Open plate fixation in displaced pediatric proximal humerus fractures is safe and leads to very goodfunctional outcomes

Oenning S, Michel PA, Vehring I, Heilmann L, Katthagen JC, Raschke MJ

Zusammenfassung

IntroductionIn displaced pediatric proximal humerus fractures (PHF), surgical treatment ranges from closed to open procedures. Soft tissue interposition can impede closed reduction, making open techniques necessary. While K-wire fixation and elastic stable intramedullary nailing (ESIN) lead to good results, plate fixation could be an alternative in patients with limited growth potential and highly unstable or insufficiently retained fractures. Only few studies with low sample sizes have assessed plate fixation, yet. In this study, the outcome of pediatric PHFs treated with plate fixation was evaluated.Materials and methodsWe present a retrospective case series of 18 patients with open growth plates and unilateral, displaced PHFs, treated with plate fixation. The mean age at trauma was 12.1 years (+/- 2.4), the mean follow-up was 6.52 years (+/- 4.37). A mean fracture angulation of 32.3 degrees (+/- 10.89 degrees) was seen. Postoperative assessments included range of motion, clinical scores [Simple Shoulder Test (SST), Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES) Shoulder Score, Pediatric/Adolescent Shoulder Score (PASS), Disabilities of Arm, Shoulder and Hand (DASH) Score], radiological parameters and subjective satisfaction.ResultsAll patients showed excellent results in SST (99.4% +/- 0.02), SSV (98.3% +/- 0.04), ASES-score (100% +/- 0) and PASS (0.99 +/- 0.01). In the DASH-score, 17 patients had excellent results, one patient showed a good outcome. Fracture healing occurred in all patients without complications. Eight patients complained about bothering scars. Age, gender and fracture morphology did not affect the outcome. Revision surgery after secondary fracture dislocation did not show a worsened outcome compared to primary plate fixation. Physeal growth plate bridging implants did not worsen the outcome. The timing of implant removal within the first 6 months postoperatively did not affect long-term function.ConclusionPlate fixation is a safe option in pediatric patients with limited growth potential and highly displaced PHFs. Plate fixation led to a good to excellent functional outcome, regardless of fracture morphology and implant positioning. A higher invasiveness and the need for implant removal must be considered.