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Samara E, Locatelli I, Tschopp B, Lutz N, Zambelli PY. Single versus double retrograde intramedullary nail technique for treatment of displaced proximal humeral fractures in children: A retrospective cohort study. J Child Orthop 2024; 18:287-294. [PMID: 38831859 PMCID: PMC11144374 DOI: 10.1177/18632521241238149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/21/2024] [Indexed: 06/05/2024] Open
Abstract
Background Highly displaced proximal humeral fractures in children with low remodeling potential need to be reduced and fixed. The use of two flexible retrograde nails became the most popular fixation technique due to the excellent functional outcome, the low complication rates, and the possibility of early mobilization. A modified single retrograde technique has been suggested by the authors to address the main disadvantage of this technique, the long operative duration. The aim of this study was to compare these techniques in terms of efficacy, and clinical and radiological outcomes. Methods We performed a retrospective, monocentric study. Two groups of patients were defined: One was treated with the standard flexible retrograde double nail technique and the other with the modified single nail technique. The demographic and fracture characteristics were similar in both groups and the postoperative immobilization with a simple sling for 2 weeks. We compared the surgical duration for the initial fixation and hardware removal procedures. The Quick Disabilities of the Arm, Shoulder, and Hand score, the secondary displacement at 1-week follow-up, the radiological union at 6-week follow-up, and the perioperative and short-term complications were also assessed for both groups. Results The surgical duration of the initial fixation procedure was significantly shorter in single nail technique group (p = 0.005). The percentage of excellent Quick Disabilities of the Arm, Shoulder, and Hand score (0) was similar in the two groups (p = 0.98). No secondary displacement was reported for the double nail technique group. In only one patient from the single nail technique group, we detected a secondary displacement at the first week control which did not need reoperation. In both groups, fractures were healed on the 6-week radiologic control. No cases of infection, superficial skin irritation, neurological damage, or complications related to implant removal were reported in both groups. Conclusions The single nail technique of fixation proximal humeral fractures in children addresses the disadvantage of long surgical times, described until today, with the double nail technique without compromising the excellent functional and radiological short-term outcomes. Level of evidence level III.
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Affiliation(s)
- Eleftheria Samara
- Pediatric Orthopedic Department, Lausanne Children’s Hospital, Lausanne, Switzerland
| | - Isabella Locatelli
- Unisanté, Centre universitaire de médecine générale et santé publique, Lausanne, Switzerland
| | - Benjamin Tschopp
- Pediatric Orthopedic Department, Lausanne Children’s Hospital, Lausanne, Switzerland
| | - Nicolas Lutz
- Pediatric Orthopedic Department, Lausanne Children’s Hospital, Lausanne, Switzerland
| | - Pierre-Yves Zambelli
- Pediatric Orthopedic Department, Lausanne Children’s Hospital, Lausanne, Switzerland
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Schippers P, Gercek E, Schneidmüller D, Strohm PC, Ruckes C, Wegner E, Baranowski A, Dietz SO. Proximal humeral fractures in children - controversies in decision making. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02534-7. [PMID: 38689019 DOI: 10.1007/s00068-024-02534-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Proximal humeral fractures in children are rare and usually treated non-operatively, especially in children younger than ten. The decision between operative and non-operative treatment is mostly based on age and fracture angulation. In the current literature, diverging recommendations regarding fracture angulation that is still tolerable for non-operative treatment can be found. Besides, there is no consensus on how fracture angulation should be determined. This study aimed to determine whether leading experts in pediatric trauma surgery in Germany showed agreement concerning the measurement of fracture angulation, deciding between operative and non-operative treatment, and choosing a treatment modality. METHODS Twenty radiographs showing a proximal humeral fracture and the patient's age were assessed twice by twenty-two senior members of the "Section of Pediatric Traumatology of the German Association for Trauma Surgery". Experts determined the fracture angulation and chose between several operative and non-operative treatment modalities. The mean of individual standard deviations was calculated to estimate the accuracy of single measurements for fracture angulation. Besides Intra-Class Correlation and Fleiss' Kappa coefficients were determined. RESULTS For fracture angulation, experts showed moderate (ICC = 0.60) interobserver and excellent (ICC = 0.90) intraobserver agreement. For the treatment decision, there was fair (Kappa = 0.38) interobserver and substantial (Kappa = 0.77) intraobserver agreement. Finally, experts preferred ESIN over K-wires for operative and a Gilchrist over a Cuff/Collar for non-operative treatment. CONCLUSIONS Firstly, there is a need for consensus among experts on how fracture angulation in PHFs in children should be reliably determined. Our data indicate that choosing one method everybody agrees to use could be more helpful than using the most sophisticated. However, the overall importance of fracture angulation should also be critically discussed. Finally, experts should agree on treatment algorithms that could translate into guidelines to standardize the care and perform reliable outcome studies. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Philipp Schippers
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Erol Gercek
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | | | - Peter C Strohm
- Clinic of Orthopedics and Trauma Surgery, Sozialstiftung Bamberg, Bamberg, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials Mainz, University Medical Center, Johannes Gutenberg University Mainz, 55131, Mainz, Germany
| | - Erik Wegner
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Andreas Baranowski
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Sven-Oliver Dietz
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
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Wang Y, Wang Q, Yao W, Zhao J, Zhao X, He M. Kirschner wire versus external fixation in the treatment of proximal humeral fractures in older children and adolescents: a comparative study. BMC Musculoskelet Disord 2023; 24:899. [PMID: 37980527 PMCID: PMC10656960 DOI: 10.1186/s12891-023-07037-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 11/12/2023] [Indexed: 11/20/2023] Open
Abstract
OBJECTIVE The purpose of this study was to compare the therapeutic effects of Kirschner wire fixation and external fixation in the treatment of proximal humeral fractures in older children and adolescents. METHODS A retrospective analysis was performed on the clinical data of older children and adolescents who underwent surgery at our institution for proximal humeral fractures between April 2014 and May 2022. One group (n = 28) underwent fracture reduction and Kirschner wire fixation, and the other group (n = 23) underwent external fixation. During the follow-up, the differences in shoulder joint function between the two groups were compared by analysing Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) and Constant-Murley scores. Postoperative complications were also recorded. RESULTS The operation time of the Kirschner wire group was shorter than that of the external fixation group (69.07 ± 11.34 min vs. 77.39 ± 15.74 min, P = 0.33). The time to remove the fixator in the external fixation group was shorter than that in the Kirschner wire group (6.74 ± 1.57 vs. 7.61 ± 1.22, P = 0.032). The Quick DASH score and Constant-Murley score of the patients in the external fixation group were significantly better than those in the Kirschner wire group at 3 months after surgery (5.63 ± 4.33 vs. 8.93 ± 6.40, P = 0.040; 93.78 ± 2.43 vs. 91.75 ± 2.15, P = 0.003). There was no significant difference in the Quick DASH score or Constant-Murley score between the patients in the external fixator group and those in the Kirschner wire group at 9 months after the operation (2.77 ± 3.14 vs. 3.17 ± 3.68, P = 0.683; 97.39 ± 1.80 vs. 96.57 ± 2.15, P = 0.152). The most common complication of the two groups was pin tract infection. The incidence rate of infection was higher in the external fixation group than that in the Kirschner wire group (9 vs. 4, P = 0.043). CONCLUSION Both Kirschner wire fixation and external fixation of N-H III and IV proximal humeral fractures in older children and adolescents produce good outcomes. External fixation is a preferred surgical treatment option for paediatric proximal humerus fractures because early mobilization of the affected limb can be realized.
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Affiliation(s)
- Yu Wang
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Qian Wang
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Wuyi Yao
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Jingxin Zhao
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Xiaobin Zhao
- Department of Radiology, Affiliated Hospital of Chengde Medical University, 36 Nanyingzi Street, Chengde, Shuangqiao District, Hebei, 067000, PR China
| | - Man He
- Department of Rehabilitation, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China.
