Which Proximal Humerus Fractures Should Be Pinned? Treatment in Skeletally Immature Patients.
Most proximal humerus fractures in skeletally immature individuals are treated nonoperatively with excellent functional results. Extensive remodeling of the proximal humerus and the wide arc of motion of the glenohumeral joint accommodate a large degree of fracture displacement and angulation. The treatment of severely displaced fractures and/or severely angulated fractures continues to be debated. Older patients and those with significantly displaced fractures may benefit from surgery because of their inability to remodel displacement and angulation during their limited remaining growth. The decision to treat a proximal humerus fracture in a skeletally immature patient operatively versus nonoperatively is dependent on the following 3 factors: displacement, bone age, and capacity to remodel. There is an increasing trend toward treating severely displaced and severely angulated fractures surgically, especially in older patients and adolescents. Smooth wires, percutaneous threaded wires, cannulated screws, and retrograde elastic stable intramedullary nailing are acceptable options for fixation.
*Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine †Division of Orthopaedic Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Erik C B
EC
King
Stephanie B
SB
Ihnow
D000293:Adolescent; D001858:Bone Nails; D016723:Bone Remodeling; D001864:Bone Wires; D002648:Child; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017759:Fractures, Malunited / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging / Q000293:injuries; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology; D016059:Range of Motion, Articular; D012784:Shoulder Fractures / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D012785:Shoulder Joint / Q000503:physiopathology*; D016896:Treatment Outcome