Department of Orthopaedic Surgery - Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Curr Opin Pediatr. 2021 Feb 1;33(1):97-104. doi: 10.1097/MOP.0000000000000979.
We aimed to review considerations, current treatment options, and complications in the management of pediatric proximal humerus fractures.
Recent literature has shown an increased incidence of operative management of proximal humerus fractures. With increased age, and increased deformity, studies report excellent outcomes after operative treatment. Still, patients under the age of 12 and with Neer grade I and II fractures are consistently treated nonoperatively.
Indications for operative management of proximal humerus fractures in skeletally immature patients have become increasingly widened. Current literature emphasizes the stratification of patients based on displacement, angulation, and shortening, with overall positive outcomes. Each case should be considered on individual bases, accounting for both radiographic parameters, developmental stages of patients, and potential complications. In the authors' opinion, adolescent patients with Neer Horowitz 3 and 4 fractures surgical management should be considered. In younger patients with nonoperative management, even with significant displacement, is the mainstay of treatment because of the tremendous remodeling potential of the proximal humerus in children.
我们旨在回顾儿童肱骨近端骨折治疗的注意事项、当前治疗选择和并发症。
近期文献表明肱骨近端骨折的手术治疗比例增加。随着年龄的增长和畸形程度的增加，研究报告术后治疗效果良好。然而，12 岁以下的患者和 Neer Ⅰ型和Ⅱ型骨折仍持续采用非手术治疗。
对于骨骼未成熟患者，肱骨近端骨折手术治疗的适应证已逐渐扩大。目前的文献强调根据移位、成角和缩短程度对患者进行分层，总体上有积极的结果。每个病例都应根据患者的个体情况考虑，包括影像学参数、患者的发育阶段和潜在的并发症。作者认为，青少年患者有 Neer-Horowitz 3 型和 4 型骨折，应考虑手术治疗。对于采用非手术治疗的年轻患者，即使存在明显的移位，也应作为主要治疗方法，因为儿童肱骨近端有巨大的重塑潜力。
