title: Elastic stable intramedullary nailing versus Kirschner wire pinning: outcome of severely displaced proximal humeral fractures in juvenile patients.
abstract: BACKGROUND
  Significantly displaced juvenile proximal humeral fractures (Neer-Horowitz type 3 and 4) usually require reduction and fixation. The most commonly used fixation methods are Kirschner wire (K-wire) pinning or retrograde elastic stable intramedullary nailing (ESIN). However, results comparing the long-term outcome of both methods are absent in the literature. The aim of this study was to provide an outcome comparison of both techniques.
  
  
  METHODS
  Included were 40 patients treated between 1998 and 2008 and who had complete records concerning operation time, duration of hospital stay, and time until implant removal. The assessment of clinical (Disabilities of Arm, Shoulder and Hand [DASH] and Constant-Murley scores) and radiologic long-term outcome was possible in 31 patients (78%). Preoperative, postoperative and follow-up radiographs of these patients were evaluated for angular deformity, reduction, and remodeling.
  
  
  RESULTS
  The mean follow-up of the 31 patients (16 ESIN; 15 K-wire) was 5.8 ± 3.6 (standard deviation) years. The operative time of the primary fixation procedure was shorter in the ESIN group (P < .001), but the hospital stay and the time until implant removal were significantly longer. No significant difference was seen between the groups at follow-up for the mean DASH (ESIN, 1.44; K-wire, 1.66) or Constant-Murley (ESIN, 89.5; K-wire, 92) scores. The neck-shaft angle was significantly improved by reduction in both groups (P < .001) and remained unchanged at follow-up.
  
  
  CONCLUSIONS
  ESIN and K-wire pinning have a favorable and comparable functional outcome and therefore seem to be adequate methods for treating Neer-Horowitz type 3 and 4 proximal humeral fractures in juvenile patients. The initially achieved improvement of the neck-shaft angle can be maintained at long-term follow-up.
authors.affiliation: Department of Paediatric Orthopaedics, Medical University of Graz, Graz, Austria. Electronic address: tanja.kraus@medunigraz.at.
authors.forename: Tanja
authors.initials: T
authors.lastname: Kraus
authors.affiliation: Department of Paediatric Orthopaedics, Medical University of Graz, Graz, Austria.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hoermann
authors.affiliation: Department of Paediatric Orthopaedics, Medical University of Graz, Graz, Austria.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Ploder
authors.affiliation: Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Silvia
authors.initials: S
authors.lastname: Zoetsch
authors.affiliation: Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Eberl
authors.affiliation: Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Singer
mesh_terms: D000293:Adolescent; D001858:Bone Nails; D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D011859:Radiography; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: displaced; growing skeleton; proximal humeral fractures