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Shah MM, Jain M, Ponugoti G, Bansal S, Shah S, Sangole C. Challenges in Management of Proximal Humerus Diaphyseal Fracture in a Patient with Brachial Plexus Birth Injury: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00020. [PMID: 37889988 DOI: 10.2106/jbjs.cc.23.00243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
CASE Two-and-a-half-month-old boy, a known case of brachial plexus birth injury, sustained proximal humeral diaphyseal fracture. Fracture healed in varus malunion and failed to remodel subsequently. Challenges were faced in the course of the management because of progression of the deformity. Finally, the fracture united after rigid internal fixation performed at 2.5 years. CONCLUSION Neuromuscular imbalance can lead to angular deformity at fracture site and cause unpredictable remodeling, as in our case. Conservative management may fail to achieve union with satisfactory alignment. Rigid internal fixation should be considered in such cases to achieve union.
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Kraal T, Struijs PAA, Langenberg LC, van Bergen CJA. Fractures around the shoulder in the skeletally immature: A scoping review. World J Orthop 2023; 14:604-611. [PMID: 37662664 PMCID: PMC10473910 DOI: 10.5312/wjo.v14.i8.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 08/17/2023] Open
Abstract
Fractures around the shoulder girdle in children are mainly caused by sports accidents. The clavicle and the proximal humerus are most commonly involved. Both the clavicle and the proximal humerus have a remarkable potential for remodeling, which is why most of these fractures in children can be treated conservatively. However, the key is to understand when a child benefits from surgical management. Clear indications for surgery of these fractures are lacking. This review focuses on the available evidence on the management of clavicle and proximal humerus fractures in children. The only strict indications for surgery for diaphyseal clavicle fractures in children are open fractures, tenting of the skin with necrosis, associated neurovascular injury, or a floating shoulder. There is no evidence to argue for surgery of displaced clavicle fractures to prevent malunion since most malunions are asymptomatic. In the rare case of a symptomatic malunion of the clavicle in children, corrective osteosynthesis is a viable treatment option. For proximal humerus fractures in children, treatment is dictated by the patient's age (and thus remodeling potential) and the amount of fracture displacement. Under ten years of age, even severely displaced fractures can be treated conservatively. From the age of 13 and onwards, surgery has better outcomes for severely displaced (Neer types III and IV) fractures. Between 10 and 13 years of age, the indications for surgical treatment are less clear, with varying cut-off values of angulation (30-60 degrees) or displacement (1/3 - 2/3 shaft width) in the current literature.
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Affiliation(s)
- Tim Kraal
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Centers, Amsterdam 1105 AZ, Netherlands
| | - Peter AA Struijs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Centers, Amsterdam 1105 AZ, Netherlands
| | - Lisette C Langenberg
- Department of Orthopedic Surgery, NoordWest Ziekenhuisgroep, Alkmaar 1815 JD, Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Erasmus University Medical Center – Sophia Children’s Hospital, Rotterdam 3015 GD, Netherlands
| | - Christiaan JA van Bergen
- Department of Orthopedic Surgery and Sports Medicine, Erasmus University Medical Center – Sophia Children’s Hospital, Rotterdam 3015 GD, Netherlands
- Department of Orthopedic Surgery, Amphia, Breda 4818 CK, Netherlands
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Lähdeoja T, Pakkasjärvi N, Aronen P, Willamo P, Aronniemi J, Sintonen H, Nietosvaara Y, Paavola M. Outcomes at a Mean of 13 Years After Proximal Humeral Fracture During Adolescence. J Bone Joint Surg Am 2023:00004623-990000000-00786. [PMID: 37083587 DOI: 10.2106/jbjs.22.01131] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND The long-term outcomes of a proximal humeral fracture during adolescence are not well known. We investigated the course of primary treatment for these injuries and the long-term outcomes in adulthood, comparing the outcomes with those from age-matched controls. We also compared outcomes after operative and nonoperative treatment via propensity score matching. METHODS We included children who sustained a proximal humeral fracture between the ages of 10.0 and 16.0 years and underwent treatment between 1995 and 2005. Data from primary treatment episodes were extracted from patient files. The patients were invited to a follow-up visit with outcome assessment and radiographs or to a telephone interview if unable to attend. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The secondary outcomes were the Simple Shoulder Test (SST), pain at rest and with strenuous use, shoulder range of motion, strength measurements, health-related quality of life (15D), and harms. Participant results were compared with the normal values of an age-matched population. The effect of operative treatment was assessed using propensity score matching and the average treatment effect was calculated. RESULTS This study included 209 patients (210 fractures). The mean follow-up (and standard deviation) was 13.1 ± 3.2 years. Outcome data were obtained from 152 participants (153 fractures); 78 participants attended the follow-up visit. The primary treatment episodes were uneventful. The mean scores were 2.5 (95% confidence interval [CI], 1.8 to 3.3 [range, 0 to 13]) for the DASH and 11.7 (95% CI, 11.5 to 11.8 [range, 8 to 12]) for the SST. Other outcomes were similarly good. There were no differences in function compared with the normal population values. Propensity matching showed no treatment effect for operative treatment compared with nonoperative treatment. CONCLUSIONS Proximal humeral fractures of adolescents heal well and rarely result in impairments whether treated operatively or nonoperatively. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tuomas Lähdeoja
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Niklas Pakkasjärvi
- Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Pasi Aronen
- Biostatistics Unit, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Patrick Willamo
- Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Johanna Aronniemi
- Department of Radiology, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Yrjänä Nietosvaara
- Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
- Department of Pediatric Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Mika Paavola
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Liu S, Zhang Y, Cao J, Fu S, Peng A. Bone cemented K-wire fixation versus elastic stable intramedullary nailing fixation of paediatric proximal humerus fractures: A prospective cohort study. Medicine (Baltimore) 2023; 102:e32959. [PMID: 36820597 PMCID: PMC9907912 DOI: 10.1097/md.0000000000032959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The objective of this study is to compare the treatments of pediatric displaced proximal humerus fractures with external-fixation technique using the combination of K-wires and bone-cement versus close reduction and internal fixation technique using elastic stable intramedullary nail. METHODS From April 2016 to March 2020, 72 children with proximal humeral fractures were allocated to group A and 44 children with proximal humeral fractures were allocated to group B. Patients in group A were treated with bone-cemented K-wire fixation, and patients in group B were treated with elastic stable intramedullary nailing. The function of the upper limb was assessed using the Shortened Version of the Disabilities of the Arm, Shoulder and Hand questionnaire and Neer score. Patient satisfaction was assessed using the 10-cm visual analogue scale. RESULTS Bone healing was achieved in group A and B after a mean time of 6.1 ± 1.2 and 6.4 ± 1.1 weeks, respectively. The mean surgical time of groups was 33 ± 9 and 54 ± 12 minutes, respectively. The mean Quick Disabilities of the Arm, Shoulder and Hand questionnaire score of groups were 0.5 ± 1.4 and 0.7 ± 1.5, respectively. Based on Neer score, we obtained 69 excellent and 3 good results in group A, and 41 excellent and 3 good results in group B. There were significant differences regarding duration of operation, cost of treatment, and postoperative angle at bone healing (P < .05). CONCLUSIONS The external cemented K-wire fixation is a useful and reliable alternative technique for the treatment of severely displaced proximal humerus fractures in children. The technique is a minimally invasive procedure with minimal complications.
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Affiliation(s)
- Shibo Liu
- Department of Orthopedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Yanlong Zhang
- Department of Orthopedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jinchao Cao
- Department of Orthopedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shijie Fu
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Aqin Peng
- Department of Orthopedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- * Correspondence: Aqin Peng, Department of Orthopedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China (e-mail: )
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Wang Q, Wang Y, Zhao H, Kong Q, Zhao J, Jin Y. Efficacy analysis of a double-Schanz screw external fixator combined with anti-rotating Kirschner wire in the treatment of proximal humerus fractures in skeletally immature patients. J Orthop Surg Res 2022; 17:544. [PMID: 36527048 PMCID: PMC9756522 DOI: 10.1186/s13018-022-03434-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The objective of this study is to evaluate the efficacy of a double-Schanz screw external fixator combined with anti-rotating Kirschner wire in the treatment of displaced Salter-Harris type II proximal humerus fractures in skeletally immature patients. METHODS A retrospective analysis was performed on 22 cases of displaced Salter-Harris type II proximal humerus fractures in skeletally immature patients who were treated with a double-Schanz screw external fixator combined with anti-rotating Kirschner wire. Patients included were the Neer-Horowitz (N-H) type 2, 3, and 4 of fracture. The basic information of the patients was recorded, fracture healing and shoulder range of motion were assessed at the last follow-up visit. The disabilities of the arm, hand (DASH) score and Constant-Murley score of the shoulder were performed to observe the occurrence of complications. RESULTS The mean age at the time of surgery was 12.41 years, and all patients completed a median follow-up of 18.18 months. There were two cases of N-H type 2, 12 cases of N-H type 3, and eight cases of N-H type 4 among the patients. At the last follow-up, all patients were able to achieve pain-free shoulder movement. There was no significant difference in shoulder function between the injured side and the uninjured side. The DASH score mean was 2.43 (95% CI 1.44-3.52). The constant score mean was 98.55 (95% CI 97.73-99.27). All patients returned to their pre-injury daily life and physical activities, and there was no significant difference in bilateral limb length at the last follow-up (p < 0.05). The most common complication of double-Schanz screw external fixator combined with anti-rotating Kirschner wire surgery was pin tract infection, which occurred in 5 cases (22.7%). There were no complications such as deep infections, vascular and nerve damage, failure of fixation, secondary fracture displacement, non-union of fracture, osteonecrosis of the humerus, joint stiffness, rotator cuff weakness and limb deformity. CONCLUSION The double-Schanz screw external fixator combined with anti-rotating Kirschner wire is a safe and effective treatment for displaced Salter-Harris type II proximal humerus fractures in skeletally immature patients over the age of 10 years.
