Hospital de Trauma "Manuel Giagni", Coronel Ángel López, 1161, 1419, Asunción, Paraguay.
Hospital Central del Instituto de Previsión Social, Asunción, Paraguay.
Eur J Orthop Surg Traumatol. 2024 Oct;34(7):3759-3766. doi: 10.1007/s00590-024-03975-x. Epub 2024 May 15.
To report the functional results of our experience and to describe intraoperative findings and complications due to the techniques used in our service.
From January 2018 to December 2022, 27 Pediatric patients aged from 8 to 16 years underwent surgery to treat proximal humerus fractures. Their demographic characteristics were evaluated, as well as their clinical characteristics on admission, type of reduction (closed/open), presence of interposition in open reductions, type of implant, complications, and functional range of movement according to two shoulder functional scores.
Mean age was 11.2 years (8-15), there was a predominance of males, who accounted for 70% of the cases, and sports accidents were the cause of injury in 44% of the cases. Anatomical location was balanced between patients, including 55% of physeal fractures and 45% of metaphyseal ones. Overall, 81.5% of patients required open reduction to achieve axis correction, and that 55.5% of fractures were fixed with Kirschner wires, and 44, 4% with elastic titanium nails. Mean QuickDASH score was 0.58 (0-1.7), and Constant score was 9 (3-24). There were no major complications, but 27% of cases subjected to open reduction presented a hypertrophic scar.
Surgical treatment of severely displaced proximal humerus fractures is successful, both with closed and open reduction; type of implant does not play a key role and should be selected based on the characteristics of each case. Surgical training should prevail at the time of decision-making. When these recommendations are followed, results can be excellent and sequelae are infrequent.
报告我们的经验的功能结果，并描述由于我们服务中使用的技术而导致的术中发现和并发症。
从 2018 年 1 月至 2022 年 12 月，27 名 8 至 16 岁的儿科患者接受了手术治疗肱骨近端骨折。评估了他们的人口统计学特征，以及入院时的临床特征、复位类型（闭合/开放）、开放复位时是否存在介入、植入物类型、并发症以及根据两种肩部功能评分的运动范围功能。
平均年龄为 11.2 岁（8-15 岁），男性占 70%，运动事故占 44%的损伤原因。解剖位置在患者之间平衡，包括 55%的骺骨骨折和 45%的干骺端骨折。总体而言，81.5%的患者需要开放复位来实现轴线矫正，55.5%的骨折用克氏针固定，44%，4%用弹性钛钉固定。平均 QuickDASH 评分为 0.58（0-1.7），常数评分为 9（3-24）。没有重大并发症，但 27%的开放复位病例出现肥厚性瘢痕。
闭合和开放复位治疗严重移位的肱骨近端骨折均取得成功；植入物类型并不起关键作用，应根据每个病例的特点选择。手术决策时应优先进行手术培训。遵循这些建议，结果可以非常好，且后遗症很少。
