SpringerLink
Log in

Functional results of displaced proximal humerus fractures in children treated by elastic stable intramedullary nail

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Displaced proximal humerus fractures within the pediatric population can be treated by elastic stable intramedullary nailing (ESIN). The main objective of our study is to evaluate functional outcome of the displaced proximal humeral fractures treated by ESIN within the pediatric group using a standardized evaluation scale. The secondary goal is to compare functional outcome of epiphyseal and metaphyseal injuries and functional outcome of children younger and older than 10 years of age.

Materials and methods

From March 2010 to December 2011, 27 children had been treated surgically using ESIN for displaced fractures at the proximal extremity of the humerus. These fractures were displaced and closed without neurovascular insult. Patients were followed radiographically and clinically on a regular basis. After hardware removal, the functional outcomes had been homogeneously assessed by using the French edition of the QuickDash® evaluation scale. The descriptive statistics including mean, standard deviation, and confidence interval have been realized.

Results

We included 27 children who were operated on consecutively (10 boys, 17 girls). The mean age at the time of operation is 11.2 ± 2.7 years (range 7.1–15.9). The mean angulation is 55.9° ± 20.3° (range 20–90). The mean apposition is 52.8 % ± 33.1 (range 10–100). The mean follow-up period is 15.2 ± 5.6 months (range 6.1–28.5). Results were considered good for children between 7.1 and 15.9 years old with epiphyseal and meataphyseal fractures. The mean QuickDash® score is 2.0 (range 0–6.5), with 14 cases showing a score of 0 (58.3 %), 2 cases with 4.3 (8.3 %), 4 cases with 4.5 (16.7 %), and 4 cases with a score of 6.5 (16.7 %). Ranges of movement were preserved. The patients regained their daily and sportive activity over the time without pain or discomfort.

Conclusion

Our study showed a good outcome of functional results within a pediatric population who had a sustained displaced proximal humeral fracture and treated by ESIN. Using a standardized evaluation scale is recommended in order to be able to evaluate the patients in a homogeneous manner.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Métaizeau JP (1988) Ostéosynthèse chez l’enfant: embrochage centromédullaire élastique stable. Ed. Sauramps Médical, Montpellier

    Google Scholar 

  2. Ligier JN, Métaizeau JP, Prévot J, Lascombes P (1988) Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg Br 70:74–77

    CAS  PubMed  Google Scholar 

  3. Lascombes P, Prévot J, Ligier JN, Métaizeau JP, Poncelet T (1990) Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Pediatr Orthop 10:167–171

    CAS  PubMed  Google Scholar 

  4. Mazda K, Khairouni A, Penneçot DF, Bensahel H (1997) Closed flexible intramedullary nailing of the femoral shaft fractures in children. J Pediatr Orthop B 6:198–202

    Article  CAS  PubMed  Google Scholar 

  5. Griffet J, El Hayek T, Baby M (1999) Intramedullary nailing of forearm fractures in children. J Pediatr Orthop 8:88–89

    CAS  Google Scholar 

  6. Griffet J, Leroux J, Boudjouraf N, Abou-Daher A, El Hayek T (2011) Elastic stable intramedullary nailing in tibial shaft fractures in children. J Child Orthop 5:297–304

    Article  PubMed Central  PubMed  Google Scholar 

  7. Ligier JN, Métaizeau JP, Prévot J (1983) Closed flexible medullary nailing in pediatric traumatology. Chir Pediatr 24:383–385

    CAS  PubMed  Google Scholar 

  8. Pritchett JW (1991) Growth plate activity in the upper extremity. Clin Orthop Relat Res 268:235–242

    PubMed  Google Scholar 

  9. Sessa S, Lascombes P, Prevot J et al (1990) Centro-medullary nailing in fractures of the upper end of the humerus in children and adolescents. Chir Pediatr 31:43–46

    CAS  PubMed  Google Scholar 

  10. **e F, Wang S, Jiao Q, Shen Y, Ni XY, Ying H (2011) Minimally invasive treatment for severely displaced proximal humeral fractures in children using titanium elastic nails. J Pediatr Orthop 31:839–846

