PubMed 2. Using the Details function - Head Splitting Fractures of the Shoulder
This is the second in a series of mini-workshops on the subject of using PubMed. It focuses on the use of the "Details" function to work out what is happening with your search. We will use the example of head splitting fractures of the shoulder. Because of the size of some of the illustrations it might be a good idea to maximize the viewing window.
When you submit a search request the PubMed robot analyses your search string (the words you type in) in a complex way.
Although this is meant to be helpful, and usually is, the translation of your request can significantly distort the intent of your search, leaving you baffled about why the search did not turn out as you expected.
When this happens and you are not sure why (eg spelling has been checked), the best plan is to use the Details function to see how your search request was interpreted.
Open PubMed and enter the search string head splitting fracture of the shoulder
This actually works quite well with a reasonably small number of citations (19) most of which are on subject. To investigate the translation of the search click on the details tab just below the search string box. (you have to do this after you have run the search not before).
I would substitute the word translated for the word "enhanced"!
Part of the Details page is reproduced below. It consists of 6 sections in reverse logical order - the original query is last and the resulting translation is first. The sections are
|The complete translation asks for
The text in the query translation box is editable. You can change the text then run the search again by clicking on the search button below. (On the real site not from this message!)
|The Search button repeats the search using the Query Translation (above)
or the new version if you have edited it.
If you click the URL button instead, the search will be repeated but a specific URL is generated for that search. You can use this to form a link to a specific search. The URLs involved are often very long and complicated.
The search results in 19 article being found
The words "of " and "the" are ignored
|Head, shoulder and fractures are MeSH terms, i.e. part of the specific
vocabulary. These terms are therefore translated as either the MeSH term or the same word
in the text. This is fortunate since the MeSH term "Head"
applies to the anatomical region (face, skull etc), not the head of the humerus.
The term "splitting" is not translated into anything else.
PubMed was the database queried and the original user query is as shown.
Conclusion: this translation is quite good but not right on target. The MeSH term "Head" is certainly not needed and the term "shoulder" may be a bit inexact. If the article was entitled "Intra-articular Fractures of the Proximal Humerus" it would not be picked up. The sensitivity of the search is completely dependent on the term "splitting". If you delete that term you get nearly 450 articles
When words are used inside quotes they have to appear exactly in that form in the article. It seems that - is considered the same as a space. If we use the term "head splitting" or "head-splitting" you get the same results. If you compare this collection with the original search we find that 3 articles (Brits, naturally) used the words "splitting of the humeral head". Consequently these article did not turn up in the search for "head splitting" in quotes which required the exact phrase but did turn up in the search for head splitting which simply requires that both words be somewhere in the article. It is precisely this type of fiddly detail which make PubMed searching unpredictable and which makes the details function a major help.
|11:||White TO, Robinson CM.||Related Articles, Links|
|Fractures involving splitting of the humeral head.
J Bone Joint Surg Br. 2002 Sep;84(7):1084; author reply 1084-5. No abstract available.
PMID: 12358377 [PubMed - indexed for MEDLINE]
|12:||Ogawa K.||Related Articles, Links|
|Fractures involving splitting of the humeral head.
J Bone Joint Surg Br. 2001 Nov;83(8):1209-10. No abstract available.
PMID: 11764443 [PubMed - indexed for MEDLINE]
|13:||Chesser TJ, Langdon IJ, Ogilvie C, Sarangi PP, Clarke AM.||Related Articles, Links|
|Fractures involving splitting of the humeral head.
J Bone Joint Surg Br. 2001 Apr;83(3):423-6.
PMID: 11341432 [PubMed - indexed for MEDLINE]
Copy the search string Intertrochanteric Fractures of the Hip exactly into the PubMed Search engine and run the search. Use the Details function to explain why this search produces such unexpected results.
Comments to the Orthopod Mailing List. Please don't forget to edit out the end of this message if you reply.
