Displaced humeral shaft fractures in children and adolescents: results and adverse effects in patients treated by elastic stable intramedullary nailing

Marengo, Lorenza; Rousset, Marie; Paonessa, Matteo; Vanni, S.; Diméglio, Alain; Samba, Antoine; Andreacchio, Antonio; Canavese, Federico

doi:10.1007/s00590-016-1758-y

Cited by 17 publications

(7 citation statements)

References 20 publications

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“…Closed reduction with ESIN fixation of humeral shaft fractures has the advantages of being minimally invasive, providing rigid fixation, and shortening the hospital stay, and is accepted by an increasing number of patients (7,8,15). As the fracture site cannot be viewed directly during closed reduction, it is necessary to repeatedly check radiographs during the operation to determine the extent of fracture reduction and position of the ESIN.…”

Section: Discussionmentioning

confidence: 99%

“…Closed reduction and fixation with an elastic stable intramedullary nail (ESIN) is an excellent choice for the treatment of pediatric humeral shaft fractures, especially for older children. The advantages of this approach include minimal invasiveness, rigid fixation of fracture sites, a short hospitalization, and early postoperative functional recovery, although complications such as skin lesions, surgical site infection, and iatrogenic fracture can arise (7,8). Additionally, both patients and doctors are exposed to high-dose radiation from X-rays used to visualize a closed fracture site with traditional surgical methods (9,10).…”

Section: Introductionmentioning

confidence: 99%

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Elastic Stable Intramedullary Nailing for Pediatric Humeral Shaft Fractures Under Ultrasonographic Guidance: A Retrospective Study

Zhang

et al. 2022

Front. Pediatr.

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ObjectiveFixation with an elastic stable intramedullary nail (ESIN) is a widely used technique for the treatment of humeral shaft fractures. Ultrasonography (US) is used as an auxiliary tool and alternative to radiography during surgery to reduce radiation damage, but whether it is effective in pediatric patients is not known. In this study we evaluated the utility of US in the treatment of pediatric humeral shaft fractures by closed reduction and fixation with an ESIN.MethodsChildren who were admitted to our hospital with humeral shaft fractures were retrospectively examined from January 2016 to March 2019. The patients were divided into 2 groups, US (treated by US-guided closed reduction and ESIN fixation) and non-US (treated with the same technique but with intraoperative radiography instead of US). The postoperative functional recovery of the 2 groups was compared.ResultsThe study population comprised 28 boys and 17 girls (age range: 4–16 years) with humeral shaft fractures. US significantly reduced radiation exposure during the operation (P = 0.008), and intraoperative US facilitated the detection of nerve and vascular injury and aided surgical planning. There was no difference between the 2 groups in postoperative recovery based on the Constant–Murley shoulder score (CMS).ConclusionsThese results demonstrate that US-guided closed reduction and ESIN fixation for humeral shaft fractures can limit radiation exposure and help doctors to determine the optimal surgical strategy to avoid radial nerve injury.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Elastic Stable Intramedullary Nailing for Pediatric Humeral Shaft Fractures Under Ultrasonographic Guidance: A Retrospective Study

Zhang

et al. 2022

Front. Pediatr.

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“…Obviously, the abbreviated form is simpler, but another explanation may be that QuickDASH does not include tasks irrelevant for children such as item 12 (changing an overhead lightbulb) or item 21 (sexual activities) included in the DASH. However, QuickDASH has not be used in children with learning impairment [33] and the parents' help might be asked to answer the questionnaire when the functional outcome is assessed in patients younger than 8 years [25]. Moreover, there are no defined parameters of correspondence between an excellent, good, satisfactory or poor outcome and the DASH or QuickDASH score.…”

Section: Discussionmentioning

confidence: 99%

Review of pediatric functional outcomes measures used to evaluate surgical management in pediatric patients with an upper extremity fracture

