title: Treatment of proximal humerus fractures in children and young adolescents.
abstract: BACKGROUND
  Fractures of the proximal humerus in children are rare and represent approximately 0.45% of all paediatric fractures. These injuries are common in patients up to an age of 16 years. The treatment of displaced subcapital fractures is still controversially discussed in literature. Therefore the aim of this study was to evaluate the short-term outcome and to provide guidelines for surgical treatment of these fractures in children and adolescents.
  
  
  METHODS
  Clinical and radiological results of 231 patients between 0 and 17 years with subcapital humerus fractures were evaluated. Patients were devided according to their treatment as followed (1) conservative treatment group (2) operative treatment group.
  
  
  RESULTS
  A total of 191 patients (82.7%) underwent conservative treatment and 40 (17.3%) underwent operative treatment. Surgical treatment consisted of open reduction and internal fixation (ORIF) (35.0%) or closed reduction and internal fixation (CRIF) (52.5%). In all operated patients an axial deviation of more than 20° was observed preoperatively. According to our groups; the surgical group presented in 90% (N = 36) of the patients with an excellent result, in 5% (N = 2) an average result was observed and in 5% (N = 2) a poor result according to Constant Murley Score was achieved. In the conservative treatment group in 185 patients (96.9%) excellent results were achieved and in 6 patients (3.1%) an average result in the Constant Murley Score was achieved.
  
  
  CONCLUSIONS
  Conservative treatment in children < 10 years and an angulation angle < 20°, as well as surgical treatment with ORIF or CRIF in patients > 10 years and with an angulation angle > 20° leads to excellent short-term outcome. However, studies with longer observation time are needed to evaluate long-term complications like limb length discrepancy.
authors.affiliation: Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Harald
authors.initials: H
authors.lastname: Binder
authors.affiliation: Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. thomas.tiefenboeck@meduniwien.ac.at.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Tiefenboeck
authors.affiliation: Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Stephan
authors.initials: S
authors.lastname: Payr
authors.affiliation: Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Mark
authors.initials: M
authors.lastname: Schurz
authors.affiliation: Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Silke
authors.initials: S
authors.lastname: Aldrian
authors.affiliation: Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Kambiz
authors.initials: K
authors.lastname: Sarahrudi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000070628:Closed Fracture Reduction / Q000706:statistics & numerical data*; D000072700:Conservative Treatment / Q000706:statistics & numerical data*; D005260:Female; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data*; D017102:Fracture Healing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000070799:Open Fracture Reduction / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: CRIF; Children; ORIF; Proximal humerus fractures; Retrospective study