Challenges in Management of Proximal Humerus Diaphyseal Fracture in a Patient with Brachial Plexus Birth Injury: A
Maulin M Shah1, Meet Jain, Godhasiri Ponugoti
1Orthokids Clinic, Ahmedabad, India.
Insights
Pediatric brachial plexus birth injury can lead to complex humeral shaft fractures. Rigid internal fixation is crucial for achieving union and correcting deformity in challenging pediatric fracture cases.
Area of Science:
- Pediatric Orthopedics
- Pediatric Trauma Surgery
- Pediatric Fracture Management
Background:
- Brachial plexus birth injury (BPBI) can predispose children to fractures.
- Proximal humeral diaphyseal fractures in infants present unique management challenges.
- Failure to remodel can lead to significant angular deformity.
Case:
Two-and-a-half-month-old boy, a known case of brachial plexus birth injury, sustained proximal humeral diaphyseal fracture. Fracture healed in varus malunion and failed to remodel subsequently. Challenges were faced in the course of the management because of progression of the deformity. Finally, the fracture united after rigid internal fixation performed at 2.5 years.
Conclusion:
Neuromuscular imbalance can lead to angular deformity at fracture site and cause unpredictable remodeling, as in our case. Conservative management may fail to achieve union with satisfactory alignment. Rigid internal fixation should be considered in such cases to achieve union.
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