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Affiliation(s)
- Qian Wang
- Trauma Department of Orthopedics, Affiliated Hospital of Chengde Medical College, 36 Nanyingzi Street, Shuangqiao District, Chengde, 067000, Hebei, People's Republic of China
| | - Yu Wang
- Trauma Department of Orthopedics, Affiliated Hospital of Chengde Medical College, 36 Nanyingzi Street, Shuangqiao District, Chengde, 067000, Hebei, People's Republic of China
| | - Huai Zhao
- Department of General Surgery, Shengjing Hospital Affiliated China Medical University, Shenyang, 110004, Liaoning, People's Republic of China
| | - Qingzhu Kong
- Trauma Department of Orthopedics, Affiliated Hospital of Chengde Medical College, 36 Nanyingzi Street, Shuangqiao District, Chengde, 067000, Hebei, People's Republic of China
| | - Jingxin Zhao
- Trauma Department of Orthopedics, Affiliated Hospital of Chengde Medical College, 36 Nanyingzi Street, Shuangqiao District, Chengde, 067000, Hebei, People's Republic of China.
| | - Yu Jin
- Trauma Department of Orthopedics, Affiliated Hospital of Chengde Medical College, 36 Nanyingzi Street, Shuangqiao District, Chengde, 067000, Hebei, People's Republic of China
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Abbot SR, Proudman S, Hall K, Williams N. Outcomes of proximal humerus fractures in children: a study protocol for a retrospective cohort study. BMJ Open 2022; 12:e062586. [PMID: 36104126 PMCID: PMC9476141 DOI: 10.1136/bmjopen-2022-062586] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Proximal humerus fractures (PHFs) comprise <3% of all fractures in children and adolescents. While it is accepted that minimally displaced PHFs can be treated conservatively, the management of severely displaced PHFs remains controversial, especially in older children. This study will aim to analyse the functional and quality-of-life outcomes of children with PHFs, in order to inform their optimal management. METHODS AND ANALYSIS We will conduct a retrospective cohort study to evaluate the outcomes of patients who were diagnosed with a paediatric PHF at the Women's and Children's Hospital (WCH) in South Australia. The primary outcome will be each participant's pain and quality-of-life outcome, determined by use of the Quick Disabilities of the Arm, Shoulder and Hand, Shoulder Pain and Disability Index and Paediatric Outcomes Data Collection Instrument. Secondary outcomes will include rates of non-union, persistent deformity and complications. The information for these variables will be acquired during a brief clinic appointment, and from the medical records and WCH radiology database. Multivariable logistic regression will be performed to determine the clinical variables associated with a worse clinical outcome. ETHICS AND DISSEMINATION The study has been approved by the Women's and Children's Health Network Human Research Ethics Committee (protocol number: 2021/HRE00250). The study findings will be submitted to peer-reviewed scientific journals for publication and disseminated at conference presentations. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12622000176763).
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Affiliation(s)
- Samuel Richard Abbot
- Orthopaedics and Trauma, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Susanna Proudman
- Rheumatology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kelly Hall
- Department of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nicole Williams
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopaedic Surgery, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
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Qi L, Jiang Y, Wang Y, Peng C, Wu D. The use of the pediatric physeal slide-traction plate in the treatment of neer–horwitz grade IV proximal humeral fractures in children: A case report and literature review. Front Surg 2022; 9:960541. [PMID: 36189382 PMCID: PMC9515401 DOI: 10.3389/fsurg.2022.960541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Proximal humeral fractures (PHFs) are rare in children. Currently, the recommended surgical methods for severely displaced PHFs are closed reduction and percutaneous fixation using K-wires or intramedullary nailing, which can't provide firm internal fixation, especially for older and high-weight children. This study aimed to introduce a novel surgical approach, pediatric physeal slide-traction plate fixation (PPSP), for Neer–Horwitz grade IV PHFs in children. Case summary A 9-year-old boy presented with left shoulder pain and swelling due to a car accident. Physical examination revealed a positive shoulder deformity and local tenderness. On physical examination, we palpated bone friction without vascular and nerve damage. Based on imaging findings, we diagnosed Neer-Horwitz grade IV PHF. In view of the patient's condition, we performed PPSP after careful communication with the patient's parents. After 22 months of follow-up, the patient's left shoulder function was satisfactory, and there was no restriction of activities. Conclusion According to previous studies, PPSP is only used for femur fractures. To the best of our knowledge, this is the first in the treatment for PHFs. Given the satisfactory outcomes, it is a safe and effective method and may provide a reference to cure analogous patients in the future.
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Affiliation(s)
| | | | | | | | - Dankai Wu
- Correspondence: Dankai Wu Chuangang Peng
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Kaya M, Karahan N. The effect of different pin configurations on cyclic stability in pediatric proximal humerus fracture fixation: A Sawbones model study. Injury 2022; 53:1824-1828. [PMID: 35221101 DOI: 10.1016/j.injury.2022.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND In sawbones with proximal humerus fracture model, three different fixation configurations, Parallel-Straight K-wires, Cross-Straight K-wires and Palm-Tree Method, were biomechanically compared. METHODS A total of 36 anatomical pediatric humerus sawbones models were used. They were divided into three equal groups; parallel fixation with straight K-wires (Group PS), cross fixation with straight K-wires (Group CS), and Palm-Tree Method (Group PT). Models were tested in abduction and torsional at a speed of 0.5 mm/s and a 0-5 mm displacement range. Loading (N) and Stiffness (N/mm) data were calculated and compared statistically. RESULTS Group PS was significantly higher than the other two groups in abduction bending cyclic load values (P<0.001). It was also significantly higher in Group CS than in Group PT (P < 0.001). No significant differences were detected between the three different fixation groups' cyclic torsional load values (p < 0.05). CONCLUSION The parallel configuration with straight K-wires will provide a more stable fixation than the cross configuration with straight or Palm-Tree Method in pediatric proximal humeral sawbones fracture modeling.
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Affiliation(s)
- Murat Kaya
- Department of Orthopedics and Traumatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey.
| | - Nazım Karahan
- Department of Orthopedics and Traumatology, Corlu District State Hospital, Tekirdag, Turkey.
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12
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Severe Infraclavicular Displacement of a Proximal Humerus Fracture with Concomitant Olecranon Fracture in a Pediatric Patient. Case Rep Orthop 2022; 2022:8673859. [PMID: 35154841 PMCID: PMC8837420 DOI: 10.1155/2022/8673859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/01/2022] [Accepted: 01/12/2022] [Indexed: 11/17/2022] Open
Abstract
Proximal humerus fractures with severe medial displacement of the humeral head are rare in adults and especially so in children. Concomitant vascular/neurovascular injury is even more uncommon but must be considered as the associated complications can carry significant morbidity. We present a case of a 12-year-old transported to the ED after a mountain bike accident in which she lost control and hit a cement wall, injuring her left upper extremity (LUE). Despite a normal vascular/sensory exam, imaging demonstrated a left comminuted proximal humerus fracture with the humerus displaced medially into the thoracic inlet as well as concern for left subclavian vessel injury. Given the possibility of vascular injury and the severe humeral head displacement, she was taken to surgery with orthopedic and vascular surgical teams. Although surgical exploration did not reveal vascular injury, this case underlines the importance of maintaining a high index of suspicion for neurovascular injury with such fractures as prompt intervention may reduce the likelihood of complications. This case also underscores the need for further research into the management of pediatric proximal humerus fractures in early adolescence.