    Article  PubMed  Google Scholar 

  11. Wei SW, Zhao YM, Yang J, Wu RK, Lou Y, Chen H et al (2012) Manipulative reduction and percutaneous pin fixation for the treatment of severely displaced proximal humerus fractures in children. Zhongguo Gu Shang 25:158–161

    PubMed  Google Scholar 

  12. Fernandez FF, Eberhardt O, Langendörfer M, Wirth T (2008) Treatment of severely displaced proximal humeral fractures in children with retrograde elastic stable intramedullary nailing. Injury 39:1453–1459

    Article  CAS  PubMed  Google Scholar 

  13. Beringer DC, Weiner DS, Noble JS, Bell RH (1998) Severely displaced proximal humeral epiphyseal fractures: a follow-up study. J Pediatr Orthop 18:31–37

    CAS  PubMed  Google Scholar 

  14. Larsen CF, Kiaer T, Lindequist S (1990) Fractures of the proximal humerus in children. Nine-year follow-up of 64 unoperated on cases. Acta Orthop Scand 61:255–257

    Article  CAS  PubMed  Google Scholar 

  15. Slongo T, Audigé L, Schlickewei W, Clavert JM, Hunter J (2006) Development and validation of the AO pediatric comprehensive classification of long bone fractures by the pediatric expert group of the AO foundation in collaboration with AO clinical investigation and documentation and the international association for pediatric traumatology. J Pediatr Orthop 26:43–49

    Article  PubMed  Google Scholar 

  16. Slongo T, Audigé L, Clavert JM, Nicolas L, Frick S, Hunter J (2007) The AO comprehensive classification of pediatric long-bone fractures: a web-based multicenter agreement study. J Pediatr Orthop 27:171–180

    Article  PubMed  Google Scholar 

  17. Slongo T, Audigé L, Lutz N, Frick S, Schmittenbecher P, Hunter J et al (2007) Documentation of fracture severity with the AO classification of pediatric long-bone fractures. Acta Orthop Scand 78:247–253

    Article  Google Scholar 

  18. Slongo TF, Audigé L (2007) AO pediatric classification group. Fracture and dislocation classification compendium for children: the AO pediatric comprehensive classification of long bone fractures (PCCF). J Orthop Trauma 21:S135–S160

    Article  PubMed  Google Scholar 

  19. Hudak PL, Armadio PC, Bombarfier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608

    Article  CAS  PubMed  Google Scholar 

  20. Beaton DE, Wright JG, Katz JN (2005) Upper Extremity Collaborative Group. Development of the Quick Dash: comparison of three item-reduction approaches. J Bone Joint Surg Am 87:1038–1046

    Article  PubMed  Google Scholar 

  21. Colovic H, Stankovic I, Dimitrijevic L, Zivkovic V, Nikolic D (2008) The value of modified DASH questionnaire for evaluation of elbow function after supracondylar fracture in children. Vojnosanit Pregl 65:27–32

    Article  PubMed  Google Scholar 

  22. Sidor ML, Zuckerman JD, Lyon T, Cuomo F, Shoenberg N (1992) The Neer classification system for proximal humeral fractures. J Bone Joint Surg Am 75:1745–1750

    Google Scholar 

  23. Karatosun V, Unver B, Alici E, Serin E (2003) Treatment of displaced, proximal, humeral, epiphyseal fractures with a two-prong splint. J Orthop Trauma 17:578–581

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, CHUl Estaing, 1, Place Lucie et Raymond Aubrac, Clermont Ferrand, 63003, France

    A. Khan, L. Athlani, M. Rousset, A. Samba & F. Canavese

Authors
  1. A. Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Athlani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Rousset
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Samba
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Canavese
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Canavese.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Khan, A., Athlani, L., Rousset, M. et al. Functional results of displaced proximal humerus fractures in children treated by elastic stable intramedullary nail. Eur J Orthop Surg Traumatol 24, 165–172 (2014). https://doi.org/10.1007/s00590-013-1177-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-013-1177-2

Keywords

Search

Navigation