Skip to main content
Erschienen in: Wiener klinische Wochenschrift 3-4/2016

01.02.2016 | original article

Treatment of proximal humerus fractures in children and young adolescents

verfasst von: Harald Binder, MD, Thomas M. Tiefenboeck, MD, Stephan Payr, MD, Mark Schurz, MD, Assoc. Prof. Silke Aldrian, MD, Assoc. Prof. Kambiz Sarahrudi, MD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 3-4/2016

Einloggen, um Zugang zu erhalten

Summary

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.
Literatur
1.
Zurück zum Zitat Rose SH, Melton LJ III, Morrey BF, Ilstrup DM, Riggs BL. Epidemiologic features of humeral fractures. Clin Orthop Relat Res. 1982;168:24–30.PubMed Rose SH, Melton LJ III, Morrey BF, Ilstrup DM, Riggs BL. Epidemiologic features of humeral fractures. Clin Orthop Relat Res. 1982;168:24–30.PubMed
2.
Zurück zum Zitat Schmittenbecher PP, Blum J, David S, Knorr P, Marzi I, Schlickewei W, et al. Treatment of humeral shaft and subcapital fractures in children. Consensus report of the child trauma section of the DGU. Unfallchirurg. 2004;107:8–14.CrossRefPubMed Schmittenbecher PP, Blum J, David S, Knorr P, Marzi I, Schlickewei W, et al. Treatment of humeral shaft and subcapital fractures in children. Consensus report of the child trauma section of the DGU. Unfallchirurg. 2004;107:8–14.CrossRefPubMed
3.
Zurück zum Zitat Baxter MP, Wiley JJ. Fractures of the proximal humeral epiphysis. Their influence on humeral growth. J Bone Joint Surg Br. 1986;68:570–3.PubMed Baxter MP, Wiley JJ. Fractures of the proximal humeral epiphysis. Their influence on humeral growth. J Bone Joint Surg Br. 1986;68:570–3.PubMed
4.
Zurück zum Zitat Dobbs MB, Luhmann SL, Gordon JE, Strecker WB, Schoenecker PL. Severely displaced proximal humeral epiphyseal fractures. J Pediatr Orthop. 2003;23:208–15.PubMed Dobbs MB, Luhmann SL, Gordon JE, Strecker WB, Schoenecker PL. Severely displaced proximal humeral epiphyseal fractures. J Pediatr Orthop. 2003;23:208–15.PubMed
5.
Zurück zum Zitat David S, Kuhn C, Ekkernkamp A. Fracture of the proximal humerus in children and adolescents. The most overtreated fracture. Chirurg. 2006;77:827–34.CrossRefPubMed David S, Kuhn C, Ekkernkamp A. Fracture of the proximal humerus in children and adolescents. The most overtreated fracture. Chirurg. 2006;77:827–34.CrossRefPubMed
6.
Zurück zum Zitat von Laer L, Kraus R, Linhart WE. Pediatric fractures and dislocations. Stuttgart: Thieme Medical; 2007. von Laer L, Kraus R, Linhart WE. Pediatric fractures and dislocations. Stuttgart: Thieme Medical; 2007.
7.
Zurück zum Zitat Neer CS II, Horwitz BS. Fractures of the proximal humeral epiphysial plate. Clin Orthop Relat Res. 1965;41:24–31.CrossRefPubMed Neer CS II, Horwitz BS. Fractures of the proximal humeral epiphysial plate. Clin Orthop Relat Res. 1965;41:24–31.CrossRefPubMed
8.
Zurück zum Zitat Bahrs C, Zipplies S, Ochs BG, Rether J, Oehm J, Eingartner C, et al. Proximal humeral fractures in children and adolescents. J Pediatr Orthop. 2009;29:238–42.CrossRefPubMed Bahrs C, Zipplies S, Ochs BG, Rether J, Oehm J, Eingartner C, et al. Proximal humeral fractures in children and adolescents. J Pediatr Orthop. 2009;29:238–42.CrossRefPubMed
9.
Zurück zum Zitat Lefevre Y, Journeau P, Angelliaume A, Bouty A, Dobremez E. Proximal humerus fractures in children and adolescents. Orthop Traumatol Surg Res. 2014;100:149–56.CrossRef Lefevre Y, Journeau P, Angelliaume A, Bouty A, Dobremez E. Proximal humerus fractures in children and adolescents. Orthop Traumatol Surg Res. 2014;100:149–56.CrossRef
10.
Zurück zum Zitat Shrader MW. Proximal humerus and humeral shaft fractures in children. Hand Clin. 2007;23:431–5, vi.CrossRefPubMed Shrader MW. Proximal humerus and humeral shaft fractures in children. Hand Clin. 2007;23:431–5, vi.CrossRefPubMed
11.
Zurück zum Zitat Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–4.PubMed Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–4.PubMed
12.
Zurück zum Zitat Schwendenwein E, Hajdu S, Gaebler C, Stengg K, Vecsei V. Displaced fractures of the proximal humerus in children require open/closed reduction and internal fixation. Eur J Pediatr Surg. 2004;14:51–5.CrossRefPubMed Schwendenwein E, Hajdu S, Gaebler C, Stengg K, Vecsei V. Displaced fractures of the proximal humerus in children require open/closed reduction and internal fixation. Eur J Pediatr Surg. 2004;14:51–5.CrossRefPubMed
13.
Zurück zum Zitat Dameron TB Jr., Reibel DB. Fractures involving the proximal humeral epiphyseal plate. J Bone Joint Surg Am. 1969;51:289–97.PubMed Dameron TB Jr., Reibel DB. Fractures involving the proximal humeral epiphyseal plate. J Bone Joint Surg Am. 1969;51:289–97.PubMed
14.
Zurück zum Zitat Arthurs OJ. Radiology of postnatal skeletal development: the proximal humerus. Skeletal Radiol. 2000;2:153–60. Arthurs OJ. Radiology of postnatal skeletal development: the proximal humerus. Skeletal Radiol. 2000;2:153–60.
Metadaten
Titel
Treatment of proximal humerus fractures in children and young adolescents
verfasst von
Harald Binder, MD
Thomas M. Tiefenboeck, MD
Stephan Payr, MD
Mark Schurz, MD
Assoc. Prof. Silke Aldrian, MD
Assoc. Prof. Kambiz Sarahrudi, MD
Publikationsdatum
01.02.2016
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 3-4/2016
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-015-0879-3

Weitere Artikel der Ausgabe 3-4/2016

Wiener klinische Wochenschrift 3-4/2016 Zur Ausgabe

mitteilungen der gesellschaft der ärzte in wien

Veranstaltungen