations in the "carrying angle'" of the arm at the humero-radioulnar junction are known to be sexually dimorphic; therefore, the hard tissue features of the distal humerus also should be sexually dimorphic. I observed six distinct visual characteristics of the distal humerus to determine sex in a blind study conducted on 649 individuals sampled from diverse biological populations. In addition to visual assessment, I collected four humeral measurements to determine whether quantitative analysis would be a better indicator of sex than non-metric analysis. I used nonparametric statistical methods to examine· the significance of each morphological feature and its relationship to known sex. All characteristics showed a high association with sex, and the relationships between sex and each characteristic were statistically strong. The final predictive quality of this method was 84% regardless of population; I concluded that my visual method is a dependable sex predictor among diverse populations. Every biological group varied considerably in size dimensions, but exhibited common morphological features of the distal humerus. This confirms that visual techniques provide accurate results regardless of biological affiliation. In many cases, visual assessment was as accurate or more accurate than metric analysis. Therefore, the distal humerus and its unique physical features provide an alternative method to previously used quantitative techniques in the determination of sex.

No description available.

Sex estimation is one of the most important, and arguably the first, parts of the biological profile that is estimated for purposes of human identification. This study will examine the utility of the distal humerus in sex estimation. The goal of this research is to corroborate the usefulness of the distal humerus in sex estimation and the usefulness of geometric morphometrics in sex estimation, as well as validate metric and visual methods for sex estimation using the distal humerus. Multiple methods of sex estimation are necessary because complete skeletons are rarely found, and often only fragments are discovered. Three methods of sex estimation utilizing the distal humerus are used in this study: epicondylar breadth (n=448), nonmetric traits per Rogers (1999) and Vance et al. (2011 (n=444)), and geometric morphometrics via a Microscribe digitizer and MorphoJ software (n=227). The sample was taken from the William M. Bass Donated Skeletal Collection and was primarily composed of White Americans. The male to female ratio was approximately equal. The results of the metric aspect of the study showed a classification accuracy of 88.84% with low intra-observer and inter-observer error rates. The results of the nonmetric aspect of the study showed a classification accuracy of 77% when all traits were combined with low intra-observer and high inter-observer error rates. The results of the geometric morphometric aspect of the study showed a classification accuracy of 55% for all landmarks, 57% for anterior landmarks, and 63% for posterior landmarks. The results show that not only is the epicondylar breadth a reliable and effective method of sex estimation, it is easily repeatable by other observers. The nonmetric method is useful when epicondylar breadth cannot be measured or when an observer is familiar with the method. The geometric morphometric method is not as strong as the other two methods, but with further research and modifications may become a feasible option for sex estimation using the distal humerus. The author concludes that the distal humerus is sexually dimorphic and can be used to estimate sex accurately.

Canine cadaveric forelimbs (136) were randomly assigned to either treatment (aiming device) or control (fluoroscopic-guided) groups, and to either diplomate or resident for humeral transcondylar screw placement. Each limb underwent a transcondylar humeral screw placement from a lateral to medial direction. Digital radiography was used to evaluate screw trajectory, measured as deviation from the epicondylar line, and eccentricity on the humeral condyle. Procedure time, difference in outcome based on experience level, and complications were recorded. In the right limb, screw trajectory with the aiming device was decreased compared to fluoroscopy. There was no difference of accuracy between leg laterality with fluoroscopy. Screw trajectory was increased with resident versus diplomate procedures. Eccentricity deviation was decreased in fluoroscopy groups. The findings of this current study suggest that the universal aiming device produced accurate transcondylar screws with comparable results to fluoroscopic- guided methods.

A 2 cm ostectomy was performed on 10 pairs of canine cadaveric humeri proximal to the supratrochlear foramen. Stabilization was with a double plate construct (DB-PLATE) (n=10) or external skeletal fixator with intramedullary pin tie-in configuration (ESF-IMP) (n=10). Cyclic testing was performed. Axial compressive load to failure testing followed. Data analyzed included dynamic stiffness, stiffness and yield load. No constructs failed during cyclic testing or lost stiffness over time, although mean dynamic stiffness was greater for DB-PLATE compared to ESF-IMP. Mean stiffness of DB-PLATE in load-toailure testing was not significantly different than ESF-IMP. Yield force of DB-PLATE was significantly higher than ESF-IMP. These results suggest that both DB-PLATE and ESF-IMP would be appropriate fixation techniques for stabilization of comminuted supracondylar humeral fractures in dogs with appropriate exercise restriction. Double plate fixation may be preferable when prolonged healing or inadequate post-operative restraint was anticipated because it was stronger in destructive testing.

