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Minerva Orthopedics 2021 February;72(1):7-14

DOI: 10.23736/S2784-8469.20.04036-9


language: English

Proximal humerus fractures in children and adolescents

Federico CANAVESE 1 , Flavia ALBERGHINA 2, Alain DIMEGLIO 3, Antonio ANDREACCHIO 4

1 Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Center, Lille, France; 2 Department of Pediatric Orthopedic Surgery, Regina Margherita Children’s Hospital, Turin, Italy; 3 Department of Pediatric Orthopedics, St. Roch Clinic, Montpellier, France; Department of Pediatric Orthopedic Surgery, Buzzi Children’s Hospital, Milan, Italy

INTRODUCTION: When performing surgical treatment in skeletally immature patients with displaced proximal humerus (PH) fractures controversy exists. In particular, there is not an absolute consensus of acceptable angulation and translation for children and adolescents with displaced PH fractures.
EVIDENCE ACQUISITION: The literature search was completed using the Medline and Embase databases from January 1980 to June 2020 for articles using the following search terms: “proximal humerus,” “fractures,” “children” and “adolescents.”
EVIDENCE SYNTHESIS: The overall outcomes of PH fractures in skeletally immature patients were reported to be good to excellent; the number of reported malunions was low and were well tolerated at the last follow up. Almost all patients were able to resume to pre-injury activities; a limited number of patients experienced some residual pain and limited loss of motion. The literature suggest that in patients between 5 and 12 years of age, up to 60-70° of angulation and up to 60% of translation can be accepted; on the other hand, up to 25-35° of angulation and up to 40% of translation can be accepted in children >12 years of age.
CONCLUSIONS: Almost any fracture in children and preadolescents can be managed without surgery, given the tremendous healing and remodeling potential as well as the range of motion of the shoulder joint which can compensate for malunion. Although no consensus of acceptable angulation and translation has been reached so far, surgery is indicated in older children and in patients with unstable fracture pattern. For patients closer to skeletal maturity, when the remodeling potential is diminished, one might consider surgical treatments to improve fracture alignment and reduce the possibility of malunion.

KEY WORDS: Humerus; Epiphyses; Fractures, bone; Child

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