Outcomes of proximal humerus fractures in children: a retrospective cohort study
Samuel Abbot1,2,3, Susanna Proudman3, Jana Bednarz4,5
1Department of Orthopaedics and Trauma, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
Insights
Most paediatric proximal humerus fractures (PHFs) heal well regardless of treatment. More research is needed to determine surgical indications for severely displaced fractures in adolescents.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Paediatric proximal humerus fractures (PHFs) traditionally managed non-operatively.
- Debate exists regarding surgical management for severely displaced PHFs in older children.
Purpose of the Study:
- To review outcomes of paediatric patients treated for PHFs.
- To guide future management of paediatric PHFs.
Main Methods:
- Retrospective review of paediatric PHFs (2010-2020).
- Outcomes assessed via QuickDASH, SPADI, PODCI, and telehealth range-of-motion.
- Multivariable logistic regression identified predictors of poorer outcomes.
Main Results:
- 125 patients participated; 46 had poorer outcomes (QuickDASH ≥2).
- Fracture severity and age ≥12 years predicted poorer outcomes.
- No evidence suggested surgical superiority for these subgroups.
Conclusions:
- Most paediatric PHFs achieve acceptable outcomes regardless of treatment.
- Multicenter studies needed to define surgical indications for displaced adolescent PHFs.
Objective:
Paediatric proximal humerus fractures (PHFs) have historically been treated non-operatively. However, the management of severely displaced PHFs in older children has been debated over the years, with contemporary studies advocating for surgery. The purpose of this study was to review the outcomes of a cohort of paediatric patients treated for a PHF to guide management of future paediatric PHFs.
Methods:
The records of the Women's and Children's Hospital in South Australia were reviewed to identify paediatric PHFs occurring between 1 January 2010 and 1 June 2020. Participants completed the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), the Shoulder Pain and Disability Index, and the Paediatric Outcomes Data Collection Instrument via phone interview. Participants' shoulder range-of-motion was assessed via telehealth using Zoom. Multivariable logistic regression was used to identify patient and clinical variables that were associated with a poorer outcome.
Results:
Of 307 patients contacted, 125 participated. Forty-six patients met the definition of a poorer clinical outcome, defined as a QuickDASH score of ≥2. Fractures of greater severity were predictive of a poorer outcome, and patients aged ≥12 years old at the time of injury had higher total QuickDASH scores. The findings did not suggest that these subgroups of patients have superior outcomes if treated surgically.
Conclusion:
The majority of paediatric PHFs have an acceptable clinical outcome, irrespective of treatment methodology. Multicentre prospective studies are required to establish the indications for surgery for adolescent patients with severely displaced PHFs.
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