Samara Eleftheria, Tschopp Benjamin, Kwiatkowski Barbara, Vardar Elif, Lutz Nicolas, Zambelli Pierre-Yves
Pediatric Orthopedic Department, Children's Hospital, Lausanne, Switzerland.
JB JS Open Access. 2021 Jan 25;6(1). doi: 10.2106/JBJS.OA.20.00119. eCollection 2021 Jan-Mar.
Displaced proximal humeral fractures in older children with low remodeling potential need to be reduced and fixed. There are many options for stabilization, including external fixation, rigid internal fixation with screws and plates, percutaneous pinning, and flexible intramedullary nailing. The use of 2 flexible retrograde nails, originated at the University of Nancy, France, became the most popular technique in Europe. The aim of this study was to describe and assess a modified, single retrograde nail technique to treat fractures of the proximal part of the humerus.
We performed a retrospective monocentric study. From June 2016 to May 2019, a modified retrograde nail technique with 1 prebent nail was used for the management of 21 consecutive children with a closed displaced proximal humeral fracture. Demographic and surgical data were collected. The surgical technique is similar to the classic elastic stable intramedullary nailing, but only 1 nail is used. The average surgical time and perioperative complications were used as criteria for the feasibility of this technique. Radiographs were obtained preoperatively; at 1, 4, and 6 weeks postoperatively; and after implant removal at an average of 4.2 months postoperatively. The clinical outcomes were assessed on the basis of the shoulder range of motion documented in the medical records and by using the French edition of the QuickDASH (shortened version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) evaluation scale at the time of implant removal.
Nineteen patients with a mean age of 12.6 years and a mean follow-up of 6 months were included in the study. The mean surgical time was 49 minutes. The single intramedullary nail technique provided a satisfactory reduction of all fractures. No perioperative complication occurred. In 1 case, partial loss of reduction was observed on the first-week control radiograph. All patients had a healed fracture, no deficits, excellent results according to the QuickDASH score, a normal range of motion, and excellent strength of the shoulder joint at the time of implant removal (at a mean of 4.2 months).
The current study confirms the feasibility and efficacy of the single retrograde intramedullary nail technique to treat displaced proximal humeral fractures in children.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
重塑潜力低的大龄儿童肱骨近端移位骨折需要进行复位和固定。稳定骨折的方法有很多种，包括外固定、使用螺钉和钢板的坚强内固定、经皮穿针固定以及弹性髓内钉固定。起源于法国南锡大学的双弹性逆行髓内钉技术成为欧洲最流行的技术。本研究的目的是描述和评估一种改良的单逆行髓内钉技术治疗肱骨近端骨折。
我们进行了一项回顾性单中心研究。2016年6月至2019年5月，采用1枚预弯髓内钉的改良逆行髓内钉技术连续治疗21例闭合性肱骨近端移位骨折患儿。收集人口统计学和手术数据。手术技术与经典的弹性稳定髓内钉技术相似，但仅使用1枚髓内钉。平均手术时间和围手术期并发症作为该技术可行性的标准。术前、术后1周、4周和6周以及术后平均4.2个月取出内固定物后均拍摄X线片。根据病历记录的肩关节活动范围以及取出内固定物时使用法国版QuickDASH（手臂、肩部和手部功能障碍[DASH]问卷的简化版）评估量表评估临床结果。
19例平均年龄12.6岁、平均随访6个月的患者纳入研究。平均手术时间为49分钟。单髓内钉技术使所有骨折均获得满意复位。未发生围手术期并发症。1例患者在术后第1周的X线片复查中出现部分复位丢失。所有患者骨折均愈合，无功能缺失，根据QuickDASH评分结果优秀，取出内固定物时（平均4.2个月）肩关节活动范围正常，肩关节力量良好。
本研究证实了单逆行髓内钉技术治疗儿童肱骨近端移位骨折的可行性和有效性。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
