title: Midterm results of surgical treatment of displaced proximal humeral fractures in children.
abstract: OBJECTIVE
  To analyse the clinical outcomes of 26 children treated surgically for displaced proximal humerus fracture.
  
  
  METHODS
  From January 2008 to December 2012, 26 children/adolescents (14 boys, 12 girls) were treated surgically for displaced fractures at the proximal extremity of the humerus. Ten were grade III and 16 were grade IV according to the Neer-Horowitz classification with a mean age of 12.8 ± 4.2 years. Twenty young patients were surgically treated with a closed reduction and direct percutaneous pinning; six required an open approach. To obtain a proper analysis, we compared the Costant scores with the contralateral shoulder (Δ Costant).
  
  
  RESULTS
  The mean follow-up period was 34 months (range 10-55). Two grade IV patients showed a loss in the reduction after percutaneous treatment. This required open surgery with a plate and screws. On average, the treated fractures healed at 40 days. The mean Δ Costant score was 8.43 (range 2-22). There was a statistically significant improvement in the mean Δ Costant score in grade III patients. In grade IV patients, there was a significant improvement in the mean Δ Costant score in those treated with open surgery versus mini-invasive surgery.
  
  
  CONCLUSIONS
  Our study shows excellent results with percutaneous k-wires. This closed surgery had success in these patients, and the excellent outcomes noted here lead us to prefer the mini-invasive surgical approach in NH grade III fractures. In grade IV, the best results were noted in patients treated with open surgery. We suggest an open approach for these patients.
  
  
  METHODS
  III.
authors.affiliation: Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy. vitopavone@hotmail.com.
authors.forename: Vito
authors.initials: V
authors.lastname: Pavone
authors.affiliation: Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: de Cristo
authors.affiliation: Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cannavò
authors.affiliation: Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Testa
authors.affiliation: Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Buscema
authors.affiliation: Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Condorelli
authors.affiliation: Orthopaedic Clinic, AOU Policlinico- Vittorio Emanuele, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sessa
mesh_terms: D000293:Adolescent; D001860:Bone Plates; D001864:Bone Wires; D002648:Child; D005260:Female; D017759:Fractures, Malunited / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007558:Italy; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D000070799:Open Fracture Reduction / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017063:Outcome Assessment, Health Care; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000175:diagnosis / Q000601:surgery; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: Children; Epiphyseal injury; Fracture; Humerus; Surgical treatment