Three point fixation of pediatric proximal humerus fractures by prebent wave-shaped wires: technical notes
1Division of Orthopedic Surgery, Rambam Health Care Campus, Haifa, Israel.
Insights
Surgical intervention for displaced pediatric proximal humerus fractures (Neer-Horowitz grade III-IV) in older children can be effectively managed with a minimally invasive three-point fixation technique using Kirschner wires, leading to excellent outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Proximal humerus fractures in children are rare and typically managed non-operatively.
- Displaced fractures (Neer-Horowitz grade III-IV) in children over 11 years may warrant surgical consideration.
Observation:
- A novel three-point fixation technique using two pre-bent Kirschner wires inserted via a single cortical hole was employed.
- This minimally invasive approach was utilized to treat four pediatric patients with displaced proximal humerus fractures.
Findings:
- The technique achieved accurate reduction and stable fixation in all treated patients.
- Patients commenced pendulous exercises on the day following surgery.
- Full shoulder range of motion, absence of pain, and no complications were observed at follow-up.
Implications:
- This minimally invasive fixation method offers a viable surgical option for specific pediatric proximal humerus fractures.
- It facilitates early mobilization and promotes favorable functional recovery in young patients.
- Further research could explore long-term outcomes and broader application of this technique.
Abstract:
Pediatric proximal humerus fractures are uncommon and mostly treated conservatively. However, surgical treatment should be considered in displaced fractures classified as Neer-Horowitz grade III-IV in children older than 11 years. We describe a three-point fixation method of applying two Kirschner wires, prebent into a wave shape, and inserted into the proximal humerus through a single cortical hole. In this minimally invasive approach, we treated four boys, obtaining accurate reduction and stable fixation, with all patients starting pendulous exercises the day after surgery. At follow-up, all patients had regained full shoulder range of motion, with no residual pain and no complications recorded.
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