Humeral Shaft Fractures In Children Research Articles

Radial Nerve Palsy Associated with Humeral Shaft Fractures in Children

Background. This is the first systematic review of the relationship between humeral shaft fractures and radial nerve palsy in children. The present comprehensive review is aimed at identifying important clinical findings between humeral diaphysis fractures and radial nerve injuries and assessing the effects of treatment. Methods. We searched electronic bibliographic databases, including PubMed, the Cochrane Library, Scopus, and Web of Knowledge, until March 2022. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the patients, interventions, comparisons, outcomes guidelines. Results. We identified 23 original papers, of which 10 were eligible for further analysis. Cases of 32 young patients with radial nerve palsy were identified and analyzed. The prevalence of radial nerve palsy was 4.34% (eight cases out of 184 patients with humeral shaft fractures). The radial nerve was most often associated with a simple transverse fracture (12A3, 17 cases (65.4%)). Conclusions. Radial nerve injury in humeral shaft fractures in children is rare, with a frequency of 4.34%. We highly recommend early surgical nerve exploration with transverse fractures in the distal third segment combined with primary radial palsy. Furthermore, we recommend making thoughtful decisions regarding early nerve exploration in the Holstein–Lewis fractures. In addition, consideration of early surgical nerve exploration in fractures resulting from high-energy trauma and open fractures despite their morphology is recommended.

Humeral Shaft Fractures in Children Incidence, Management and Treatment Effects.

Humeral shaft fractures are relatively rare in children, with incidence between 0.4% and 3% of all fractures in children and between 10% and 20% of all humeral fractures. The purpose of our study was to retrospectively evaluate all humeral shaft fractures treated at children's trauma center from january 2012 till december 2021. We retrospectively evaluated the group of 104 skeletally immature patients with humeral shaft fracture treated in our hospital. We have analyzed: age; sex; fracture type, management; time of bone healing; final effect and complications. The non-surgical group consisted of 73 patients (27 girls and 46 boys) with an average age of 8.03 (0.6 - 17.7), while the surgical group consisted of 31 patients (16 girls and 15 boys) with an average age of 12.47 (5,7- 17.8). The mean follow-up was 7.65 months (4-12) in non-surgical group, and 13.38 months (4-24) in surgical group. We have analyzed the results statistically, confirming increase the frequency of the above-mentioned fractures and increase the number of patients treated with surgery. We achieved good effect in all patients. 1. Humeral shaft fractures in children are relatively rare. Although in recent years, we have observed an increase of their frequency; 2. The vast majority of humeral shaft fractures are treated non-surgically with good clinical results; 3. Increase of number of patients treated surgically has been noticeable in the last decade; 4. Surgery is associated with a relatively low risk of complications and allows for cast withdrawal, which significantly improves the patients comfort.

Paediatric Humeral Shaft Fractures: An Overview and Modern Management Approach

Paediatric humeral shaft fractures are a relatively uncommon injury comprising less than 3% of all paediatric fractures. Although these injuries are uncommon, it is important to be familiar with managing such injuries and recognising which types of fractures require surgical stabilisation or referral to specialist tertiary care. This paper provides a broad overview of humeral diaphyseal fractures in children including key management principles. We discuss aetiology, non-accidental trauma (NAT), clinical findings, imaging, fracture patterns, classification, associated injuries, management (non-operative and operative) and complications. Due to the increasing trend of managing these injuries with surgical fixation, we also review the recent available literature evaluating these surgical options. Overall, there is good evidence that the majority of humeral shaft fractures in children and adolescents can be successfully managed non-operatively. However, operative management when clinically indicated, especially in older children and adolescents, has shown to be beneficial with good clinical outcomes and low complication rates. Further research with paediatric-specific core outcomes is recommended to further evaluate this underrepresented topic.

Humeral shaft fractures in children and adolescents

Humeral shaft fractures in children and adolescents

Treatment of humeral shaft fractures in children with closed reduction and external fixation

To explore the clinical effect of closed reduction and minimally invasive treatment of humeral shaft fractures in children. From July 2011 to April 2015, 39 cases of pediatric humeral shaft fractures were treated by closed reduction and external fixation, including 27 males and 12 females with a mean age of 8.6 years old ranging from 3 to 14 years old. Time from injury to the treatment was 2 h to 7 days with an average of 2.7 days. There were 6 cases of upper fracture, 21 cases of middle fracture and 12 cases of lower fracture. All children were closed injury, appeared pain, swelling, local deformity and limited mobility and other symptoms after injury. X-ray examination showed humeral shaft fracture. Neer score of shoulder joint function and HSS score of elbow joint function were used to record and analyze the pain, function and activity of shoulder and elbow joint before and after treatment. All the 39 cases were followed up for 6 to 12 months with a mean of 8.6 months. Two cases appeared postoperative superficial infection of the needle, and healed after dress; other cases gained good pinhole healing. There were significant differences in the pain, function and activity of the shoulder of Neer score before and after the treatment (P<0.05). There were significant differences in the pain and function of the elbow of HSS before and after treatment (P<0.05). According to the evaluation of Neer score of shoulder function, the total score was 88.82±2.50, 29 cases were excellent, 9 cases were good, and 1 case was fair. According to the evaluation of HSS score of elbow joint function evaluation, the total score was 91.51±5.09, 30 cases were excellent, 7 cases were good, 2 cases were general. Manual closed reduction combined with external fixation for the treatment of humeral shaft fractures in children has advantages of less trauma, definite reduction effect, reliable fixation and benefit for early functional exercise of the shoulder and elbow joint. This therapy can be used as one of clinical methods for the treatment of humeral shaft fractures in children.