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13
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Merckaert S, Chaibi E, Meriem S, Kwiatkowski B, Divjak N, Zambelli PY. Epidemiology of Pediatric Upper Extremity Fractures in a Tertiary Care Center in Switzerland. Pediatr Emerg Care 2021; 37:e825-e835. [PMID: 32106152 DOI: 10.1097/pec.0000000000002047] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Fractures in children are common and account for 10% to 25% of injuries in children with considerable effects on activity restriction and subsequent high socioeconomically impact. Eighty percent of all fractures in children occur at the upper extremity. The article investigates the epidemiology and fracture pattern of the upper extremity within a pediatric population consulting a tertiary referral hospital in Switzerland. METHODS Study population included all patients younger than 18 years presenting with an upper extremity fracture. Recorded data were age, sex, side, season of the year, mechanism, type of fracture, and applied treatment. RESULTS Fractures of the upper extremities represented 76% with a mean age of 9 years and 7 months. Compared with girls, boys had a risk ratio of 1.35 (1.14-1.6) of having a traumatic injury. The radius, with 298 fractures (37%), was the most injured bone. Overall simple fall from his or her height and soccer represented the main injury mechanisms accounting for 26% and 9%, respectively. Eighty-six percent of fractures were treated by cast with or without closed reduction, 11% (92) by closed reduction and pinning or elastic stable intramedullary, and only 3% of fractures were treated by open reduction and internal fixation. CONCLUSIONS Eighty-six percent of all fractures could be treated by conservative methods. Only 17% need surgical treatments by orthopedic surgeons. This shows how important it is to train residents in pediatrics for the treatment of upper limb fractures in children.
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Affiliation(s)
- Sophie Merckaert
- From the Department of Women, Mother, and Child's Health Care, Paediatric Surgery, Unit of Paediatric Orthopedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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14
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Kim AE, Chi H, Swarup I. Proximal Humerus Fractures in the Pediatric Population. Curr Rev Musculoskelet Med 2021; 14:413-420. [PMID: 34709578 DOI: 10.1007/s12178-021-09725-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to review recent literature focusing on proximal humerus anatomy, epidemiology of these fractures, diagnosis and treatment options, and clinical outcomes. RECENT FINDINGS Non- or minimally displaced proximal humerus fractures treated nonoperatively do not lead to short- or long-term complication and do not cross over to operative treatment. There is a higher rate of operative management with older age, increased injury severity score, treatment at an adult hospital, and private insurance. Operative management is preferred with closed or open reduction and percutaneous pinning, but elastic nailing and plate fixation are other options with good postoperative outcomes. Pediatric proximal humerus fractures occur after fall onto the affected shoulder or arm. Diagnosis is usually made with radiographs. Understanding the proximal humerus anatomy is critical to the proper management of these injuries to aid reduction and predict remodeling potential. There is considerable debate around the management of proximal humerus fractures in the pediatric population. Treatment is based on patient age, fracture displacement, and remodeling capacity. Nonoperative management is successful in younger patients or less displaced fractures, and operative management is usually considered in older patients with more displaced fractures.
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Affiliation(s)
- Arin E Kim
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Hannah Chi
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA. .,University of California, San Francisco, 747 52nd Street, OPC First Floor, Oakland, CA, 94609, USA.
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15
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Li J, Rai S, Qian H, Tang X, Liu R, Hong P. Operative choice for displaced proximal humeral fractures in adolescents with open visible physis: A comparative study of external fixator vs. Kirschner wire. Injury 2021; 52:2279-2284. [PMID: 33731292 DOI: 10.1016/j.injury.2021.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND For adolescents with severely displaced proximal humeral fracture (PHF), surgery is a good choice yielding excellent outcomes, and Kirchner wire (KW) is a cost-effective choice for fixation. Purpose of this study is to compare the clinical outcomes of external fixator (EF) and KW for the treatment of PHF in adolescents. METHODS Patients of PHF operated at our institute, from January 2008 to January 2016, were reviewed retrospectively. Demographic data, including sex, age at the time of surgery, operated side, and hardware choice, were collected from the hospital database. Preoperative radiographs were reviewed and classified according to Neer-Horwitz classification. Shoulder function was evaluated at the last follow-up using the American Shoulder and Elbow Surgeons (ASES) score. Complications, including infection, malunion, nonunion, stiffness of the shoulder joint, and failure of fixation were also recorded. RESULTS Thirty-five patients, including 23 males and 12 females, were included in the EF group, whereas 40 patients, including 25 males and 15 females, were included in the KW group (P = 0.867). The average age of patients in the EF group was 13.3 ± 1.7 years, and that of KW was 13.6 ± 1.8 years (P = 0.409). Patients in both groups were followed-up for at least 12 months. The operative time in the EF group (42.4 ± 11.2 min) was significantly shorter than those in the KW group (54 ± 13.6 min) (P < 0.001). The frequency of fluoroscopy in the EF group (12 ± 2.4 times) was significantly less than those in the KW group (17 ± 2.8 times (P < 0.001). The rate of open reduction was significantly higher in KW (35%) group than those in the EF group (0%) (P < 0.001). There was no case of nonunion and malunion in both groups. CONCLUSION External fixator is superior to Kirschner wire in the treatment of proximal humeral fractures in adolescents with shorter operative time and lower rate of open reduction with comparable clinical outcomes.
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Affiliation(s)
- Jin Li
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Mahankal, Kathmandu, Nepal
| | - Huabing Qian
- Department of Orthopaedics, The Second People's Hospital of Lincang City, Lincang, China
| | - Xin Tang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruikang Liu
- First School of Clinical Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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16
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Freislederer F, Bensler S, Specht T, Magerkurth O, Eid K. Plate Fixation for Irreducible Proximal Humeral Fractures in Children and Adolescents-A Single-Center Case Series of Six Patients. CHILDREN-BASEL 2021; 8:children8080635. [PMID: 34438526 PMCID: PMC8393487 DOI: 10.3390/children8080635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022]
Abstract
Background: Recommended treatment for severely displaced proximal humeral fractures in children is the closed reduction and percutaneous fixation by K-wires or intramedullary nailing. Methods: From January 2016 to January 2017 6, 21 children/adolescents (range 8 to 16 years) with proximal humeral fractures were treated surgically for severe displacement. In these six patients, several attempts of closed reduction were unsuccessful, and an open reduction was performed. The humeral head was fixed with a 3.5 mm T-plate without affecting the growth plate. Plate removal was performed at a mean interval of 132 days after initial surgery. Two years after initial surgery, the clinical outcome was assessed by the Constant–Murley score and QuickDASH score (including sport/music and work) and the shoulder joint was evaluated with a standardized sonographic examination for the rotator cuff and the conjoint tendon. Results: In all six patients, dorsal displacement of the fracture was irreducible due to the interposition of tendinous or osseous structures. Intraoperatively, the interposed structures were the long biceps tendon in two, periosteal tissue in two, a bony fragment in one, and the long biceps tendon together with the conjoint tendon in one case. At mean follow-up of 26 months (range 22 months to 29 months), patients showed very good clinical results with an excellent mean Constant–Murley score of 97.5 (range 91 to 100) and mean QuickDASH score (including sport/music and work) of 5.5 (range 0–20.8). An X-ray follow-up 6 weeks after surgery demonstrated early consolidation and correct alignment in all patients. A sonographic evaluation at 2 years post injury showed that the biceps and the conjoined tendon were intact in all patients. Conclusions: If a proximal humeral fracture is not reducible by closed means, a tissue entrapment (most likely biceps tendon) should be considered. Treatment with an open reduction and plate fixation yields very good clinical and radiological results and preserves interposed structures as the biceps and conjoint tendon.
