Closed/open reduction and titanium elastic nails for severely displaced proximal humeral fractures in children

Purpose

The aim of the study was to evaluate the clinical outcome of closed/open reduction and titanium elastic nails (TENs) in children with severely displaced proximal humeral fractures.

Methods

A retrospective study was performed on 37 children suffering from proximal humeral fracture between April 2009 and July 2012. All these patients were treated by closed or open reduction with TEN fixation. The healing process was assessed by radiographic and clinical follow-up for up to 36 months. Radiographic assessment was performed on the scheduled follow-ups to examine fracture healing, remodelling, bone growth and residual deformity. The clinical outcomes were evaluated using the Neer shoulder score and patients’ satisfaction report at the final follow-up. Complications related to the treatment were also recorded.

Results

All patients had a mean follow-up period of 24 months (12–36) after surgery. All fractures were healed, radiologically, at a median time of eight weeks (seven to ten weeks). There were no major complications related to the treatment. Two patients complained about skin irritation around the sides of the prominent distal ends of the nails. Implant removal took place at an average of 5.8 months post-operatively as an outpatient procedure. There were no observed complications in association with the removal of the hardware. At the final follow-up, the mean Neer shoulder score was 96.65 (range 83–100). Thirty patients were very satisfied with their surgical outcomes and the remaining seven were satisfied. Function of the affected arm returned to normal at the end of the follow-up period in all cases.

Conclusions

Combining closed or open reduction with TEN fixation is recommended for treating severely displaced proximal humeral fractures in children. Our data showed evidence of satisfactory outcomes with a low complication rate and a fast return to normal mobility of the affected arms.