TREATMENT OF SEVERE DISPLACED PROXIMAL HUMERAL FRACTURES WITH TITANIUM ELASTIC NAILS IN OLDER CHILDREN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANGXiaolin , SHAOJingfan , YANGXiaojin , LIHonglin , LIUFangna , BIBo

Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, 430030, P. R. China;

Corresponding author：

WANGXiaolin, Email: olaf7819@163.com

Keywords：

Proximal humeral fracture; Titanium elastic nail; Internal fixation; Older children

DOI：

10.7507/1002-1892.20140077

Video：

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Objective To evaluate the effectiveness of titanium elastic nails for severe displaced proximal humeral fractures in older children. Methods Between April 2009 and July 2012, 31 cases of severe displaced proximal humeral fractures were treated with closed or open reduction and fixation with 2 titanium elastic nails, and the clinical data were retrospectively analyzed. There were 23 boys and 8 girls, aged from 10 to 15 years (mean, 12.8 years). The causes of injury were sports injury (16 cases), traffic accident (11 cases), and falling from height (4 cases). The interval from injury to operation was 6 hours to 7 days (mean, 72 hours). According to Neer-Horwitz classification, 17 cases were rated as type III fracture and 14 cases as type IV fracture. There were 21 cases of metaphyseal fractures and 10 cases of epiphyseal fractures. Results Satisfactory reduction of fracture and stable fixation were obtained in all patients (closed reduction in 23 cases and open reduction in 8 cases). Primary healing was achieved in all incisions; no infection and neurovascular injury occurred. All patients were followed up 12-36 months with an average of 20 months. X-ray films showed that all fractures healed at 7-10 weeks (mean, 8 weeks). During follow-up, no disturbance of development or angulation deformity caused by premature physeal closure or bone bridge formation was observed. At last follow-up, the average Neer score of the shoulder was 95.7 (range, 83-100). The appearance and motion of the shoulder were normal. There was no significant difference in the upper extremity length between affected side and contralateral side[(67.68±2.56) cm vs. (67.61±2.54) cm; t=-1.867,P=0.072]. Conclusion Titanium elastic nails for severe displaced humeral fractures in older children is a safe and effective method with a low complication incidence.

Citation： WANGXiaolin, SHAOJingfan, YANGXiaojin, LIHonglin, LIUFangna, BIBo. TREATMENT OF SEVERE DISPLACED PROXIMAL HUMERAL FRACTURES WITH TITANIUM ELASTIC NAILS IN OLDER CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(3): 345-348. doi: 10.7507/1002-1892.20140077 Copy

1.	Bishop JY, Flatow EL. Pediatric shoulder trauma. Clin Orthop Relat Res, 2005, (432):41-48.
2.	Neer CS 2nd, Horwitz BS. Fractures of the proximal humeral epiphyseal plate. Clin Orthop Relat Res, 1965, (41):24-31.
3.	Kohler R, Trillaud JM. Fracture and fracture separation of the proximal humerus in children:report of 136 cases. J Pediatr Orthop, 1983, 3(3):326-332.
4.	Beringer DC, Weiner DS, Noble JS, et al. Severely displaced proximal humeral epiphyseal fractures:a follow-up study. J Pediatr Orthop, 1998, 18(1):31-37.
5.	林浩, 黄东, 吴伟炽, 等. 闭合复位经皮克氏针内固定治疗儿童肱骨近端骨折. 中华创伤骨科杂志, 2012, 12(4):355-356.
6.	Pahlavan S, Baldwin KD, Pandya NK, et al. Proximal humerus fractures in the pediatric population:a systematic review. J Child Orthop, 2011, 5(3):187-194.
7.	Hutchinson PH, Bae DS, Waters PM, et al. Intramedullary nailing versus percutaneous pin fixation of pediatric proximal humerus fractures:a comparison of complications and early radiographic results. J Pediatr Orthop, 2011, 31(6):617-622.
8.	Ligier JN, Metaizeau JP, Prévot J. Closed flexible medullary nailing in pediatric traumatology. Chir Pediatr, 1983, 24(6):383-385.
9.	Johnson P, Kurien B, Belthur MV, et al. Flexible nailing for displaced proximal humeral fractures in children. J Bone Joint Surg (Br), 2006, 88-B(suppl I):119.
10.	Rajan RA, Hawkins KJ, Metcalfe J, et al. Elastic stable intramedullary nailing for displaced proximal humeral fractures in older children. J Child Orthop, 2008, 2(1):15-19.
11.	Xie F, Wang S, Jiao Q, et al. Minimally invasive treatment for severely displaced proximal humeral fractures in children using titanium elastic nails. J Pediatr Orthop, 2011, 31(8):839-846.
12.	Bahrs C, Zipplies S, Ochs BG, et al. Proximal humeral fractures in children and adolescents. J Pediatr Orthop, 2009, 29(3):238-242.
13.	Dameron TB Jr, Reibel DB. Fractures involving the proximal humeral epiphyseal plate. J Bone Joint Surg (Am), 1969, 51(2):289-297.
14.	Larsen CF, Kiaer T, Lindequist S. Fractures of the proximal humerus in children. Nine-year follow-up of 64 unoperated on cases. Acta Orthop Scand, 1990, 61(3):255-257.
15.	Herscovici D Jr, Saunders DT, Johnson MP, et al. Percutaneous fixation of proximal humeral fractures. Clin Orthop Relat Res, 2000, (375):97-104.
16.	韦盛旺, 赵友明, 杨杰, 等. 大龄儿童肱骨近端骨折非手术治疗与手术治疗疗效比较. 中华小儿外科杂志, 2012, 33(2):113-117.
17.	Chee Y, Agorastides I, Garg N, et al. Treatment of severely displaced proximal humeral fractures in children with elastic stable intramedullary nailing. J Pediatr Orthop B, 2006, 15(1):45-50.
18.	Zaltz I, Waters PM, Kass JR. Ulnar nerve instability in children. J Pediatr Orthop, 1996, 16(5):567-569.
19.	Fernandez FF, Eberhardt O, Langendörfer M, et al. Treatment of severely displaced proximal humeral fractures in children with retrograde elastic stable intramedullary nailing. Injury, 2008, 39(12):1453-1459.