Other workshops in this series
Myles Clough email@example.com
Abstracts of the relevant papers found by this search
1: Am J Orthop. 2003 Jul;32(7):349-52. The management of anterior dislocation of the shoulder with proximal humerus fracture, bony Bankart lesion, and associated glenoid labrum avulsion: a report of 2 cases. Lahav A, Rogachefsky R, Toledano B, Meinhard BP. State University of New York at Stony Brook Medical Center, Stony Brook, New York, USA. Proximal humerus fractures are common in the older population. These fractures can be associated with dislocation of the shoulder. Four-part fracture-dislocations and head-splitting 3-part fractures are generally indicated for shoulder hemiarthroplasty in the older population. When such surgery is warranted, inspection of the glenoid during the procedure is indicated, as loss of evaluation may lead to postoperative shoulder instability. There is value in alerting orthopedic surgeons to the possibility of anterior glenoid rim fracture in association with proximal shoulder fracture-dislocation. We focus on this issue and advise that the lesion can be visualized and confirmed at open reconstruction and does not need multiple radiographic views. Publication Types: Case Reports PMID: 12892280 [PubMed - indexed for MEDLINE] 2: Orthopade. 2001 Jun;30(6):386-94. [Shoulder hemi-arthroplasty in proximal humeral fractures] [Article in German] Heers G, Torchia ME. Orthopadische Universitatsklinik Regensburg, Kaiser-Karl-V. Allee 3, 93077 Bad Abbach. firstname.lastname@example.org Most fractures of the proximal humerus with significant displacement are best treated surgically. The range of surgical treatment varies from closed reduction and pinning to hemiarthroplasty depending on the degree of displacement, age of the patient, and bone quality. Determining whether or not the individual fractured bone segments are displaced to a significant degree requires high quality x-rays which can be difficult to obtain from acutely injured patients. Indications for replacement of the humeral head in acute fractures include: head splitting fractures in elderly patients, Neer 4-part fracture dislocations, selected 3 part fractures and fracture dislocations in elderly patients with poor bone quality and a very small head fragment, selected severe impression fractures in elderly patients that involve more than 40% to 50% of the articular surface and selected anatomical neck fractures in which internal fixation is not possible. If a prosthetic replacement of the humeral head is chosen, secure repair of the tuberosities is essential to avoid tuberosity migration and malunion. The clinical results of prosthetic replacement of the proximal humerus for acute fractures are superior to those for late arthroplasty. This treatment modality has been proven to relieve pain. However, even for patients treated with primary arthroplasty, a restricted range of motion has to be expected postoperatively. Furthermore, several studies indicate that a significant number of complications can occur following early and late prosthetic replacement. Humeral head replacement as a salvage procedure after malunions or failed open reduction and internal fixation is technically demanding with a relatively high rate of complications. Newer implant designs and instruments may improve the clinical results. Publication Types: Review Review, Tutorial PMID: 11480091 [PubMed - indexed for MEDLINE] 3: Orthopade. 2000 Apr;29(4):327-41. [Proximal and distal humerus fractures in advanced age] [Article in German] Lill H, Josten C. Klinik fur Unfall- und Wiederherstellungschirurgie, Universitat Leipzig. In contrast to distal humeral fractures, humeral head fractures represent a common injury to the old patient. For both fracture localizations osteoporosis and multi-morbidity are of significant importance. The classification for humeral head fractures in one-, two-, three- and four-part fractures is generally accepted. Valgus impacted head fractures as well as head-splitting fractures are considered a separate entity. In none or minimally displaced fractures good functional results are achieved by conservative means. Although numerous therapeutical procedure are offered in the treatment of displaced fractures of the proximal humerus the result are often disappointing. Generally, minimal invasive surgical procedures should be preferred. However, in dislocated multi-part fractures a primary humeral head replacement is often the treatment of choice. In patients with multifarious morbidity a conservative treatment is always to be included into the therapeutical considerations. Distal fractures of the humerus are classified into extraarticular, intraarticular uni-condylar and intraarticular bi-condylar fractures. The therapeutical recommendations, also in the elderly, is relatively homogeneous: primary open reduction and internal fixation (ORIF) should be carried out aiming for an early postoperative functional treatment. Depending from soft tissue conditions and accompanying injuries the functional results are often good or moderate and are generally comparable to those of younger patients. Following a correct indication for surgical intervention the main priority for both distal and proximal humeral fractures is an early definitive surgical treatment. Publication Types: Review Review, Tutorial PMID: 10851693 [PubMed - indexed for MEDLINE] 4: Orthop Clin North Am. 2000 Jan;31(1):51-61. Management of surgical neck nonunions. Galatz LM, Iannotti JP. Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA. A surgical neck nonunion is a seriously debilitating complication of a proximal humerus fracture. Patients have virtually no functional use of their shoulders and experience pain. Successful treatment is reliable in relief of pain and potentially can restore function. The diagnosis is not difficult, however, a CT scan may be necessary to identify tuberosity or head-splitting fractures. Successful treatment for these nonunions is difficult but gratifying because the percent improvement is immense. Publication Types: Review PMID: 10629332 [PubMed - indexed for MEDLINE] 5: Orthop Clin North Am. 1998 Jul;29(3):467-75. Shoulder hemiarthroplasty for proximal humeral fractures. Hartsock LA, Estes WJ, Murray CA, Friedman RJ. Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, USA. Shoulder hemiarthroplasty is a well-accepted surgical procedure for the treatment of specific subtypes of proximal humeral fractures, including four-part fractures, three-part fractures associated with severe osteopenia, head-splitting and severe articular impression fractures. Careful patient assessment and meticulous surgical technique are essential to prevent complications. The results are satisfactory in approximately 80% of cases. The results are better in younger patients and in acute versus chronic fractures. There are a significant number of complications that are related to technical details of the procedure. Careful placement of the prosthesis and secure reattachment of the tuberosities to the shaft reduce the chance of complication following surgery. Good to excellent results in terms of range of motion and pain relief can be expected in most patients. Publication Types: Review Review, Tutorial PMID: 9706293 [PubMed - indexed for MEDLINE] 6: Clin Orthop Relat Res. 1996 Jun;(327):225-37. Surgical treatment of complex fracture of the proximal humerus. Ko JY, Yamamoto R. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan. Sixteen patients aged 19 to 63 years (average, 52 years) were observed from 1.8 to 5.6 years (average, 3.8 years) after open reduction and internal fixation with or without external fixation of 3- and 4-part displaced fractures of the proximal humerus. There were 12, 3-part displaced greater tuberosity and surgical neck fractures with 6 concomitant dislocations. Four cases were 4-part fractures with 3 concomitant dislocations. Fixation was achieved with heavy sutures or wire that incorporated the rotator cuff tendon, tuberosities, and shaft combined with threaded pins or Hoffmann external fixation to enhanced stability for early rehabilitation. According to Neer's criteria, 14 (87%) of the 16 patients had satisfactory or excellent results. Two (13%) of the 16 had unsatisfactory results. The use of a technique of limited soft tissue dissection and internal fixation with or without external fixation achieved good fracture stability and a high percentage of satisfactory results. The limitations of the procedure include (1) patients who could not tolerate anesthesia, (2) complex displaced fractures in older patients with osteoporotic bone that cannot hold pins or external fixation, (3) older patients with 4-part fracture dislocations in which avascular necrosis of the humeral head occurs frequently and in which a subsequent endoprosthesis insertion is inappropriate if osteosynthesis fails, and (4) head splitting fractures. The described approach provides an alternative method for the treatment of complex displaced fractures of the proximal humerus. PMID: 8641068 [PubMed - indexed for MEDLINE] 7: J Bone Joint Surg Am. 1992 Jul;74(6):884-9. Modular hemiarthroplasty for fractures of the proximal part of the humerus. Moeckel BH, Dines DM, Warren RF, Altchek DW. Shoulder Service, Hospital for Special Surgery, New York City, N.Y. 10021. A new biomodular prosthesis was used for the treatment of a displaced fracture of the proximal part of the humerus in twenty-two shoulders in twenty-two patients. The fractures were classified according to the Neer system; there were thirteen four-part, five three-part, and four head-splitting fractures. There were fifteen women and seven men, and the mean age was seventy years (range, forty-nine to eighty-seven years). The hemiarthroplasty was performed an average of eleven days (range, one to forty-five days) after the injury. The deltopectoral interval was used in all patients, and the prosthesis was implanted with cement in twenty of the shoulders. All of the patients participated in a supervised program of rehabilitation. The patients were followed for an average of thirty-six months (range, twenty-six to forty-nine months). Twenty of the twenty-two patients had a good or excellent result. The active forward elevation averaged 119 degrees; external rotation, 40 degrees; and internal rotation, to the twelfth thoracic vertebra. All of the patients except for the two who had a poor result had satisfactory relief of pain. The two patients who had a poor result had a successful revision with a modular prosthesis of the same design. The modular head could be removed, enabling the surgeon to gain access to the glenoid and to adjust the soft tissues. The over-all scores correlated inversely with the age of the patients and the interval from the injury to the operation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 1634578 [PubMed - indexed for MEDLINE] 8: Langenbecks Arch Chir. 1990;375(4):225-30. [Humerus head resection as therapy of compound fracture of the upper arm--results] [Article in