Treatment of proximal humeral fractures in childhood and adolescence : Consensus report of the pediatric traumatology section of the German Society for Trauma Surgery

Abstract

Proximal humeral fractures are arelatively common injury in childhood and adolescence, accounting for 0.45-2% of all fractures [2, 18]. Treatment is usually conservative but is still the subject of ascientific debate [9, 12]. In addition to the S1-LL, there are different recommendations for the diagnostics and treatment of these fractures in the literature. As part of the 10thscientific meeting of the SKT of the DGU, the existing recommendations and the relevant or current literature were critically discussed by apanel of experts and aconsensus was formulated. An algorithm for the diagnostics, therapy and treatment was integrated into this. The measurement of axial deviation and tilt is not interobserver and intraobserver reliable [3]. The age limit for when complete correction is possible was set at an age of 10years, as the correction potential changes around this age. For diagnostic purposes, well-centered X‑ray images in 2planes (true AP and Y‑images without thoracic parts) is defined as the standard. At the age of less than 10years, any malposition can be treated conservatively with Gilchrist bandaging for 2-3weeks. Surgery can only be indicated in individual cases, e.g., in the event of severe pain or the need for rapid weight bearing. An ad latus displacement of more than half the shaft width should not be tolerated over the age of 10years. Due to the variance in the measurement results, it is not possible to recommend surgical treatment depending on the extent of the ad axim dislocation. As aguideline, the greater the dislocation and the closer the child is to growth joint closure, the more likely surgical treatment is indicated. The development should be taken into account. The gold standard is retrograde, radial and unilateral ESIN osteosynthesis using two intramedullary nails. Osteosynthesis does not require immobilization. Afollow-up X‑ray is planned for unstable fractures without osteosynthesis after 1week, otherwise optional for documentation of consolidation after 4-6weeks, e.g., if sports clearance is to be granted and before metal removal (12weeks). Recommendations for surgical indications based on the extent of tilt are not reproducible and seem difficult in view of the current literature [3, 9, 12]. Apragmatic approach is recommended. The prognosis of the fracture appears to be so good, taking the algorithm into account, that restitutio ad integrum can be expected in most cases.