Fractures of the proximal humerus in children and adolescents

• Main Authors: Ruban Raj Joshi, Dr, Sagar Narang, Dr, G D Sundararaj, Dr
• Format: Article
• Language: English
• Published: Lumbini Medical College 2013-12-01
• Series: Journal of Lumbini Medical College
• Online Access: https://jlmc.edu.np/index.php/JLMC/article/view/43
• ISSN: 2392-4632; 2542-2618

Background: In most children proximal humeral fractures are treated non-operatively with generally good results. The aim of the study was to evaluate the clinical outcome of closed/open reduction in children with severely displaced proximal humeral fractures. Materials and Methods: The charts of 15 patients (8 girls and 7 boys; mean age: 9.4 years) with proximal humeral fractures who were managed at our institution were reviewed from October 2011 to December 2013. Results: There were 7 metaphyseal fractures and 8 physeal injuries which were angulated according to Neer-Horowitz score as grade II (n=2), grade III(n=4) and grade IV(n=9). Associated lesions comprised open fracture with head trauma in a 2 year old female child which was operated on primarily and the 14 others by secondary intention. All patients were treated surgically with either closed (n = 5) or open (n=10) reduction and internal fixation with Kirschner wire or titanium elastic nails (TENs). They were assessed for clinical and radiological healing at a mean follow up of 1.25 years ranging from 0.5 to 2.0 years. Conclusion: Surgical option is indicated for severely displaced and unstable fractures in older children and adolescents. In addition to the periosteum , long head of the biceps, deltoid muscle, and bone fragments in combination can prevent fracture reduction. Key words: Proximal humerus fracture, Children, Open reduction, Operative.