Treatment of proximal humerus fractures in children with a modified palm tree technique

Although most pediatric proximal humeral fractures can be successfully treated conservatively with satisfactory results, many operative techniques have been described for the treatment of displaced proximal humeral fractures. The aim of this study is to evaluate the efficacy of percutaneous fixation using a modified palm tree technique for proximal humerus fractures in children. Between March 2011 and May 2013, the modified palm tree technique was used for the management of 30 children (20 boys and 10 girls) with displaced proximal humeral fractures. The average age of the patients was 11.5 years (age range from 8 to 15 years). They were evaluated clinically by the Constant-Murley score and by radiological analysis. The average follow-up duration was 18 months. The average time of fracture union was 6 weeks (range from 4 to 8 weeks). The average Constant score of the patients was 92 (range from 87 to 95), with excellent results in 27 (90%) cases, good results in three (10%) cases, and no fair or poor results (0%). The reported complications were superficial pin-tract infection in five cases, treated by daily dressing and local antibiotics, and malunion with a varus deformity in two cases (about 15°), with no recorded cases with deep infection. None of the cases required open reduction. No cases were complicated by avascular necrosis of the head humerus or loss of fixation. Kirschner wires were removed after an average period of 7 weeks. The modified palm tree technique represents an efficient method for the treatment of proximal humerus fractures in children. It produces a good grip in both the proximal and distal fragments. It allows for early joint movements.