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Open reduction of proximal humerus fractures in the adolescent population

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Purpose

Proximal humerus fractures in the pediatric population are a relatively uncommon injury, with the majority of injuries treated in a closed fashion due to the tremendous remodeling potential of the proximal humerus in the skeletally immature. Yet, in adolescent patients, open treatment is, at times, necessary due to unsatisfactory alignment following a closed reduction, loss of previously achieved closed reduction, and limited remodeling when close to skeletal maturity. The purpose of our study was to examine the open reduction of adolescent proximal humerus fractures.

Methods

A retrospective review of the outcomes of proximal humerus fractures in the adolescent population which were consecutively treated at our institution with open reduction was performed.

Results

Ten children met the inclusion criteria, with a mean age of 14.3 years (±1.3) and a mean weight of 60.7 kg (±14.9) at the time of injury. There were seven Salter-Harris 2 fractures and three Salter-Harris 1 fractures. The largest mean angulation was 55.0° (±33.9) and the largest mean displacement was 87.0 % (±22.8). Intra-operatively, impediments to closed reduction within the fracture site which were found included: periosteum (90.0 %), biceps tendon (90.0 %), deltoid muscle (70.0 %), and comminuted bone (10.0 %). K-wire fixation was most commonly used (70.0 %), followed by flexible nails (20.0 %) and cannulated screws (10.0 %) for fixation. All patients achieved radiographic union at a mean of 4.0 weeks (±0.7), had non-painful full shoulder range of motion and rotator cuff strength at final follow-up (mean 7.7 ± 4.6 months), and returned to pre-injury sporting activities.

Conclusions

The operative treatment of proximal humerus fracture, particularly in adolescents with severe displacement/angulation having failed closed methods of treatment, is increasingly considered to be an acceptable modality of treatment. In addition to the long head of the biceps, periosteum, deltoid muscle, and bone fragments in combination can prevent fracture reduction. Surgeon preference and skill should dictate implant choice, and the risk of physeal damage utilizing these implants in this age group is low.

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Authors and Affiliations

  1. Department of Pediatric Orthopaedic Surgery, Children’s Hospital and Research Center Oakland, 747 52nd Street, Oakland, CA, 94609, USA

    Nirav K. Pandya

  2. Department of Pediatric Orthopaedic Surgery, Rady Children’s Hospital San Diego and the University of California—San Diego, 3030 Children’s Way, Suite 410, San Diego, CA, 92103, USA

    Dominque Behrends & Harish S. Hosalkar

Authors
  1. Nirav K. Pandya
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  2. Dominque Behrends
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  3. Harish S. Hosalkar
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Corresponding author

Correspondence to Harish S. Hosalkar.

Additional information

Study was conducted at Rady Children’s Hospital.

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Pandya, N.K., Behrends, D. & Hosalkar, H.S. Open reduction of proximal humerus fractures in the adolescent population. J Child Orthop 6, 111–118 (2012). https://doi.org/10.1007/s11832-012-0398-y

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  • DOI: https://doi.org/10.1007/s11832-012-0398-y

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