Physeal injuries of the proximal humerus: long-term results in seventy two patients

Abstract

Purpose The aim of this study was to evaluate our treatment methods of proximal humeral physeal injuries retrospectively and elucidate the relationship between the trauma mechanism, the radiographic injury pattern, the consequent therapy and the functional outcome, and to further deduct and verify prognostic criteria. Methods At our Department of Trauma Surgery, 303 children and adolescent patients with fractures of the proximal humeral epiphysis were treated from 1992 to 2009. 72 cases were diagnosed as physeal fractures according to the Salter-Harris classification and were included in our study. Results 15 physeal fractures of the proximal humerus were reconstructed anatomically by open or closed reduction and produced 93.3% excellent results. 57 physeal fractures were treated in a conservative way and produced 94.7% excellent results. Conclusion We state that epiphyseal injuries should to be treated depending on the age of the patient. This is the only way to decrease the rate of posttraumatic epiphysiodesis with consequent problems, including limb-length discrepancy and/or angular deformities.

Salter-Harris Type II Humeral Head Fracture with Kirschner Wire Fixation in a Goat

“…Proximal humeral epiphyseal fractures are infrequently reported in both the human and veterinary literature. 15,16 Dissimilarly to that of companion animals, goat humeri characteristically possess unique anatomical variances that result in a dense region of bone located in close proximity to the body, which may further reduce the likelihood of proximal humeral fractures in this species. [5][6][7][8][9] Epidemiological studies in paediatrics have identified Salter-Harris type II fractures of the proximal humeral epiphysis to be the most common fracture configuration and often the result of high energy trauma.…”

“…[5][6][7][8][9] Epidemiological studies in paediatrics have identified Salter-Harris type II fractures of the proximal humeral epiphysis to be the most common fracture configuration and often the result of high energy trauma. 15,16 Such trauma typically results in fractures propagating along epiphyseal scar lines, with muscle forces on fracture fragments and limb position at the time of impact also in consideration for fracture type and severity. 17 Isolated epiphyseal separation is rare and occurs typically in newborns and toddlers, 15 with treatment often conservative and consisting of shoulder immobilization.…”

“…15,16 Such trauma typically results in fractures propagating along epiphyseal scar lines, with muscle forces on fracture fragments and limb position at the time of impact also in consideration for fracture type and severity. 17 Isolated epiphyseal separation is rare and occurs typically in newborns and toddlers, 15 with treatment often conservative and consisting of shoulder immobilization. 15 Despite previous studies identifying similar outcomes between surgery and non-operative treatment, 15,18 management of proximal humeral fractures in people has evolved toward favouring surgical intervention, particularly in older patients and those with grossly displaced or angulated fractures.…”

“…17 Isolated epiphyseal separation is rare and occurs typically in newborns and toddlers, 15 with treatment often conservative and consisting of shoulder immobilization. 15 Despite previous studies identifying similar outcomes between surgery and non-operative treatment, 15,18 management of proximal humeral fractures in people has evolved toward favouring surgical intervention, particularly in older patients and those with grossly displaced or angulated fractures. 19,20 German national guidelines for proximal humeral fractures in people recommend reduction and stabilization by elastic-stable intramedullary nailing in patients over the age of 10 years, with minimally displaced fractures often left untreated due to the highly potent epiphyseal plate.…”

Salter-Harris Type II Proximal Humerus Injuries

“…4,5 Operative treatment should be considered when there is a marked displacement. 4,5 Operative treatment should be considered when there is a marked displacement.…”