1. Bishop JY, Flatow EL. Pediatric shoulder trauma. Clin Orthop Relat Res, 2005, (432):41-48.
2. Neer CS 2nd, Horwitz BS. Fractures of the proximal humeral epiphyseal plate. Clin Orthop Relat Res, 1965, (41):24-31.
3. Kohler R, Trillaud JM. Fracture and fracture separation of the proximal humerus in children:report of 136 cases. J Pediatr Orthop, 1983, 3(3):326-332.
4. Beringer DC, Weiner DS, Noble JS, et al. Severely displaced proximal humeral epiphyseal fractures:a follow-up study. J Pediatr Orthop, 1998, 18(1):31-37.
5. 林浩, 黄东, 吴伟炽, 等. 闭合复位经皮克氏针内固定治疗儿童肱骨近端骨折. 中华创伤骨科杂志, 2012, 12(4):355-356.
6. Pahlavan S, Baldwin KD, Pandya NK, et al. Proximal humerus fractures in the pediatric population:a systematic review. J Child Orthop, 2011, 5(3):187-194.
7. Hutchinson PH, Bae DS, Waters PM, et al. Intramedullary nailing versus percutaneous pin fixation of pediatric proximal humerus fractures:a comparison of complications and early radiographic results. J Pediatr Orthop, 2011, 31(6):617-622.
8. Ligier JN, Metaizeau JP, Prévot J. Closed flexible medullary nailing in pediatric traumatology. Chir Pediatr, 1983, 24(6):383-385.
9. Johnson P, Kurien B, Belthur MV, et al. Flexible nailing for displaced proximal humeral fractures in children. J Bone Joint Surg (Br), 2006, 88-B(suppl I):119.
10. Rajan RA, Hawkins KJ, Metcalfe J, et al. Elastic stable intramedullary nailing for displaced proximal humeral fractures in older children. J Child Orthop, 2008, 2(1):15-19.
11. Xie F, Wang S, Jiao Q, et al. Minimally invasive treatment for severely displaced proximal humeral fractures in children using titanium elastic nails. J Pediatr Orthop, 2011, 31(8):839-846.
12. Bahrs C, Zipplies S, Ochs BG, et al. Proximal humeral fractures in children and adolescents. J Pediatr Orthop, 2009, 29(3):238-242.
13. Dameron TB Jr, Reibel DB. Fractures involving the proximal humeral epiphyseal plate. J Bone Joint Surg (Am), 1969, 51(2):289-297.
14. Larsen CF, Kiaer T, Lindequist S. Fractures of the proximal humerus in children. Nine-year follow-up of 64 unoperated on cases. Acta Orthop Scand, 1990, 61(3):255-257.
15. Herscovici D Jr, Saunders DT, Johnson MP, et al. Percutaneous fixation of proximal humeral fractures. Clin Orthop Relat Res, 2000, (375):97-104.
16. 韦盛旺, 赵友明, 杨杰, 等. 大龄儿童肱骨近端骨折非手术治疗与手术治疗疗效比较. 中华小儿外科杂志, 2012, 33(2):113-117.
17. Chee Y, Agorastides I, Garg N, et al. Treatment of severely displaced proximal humeral fractures in children with elastic stable intramedullary nailing. J Pediatr Orthop B, 2006, 15(1):45-50.
18. Zaltz I, Waters PM, Kass JR. Ulnar nerve instability in children. J Pediatr Orthop, 1996, 16(5):567-569.
19. Fernandez FF, Eberhardt O, Langendörfer M, et al. Treatment of severely displaced proximal humeral fractures in children with retrograde elastic stable intramedullary nailing. Injury, 2008, 39(12):1453-1459.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF SEVERE DISPLACED PROXIMAL HUMERAL FRACTURES WITH TITANIUM ELASTIC NAILS IN OLDER CHILDREN

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