Comparison of conservative treatment outcomes for proximal humeral epiphyseal fractures in patients of different ages

Wei, Shengwang; Shi, Zhanying; Zhao, Yongliang; Wu, Hao; Hu, Jian; Huang, Zhanzhu; Zhao, Jinmin

doi:10.1007/s00132-018-03677-3

Cited by 6 publications

(22 citation statements)

References 17 publications

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“…15 No study demonstrated a significant difference between the degree of deformity at final follow-up for patients treated surgically versus nonoperatively, or for patients aged greater or less than 12 years. 6,13,14 There were no cases of non-union reported in any study. 6,9,11,13,[42][43][44] Table 3 shows the relative numbers of complications for each grade as per the Clavien-Dindo classification.…”

Section: Complications Reportedmentioning

confidence: 74%

“…There was a general consensus in the studies written since 2013 that adolescents managed conservatively for severely displaced fractures are at risk of a poorer clinical outcome. 6,9,10,13,14,21,[41][42][43][44] Excellent outcomes were observed for patients ≥12 years with severely displaced PHFs treated surgically with K-wire fixation, 6,14,44 ESIN, 9,14,42,43 and external fixator. 10,44 Pavone et al 6 reported only two adolescent patients with Grade IV PHFs who had a "fair" outcome following surgery; the remaining 14 patients with Grade IV fractures treated surgically had either a good or excellent outcome.…”

Section: Discussionmentioning

confidence: 93%

“…Studies including only physeal fractures. All participants in the study by Wei et al 13 were managed conservatively for physeal PHFs of all grades of severity. A significantly higher number of cases in the <11-year-old group had an "excellent" rather than "good" CMS at 2-year follow-up compared with the ≥11-year-old group (p < 0.05).…”

Section: Functional Outcomesmentioning

confidence: 99%

“…7 These fractures have a profound ability to remodel, as the proximal humeral growth plate is responsible for 80% of humeral longitudinal growth. [8][9][10][11][12][13][14] The glenohumeral joint has the widest range of motion of any joint in the body and can accommodate a 1117445C HOXXX10.…”

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confidence: 99%

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Predictors of outcomes of proximal humerus fractures in children and adolescents: A systematic review

Abbot

Proudman

Ravichandran

et al. 2022

Journal of Children's Orthopaedics

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Purpose: Minimally displaced pediatric proximal humerus fractures can be reliably managed non-operatively; however, there is considerable debate regarding the appropriate management of severely displaced proximal humerus fractures, particularly in older children and adolescents with limited remodeling potential. The purpose of this study was to perform a systematic review to answer the questions: “What are the functional and quality-of-life outcomes of pediatric proximal humerus fractures?” and “What factors have been associated with a poorer outcome?” Methods: A review of Medline and Embase was performed on 4 July 2021 using search terms relevant to proximal humerus fractures, surgery, non-operative management, pediatrics, and outcomes. Studies including ≥10 pediatric patients with proximal humerus fractures, which assessed clinical outcomes by use of an established outcome measure, were selected. The following clinical information was collected: participant characteristics, treatment, complications, and outcomes. Results: Twelve articles were selected, including four prospective cohort studies and eight retrospective cohort studies. Favorable outcome scores were found for patients with minimally displaced fractures, and for children aged less than 10 years, irrespective of treatment methodology or grade of fracture displacement. Older age at injury and higher grade of fracture displacement were reported as risk factors for a poorer patient-reported outcome score. Conclusion: An excellent functional outcome can be expected following non-operative management for minimally displaced pediatric proximal humerus fractures. Prospective trials are required to establish a guideline for the management of severely displaced proximal humerus fractures in children and adolescents according to fracture displacement and the degree of skeletal maturity. Level of evidence: level V.

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Section: Complications Reportedmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 93%

Section: Functional Outcomesmentioning

confidence: 99%

mentioning

confidence: 99%

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Predictors of outcomes of proximal humerus fractures in children and adolescents: A systematic review

Abbot

Proudman

Ravichandran

et al. 2022

Journal of Children's Orthopaedics

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“…In this study, we also noted a decreasing trend in operative management over time. For instance, the rate of operative management of proximal humerus fractures in adolescents decreased from 15 20 Lastly, another consideration is the cost of operative treatment. Our study showed that operative treatment had a 12.5 times higher billed cost ($22046) compared to nonoperative treatment ($1760), and this information should be offered during shared decision-making.…”

Section: Discussionmentioning

confidence: 99%

Decreasing Rate of Operative Management of Proximal Humerus Fractures in Adolescents: A National Database Study

Kim¹,

Swarup²

2022

Journal of the Pediatric Orthopaedic Society of North America

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Background: There is no consensus on the operative treatment of adolescent proximal humerus fractures. The purpose of this study was to investigate the trends in treatment of proximal humerus fractures in adolescents and identify predictors of operative management. Methods: The Pediatric Health Information System database was used to identify patients ages 10 to 18 diagnosed with proximal humerus fractures between 2004 to 2019. Open fractures were excluded from the analysis. Descriptive, univariate, and multivariate analyses were used to determine trends and predictors of operative management. Results: A total of 17,515 proximal humerus fracture admissions were identified and 2081 (11.9%) were treated operatively. The mean age was 12.5 years and 37.5% of patients were female. The rate of operative management decreased from 15.1% to 8.9 during the study period (p<0.01). There was a higher rate of operative management in boys (13.4% vs. 9.4%, p< 0.01). The operative cohort was older (13.4 years vs. 12.4 years, p<0.01), and patients who lived in rural areas had twice the rate of operative management (20.7% vs. 10.8%, p<0.01). Operative patients had higher billed charges and longer hospital stay (p < 0.05), but there was no significant difference in mean estimated household income between operative and nonoperative groups (p > 0.05). A multivariate analysis showed increased odds of operative management with older age (OR 1.32, 1.29-1.36), and residence in the South (OR 1.19, 1.05-1.34). The odds of operative management were lower in more recent years (OR 0.94, 0.93-0.95) and in urban settings (OR 0.41, 0.35-0.47). Conclusion: From 2004 to 2019, there has been a significant decrease in the rate of operative management of adolescent proximal humerus fractures at children’s hospitals. Patients who are older, male, or reside in rural areas or the South are more likely to be treated operatively.

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Outcomes of proximal humerus fractures in children: a retrospective cohort study

Abbot,

Proudman,

Bednarz

et al. 2024

ANZ Journal of Surgery

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ObjectivePaediatric 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.MethodsThe 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.ResultsOf 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.ConclusionThe 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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Comparison of conservative treatment outcomes for proximal humeral epiphyseal fractures in patients of different ages

Cited by 6 publications

References 17 publications

Predictors of outcomes of proximal humerus fractures in children and adolescents: A systematic review

Predictors of outcomes of proximal humerus fractures in children and adolescents: A systematic review

Decreasing Rate of Operative Management of Proximal Humerus Fractures in Adolescents: A National Database Study

Outcomes of proximal humerus fractures in children: a retrospective cohort study

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