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Affiliation(s)
- Florian Freislederer
- Department of Orthopaedics and Traumatology, Kantonsspital Baden (KSB), Im Ergel 1, 5404 Baden, Switzerland;
- Correspondence: (F.F.); (K.E.)
| | - Susanne Bensler
- Unit for Musculoskeletal Radiology, Department of Radiology, Kantonsspital Baden (KSB), Im Ergel 1, 5404 Baden, Switzerland;
| | - Thomas Specht
- Department of Orthopaedics and Traumatology, Kantonsspital Baden (KSB), Im Ergel 1, 5404 Baden, Switzerland;
| | - Olaf Magerkurth
- Unit for Pediatric Radiology, Department of Radiology, Kantonsspital Baden (KSB), Im Ergel 1, 5404 Baden, Switzerland;
| | - Karim Eid
- Department of Orthopaedics and Traumatology, Kantonsspital Baden (KSB), Im Ergel 1, 5404 Baden, Switzerland;
- Correspondence: (F.F.); (K.E.)
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17
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Fabricant PD, Anatone AJ, Lin KM, Brusalis CM, Mackie AT, Pinnamaneni S, Taylor SA. Corrective Proximal Humerus Osteotomy with Blade Plate Osteosynthesis in Adolescents: A Report of 2 Cases. JBJS Case Connect 2021; 11:01709767-202109000-00034. [PMID: 34293781 DOI: 10.2106/jbjs.cc.20.00989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Two cases are presented to highlight the indications, surgical technique, and early clinical outcomes associated with proximal humerus corrective osteotomy using a 90° cannulated blade plate in adolescent patients. CONCLUSION A complex deformity of the proximal humerus in the adolescent patient poses an uncommon yet debilitating clinical condition that is challenging to manage. We report a unique method for surgical correction and fixation using an infant hip osteotomy 90° blade plate that restores native shoulder anatomy, improves function, and has led to early clinical success.
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Affiliation(s)
- Peter D Fabricant
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Alex J Anatone
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Kenneth M Lin
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Alexandra T Mackie
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Sridhar Pinnamaneni
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Samuel A Taylor
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
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18
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CANAVESE F, ALBERGHINA F, DIMEGLIO A, ANDREACCHIO A. Proximal humerus fractures in children and adolescents. MINERVA ORTHOPEDICS 2021; 72. [DOI: 10.23736/s2784-8469.20.04036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
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19
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Kimmeyer M, Lehmann LJ, Gerhardt C, Schmalzl J. Development and function of a natural reverse shoulder in a patient with thalidomide-induced dysmelia. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:60-64. [PMID: 37588638 PMCID: PMC10426524 DOI: 10.1016/j.xrrt.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Michael Kimmeyer
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Karlsruhe, Germany
| | - Lars-Johannes Lehmann
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Karlsruhe, Germany
| | - Christian Gerhardt
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Karlsruhe, Germany
| | - Jonas Schmalzl
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Karlsruhe, Germany
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Würzburg, Germany
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20
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Do pediatric shoulder fractures benefit from surgery? Curr Opin Pediatr 2021; 33:97-104. [PMID: 33315684 DOI: 10.1097/mop.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We aimed to review considerations, current treatment options, and complications in the management of pediatric proximal humerus fractures. RECENT FINDINGS Recent literature has shown an increased incidence of operative management of proximal humerus fractures. With increased age, and increased deformity, studies report excellent outcomes after operative treatment. Still, patients under the age of 12 and with Neer grade I and II fractures are consistently treated nonoperatively. SUMMARY Indications for operative management of proximal humerus fractures in skeletally immature patients have become increasingly widened. Current literature emphasizes the stratification of patients based on displacement, angulation, and shortening, with overall positive outcomes. Each case should be considered on individual bases, accounting for both radiographic parameters, developmental stages of patients, and potential complications. In the authors' opinion, adolescent patients with Neer Horowitz 3 and 4 fractures surgical management should be considered. In younger patients with nonoperative management, even with significant displacement, is the mainstay of treatment because of the tremendous remodeling potential of the proximal humerus in children. VIDEO ABSTRACT http://links.lww.com/MOP/A56.
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21
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Dharmshaktu G, Adhikari N, Mourya P. Fracture-subluxation of the shoulder in children: A case series and literature review. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2021. [DOI: 10.4103/jotr.jotr_25_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Abstract
Background The aim of this study was to evaluate the impact of COVID-19 on the shoulder and elbow trauma in a skeletally immature population in 30 days starting from March 8, 2020, the first day of restrictions in Italy, and to compare it with the same period of 2019. Materials and methods All the skeletally immature (younger than 18 years) patients managed in the emergency unit of our hospital between March 8, 2020, and April 8, 2020 (COVID-19 [C19] period), for a shoulder and elbow trauma were retrospectively included and compared with patients with similar ages admitted in the same period of 2019 (no COVID-19 period). Six categories of diagnosis were distinguished: (1) contusions, (2) no physeal fractures, (3) physeal fractures (Salter-Harris), (4) sprains/subluxations, (5) dislocations, and (6) others (tendinitis, wounds, low back pain, and joint inflammation). According to the mechanism of injury, we arbitrarily distinguished 5 subgroups: (1) accidental fall; (2) sport trauma; (3) accident at school; (4) high-energy trauma occurred by car, public transport, and pedestrian investment; and (5) fall from height. Results During the C19 period, the number of total accesses in our trauma center steeply decreased: two-thirds less. Regardless of the patient age, we performed 65% less first aid shoulder/elbow services. The number of skeletally immature patients treated at our trauma center for all types of injuries was 350 during the no COVID-19 period and 54 during the C19 period; therefore, the influx of pediatric patients during the C19 period decreased by 84.6%. Furthermore, during the C19 period, (1) there were no cases of fractures, physeal fractures, and dislocations of the shoulder; (2) there were no cases of contusion, physeal fractures, and dislocations of the elbow; and (3) we observed the absence of high-energy, sports, and school injuries; and (4) during the pandemic, shoulder and elbow injuries mainly occurred as a result of accidental fall at home. Conclusions The pandemic forced us to become aware of the ways and places where skeletally immature subjects report shoulder and elbow traumas; therefore, it would be desirable that more considerable attention be directed toward the prevention of injury in areas at risk.
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Imaging to improve agreement for proximal humeral fracture classification in adult patient: A systematic review of quantitative studies. J Clin Orthop Trauma 2020; 11:S16-S24. [PMID: 31992911 PMCID: PMC6977161 DOI: 10.1016/j.jcot.2019.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 11/20/2022] Open
Abstract
Proximal humeral fracture classification has low reproducibility. Many studies have tried to increase inter- and intra-observer agreement with more sophisticated imaging. The aim of this review was to determine which imaging modality produces the best inter- and intra-observer agreement for proximal humeral fracture classification in adults and to determine if this varies with observer experience or fracture complexity. OvidMEDLINE, The Cochrane Library, EBSCO CINAHL and Elsevier Scopus were searched on July 22nd, 2018. Quantitative studies comparing at least two imaging modalities for inter- or intra-observer agreement of proximal humeral fracture classification in adults were eligible for inclusion in this systematic literature review. Two reviewers independently screened and extracted data. Study quality was appraised using a modified Downs and Black checklist. The search strategy identified 1987 studies, of which 15 met the eligibility criteria. All included studies addressed inter-observer agreement and 8 provided results for intra-observer agreement. A narrative synthesis was performed. Trends were compared between studies as clinical heterogeneity and the statistical measures used by included studies prevented meta-analysis. Inter- and intra-observer agreement was found to increase from radiographs (x-ray) to two-dimensional (2D) computed tomography (CT) to three-dimensional (3D) CT. 2D and 3D CT may improve inter-observer agreement to a greater extent in less experienced observers and in more complex fractures. Future studies should compare 2D and 3D CT with subgroups categorising surgeon experience and fracture complexity. X-ray should be used for initial assessment; however doctors should have a low threshold for ordering CT. PROSPERO number: CRD42018094307.
