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Bones of the Upper Limb: Humerus01:19

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The upper limb consists of the arm, forearm, wrist, and hand bones. The humerus is the single bone of the upper arm region. Proximally, it has a large, spherical, smooth head that articulates with the glenoid cavity of the scapula to form the glenohumeral or shoulder joint. The margin of the head is the anatomical neck, a residual epiphyseal plate. Laterally it extends to form bony projections called the greater tubercle and the lesser tubercle. Next to the tubercles is the surgical neck, a...
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Nine muscles are involved in arm movements. Two of these, the pectoralis major and latissimus dorsi, originate from the axial skeleton and are called axial muscles. The other seven originate from the scapula and are called the scapular muscles.
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The ulna and radius are parallel bones of the antebrachium or the forearm. The ulna lies medially and consists of a bony tip called the olecranon process at its proximal end. This hook-like projection articulates with the olecranon fossa of the humerus and forms the "hinged" ulnohumeral part of the elbow joint. This joint facilitates forearm extension and flexion while preventing its hyperextension. Similarly, the coronoid process, another bony projection on the proximal/anterior side...
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The muscles surrounding the shoulder girdle, including the clavicle and scapula, primarily stabilize the scapula. This stable base allows other muscles to move the humerus effectively. Scapular movements often mirror those of the humerus and extend its range of motion. For instance, raising the arm above the head would not be feasible without simultaneous upward rotation of the scapula.
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The radius is longer of the two bones that make up the human antebrachium or forearm. At the proximal end, the radius articulates with the capitulum of the humerus and the radial notch of the ulna to form the elbow joint. At the distal end, the radius articulates with the ulna via the ulnar notch, forming the distal radioulnar joint. Distally, the radius also attaches to the carpal wrist bones (scaphoid and lunate) to form the radiocarpal joint.
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Functional Classification of Joints
The functional classification of joints is determined by the amount of mobility between the adjacent bones. Joints are functionally classified as a synarthrosis or immobile joint, an amphiarthrosis or slightly moveable joint, or as a diarthrosis, a freely moveable joint. Fibrous and cartilaginous joints can be functionally classified as either synarthroses  or amphiarthroses, whereas all synovial joints are classified as diarthroses.
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Proximal humerus fracture and acromioclavicular joint dislocation.

Maren Bieling1, Alexander Ellwein1,2, Helmut Lill1

  • 1Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift , Hannover, Germany.

Innovative Surgical Sciences
|August 5, 2024
PubMed
Summary
This summary is machine-generated.

Proximal humerus fractures and acromioclavicular joint injuries are common. Treatment varies from non-operative to surgical options like osteosynthesis, endoprosthetics, or Endobutton systems, depending on injury severity and patient factors.

Keywords:
acromioclavicular joint instabilityarthroscopic assisted Endobutton systemshorizontal instabilityjoint-preserving locking plate fixationproximal humerus fracturereverse total shoulder arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Traumatology
  • Sports Medicine

Background:

  • Proximal humerus fractures are common in older adults, often linked to osteoporosis, requiring tailored treatment based on displacement.
  • Acromioclavicular joint injuries predominantly affect young athletes, with severity dictating treatment, ranging from conservative to surgical interventions.

Purpose of the Study:

  • To review current treatment strategies for proximal humerus fractures and acromioclavicular joint injuries.
  • To discuss the decision-making process for operative versus non-operative management.
  • To highlight advancements in surgical techniques and implant systems.

Main Methods:

  • Review of current literature on proximal humerus fractures and acromioclavicular joint injuries.
  • Analysis of treatment algorithms based on fracture classification and patient-specific factors.
  • Comparison of historical and modern surgical techniques, including osteosynthesis, reverse shoulder arthroplasty, and Endobutton systems.

Main Results:

  • Non-operative treatment is suitable for minimally displaced proximal humerus fractures; complex cases benefit from surgical intervention, with reverse shoulder arthroplasty showing good long-term results.
  • Acromioclavicular joint injury management depends on Rockwood classification, with ongoing debate regarding surgical indications for higher grades.
  • Minimally invasive Endobutton systems are now the standard for acromioclavicular joint injuries, replacing older methods like hook plates due to fewer complications.

Conclusions:

  • Optimal treatment for proximal humerus fractures and acromioclavicular joint injuries requires careful consideration of fracture morphology, injury severity, and individual patient factors.
  • Advancements in surgical techniques, such as reverse shoulder arthroplasty and Endobutton systems, have improved outcomes for complex upper extremity trauma.
  • Further research is needed to clarify optimal surgical indications for higher-grade acromioclavicular joint injuries.