Modified Velpeau Sling Application for the Treatment of Fractures Around Shoulder in Infants

Abstract

Background: Fractures around the shoulder region in infants are treated by arm-chest bandaging, adhesive strapping, or sling application. These conventional treatment methods are associated with issues like skin irritation, excoriation, movement of bone fragments causing muscle spasm, and difficulty in nursing care. We describe the technique of modified Velpeau sling application and reviewed its efficacy at a long-term follow-up. Methods: A retrospective study was conducted with 19 infants who presented between 2009 and 2018 to a tertiary care center in western India with either clavicle or humerus fracture. Inclusion criteria was any infant with humerus or clavicle fracture that underwent modified Velpeau sling application and had a minimum follow-up of 2 years. Patients were followed at weekly intervals until sling discontinuation based on the fracture healing. At further follow-up, children were assessed for the presence of angular or rotational malalignment and limb length discrepancy. Functional outcome was measured by the Paediatric Adolescent Shoulder Survey at the final follow-up. Results: Seven clavicle and 12 humerus fractures were treated with this technique. The mean age at presentation was 50 days (range, 1 d to 7 mo). The average follow-up was 6 years (range, 2 to 10 y). Two infants had underlying osteogenesis imperfecta. Infants without underlying pathology had no angular/rotational malalignment or limb length discrepancy, while both infants with underlying osteogenesis imperfecta had a varus alignment and shortening of the humerus. Infants without underlying pathology demonstrated good functional outcomes measured by the Paediatric Adolescent Shoulder Survey questionnaire, while those with pathology had functional limitations. Conclusions: The modified Velpeau method is an effective way of treating fractures around the shoulder region in infants without underlying pathology. Several advantages such as accessibility of sling material, easy application, inexpensive material, and absence of skin-related complications make this an effective treatment. Level of Evidence: Level IV—therapeutic study.

Analysis of Efficacy, Complications, and Inflammatory Reactions of Bridge Combined Internal Fixation System for Periarticular Fractures of the Shoulder

“…For such fractures, conservative treatment methods, such as arm sling and spica bandages, are usually used [14]. However, the application of these traditional 3 Computational and Mathematical Methods in Medicine treatments has limitations such as poor efficacy, bone fragment movement, and nursing difficulties [15]. Therefore, it is of great practical significance to change the treatment methods to improve the curative effect and safety in view of various hindrances in the past treatment of such fractures.…”

Is There a Role for Isolated Closed Reduction in the Emergency Department Without Fixation for Displaced Proximal Humerus Fractures in Adolescents?

“…Nonoperative treatment of these fractures in pediatric patients has been found to yield optimal results. [16][17][18] PHFx have immense remodeling potential in the pediatric and younger adolescent population 19,20 which may obviate the need for anatomic reduction in patients with growth potential. Treatment for patients near skeletal maturity, however, is still not well established.…”

“…Our study differs from most in its prospective design and selection of only displaced fractures. Nonoperative treatment of these fractures in pediatric patients has been found to yield optimal results 16–18 . PHFx have immense remodeling potential in the pediatric and younger adolescent population 19,20 which may obviate the need for anatomic reduction in patients with growth potential.…”

Challenges in Management of Proximal Humerus Diaphyseal Fracture in a Patient with Brachial Plexus Birth Injury

“…In children younger than 10 years, up to 60° angulation can be expected to remodel. Various treatment modalities, such as modified Velpeau sling 5 , plaster immobilization, and strapping, are recommended at this age 6 . However, in the setting of neuromuscular disorders or nerve palsies, the altered muscular forces at the fracture site can lead to unpredictable remodelling 7 .…”