title: Severely displaced proximal humeral epiphyseal fractures.
abstract: The purpose of this study was to document the late outcome of a group of patients with Neer grade III/IV proximal humeral physeal fractures who were treated with reduction of the fracture and maintenance of reduction until fracture consolidation. A total of 28 patients treated between 1984 and 1999 at a large children's hospital were included in this study. Nineteen of the 28 patients were 15 years or older (range 5-16 y). All patients were treated in the operating room with closed reduction followed by immobilization (n = 3), closed reduction and pin fixation (n = 20), open reduction and screw fixation (n = 3), or open reduction and pin fixation (n = 2). Postoperatively, all had Neer grade I or II displacement, which was maintained until fracture union. No operative or postoperative complications occurred. At an average follow-up of 4 years, all patients had near-normal glenohumeral motion and excellent strength and uniformly reported regaining full preinjury functional use of the involved extremity. Achieving and maintaining reduction in Neer grade III/IV proximal humeral epiphyseal fractures can be safely performed and results in excellent long-term shoulder function. This is of particular significance in the older adolescent who has minimal remodeling potential.
authors.affiliation: St. Louis Shriners Hospital for Children, Missouri, USA. mattdobbs@earthlink.net
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Dobbs
authors.forename: Scott L
authors.initials: SL
authors.lastname: Luhmann
authors.forename: J Eric
authors.initials: JE
authors.lastname: Gordon
authors.forename: William B
authors.initials: WB
authors.lastname: Strecker
authors.forename: Perry L
authors.initials: PL
authors.lastname: Schoenecker
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004838:Epiphyses / Q000293:injuries*; D005260:Female; D005592:Fracture Fixation; D006801:Humans; D008297:Male; D011859:Radiography; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome