Treatment of severely displaced proximal humeral fractures in children with retrograde elastic stable intramedullary nailing

Fernandez, F. F.; Eberhardt, Oliver; Langendörfer, M.; Wirth, Thomas

doi:10.1016/j.injury.2008.04.001

Cited by 66 publications

(72 citation statements)

References 10 publications

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“…As a result, even significantly angulated and displaced fractures have achieved union in positions that have allowed for normal or near-normal functional outcome. In children up to 10 years of age, axial malalignment of the proximal humerus of as much as 60° in varus, anteversion, or retroversion can be corrected by remodeling; however, beyond 10 years of age, the remodeling potential is not as high and correction can be expected only with axial deformities of up to 20–30° [12]. It is important to note that the majority of previously published outcome studies evaluating displaced proximal humeral epiphyseal fractures included few patients that were 15 years or older [11].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have demonstrated excellent results with all of these surgical techniques and suggest that the anatomic reduction of severely displaced proximal humerus fractures is justified, especially in patients over 13 years of age [6, 9, 7, 12, 25]. Burgos-Flores et al noted excellent results in 22 patients with Neer grade III and IV proximal humeral epiphyseal fractures treated with closed or open reduction and wire fixation at a mean of 6.8 years of follow up.…”

Section: Discussionmentioning

confidence: 99%

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Proximal humerus fractures in the pediatric population: A systematic review

Pahlavan

Baldwin

Pandya

et al. 2011

Journal of Children's Orthopaedics

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PurposeProximal humerus fractures and epiphyseal separations in skeletally immature children and adolescents are traditionally treated non-operatively. Recently, authors have described the operative fixation of these injuries, particularly in older children and adolescents with displaced fractures. We performed a systematic review of the literature to identify operative indications for proximal humerus fractures in children and to compare the results by age, displacement, and treatment modality.MethodsA systematic review of the literature from January 1960 to April 2010 was performed. All studies with patients under the age of 18 years who were treated for a proximal humerus fracture either operatively or non-operatively were included.ResultsThe available literature is largely composed of uncontrolled case series (Level IV). According to findings, the literature shows that asymptomatic union is the rule in proximal humerus fractures in children and adolescents. Poorer outcomes were noted in operatively treated patients, patients with more displaced fractures, and older patients.ConclusionsThe currently available literature supports a non-operative treatment approach, particularly in younger children with more growth remaining. Older patients (>13 years) with more widely displaced fractures may benefit from anatomic reduction with stabilization, though the data in the literature at this point is too weak to strongly recommend this approach. Further analysis with a more rigorous scientific method is necessary to evaluate the optimum treatment modality in this subgroup.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Proximal humerus fractures in the pediatric population: A systematic review

Pahlavan

Baldwin

Pandya

et al. 2011

Journal of Children's Orthopaedics

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“…Other studies have noted that patients up to 10 years of age, 60°of varus, anteversion, or retroversion can remodel [9]. As a result, the majority of studies which have investigated non-operative outcomes of pediatric proximal humerus fractures have concentrated on nonadolescent patients [5,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Open reduction of proximal humerus fractures in the adolescent population

Pandya¹,

Behrends

Hosalkar

2012

Journal of Children's Orthopaedics

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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.

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“…[3] Also, other shaft and selected metaphyseal fractures as well children with polyfractures, were in line with current enlargement of ESIN indications. [1][2][3]5] But, care must be taken for arguable indications reported by Bopst et al, [6] such as femur shaft fracture in the preschool child for whom the orthopaedic treatment remains effective, without affecting the school attendance. However, the use of ESIN is much recent and not yet implemented in our routine practice for reasons including insufficient equipment, people with low socioeconomic level, and ineffectual welfare system, making this procedure still looked at critically as compared with the conservative treatment.…”

Section: Discussionmentioning

confidence: 99%