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Operative Versus Nonoperative Management of Pediatric Proximal Humerus Fractures: A Meta-Analysis and Systematic
Hae-Ryong Song1, Mi Hyun Song2
1Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea.
Clinics in Orthopedic Surgery
|December 4, 2023
Summary
Operative treatment for pediatric proximal humerus fractures is used in 33% of cases, increasing to 60% for severe displacements. Older age and severe displacement significantly influence the decision for surgical intervention in pediatric humerus fractures.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Proximal humerus fractures represent 2% of pediatric fractures.
- Nonoperative management is typical, but operative treatment for displaced fractures, especially in adolescents, remains debated.
- This meta-analysis examines demographic factors and treatment strategies for pediatric proximal humerus fractures.
Approach:
- A systematic literature search was performed across major databases (Embase, Medline, PubMed, Cochrane Library).
- Data extracted included demographics, fracture classification (Neer-Horwitz, Salter-Harris), and treatment methods (operative vs. nonoperative).
- Statistical analysis utilized odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs).
Key Points:
- Overall, 33% of pediatric proximal humerus fractures received operative treatment, while 67% were managed nonoperatively.
- Severely displaced fractures (OR, 10.00) and older patient age (WMD, 3.26) were significantly associated with operative treatment.
- Percutaneous pinning and intramedullary nailing showed no significant difference in preference for surgical techniques (OR, 5.09).
Conclusions:
- The operative treatment rate for pediatric proximal humerus fractures is 33%, rising to 60% for Neer-Horwitz grade III/IV fractures.
- Severely displaced fractures and older age are key factors influencing the decision for operative treatment.
- Surgical technique selection may depend more on fracture location than surgeon preference.