Ziel der vorliegenden Arbeit war es, die Verteilung der Knochenmineraldichte im proximalen Humerus bezogen auf mögliche Regionen, die als Verankerungsfläche für Implantate dienen, zu untersuchen. Diese Erkenntnisse sollten dazu beitragen, das Design der Implantate (z. B. Fadenanker, Schraube) zu optimieren. Außerdem sollen die Untersuchungsergebnisse als Grundlage für weitere Finite Elemente Berechnungen dienen, indem die gewonnenen Daten in digitalisierter Form in weitere biomechanische Studien einfließen können. Für die Untersuchung wurden vom anatomischen Institut der Universität Würzburg insgesamt 23 Humerusköpfe, von denen acht keine Markierungsplakette besaßen, zur Verfügung gestellt. Somit konnte nur bei 15 Präparaten das Geschlecht und das Sterbealter der dazugehörigen Leichen zurückverfolgt werden. Es handelte sich um 11 weibliche und vier männliche Verstorbene mit einem mittleren Sterbealter von 81,5 Jahren ± 10,2 (55 - 93 Jahre). Die Präparate wurden in einer Alkohol-Formalin-Lösung konserviert. Eine etwaige Schulteranamnese konnte post mortem nicht eruiert werden. Die Humerusköpfe wurden mit einem pQCT-Scanner (Stratec 2000), welcher eine selektive, volumenbezogene Bestimmung der Bereiche des Knochens erlaubt, untersucht. 30 definierte Schnittbilder pro Humerus wurden anschließend auf einem UNIX-System der Firma HERMES in digitale 3D-Modelle umgewandelt. Die Auswertung der Daten sowie die Berechnung der Knochendichte erfolgte mit Hilfe des Programms AVS-Express der Firma Advanced Visual Systems. Für die Knochendichtemessung wurde das Caput humeri in drei transversale Schnittebenen gedrittelt. Hier wurde jeweils die Dichte im Bereich der dorsalen, medialen sowie ventralen Gelenkflächenregion, im Bereich des Tuberculum minus, des Sulcus intertubercularis und des Tuberculum majus gemessen. Weiter distal wurde eine vierte Ebene im Schaftbereich festgelegt, auf deren Höhe die Knochendichte der dorsalen, ventralen, medialen und lateralen Kortikalis bestimmt wurde. Abgesehen von drei ROI`s fand sich beim männlichen Kollektiv die gemessene Knochendichte signifikant höher als bei den Frauen, was mit der Zunahme osteoporotischer Frakturen bei älteren Frauen korreliert. Die regionale Verteilung der Knochendichte korreliert gut bis auf den Sulcus intertubercularis mit den klinischen Frakturtypen nach Neer, wobei dieses Areal in Bezug auf den Verlauf der Frakturlinien eher den gemessenen Werten als dieser häufig verwendeten Klassifikation folgt. Mit zunehmender Tiefe vermindert sich insbesondere in den Tuberkula die Mineralisationsdichte, so dass die meisten Anker oberflächennah im Kortex die beste Substanz für eine Fixierung finden. / The aim of the present study was to analyse the distribution of bone mineral density in the proximal humerus in relation to potential regions serving as anchoring surface for implants. These results should help to optimize the design of implants (for example suture anchors, screws). In addition the results should serve as a basis for other finite element calculations by the data collected may be taken into other biomechanical studies in digitalized form.

Thesis (Ph. D.)--University of Oregon, 2008. / Typescript. Includes vita and abstract. "This dissertation includes unpublished co-authored material"--P. v. Includes bibliographical references (leaves 119-128). Also available online in Scholars' Bank; and in ProQuest, free to University of Oregon users.