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Elastic stable intramedullary nailing for displaced proximal humeral fractures in older children
Rohan Ananda Rajan1, Keith J Hawkins, James Metcalfe
1Derby Royal Infirmary, 14 London Road, Derby, DE1 2QY, UK, rohan.rajan@nhs.net.
Insights
Elastic stable intramedullary nailing (ESIN) effectively treats displaced proximal humeral physeal fractures in children. This safe method allows for early functional recovery and high patient satisfaction.
Area of Science:
- Pediatric Orthopedics
- Pediatric Trauma Surgery
- Skeletal Development
Background:
- Proximal humeral physeal fractures are common in children.
- Severe displacement poses challenges for non-operative management.
- Intramedullary fixation offers a potential solution for these injuries.
Purpose of the Study:
- To evaluate the effectiveness of elastic stable intramedullary nailing (ESIN) for severely displaced proximal humeral physeal fractures.
- To assess functional outcomes and patient satisfaction after ESIN fixation.
Main Methods:
- Retrospective study of 14 skeletally immature patients (10-15 years) with displaced proximal humeral physeal fractures.
- Fractures graded using Neer classification; severe displacement defined as Neer II-IV, >1 cm displacement, or >45 degrees angulation.
- Follow-up included Disabilities of the Arm, Shoulder and Hand (DASH) score, Neer Shoulder score, radiographic assessment, and subjective satisfaction.
Main Results:
- All 14 fractures achieved radiological union within a median of 8 weeks.
- Mean follow-up was 30 months.
- High functional scores were observed: mean Neer Shoulder score 96.79, mean DASH score 2.26.
- Subjective satisfaction was high, with 71% very satisfied and 29% satisfied.
Conclusions:
- Elastic stable intramedullary nailing (ESIN) is a safe and effective method for managing displaced proximal humeral physeal fractures in older children.
- ESIN facilitates early return to pre-injury function.
- This technique is recommended following successful fracture reduction.
Purpose:
To demonstrate the effectiveness of intramedullary fixation of severely displaced proximal humeral physeal fractures in skeletally immature children using the elastic stable intramedullary nail (ESIN).
Methods:
Retrospective recruitment of 14 patients aged 10-15-years old with severely displaced proximal humeral physeal fractures between 1999 and 2004 in a single regional specialist paediatric orthopaedic hospital. The fractures were graded using the Neer classification; severe displacement constituted Neer II-IV or displacement >1 cm and angulation >45 degrees . Patients were followed up and assessed using the Disabilities of the Arm, Shoulder and Hand score (DASH) and the Neer Shoulder score. Radiographs were assessed for deformity. Subjective satisfaction was assessed.
Results:
Fourteen patients with mean follow-up of 30 months (12-66 m) from surgery. All fractures were radiologically united at a median time of eight weeks (7-10 weeks). At follow-up, Neer Shoulder mean score was 96.79 (range 83-100) and DASH mean score 2.26 (0-7.5). Subjectively 71% were very satisfied and 29% were satisfied.
Conclusions:
We commend stabilisation using ESIN in the management of the displaced proximal humeral physeal fracture in older children, once reduction of the fracture has been achieved by either closed or open means. ESIN is safe and allows early return to pre-injury function.