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Kelley LM, Schlegel M, Hecker-Nolting S, Kevric M, Haller B, Rössig C, Reichardt P, Kager L, Kühne T, Gosheger G, Windhager R, Specht K, Rechl H, Tunn PU, Baumhoer D, Wirth T, Werner M, von Kalle T, Nathrath M, Burdach S, Bielack S, von Lüttichau I. Pathological Fracture and Prognosis of High-Grade Osteosarcoma of the Extremities: An Analysis of 2,847 Consecutive Cooperative Osteosarcoma Study Group (COSS) Patients. J Clin Oncol 2020; 38:823-833. [PMID: 31928458 DOI: 10.1200/jco.19.00827] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The objective of this study was to investigate potential correlations between pathologic fractures (PFs) and prognosis of patients with primary central high-grade osteosarcoma of the extremities. METHODS We retrospectively analyzed 2,847 patients registered in the Consecutive Cooperative Osteosarcoma Study Group database with primary central high-grade osteosarcoma of the extremities, treated between 1980 and 2010. Intended treatment included pre- and postoperative chemotherapy and surgery. Univariable and multivariable survival analyses were performed for all patients and then differentiated for adult and pediatric (≤ 18 years at time of diagnosis) patients. RESULTS A total of 2,193 patients were ≤ 18 years of age; 11.3% of all patients had PFs. In the overall cohort, presence of PF correlated significantly with tumor site, histologic subtype, relative tumor size, and primary metastases, but not with body mass index or local surgical remission. In univariable analysis, 5-year overall survival (OAS) of patients with and without PF was 63% versus 71%, respectively (P = .007), and 5-year event-free survival (EFS) was 51% versus 58% (P = .026). In pediatric patients, OAS and EFS did not differ significantly between patients with and without PF. In adults, 5-year OAS in patients with and without PF was 46% versus 69% (P < .001), and 5-year EFS was 36% versus 56% (P < .001). In multivariable analysis, PF was not a statistically significant factor for OAS or EFS in the total cohort or in pediatric patients. In adult patients, PF remained an independent prognostic factor for OAS (P = .013; hazard ratio [HR], 1.893). It was not a significant prognostic factor for EFS (P = .263; HR, 1.312). CONCLUSION In this largest study to date with extremity osteosarcomas, we observed the occurrence of PF to correlate with inferior OAS expectancies in adult but not in pediatric patients.
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Affiliation(s)
- Lisa Marie Kelley
- Department of Pediatrics, Kinderklinik München Schwabing, Technical University of Munich School of Medicine, CCCM Munich Comprehensive Cancer Center and German Translational Cancer Research Consortium DKTK, Munich, Germany
| | - Miriam Schlegel
- Department of Pediatrics, Kinderklinik München Schwabing, Technical University of Munich School of Medicine, CCCM Munich Comprehensive Cancer Center and German Translational Cancer Research Consortium DKTK, Munich, Germany
| | - Stefanie Hecker-Nolting
- Paediatrics 5, Oncology-Hematology-Immunology, Klinikum Stuttgart, Olgahospital Stuttgart, Cancer Center, Cooperative Osteosarcoma Study Group COSS, Stuttgart, Germany
| | - Matthias Kevric
- Paediatrics 5, Oncology-Hematology-Immunology, Klinikum Stuttgart, Olgahospital Stuttgart, Cancer Center, Cooperative Osteosarcoma Study Group COSS, Stuttgart, Germany
| | - Bernhard Haller
- Institute for Medical Informatics, Statistics, and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claudia Rössig
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Peter Reichardt
- Helios Klinikum Berlin-Buch, Klinik für Onkologie und Palliativmedizin, Berlin, Germany
| | - Leo Kager
- Department of Pediatrics, St Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Thomas Kühne
- Pediatric Oncology and Hematology, Universitäts-Kinderspital beider Basel, Basel, Switzerland
| | - Georg Gosheger
- Universitätsklinikum Münster, Klinik für Allgemeine Orthopädie und Tumororthopädie, Münster, Germany
| | - Reinhard Windhager
- Allgemeines Krankenhaus der Stadt Wien, Universitätsklinik für Orthopädie der Medizinischen Universität Wien, Vienna, Austria
| | - Katja Specht
- Technische Universität München, Institut für Allgemeine Pathologie und Pathologische Anatomie, Munich, Germany
| | - Hans Rechl
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Munich, Germany
| | - Per-Ulf Tunn
- Helios Klinikum Berlin-Buch, Klinik für Tumororthopädie, Sarkomzentrum Berlin-Brandenburg, Berlin, Germany
| | - Daniel Baumhoer
- Bone Tumor Reference Center at the Institute of Pathology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Thomas Wirth
- Klinik für Orthopädie, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Mathias Werner
- Vivantes Klinikum im Friedrichshein, Institut für Pathologie, Osteopathologie-Referenzzentrum, Berlin, Germany
| | - Thekla von Kalle
- Radiological Institute, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Michaela Nathrath
- Department of Pediatrics, Kinderklinik München Schwabing, Technical University of Munich School of Medicine, CCCM Munich Comprehensive Cancer Center and German Translational Cancer Research Consortium DKTK, Munich, Germany.,Pediatric Hematology and Oncology, Klinikum Kassel, Kassel, Germany
| | - Stefan Burdach
- Department of Pediatrics, Kinderklinik München Schwabing, Technical University of Munich School of Medicine, CCCM Munich Comprehensive Cancer Center and German Translational Cancer Research Consortium DKTK, Munich, Germany
| | - Stefan Bielack
- Paediatrics 5, Oncology-Hematology-Immunology, Klinikum Stuttgart, Olgahospital Stuttgart, Cancer Center, Cooperative Osteosarcoma Study Group COSS, Stuttgart, Germany
| | - Irene von Lüttichau
- Department of Pediatrics, Kinderklinik München Schwabing, Technical University of Munich School of Medicine, CCCM Munich Comprehensive Cancer Center and German Translational Cancer Research Consortium DKTK, Munich, Germany
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Hannonen J, Hyvönen H, Korhonen L, Serlo W, Sinikumpu JJ. The incidence and treatment trends of pediatric proximal humerus fractures. BMC Musculoskelet Disord 2019; 20:571. [PMID: 31775692 PMCID: PMC6882178 DOI: 10.1186/s12891-019-2948-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/14/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Proximal humerus fractures comprise approximately 2% of all pediatric fractures. In general, upper extremity fractures have increased in children. However, recent trends of proximal humerus fractures are not analyzed yet. The aim was to study the incidence and treatment trends of proximal humerus fractures in children. METHODS All 300 children, aged < 16 years, who suffered from a proximal humerus fracture in the catchment area of Oulu University Hospital, Finland, between 2005 and 2015, were included. Radiographs were reviewed, and patients, injuries, treatments, and outcomes were comprehensively studied. Annual incidence was based on the child population at risk, which changed between 84.500 and 88.100 in the study time. RESULTS The annual incidence of childhood proximal humerus fractures was mean 31.4/100,000 and no variation trend was found. The majority (92%) was treated nonoperatively, however, there was an increase of operative fixation from 0 to 16% during the study time (Difference 16, 95% CI 0.3 to 34.9%, P = 0.045). Bayonet displacement increased the risk of surgical fixation up to 16-fold (95% CI 4.8-51.4, P < 0.001) in a multivariate analysis when adjusted with other potential risk factors. Higher age was also associated with operative treatment (P = 0.002). The most usual recreational activities were horse riding, downhill skiing, snowboarding, and trampolining. CONCLUSION Contrary to most upper extremity fractures in children, proximal humerus fractures did not increase during the long study period. However, their operative treatment increased compared to nonoperative treatment, but the evidence supporting that trend remains unclear.
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Affiliation(s)
- Juuli Hannonen
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, PoB 23, 90029 OYS, Oulu, Finland.
| | - Hanna Hyvönen
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, PoB 23, 90029 OYS, Oulu, Finland
| | - Linda Korhonen
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, PoB 23, 90029 OYS, Oulu, Finland
| | - Willy Serlo
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, PoB 23, 90029 OYS, Oulu, Finland
| | - Juha-Jaakko Sinikumpu
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, PoB 23, 90029 OYS, Oulu, Finland
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Chae W, Khan A, Abbott S, Assiotis A. Proximal Humerus Fractures in Children: Experience from a Central London Paediatric Orthopaedic Service. Open Orthop J 2019. [DOI: 10.2174/1874325001913010202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Objective:
Proximal humeral fractures are commonly observed in children who sustain falls whilst running, or from heights. Appropriate and correct treatment is key in order to avoid limb length discrepancy and functional deficiencies. Current treatment methods include non-operative management such as collar and cuff immobilisation, and operative methods such as elastic stable intramedullary nails or Kirschner wires. This paper aims to present the demographics of this patient population and our experience in managing patients with proximal humerus fractures in an urban tertiary referral centre.
