Proximal Humerus Fractures: What Alignment is Acceptable in Children 10 and Up?

Abstract

Background: Fractures of the proximal humerus in skeletally immature patients are rare, and even rarer still in individuals approaching skeletal maturity. Concepts regarding remodeling potential, amount of deformity and functional demands can guide our treatment decision making, but criteria are poorly defined. The purpose of this manuscript is to discuss the issues and the best available evidence. Methods: A search of the English literature was carried out using PubMed to identify papers on the topic of proximal humerus fractures in skeletally immature individuals. Results: The literature available on the topic of pediatric proximal humerus fractures is limited, especially regarding fractures in patients approaching skeletal maturity. Certainly, as the remodeling potential decreases and the amount of deformity and functional demand increase, the need for operative treatment increases. The exact tolerances and criteria have not been established. A variety of surgical techniques exist, and have been shown to be helpful. Conclusions: Operative treatment may be necessary in individuals approaching skeletal maturity. Concepts discussed in this paper regarding remodeling, amount of deformity and functional demand may help the surgeon to make appropriate treatment decisions. Future prospective comparative studies which are pending will hopefully shed further light on this matter.

Efficacy analysis of a double-Schanz screw external fixator combined with anti-rotating Kirschner wire in the treatment of proximal humerus fractures in skeletally immature patients

“…For proximal humeral fractures in adolescents, which patients need surgery and which surgical method is best remains controversial. Because the adolescent bone is closer to maturity and its plasticity is significantly reduced after fracture, which increases the risk of poor prognosis, numerous current studies support aggressive surgical treatment for displaced proximal humerus in adolescents [4,9] to achieve better fracture healing and functional outcomes. At present, the surgical fixation methods used include Kirschner wire, elastic stable intramedullary nails, cannulated screw and locking compression plate, etc.…”

Significant Asymmetry of the Bilateral Upper Extremities of a Skeleton Excavated from the Mashiki-Azamabaru Site, Okinawa Island, Japan

“…There are no obvious signs of fracture in the remaining skeleton of the left upper extremity, but it is still possible that there has been severe trauma to the nonremaining part of the body, especially to the proximal humerus. Fractures of the proximal humerus in patients who are skeletally immature or approaching skeletal maturity are rare, but it is now recognised that nonsurgical treatment generally leads to good functional results [ 32 , 33 ]. On the other hand, given the level of medical care and the environment in ancient times, it is possible that the fracture could have not been treated appropriately, leading to disuse atrophy.…”

Fracturas controvertidas de miembro superior en niños y adolescentes: un debate basado en la evidencia

“…Aunque estos valores no han sido consensuados, la mayoría de los autores toman como parámetro de tolerancia angulaciones superiores a 20-45 grados en pacientes mayores de 12 años. 59,61,65,[68][69][70][71] Debido a que la capacidad de remodelación va disminuyendo progresivamente a medida que el paciente se acerca a la madurez esquelética, el resultado podría empeorar con la edad si se opta por tratamiento conservador en una fractura con un desplazamiento no tolerable. Múltiples autores han demostrado una mayor incidencia de deformidades residuales, limitaciones en rango de movimiento y resul-www.medigraphic.org.mx tados funcionales indeseables en pacientes adolescentes tratados sin cirugía.…”