Proximal Humeral Fractures in Children and Adolescents

Bahrs, Christian; Zipplies, Sebastian; Ochs, Björn Gunnar; Rether, J. R.; Oehm, Justus; Eingartner, C.; Rolauffs, Bernd; Weise, K.

doi:10.1097/bpo.0b013e31819bd9a7

Cited by 75 publications

(101 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Traditionally, the long head of the biceps and/or periosteum has been reported to prevent the reduction of proximal humerus fractures in a closed fashion [2, 9, 10, 12-14, 22, 24]. Bahrs et al [13] examined 43 patients with proximal humerus fractures (33 treated operatively), in which 17 could not be closed reduced under general anesthesia. In seven cases, the biceps was entrapped, and in two cases, periosteum was entrapped.…”

Section: Discussionmentioning

confidence: 99%

“…It is within this adolescent age group that interposition of periosteum, entrapped long head of the biceps tendon, and/or other structures have been cited as potential impediments to anatomic or acceptable nearanatomic reduction [13]. Furthermore, as patients approach skeletal maturity, remodeling potential is limited and the results can be potentially worse with non-operative treatment, particularly in non-anatomically reduced fractures.…”

Section: Introductionmentioning

confidence: 99%

“…Yet, there are a subset of studies showing excellent outcomes in patients operatively treated with severely displaced injuries, particularly those above the age of 13 years [12][13][14][15]. It is within this adolescent age group that interposition of periosteum, entrapped long head of the biceps tendon, and/or other structures have been cited as potential impediments to anatomic or acceptable nearanatomic reduction [13].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Open reduction of proximal humerus fractures in the adolescent population

Pandya¹,

Behrends

Hosalkar

2012

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

Purpose Proximal humerus fractures in the pediatric population are a relatively uncommon injury, with the majority of injuries treated in a closed fashion due to the tremendous remodeling potential of the proximal humerus in the skeletally immature. Yet, in adolescent patients, open treatment is, at times, necessary due to unsatisfactory alignment following a closed reduction, loss of previously achieved closed reduction, and limited remodeling when close to skeletal maturity. The purpose of our study was to examine the open reduction of adolescent proximal humerus fractures. Methods A retrospective review of the outcomes of proximal humerus fractures in the adolescent population which were consecutively treated at our institution with open reduction was performed. Results Ten children met the inclusion criteria, with a mean age of 14.3 years (±1.3) and a mean weight of 60.7 kg (±14.9) at the time of injury. There were seven SalterHarris 2 fractures and three Salter-Harris 1 fractures. The largest mean angulation was 55.0°(±33.9) and the largest mean displacement was 87.0 % (±22.8). Intra-operatively, impediments to closed reduction within the fracture site which were found included: periosteum (90.0 %), biceps tendon (90.0 %), deltoid muscle (70.0 %), and comminuted bone (10.0 %). K-wire fixation was most commonly used (70.0 %), followed by flexible nails (20.0 %) and cannulated screws (10.0 %) for fixation. All patients achieved radiographic union at a mean of 4.0 weeks (±0.7), had non-painful full shoulder range of motion and rotator cuff strength at final follow-up (mean 7.7 ± 4.6 months), and returned to pre-injury sporting activities. Conclusions The operative treatment of proximal humerus fracture, particularly in adolescents with severe displacement/angulation having failed closed methods of treatment, is increasingly considered to be an acceptable modality of treatment. In addition to the long head of the biceps, periosteum, deltoid muscle, and bone fragments in combination can prevent fracture reduction. Surgeon preference and skill should dictate implant choice, and the risk of physeal damage utilizing these implants in this age group is low.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Open reduction of proximal humerus fractures in the adolescent population

Pandya¹,

Behrends

Hosalkar

2012

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

show abstract

“…UCLA, Neer) we recorded the Constant-Score. Based on previous studies [36-42] we used a linear regression between the logit transformed results of the DASH-Score, the UCLA-Score and the Neer-Score with the logit transformed Constant-Score. This was performed in accordance to previously published articles [43,44].…”

Section: Methodsmentioning

confidence: 99%

Complication rates and outcomes stratified by treatment modalities in proximal humeral fractures: a systematic literature review from 1970–2009

et al. 2013

Self Cite

View full text Add to dashboard Cite

BackgroundThe optimal treatment of complex, displaced proximal humeral fractures is controversial. A systematic literature review of the time period from 1970 to 2009 was conducted. The purpose was to evaluate the clinical success and complications of the available treatment modalities to determine specific treatment recommendations for the different fracture patterns.MethodsThe databases (PubMed/EMBASE) were searched for the time period (01/1970–09/2009). Study quality, treatment modalities, classification, outcome scores and complications of 200 publications including 9377 patients were analyzed. Interventions were compared by analysis of variance with subsequent Tukey’s-test. Complication rates among methods were compared by using Pearson’s-chi-square-test and pairwise comparisons using Fisher’s-two-tailed-exact-test.ResultsHemiarthroplasty, angle-stable plate and non-operative treatment were used for 63% of the follow-up-patients. For 3- and 4-part fractures, patients with hemiarthroplasty [3-Part: 56.4 (lower/upper 95% confidence interval (CI): 43.3-68.7); 4-Part: 49.4 (CI: 42.2-56.7)] received a lower score than different surgical head-preserving methods such as ORIF [3-Part: 82.4 (CI: 76.6-86.9); 4-Part: 83.0 (CI:78.7-86.6)], intramedullary nailing [3-Part: 79.1 (CI:74.0-83.4)] or angle-stable plates [4-Part: 66.4 (CI: 59.7-72.4)].The overall complication rate was 56%. The most common complications were fracture-displacement, malunion, humeral head necrosis and malreduction. The highest complication rates were documented for conventional plate and hemiarthroplasty and for AO-C, AO-A, for 3- and 4-part fractures. Only 25% of the data were reported with detailed classification results and the corresponding outcome scores.DiscussionDespite the large amount of patients included, it is difficult to determine adequate recommendations for the treatment of proximal humeral fractures because a relevant lack of follow-up data impaired subsequent analysis. For displaced 3- and 4-part fractures head-preserving therapy received better outcome scores than hemiarthroplasty. However, a higher number of complications occurred in more complex fractures and when hemiarthroplasty or conventional plate osteosynthesis was performed. Thus, when informing the patient for consent, both the clinical results and the possibly expected complications with a chosen treatment modality should be addressed.

show abstract

“…Conservative management and early mobilization can therefore be implemented, with the acceptance of even severely angulated or displaced fractures, particularly in younger children. For patients nearing skeletal maturity with significant angulation or displacement (Neer III-IV), who lack this remodelling potential, closed reduction and immobilisation is required, progressing to open reduction with pin or screw fixation when closed reduction is not achieved and in order to prevent deformity [22,25,26].…”

Section: Proximal Humeral Fracturementioning

confidence: 99%