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Closed/open reduction and titanium elastic nails for severely displaced proximal humeral fractures in children
Xiaolin Wang1, Jingfan Shao, Xiaojin Yang
1Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Tongji Hospital, Jiefang Avenue, Wuhan, Hubei, China, 430030, olaf7819@163.com.
Insights
Titanium elastic nails (TENs) offer a safe and effective treatment for severely displaced proximal humeral fractures in children, leading to excellent functional recovery and high patient satisfaction with minimal complications.
Area of Science:
- Orthopedic surgery
- Pediatric traumatology
Background:
- Proximal humeral fractures in children can be challenging to manage, especially when severely displaced.
- Optimal surgical techniques are crucial for achieving good functional outcomes and minimizing long-term sequelae.
Purpose of the Study:
- To evaluate the clinical outcomes of using titanium elastic nails (TENs) for treating severely displaced proximal humeral fractures in pediatric patients.
- To assess fracture healing, bone remodeling, and functional recovery following TEN fixation.
Main Methods:
- A retrospective analysis of 37 children with proximal humeral fractures treated with closed or open reduction and TEN fixation.
- Radiographic and clinical follow-up for up to 36 months, assessing healing, remodeling, and deformity.
- Clinical outcomes evaluated using the Neer shoulder score and patient satisfaction.
Main Results:
- All 37 fractures healed radiologically within a median of eight weeks.
- Mean follow-up was 24 months, with excellent mean Neer shoulder scores (96.65).
- High patient satisfaction (30 very satisfied, 7 satisfied) and full return to normal arm function were observed; minor skin irritation was the main complication.
Conclusions:
- Closed or open reduction with TEN fixation is a recommended treatment for severely displaced proximal humeral fractures in children.
- This technique demonstrates satisfactory clinical outcomes, a low complication rate, and promotes rapid return to normal mobility.
Purpose:
The aim of the study was to evaluate the clinical outcome of closed/open reduction and titanium elastic nails (TENs) in children with severely displaced proximal humeral fractures.
Methods:
A retrospective study was performed on 37 children suffering from proximal humeral fracture between April 2009 and July 2012. All these patients were treated by closed or open reduction with TEN fixation. The healing process was assessed by radiographic and clinical follow-up for up to 36 months. Radiographic assessment was performed on the scheduled follow-ups to examine fracture healing, remodelling, bone growth and residual deformity. The clinical outcomes were evaluated using the Neer shoulder score and patients' satisfaction report at the final follow-up. Complications related to the treatment were also recorded.
Results:
All patients had a mean follow-up period of 24 months (12-36) after surgery. All fractures were healed, radiologically, at a median time of eight weeks (seven to ten weeks). There were no major complications related to the treatment. Two patients complained about skin irritation around the sides of the prominent distal ends of the nails. Implant removal took place at an average of 5.8 months post-operatively as an outpatient procedure. There were no observed complications in association with the removal of the hardware. At the final follow-up, the mean Neer shoulder score was 96.65 (range 83-100). Thirty patients were very satisfied with their surgical outcomes and the remaining seven were satisfied. Function of the affected arm returned to normal at the end of the follow-up period in all cases.
Conclusions:
Combining closed or open reduction with TEN fixation is recommended for treating severely displaced proximal humeral fractures in children. Our data showed evidence of satisfactory outcomes with a low complication rate and a fast return to normal mobility of the affected arms.
