Elastic stable intramedullary nailing versus Kirschner wire pinning: outcome of severely displaced proximal humeral fractures in juvenile patients

Kraus, Tanja; Hoermann, Stefanie; Ploder, Gudrun; Zoetsch, Silvia; Eberl, Robert; Singer, Georg

doi:10.1016/j.jse.2014.01.015

Cited by 30 publications

(37 citation statements)

References 19 publications

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“…All of them had favourable functional results. [ 27 ] The same result was reported by Giebel et al; the range of age in their study was 13 to 16 years. [ 29 ] All of the patients had a good to excellent function at the final follow-up.…”

Section: Resultssupporting

confidence: 86%

“…[ 6 , 29 ] The remaining complication was a superficial skin irritation leading to an early removal of K-wires. [ 27 ] The elevated risk of complications after open reduction should therefore entail an avoidance of open reposition.…”

Section: Discussionmentioning

confidence: 99%

“…This is backed up by the fact that the studies which have been published since 2010 have only treated this subject. [ 12 – 15 , 26 , 27 ] Since 2000 only two studies meeting the inclusion criteria comprising more than 3 patients have been published which evaluated conservative treatment options for significantly displaced fractures. [ 26 , 30 ]…”

Section: Discussionmentioning

confidence: 99%

“…Limitations of this meta-analysis and review naturally correspond to the limitations of the single studies included, such as study design and the use of shoulder scores as outcome parameters, which are not validated for children and adolescents. [ 27 ] A publication bias could not be excluded which is due to the small study size (small study sizes show large effects.). Since proximal humerus fractures are rare fractures of children, studies usually were of a retrospective nature (18/19 studies).…”

Section: Discussionmentioning

confidence: 99%

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Age- and severity-adjusted treatment of proximal humerus fractures in children and adolescents—A systematical review and meta-analysis

et al. 2017

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BackgroundFractures of the proximal humerus in patients under the age of 18 years show a low incidence; existing clinical studies only comprise small patient numbers. Different treatment methods are mentioned in the literature but a comparison of the outcome of these methods is rarely made. Up to now, no evidence-based algorithm for conservative and operative treatment is available. The aim of this systematic review with meta-analysis was therefore to gather the best evidence of different treatment methods and their associated functional outcome, complication rates, rates of limb length discrepancies and radiological outcome.Methods and findingsThe OVID database was systematically searched on September 30th in 2016 in order to find all published clinical studies on the subject of proximal humerus fractures of patients ≤18 years. Exclusion criteria were previously defined. The Coleman Methodology Score was used to evaluate the quality of the single studies. 886 studies have been identified by the search strategy. 19 studies with a total of 643 children (mean age: 11.8 years) were included into the meta-analysis with a mean Coleman Methodology Score of 71 ± 7.4 points. 18 of the 19 studies eligible for inclusion were retrospective ones, of the best quality available (mean follow-up ≥ 1 year, mean follow-up rate ≥ 65%). 56% of the patients were male. Proximal humerus fractures were treated conservatively in 41% and surgically in 59% of the cases (Elastic Stable Intramedullary Nailing (ESIN): 31%; K-wires: 20%; 8% other methods, e.g. plate osteosynthesis, olecranon traction). The overall success rate (good/excellent outcome) for all treatment methods was 93%. The success rate of ESIN (98%) and of K- wire fixation (95%) was significantly higher (p = 0.01) than the success rate of conservative treatment options (91%). A subgroup analysis of severely displaced fractures (Neer grade III/IV, angulation ≥ 20°) resulted in a change of success rates, to the disadvantage of conservative treatment methods (conservative treatment 82%, ESIN 98%, K-wires 95%; p < 0.001). Complication rates did not differ to a significant extent. 9% of the complications occurred in the patients treated by K-wire fixation, 8% if a conservative treatment option was chosen and 7% in the fractures that were stabilized by ESIN. A change from a one-nail technique to a two-nail technique reduced the complication rate of ESIN significantly. Follow-up X- rays without residual deformity could be found in 96% of the patients treated by ESIN, a rate which was higher than in the patients treated conservatively (93%) or by K-wire fixation (88%). The rate of arm length discrepancies at final follow- up was lower if the fractures were stabilized by ESIN (4%) than if they were treated conservatively (9%) or by K-wires (19%). An evaluation of age-dependent treatment options was performed.ConclusionsBy performing this meta-analysis an evidence-based treatment algorithm could be introduced to treat the fractures according to the severity of displacement and according...

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Section: Resultssupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Age- and severity-adjusted treatment of proximal humerus fractures in children and adolescents—A systematical review and meta-analysis

et al. 2017

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“…The indications of ESIN in humeral fractures vary depending on the fracture site: the proximal metaphysis or the diaphysis. In the fractures of the surgical neck of the humerus, ESIN is indicated because it reduces the period of immobilization required in the case of conservative treatment [ 6 , 9 – 12 ].…”

Section: Humeral Fracturesmentioning

confidence: 99%

Elastic stable intramedullary nailing for fractures in children – specific applications

Cosma

Vasilescu

2014

Medicine and Pharmacy Reports

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Elastic stable intramedullary nailing (ESIN) is a new minimally invasive technique for the treatment of pediatric fractures. It approximates the physiological healing process of bone, without opening the fracture site. Also, the operative stress is minimal because of the minimally invasive nature of the procedure, and the volume of implants is small, offering a very good stability without plaster cast immobilization.

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Paediatric Trauma Around the Shoulder

Ahmed

Ibrahim

2019

Textbook of Shoulder Surgery

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Elastic stable intramedullary nailing versus Kirschner wire pinning: outcome of severely displaced proximal humeral fractures in juvenile patients

Cited by 30 publications

References 19 publications

Age- and severity-adjusted treatment of proximal humerus fractures in children and adolescents—A systematical review and meta-analysis

Age- and severity-adjusted treatment of proximal humerus fractures in children and adolescents—A systematical review and meta-analysis

Elastic stable intramedullary nailing for fractures in children – specific applications

Paediatric Trauma Around the Shoulder

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