Method:
We assessed 41 cases across two sites in central London, identified via hospital electronic notes and our radiology digital system. We analysed patient demographics, mechanism of injury, time to discharge from orthopaedic services taking into account radiological and clinical union, and the treatment methods utilised.
Results:
The mean age of the cohort was 8.6 years old. 70% of the injuries were due to falls and 85% of cases were treated without an operation. The mean time to discharge from our service following radiological and clinical union was 46 days (9 – 161 days). Mean radiological and clinical union were 21.8 and 36.2 days respectively.
Conclusion:
These results support a non-operative approach, especially in cases with patients under 10 years of age. Surgery should only be undertaken in patients who have severe displacement and who have failed attempts at closed reduction. We would advocate a similar approach in institutions dealing with a comparable population of patients, as long as there are provisions for referral of more complex cases that require surgical stabilisation.
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Missed Thrower's Fracture of the Humerus in a Pediatric Athlete: A Case Report. J Emerg Med 2018; 55:547-552. [DOI: 10.1016/j.jemermed.2018.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/11/2018] [Indexed: 11/19/2022]
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Korhonen L, Perhomaa M, Kyrö A, Pokka T, Serlo W, Merikanto J, Sinikumpu JJ. Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: Results of a prospective randomized trial in children with at least two years of follow-up. Biomaterials 2018; 185:383-392. [PMID: 30292588 DOI: 10.1016/j.biomaterials.2018.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/02/2018] [Accepted: 09/07/2018] [Indexed: 01/28/2023]
Abstract
There are disadvantages in Elastic Stable Intramedullary Nailing (ESIN) of forearm-shaft fractures, such as the need of implant removal. Biodegradable Intramedullary Nailing (BIN) is a new technique developed for these fractures. We hypothesized that there is no difference in rotational ROM between the patients treated by BIN vs. ESIN. A randomized, controlled clinical trial included patients, aged 5-15 years, requiring surgery for forearm-shaft fractures. Biodegradable polylactide-co-glycolide (PLGA) nails (Activa IM-Nail™, Bioretec Ltd., Finland) were used in 19 and titanium nails (TEN®, SynthesDePuy Ltd., USA) in 16 patients. Rotational ROM of forearm after two years was the primary outcome. Elbow and wrist ROM, pain and radiographic bone healing were secondary outcomes. Forearm rotation was mean 162° and 151° in BIN and ESIN groups, respectively (P = 0.201). No difference between the groups was found in any other ROMs. Three cases in the ESIN vs. none in the BIN group reported pain (P = 0.113). There was no clinically significant residual angulation in radiographs. Two adolescents in the BIN group vs. none in the ESIN (P = 0.245) were excluded because of implant failure; another two with complete bone union suffered from re-injury. Therefore, satisfactory implant stability among older children needs to be studied.
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Affiliation(s)
- Linda Korhonen
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, Oulu, Finland.
| | - Marja Perhomaa
- Department of Radiology, Pediatric Radiology, Oulu University Hospital, Finland
| | - Antti Kyrö
- Department of Orthopedics, Päijät-Häme Central Hospital, Lahti, Finland
| | - Tytti Pokka
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, Oulu, Finland
| | - Willy Serlo
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, Oulu, Finland
| | - Juhani Merikanto
- Department of Orthopedics, Päijät-Häme Central Hospital, Lahti, Finland
| | - Juha-Jaakko Sinikumpu
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, Oulu, Finland
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Pogorelić Z, Kadić S, Milunović KP, Pintarić I, Jukić M, Furlan D. Flexible intramedullary nailing for treatment of proximal humeral and humeral shaft fractures in children: A retrospective series of 118 cases. Orthop Traumatol Surg Res 2017; 103:765-770. [PMID: 28330797 DOI: 10.1016/j.otsr.2017.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/02/2017] [Accepted: 02/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to analyze outcomes of treatment and complications in children treated with flexible intramedullary nailing (FIN) due to humeral fracture. HYPOTHESIS The FIN for treatment of humeral fractures in children would allow an early functional and cast-free follow-up with a quick pain reduction and low complication rate. PATIENTS AND METHODS From May 2002 until May 2016 case records of all children who underwent fixation with titanium intramedullary nails because of humeral fracture were retrospectively reviewed. The study included 118 patients treated with FIN for proximal humeral or humeral shaft fracture. The average age at the time of trauma was 12 years. Mean follow-up was 77 months. Left hand was affected in 51% of patients. The most common mechanism of injury was fall (n=58), followed by sports injuries, road traffic accidents, pathological fractures, motorbike accidents and bicycle riding. RESULTS There were no residual valgus/varum deformities. All patients achieved complete radiographic healing at a mean of 7.5 weeks. Nine complications were recorded: 1 humeral shaft fracture in patient with osteogenesis imperfecta, 4 entry site skin irritations, 2 skin infections and 2 radial nerve injuries. There were no cases of delayed union, nonunion or mal-union. After removal of the nails, all patients regained full function and all complications resolved. DISCUSSION The FIN for humeral fractures is a minimally invasive, simple and well reproducible technique with very low complication rate. CONCLUSION The FIN for treatment of humeral fractures shows very good functional and cosmetic results. It allows an early functional and cast-free follow-up with a quick pain reduction. LEVEL OF EVIDENCE Level IV - retrospective study.
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Affiliation(s)
- Z Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; University of Split, School of Medicine, Šoltanska 2, 21000 Split, Croatia.
| | - S Kadić
- University of Split, School of Medicine, Šoltanska 2, 21000 Split, Croatia
| | - K P Milunović
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
| | - I Pintarić
- University of Split, School of Medicine, Šoltanska 2, 21000 Split, Croatia; Department of Anatomy, University of Split, School of Medicine, Šoltanska 2, 21000 Split, Croatia
| | - M Jukić
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
| | - D Furlan
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
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Gladstein AZ, Schade AT, Howard AW, Camp MW. Reducing resource utilization during non-operative treatment of pediatric proximal humerus fractures. Orthop Traumatol Surg Res 2017; 103:115-118. [PMID: 27894835 DOI: 10.1016/j.otsr.2016.09.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/10/2016] [Accepted: 09/05/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The majority of proximal humeral fractures in the skeletally immature are treated non-operatively. Operative indications vary but are largely based on degree of displacement. Non-union is rare. Non-operatively treated fractures are typically monitored radiographically to assess healing. HYPOTHESIS We hypothesize that the decision to treat fractures operatively is made at the time of first imaging and that follow-up X-rays do not lead to a change in management. MATERIAL AND METHODS We retrospectively reviewed the records of 239 patients treated for proximal humerus fractures over a 5-year period. There were 225 who were treated non-operatively. Records were reviewed for the number of clinic visits and radiographs, as well as any change to operative management based on follow-up X-rays. RESULTS The primary outcome of the study was the proportion of proximal humerus fractures, initially treated non-operatively, for which displacement or angulation on follow-up radiographs led to a change to operative treatment. Secondary outcomes were the number of follow-up radiographs obtained after the initial diagnosis and initiation of non-operative treatment. Of the 225 patients that were initially managed non-operatively, only 1 patient required subsequent surgical management. This patient underwent a proximal humerus epiphysiodesis 365 days from injury after development of a partial growth arrest. The mean number of fracture clinic visits for patients managed non-operatively was 2.67 (±1.24). The mean number of radiology department visits and radiographs obtained was 3.57 (±1.44) and 8.36 (±3.89) respectively. No clinical or radiographic non-unions were identified in these patients. No patients suffered a refracture during the review period. DISCUSSION This study shows that of the 239 uncomplicated pediatric proximal humerus fractures treated at our hospital over a 5-year period, only 1 had a change in treatment plan, from non-operative to operative, based on follow-up radiographs. These data suggest that non-operative treatment of proximal humerus fractures seldom results in displacement that warrants operative intervention. Moreover, they suggest that there is little utility to the routine use of postoperative radiographs in follow-up of these patients. STUDY DESIGN Retrospective case series. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- A Z Gladstein
- Pennsylvania Hospital, Sports Medicine, 800, Spruce street, Philadelphia, PA 19103 United States; Texas Children's Hospital Department of Orthopaedic Surgery, 6620 Fannin, St. Houston, TX 77030, United States.
| | - A T Schade
- Royal Stoke University Hospitals, Stoke on Trent, St4-6QG, United Kingdom
| | - A W Howard
- Department of Orthopaedic Surgery, The Hospital for Sick Children, M5G 1X8 Toronto, Ontario, Canada
| | - M W Camp
- Department of Orthopaedic Surgery, The Hospital for Sick Children, M5G 1X8 Toronto, Ontario, Canada
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Three point fixation of pediatric proximal humerus fractures by prebent wave-shaped wires: technical notes. J Pediatr Orthop B 2017; 26:1-4. [PMID: 27336712 DOI: 10.1097/bpb.0000000000000359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pediatric proximal humerus fractures are uncommon and mostly treated conservatively. However, surgical treatment should be considered in displaced fractures classified as Neer-Horowitz grade III-IV in children older than 11 years. We describe a three-point fixation method of applying two Kirschner wires, prebent into a wave shape, and inserted into the proximal humerus through a single cortical hole. In this minimally invasive approach, we treated four boys, obtaining accurate reduction and stable fixation, with all patients starting pendulous exercises the day after surgery. At follow-up, all patients had regained full shoulder range of motion, with no residual pain and no complications recorded.