Alberghina

Andreacchio

Pavone

et al. 2021

Journal of Pediatric Orthopaedics B

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For two decades, many scores, questionnaires, and rating systems have been used to evaluate the functional outcome of children with an upper extremity fracture (UEF). However, only a few of these were created specifically for children, and many assess only elbow function. In the absence of any published review on this topic, we set out to identify and categorize different scores used to evaluate the clinical and functional outcomes of surgically treated pediatric UEFs. A literature search was performed, and 38 studies were identified. The scores used more often were the shortened version of the Disability of the Arm, Shoulder and Hand questionnaire and the Mayo Elbow Performance Score/Index. In a lower number of studies, authors used other scoring systems, including the Mayo Wrist Score, the Patient-Rated Wrist Evaluation, the Patient-Rated Elbow Evaluation, the Métaizeau functional scoring system, the Oxford Elbow Score, the Price and Flynn criteria, the Hardacre Functional Score, the Neer Shoulder Score, the Constant-Murley Shoulder Score, the Modified Orthopedic Trauma Association Score, the Medical Outcomes Study Short Form-36, and the Pediatric Outcomes Data Collection Instrument. Some specific pediatric scoring systems to evaluate the functional outcome of children with a UEF have been suggested, but a single tool that is valid and reliable for skeletally immature patients of all ages is not yet available. Further studies are needed to identify specific pediatric measurements to increase validity, responsiveness, sensitivity, and interpretability of upper limb functional outcome scores in common clinical practice.

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“…Shaft fractures of the humerus comprise only 2-5% of all childhood fractures (1). They usually occur because of a direct trauma, where the trauma energy is usually high.…”

Section: Introductionmentioning

confidence: 99%

“…In children, the same procedures are available, including pinning, intramedullary rodding, screw fixation, compressive plating and external fixation ( 5 ). However, elastic stable intramedullary nailing (ESIN) has gained popularity since the literature in the field has increased recently ( 1 , 7 , 9 , 10 ). ESIN is a straightforward technique and it can be performed both in antegrade and retrograde direction ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not Changed

et al. 2020

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Introduction: Humeral shaft fractures have traditionally been treated non-operatively due to their good union and low rate of functional impairment. In the recent years, upper extremity fractures and their operative treatment have increased in children. Nevertheless, the trends of humeral shaft fractures are not clear. Materials and Methods: All children aged <16 years, with a humeral shaft fracture in the geographical catchment area of Northern Finland Hospital District, with a yearly child population-at-risk of ∼86 000 from the year 2001 until the end of 2015 were included. There were 88 cases, who comprised the study population. Radiographs were available of all. Injury, patient, and treatment characteristics were reviewed from hospital databases. Results: There was an increasing trend of surgical fixation of humeral shaft fractures during the 15 years' study period (β = 1.266, 95% CI 0.17 to 2.36, p = 0.035). However, we found no patient or fracture-related reasons that could have explained the increasing trend of surgical care. Comminuted fracture increased the risk of operative treatment 8-fold (Odds Ratio, OR 7.82, 95% CI 1.69 to 36.3, p = 0.009). Higher age, greater angular deformity or greater diameter of the humerus were not associated with the increased operation risk. Conclusions: The treatment philosophy concerning pediatric humeral shaft fractures has presented a shift from conservative care to surgical fixation. To authors' understanding there is not evidence supporting the increasing rate of osteosynthesis.

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Displaced humeral shaft fractures in children and adolescents: results and adverse effects in patients treated by elastic stable intramedullary nailing

Cited by 17 publications

References 20 publications

Elastic Stable Intramedullary Nailing for Pediatric Humeral Shaft Fractures Under Ultrasonographic Guidance: A Retrospective Study

Elastic Stable Intramedullary Nailing for Pediatric Humeral Shaft Fractures Under Ultrasonographic Guidance: A Retrospective Study

Review of pediatric functional outcomes measures used to evaluate surgical management in pediatric patients with an upper extremity fracture

A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not Changed

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