German] Skruodies B, Wening JV, Jungbluth KH. Abteilung fur Unfallchirurgie, Chirurgische Universitatsklinik Hamburg-Eppendorf. Proximal humeral fractures are frequent injuries in older patients. Most of these fractures respond satisfactorily to conservative treatment. Problems arise in cases of four-part displacements and in head-splitting fractures with massive defects in the articular surface. Between 1970 to 1988 eight patients were treated in our clinic in this situation by resection of the humeral head. 6 patients could be followed-up for an average of 69 months. Postoperative findings showed a restricted range of motion in all operated shoulders. The average abduction of the arm was 60 degrees (40-80 degrees) and elevation 60 degrees (40-80 degrees). The patients showed a mean external rotation of 17 degrees (5-30 degrees) and an internal rotation of 48 degrees (5-90 degrees). Only one patient was painless, 2 patients had pain during the night, and 3 patients suffered from various pain symptoms. Nevertheless 5 of 6 patients assessed the result as satisfactory and one patient as good. Publication Types: Case Reports PMID: 2395390 [PubMed - indexed for MEDLINE] 9: Injury. 1989 Jul;20(4):195-9. Treatment of displaced fractures of the proximal humerus: transcutaneous reduction and Hoffmann's external fixation. Kristiansen B. Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Denmark. Experience with transcutaneous reduction and external fixation of displaced fractures of the proximal humerus is presented in a series of 28 cases followed for 1 year or more. In 18 cases near-anatomical fracture reduction was obtained, while no improvement of fracture position was seen in two cases. Loosening of the pins was a major complication in five cases, all in patients with severe osteoporosis or head splitting fractures, where fracture reduction was unsatisfactory. The functional results were satisfactory, and the method is considered a useful alternative in the treatment of these difficult fractures. PMID: 2592091 [PubMed - indexed for MEDLINE] 10: Unfallchirurgie. 1985 Aug;11(4):215-8. [Humeral head fractures following epileptic attacks. Case report on a rare but typical injury] [Article in German] Siebler G, Lausen M. We report about two patients with posterior fracture-dislocation of the shoulder following convulsive seizures, one case unilateral, one case bilateral. The radiological findings are typical and similar to the cases described in literature: Impression or head splitting fracture of the ventro-medial part of the humeral head associated with posterior dislocation. The mechanism of injury, methods of treatment and late results are discussed. Publication Types: Case Reports PMID: 4049575 [PubMed - indexed for MEDLINE] 11: J Bone Joint Surg Br. 2002 Sep;84(7):1084; author reply 1084-5. Comment on: J Bone Joint Surg Br. 2001 Apr;83(3):423-6. Fractures involving splitting of the humeral head. White TO, Robinson CM. Publication Types: Comment Letter PMID: 12358377 [PubMed - indexed for MEDLINE] 12: J Bone Joint Surg Br. 2001 Nov;83(8):1209-10. Comment on: J Bone Joint Surg Br. 2001 Apr;83(3):423-6. Fractures involving splitting of the humeral head. Ogawa K. Publication Types: Comment Letter PMID: 11764443 [PubMed - indexed for MEDLINE] 13: J Bone Joint Surg Br. 2001 Apr;83(3):423-6. Comment in: J Bone Joint Surg Br. 2001 Nov;83(8):1209-10. J Bone Joint Surg Br. 2002 Sep;84(7):1084; author reply 1084-5. Fractures involving splitting of the humeral head. Chesser TJ, Langdon IJ, Ogilvie C, Sarangi PP, Clarke AM. Bristol Royal Infirmary, Southmead Hospital, UK. Splitting fractures of the humeral head are rare; part of the humeral head dislocates and the unfractured part remains attached to the shaft. We report eight cases in young patients. In five the diagnosis was made at presentation: three had minimal internal fixation using a superior subacromial approach, one had a closed reduction and one a primary prosthetic replacement. All five patients regained excellent function with no avascular necrosis at two years. In three the injury was initially unrecognised; two developed a painless bony ankylosis and one is awaiting hemiarthroplasty. It is important to obtain the three trauma radiographic views to diagnose these unusual fractures reliably. CT delineates the configuration of the fracture. In young patients open reduction and internal fixation seems preferable to replacement of the humeral head, since we have shown that the head is potentially viable. PMID: 11341432 [PubMed - indexed for MEDLINE] 14: J South Orthop Assoc. 1995 Spring;4(1):3-8. Internal fixation of proximal humeral fractures. Dahners LE. Division of Orthopaedics, University of North Carolina, Chapel Hill 27599-7055, USA. Fractures of the proximal humerus are common, especially in elderly individuals, and are usually classified according to Neer into fractures having one, two, three, or four parts with or without an associated dislocation or an injury splitting the humeral head. This article is intended to assist the surgeon in selecting and using techniques for internal fixation of these fractures. The use of open reduction and internal fixation using plates and screws has become less popular because of the extensive dissection required and the tendency for the plate to impinge. Use of multiple percutaneous pins to fix the humeral head to the shaft (surgical neck) and heavy sutures or wires to reattach the tuberosities is often preferable. PMID: 7767676 [PubMed - indexed for MEDLINE]