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Minerva Ortopedica e Traumatologica 2018 December;69(4):107-11

DOI: 10.23736/S0394-3410.18.03898-5


lingua: Inglese

Functional outcomes of the percutaneous pinning in the treatment of proximal humeral fractures in skeletally immature patients

Andrea VOTO , Raffaele D. D’AMATO, Federica FORMICONI, Carlo F. MINOLI, Laura PERETTO, Antonio MEMEO

Unit of Orthopedics and Pediatric Traumatology, ASST Gaetano Pini-CTO, Milan, Italy

BACKGROUND: Proximal humeral fractures represent a rare occurrence in pediatric age, representing only 0.45% of all the pediatric fractures. In 70% of the cases there is a fracture in the metaphyseal structure, while the other 30% are represented by physis and/or epiphysis fracture, manly represented by Salter-Harris type II. At the moment, no standardized treatment protocol for this kind of fracture has been proposed in the relevant literature. The factors that must be taken in account are age, displacement and complications that might be present.
METHODS: From 2014 to 2017, we treated with closed reduction and percutaneous pinning 30 patients (18 males and 12 females) with severely displaced proximal humeral fracture. The mean age at fracture was 11.8 years old. All patients were clinically evaluated with the QuickDASH scale (Disability of Arm, Shoulder and Hand Questionnaire) at a minimum follow-up of 12 months.
RESULTS: All our patients reached full radiological and clinical healing at the 3 months follow-up. In 90% of cases, our patients score a 0 on the QuickDASH scale, corresponding to a complete functional recovery, at 3 months. We had no vascular nor nervous complications. Two patients needed oral antibiotic therapy for a superficial infection of the K-wires.
CONCLUSIONS: The pediatric fractures of the proximal humerus should be therefore evaluated carefully, due to the possibility of a non-surgical approach in most of the cases. Severely displaced fractures in older children could benefit from surgical approach due to the high healing rate and very low rate of complications. As for the surgical approach, we consider percutaneous pinning with K-wire a valid opportunity to reach the maximum result with minimum surgical risk.

KEY WORDS: Humeral fractures - Treatment outcome - Fracture dislocation - Child

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