Pandya Nirav K, Behrends Dominque, Hosalkar Harish S
Department of Pediatric Orthopaedic Surgery, Children's Hospital and Research Center Oakland, 747 52nd Street, Oakland, CA 94609 USA.
J Child Orthop. 2012 Jun;6(2):111-8. doi: 10.1007/s11832-012-0398-y. Epub 2012 Mar 29.
Proximal humerus fractures in the pediatric population are a relatively uncommon injury, with the majority of injuries treated in a closed fashion due to the tremendous remodeling potential of the proximal humerus in the skeletally immature. Yet, in adolescent patients, open treatment is, at times, necessary due to unsatisfactory alignment following a closed reduction, loss of previously achieved closed reduction, and limited remodeling when close to skeletal maturity. The purpose of our study was to examine the open reduction of adolescent proximal humerus fractures.
A retrospective review of the outcomes of proximal humerus fractures in the adolescent population which were consecutively treated at our institution with open reduction was performed.
Ten children met the inclusion criteria, with a mean age of 14.3 years (±1.3) and a mean weight of 60.7 kg (±14.9) at the time of injury. There were seven Salter-Harris 2 fractures and three Salter-Harris 1 fractures. The largest mean angulation was 55.0° (±33.9) and the largest mean displacement was 87.0 % (±22.8). Intra-operatively, impediments to closed reduction within the fracture site which were found included: periosteum (90.0 %), biceps tendon (90.0 %), deltoid muscle (70.0 %), and comminuted bone (10.0 %). K-wire fixation was most commonly used (70.0 %), followed by flexible nails (20.0 %) and cannulated screws (10.0 %) for fixation. All patients achieved radiographic union at a mean of 4.0 weeks (±0.7), had non-painful full shoulder range of motion and rotator cuff strength at final follow-up (mean 7.7 ± 4.6 months), and returned to pre-injury sporting activities.
The operative treatment of proximal humerus fracture, particularly in adolescents with severe displacement/angulation having failed closed methods of treatment, is increasingly considered to be an acceptable modality of treatment. In addition to the long head of the biceps, periosteum, deltoid muscle, and bone fragments in combination can prevent fracture reduction. Surgeon preference and skill should dictate implant choice, and the risk of physeal damage utilizing these implants in this age group is low.
儿童肱骨近端骨折相对少见，由于骨骼未成熟的儿童肱骨近端具有巨大的重塑潜力，大多数此类损伤采用闭合方式治疗。然而，对于青少年患者，有时由于闭合复位后对线不满意、先前获得的闭合复位丢失以及接近骨骼成熟时重塑受限，开放治疗是必要的。我们研究的目的是探讨青少年肱骨近端骨折的切开复位。
对在我们机构连续接受切开复位治疗的青少年肱骨近端骨折的结果进行回顾性分析。
10名儿童符合纳入标准，受伤时平均年龄为14.3岁（±1.3），平均体重为60.7kg（±14.9）。有7例Salter-Harris 2型骨折和3例Salter-Harris 1型骨折。最大平均成角为55.0°（±33.9），最大平均移位为87.0%（±22.8）。术中发现骨折部位闭合复位的阻碍因素包括：骨膜（90.0%）、肱二头肌肌腱（90.0%）、三角肌（70.0%）和粉碎性骨块（10.0%）。最常用克氏针固定（70.0%），其次是弹性髓内钉（20.0%）和空心螺钉（10.0%）进行固定。所有患者平均在4.0周（±0.7）时达到影像学愈合，末次随访时（平均7.7±4.6个月）肩部活动范围正常且无痛，肩袖肌力正常，并恢复到伤前的体育活动。
肱骨近端骨折的手术治疗，特别是对于严重移位/成角且闭合治疗失败的青少年患者，越来越被认为是一种可接受的治疗方式。除了肱二头肌长头外，骨膜、三角肌和骨碎片共同作用可阻碍骨折复位。外科医生的偏好和技术应决定植入物的选择，在这个年龄组使用这些植入物导致骨骺损伤的风险较低。
