Open plate fixation in displaced pediatric proximal humerus fractures is safe and leads to very good functional
Sebastian Oenning1, Philipp A Michel2, Imke Vehring2
1Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Waldeyer Straße 1, 48149, Muenster, Germany. Sebastian.oenning@ukmuenster.de.
Insights
Plate fixation is a safe surgical option for displaced pediatric proximal humerus fractures (PHF) in patients with limited growth potential. This method yields excellent functional outcomes, with complications primarily related to surgical invasiveness and implant removal.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Displaced pediatric proximal humerus fractures (PHF) often require surgical intervention.
- Soft tissue interposition can complicate closed reduction, necessitating open techniques.
- While K-wire fixation and ESIN are common, plate fixation is an alternative for specific cases.
Purpose of the Study:
- To evaluate the outcomes of pediatric PHFs treated with plate fixation.
- To assess functional and radiological results in a cohort of young patients.
Main Methods:
- Retrospective case series of 18 pediatric patients with displaced PHFs treated with plate fixation.
- Mean age at trauma was 12.1 years, with a mean follow-up of 6.52 years.
- Postoperative assessments included range of motion, clinical scores (SST, SSV, ASES, PASS, DASH), and radiological parameters.
Main Results:
- Excellent functional outcomes reported across multiple clinical scores (SST, SSV, ASES, PASS).
- 17 out of 18 patients achieved excellent results on the DASH score.
- All fractures healed without complications; 8 patients reported bothersome scars. Implant positioning and timing of removal did not negatively impact outcomes.
Conclusions:
- Plate fixation is a safe and effective treatment for displaced pediatric PHFs in patients with limited growth potential.
- Good to excellent functional outcomes are achievable irrespective of fracture morphology or implant positioning.
- Considerations include the higher invasiveness of plate fixation and the necessity for implant removal.
Introduction:
In displaced pediatric proximal humerus fractures (PHF), surgical treatment ranges from closed to open procedures. Soft tissue interposition can impede closed reduction, making open techniques necessary. While K-wire fixation and elastic stable intramedullary nailing (ESIN) lead to good results, plate fixation could be an alternative in patients with limited growth potential and highly unstable or insufficiently retained fractures. Only few studies with low sample sizes have assessed plate fixation, yet. In this study, the outcome of pediatric PHFs treated with plate fixation was evaluated.
Materials And Methods:
We present a retrospective case series of 18 patients with open growth plates and unilateral, displaced PHFs, treated with plate fixation. The mean age at trauma was 12.1 years (± 2.4), the mean follow-up was 6.52 years (± 4.37). A mean fracture angulation of 32.3° (± 10.89°) was seen. Postoperative assessments included range of motion, clinical scores [Simple Shoulder Test (SST), Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES) Shoulder Score, Pediatric/Adolescent Shoulder Score (PASS), Disabilities of Arm, Shoulder and Hand (DASH) Score], radiological parameters and subjective satisfaction.
Results:
All patients showed excellent results in SST (99.4% ± 0.02), SSV (98.3% ± 0.04), ASES-score (100% ± 0) and PASS (0.99 ± 0.01). In the DASH-score, 17 patients had excellent results, one patient showed a good outcome. Fracture healing occurred in all patients without complications. Eight patients complained about bothering scars. Age, gender and fracture morphology did not affect the outcome. Revision surgery after secondary fracture dislocation did not show a worsened outcome compared to primary plate fixation. Physeal growth plate bridging implants did not worsen the outcome. The timing of implant removal within the first 6 months postoperatively did not affect long-term function.
Conclusion:
Plate fixation is a safe option in pediatric patients with limited growth potential and highly displaced PHFs. Plate fixation led to a good to excellent functional outcome, regardless of fracture morphology and implant positioning. A higher invasiveness and the need for implant removal must be considered.
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