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Bisaccia M, Meccariello L, Manni M, Falzarano G, Medici A, Rinonapoli G, Di Giacinto S, Colleluori G, Vicente CI, Ceccarini P, Bisaccia O, Caraffa A. Treatment of acute proximal humeral fractures in children with modular external fixator. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2016.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Pavone V, de Cristo C, Cannavò L, Testa G, Buscema A, Condorelli G, Sessa G. Midterm results of surgical treatment of displaced proximal humeral fractures in children. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:461-7. [PMID: 27151160 DOI: 10.1007/s00590-016-1773-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 04/24/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To analyse the clinical outcomes of 26 children treated surgically for displaced proximal humerus fracture. MATERIALS AND METHODS From January 2008 to December 2012, 26 children/adolescents (14 boys, 12 girls) were treated surgically for displaced fractures at the proximal extremity of the humerus. Ten were grade III and 16 were grade IV according to the Neer-Horowitz classification with a mean age of 12.8 ± 4.2 years. Twenty young patients were surgically treated with a closed reduction and direct percutaneous pinning; six required an open approach. To obtain a proper analysis, we compared the Costant scores with the contralateral shoulder (Δ Costant). RESULTS The mean follow-up period was 34 months (range 10-55). Two grade IV patients showed a loss in the reduction after percutaneous treatment. This required open surgery with a plate and screws. On average, the treated fractures healed at 40 days. The mean Δ Costant score was 8.43 (range 2-22). There was a statistically significant improvement in the mean Δ Costant score in grade III patients. In grade IV patients, there was a significant improvement in the mean Δ Costant score in those treated with open surgery versus mini-invasive surgery. CONCLUSIONS Our study shows excellent results with percutaneous k-wires. This closed surgery had success in these patients, and the excellent outcomes noted here lead us to prefer the mini-invasive surgical approach in NH grade III fractures. In grade IV, the best results were noted in patients treated with open surgery. We suggest an open approach for these patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vito Pavone
- Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy.
| | - Claudia de Cristo
- Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy
| | - Luca Cannavò
- Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy
| | - Gianluca Testa
- Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy
| | - Antonio Buscema
- Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy
| | - Giuseppe Condorelli
- Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy
| | - Giuseppe Sessa
- Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy
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Binder H, Tiefenboeck TM, Payr S, Schurz M, Aldrian S, Sarahrudi K. Treatment of proximal humerus fractures in children and young adolescents. Wien Klin Wochenschr 2015; 128:120-4. [PMID: 26546351 DOI: 10.1007/s00508-015-0879-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Fractures of the proximal humerus in children are rare and represent approximately 0.45% of all paediatric fractures. These injuries are common in patients up to an age of 16 years. The treatment of displaced subcapital fractures is still controversially discussed in literature. Therefore the aim of this study was to evaluate the short-term outcome and to provide guidelines for surgical treatment of these fractures in children and adolescents. METHODS Clinical and radiological results of 231 patients between 0 and 17 years with subcapital humerus fractures were evaluated. Patients were devided according to their treatment as followed (1) conservative treatment group (2) operative treatment group. RESULTS A total of 191 patients (82.7%) underwent conservative treatment and 40 (17.3%) underwent operative treatment. Surgical treatment consisted of open reduction and internal fixation (ORIF) (35.0%) or closed reduction and internal fixation (CRIF) (52.5%). In all operated patients an axial deviation of more than 20° was observed preoperatively. According to our groups; the surgical group presented in 90% (N = 36) of the patients with an excellent result, in 5% (N = 2) an average result was observed and in 5% (N = 2) a poor result according to Constant Murley Score was achieved. In the conservative treatment group in 185 patients (96.9%) excellent results were achieved and in 6 patients (3.1%) an average result in the Constant Murley Score was achieved. CONCLUSION Conservative treatment in children < 10 years and an angulation angle < 20°, as well as surgical treatment with ORIF or CRIF in patients > 10 years and with an angulation angle > 20° leads to excellent short-term outcome. However, studies with longer observation time are needed to evaluate long-term complications like limb length discrepancy.
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Affiliation(s)
- Harald Binder
- Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas M Tiefenboeck
- Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Stephan Payr
- Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Mark Schurz
- Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Silke Aldrian
- Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Kambiz Sarahrudi
- Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Singer G, Parzer S, Castellani C, Wegmann H, Lindbichler F, Till H, Eberl R. The influence of brace immobilization on the remodeling potential of thoracolumbar impaction fractures in children and adolescents. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:607-13. [PMID: 26411349 DOI: 10.1007/s00586-015-4250-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/20/2015] [Accepted: 09/20/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Different treatment methods including immediate mobilization with or without brace, bed rest or immobilization using thoracolumbosacral orthosis have been applied for stable compression fractures of the pediatric spine. The aim of this study was to evaluate the influence of bracing on the remodeling capacity of pediatric thoracolumbar type A 1.2 impaction fractures. Additionally, the prevalence of pain and functional disabilities were assessed. METHODS All children treated conservatively between 2000 and 2011 with impaction fractures of the thoracolumbar spine (A 1.2) were included and re-invited for a clinical [including VAS 0-100, Oswestry disability index (ODI)] and radiological follow-up examination. Changes of the sagittal index (SI) at the time of the accident, the latest control visit and at the follow-up examination were analyzed. RESULTS Seventy-two patients with a mean age of 12 years (1.8-18 years) and a total number of 133 fractured vertebrae were included. The mean SI at the time of injury was 0.76 (range 0.45-0.94, SD 0.08); 34 patients with 67 fractured vertebrae were included in the follow-up examination after a mean of 7.9 years (2.4-13.1 years). The mean SI of the 67 affected vertebrae at follow-up significantly increased to 0.92 (range 0.74-1, SD 0.06). The initial treatment regimen (brace vs no brace) did not influence the remodeling capacity. More than half of the patients (n = 18, 53 %) complained about occasional back-related pain which was not associated with the remodeling process. The mean ODI was 5.8 (range 0-26, SD 6.6) and the mean VAS of the re-evaluated patients was 87 (range 53-100, SD 14). CONCLUSIONS A significant remodeling capacity of thoracolumbar vertebral impaction fractures sustained in childhood is demonstrated. Bracing does not seem to influence the long-term outcome of these injuries. More studies have to be performed to define the role of bracing in these fractures.
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Affiliation(s)
- Georg Singer
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria.
| | - Stephan Parzer
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Christoph Castellani
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Helmut Wegmann
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Franz Lindbichler
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Holger Till
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Robert Eberl
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
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Cosma D, Vasilescu DE. Elastic Stable Intramedullary Nailing for Fractures in Children - Specific Applications. ACTA ACUST UNITED AC 2014; 87:147-51. [PMID: 26528014 PMCID: PMC4508591 DOI: 10.15386/cjmed-275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/19/2014] [Accepted: 06/30/2014] [Indexed: 12/12/2022]
Abstract
Elastic stable intramedullary nailing (ESIN) is a new minimally invasive technique for the treatment of pediatric fractures. It approximates the physiological healing process of bone, without opening the fracture site. Also, the operative stress is minimal because of the minimally invasive nature of the procedure, and the volume of implants is small, offering a very good stability without plaster cast immobilization.
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Affiliation(s)
- Dan Cosma
- Department of Pediatric Surgery and Orthopedics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dana Elena Vasilescu
- Department of Pediatric Surgery and Orthopedics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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