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Surgery Suggested as Effective, Safe Treatment For Paediatric Displaced Fractures Of The Proximal Humerus
A DGReview of :"Displaced fractures of the proximal humerus in children require open/closed reduction and internal fixation"
European Journal of Pediatric Surgery
04/02/2004
By Mary Beth Nierengarten
Open or closed reduction with internal fixation (ORIF/CRIF) is an effective and safe treatment for children with displaced fractures of the proximal humerus, report researchers from Austria.
Although conservative treatment is recommended for undisplaced and displaced fractures of the proximal humerus in children, treatment remains controversial and many clinicians have little experience with this rare injury.
To clarify which patients may need surgical management based on the extent of displacement as well as patient age, S. Schwendenwein, MD, University of Vienna Medical School, and colleagues retrospectively examined 16 patients with fractures of the proximal humeral epiphysis treated between 1992 and 2002. At a mean age of 10.6 years, 9 patients were male and 7 female. Injuries included subcapital fracture in 10 patients and physeal fractures in 6 patients.
Of the 16 patients, 15 were treated surgically -- 10 received open reduction and 5 closed reduction. Anatomical reduction was achieved in all patients, with 3.2 weeks as the average immobilisation time, and 8 weeks as the average time to remove implants. No infections occurred.
At a mean follow up of 23.8 months, none of the patients had decreased mobility or discrepancy in limb length. All patients, except 1, achieved a good or very good clinical result. Because of additional injuries, 1 patient achieved only an average result. No major axial deviation nor growth disturbance were found by radiological examination in any patient. Of the surgical patients, 3 expressed dissatisfaction due to an enlarged surgical scar.
Although this study did not directly compare surgical treatment to conservative treatment in these patients, the authors conclude that "the absence of growth disorders and mobility impairments in our patient group supports the indication for surgery in the treatment of displaced epiphyseal injuries of the proximal upper arm in children."
Eur J Pediatr Surg 2004 Feb;14:1:51-5.
"Displaced fractures of the proximal humerus in children require open/closed reduction and internal fixation"
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