Flexible intramedullary nailing for treatment of proximal humeral and humeral shaft fractures in children: A retrospective series of 118 cases

BackgroundThe aim of this study was to analyze outcomes of treatment and complications in children treated with flexible intramedullary nailing (FIN) due to humeral fracture. HypothesisThe FIN for treatment of humeral fractures in children would allow an early functional and cast-free follow-up with a quick pain reduction and low complication rate. Patients and methodsFrom May 2002 until May 2016 case records of all children who underwent fixation with titanium intramedullary nails because of humeral fracture were retrospectively reviewed. The study included 118 patients treated with FIN for proximal humeral or humeral shaft fracture. The average age at the time of trauma was 12 years. Mean follow-up was 77 months. Left hand was affected in 51% of patients. The most common mechanism of injury was fall (n=58), followed by sports injuries, road traffic accidents, pathological fractures, motorbike accidents and bicycle riding. ResultsThere were no residual valgus/varum deformities. All patients achieved complete radiographic healing at a mean of 7.5 weeks. Nine complications were recorded: 1 humeral shaft fracture in patient with osteogenesis imperfecta, 4 entry site skin irritations, 2 skin infections and 2 radial nerve injuries. There were no cases of delayed union, nonunion or mal-union. After removal of the nails, all patients regained full function and all complications resolved. DiscussionThe FIN for humeral fractures is a minimally invasive, simple and well reproducible technique with very low complication rate. ConclusionThe FIN for treatment of humeral fractures shows very good functional and cosmetic results. It allows an early functional and cast-free follow-up with a quick pain reduction. Level of evidenceLevel IV – retrospective study.

Displaced humeral shaft fractures in children and adolescents: results and adverse effects in patients treated by elastic stable intramedullary nailing.

The objectives of this study were to retrospectively investigate the clinical and radiological outcome of humeral shaft fractures treated by ESIN in children <16years old and to evaluate the functional outcome of these injuries using the short version of the Disabilities of the Arm, Shoulder and Hand Outcome questionnaire (Quick DASH(®)). We retrospectively evaluated children with fractures of the humeral shaft, surgically treated by ESIN. All the patients were regularly followed clinically and radiographically for at least 1year after their index surgery. After hardware removal, the patients were asked to answer the short version of the Disabilities of the Arm, Shoulder and Hand Outcome questionnaire (Quick DASH). Thirty-eight patients met the inclusion criteria. Mean age at the time of trauma was 11.1years. Mean follow-up was 30months. All fractures healed, but three patients had a residual valgus of >10°, two a residual varum of >10°, four a residual recurvatum deformity of >10°, and one a residual procurvatum deformity of >10°. Four complications were observed. Functional outcome was nevertheless good in all the patients, with a mean Quick DASH(®) score of 3. The study shows good clinical and functional outcomes in children and adolescents with closed isolated fractures of the humeral shaft surgically treated by ESIN, even with ensuing mild residual frontal and sagittal plane deformity. However, conservative treatment has also been advocated in the scientific literature for this type of injuries, and surgical treatment should not be considered as the only option for the management of humeral shaft fractures in older children and adolescents.

Retrograde Single Elastic Intramedullary Nail in Closed Simple Diaphyseal Humeral Shaft Fractures in Children

Retrograde Single Elastic Intramedullary Nail in Closed Simple Diaphyseal Humeral Shaft Fractures in Children

Treatment of humeral shaft fractures by a single elastic stable intramedullary nail in children

Objective The aim of this study was to assess the effectiveness of intramedullary fixation of displaced humeral shaft fractures in skeletally immature children using a single elastic stable intramedullary nail. Background Almost all pediatric humeral shaft fractures can be treated successfully using closed methods. Some patients, however, require internal fixation either because of an inability to maintain an adequate reduction, significant soft tissue injury, or concomitant fractures. In this study, the functional and radiological results of the management of humeral shaft fractures in children using a single retrograde elastic intramedullary nail will be evaluated. Patients and methods Twenty pediatric patients ranging in age from 6 to 16 years (mean age 10 years) were treated surgically using a retrograde single elastic intramedullary nail. Relative surgical indications included open fractures, inability to maintain an acceptable reduction, concomitant lower extremity fractures, and closed head injury. Two patients had associated radial nerve injury at presentation. Among the patients, 16 were males and four were females. Results The patients were followed for a mean of 5.5 months, with a range from 4 to 6 months. Radiographically, all fractures healed in good alignment. Solid union occurred from 5 to 10 weeks, with a mean of 8 weeks. There were no intraoperative complications, including neurologic or vascular injury, and two patients developed superficial wound infections postoperatively. Conclusion It was found that single elastic intramedullary nail fixation with the aid of a functional arm brace is an adequate technique for the treatment of humeral shaft fractures in pediatric patients when surgical stabilization is indicated. This simple minimally invasive technique provides stable fixation, with minimal soft tissue stripping at the fracture site, and led to bone union in all the cases studied. Level of evidence Case series, level IV.

Percutaneous Kirschner wire (K-wire) fixation for humerus shaft fractures in children: A treatment concept

Background:Fractures of the humeral shaft are uncommon, representing less than 10 percent of all fractures in children. Humeral shaft fractures in children can be treated by immobilisation alone. A small number of fractures are unable to be reduced adequately or maintained in adequate alignment, and these should be treated surgically. In the present study, Kirschner wires (K-wire) were used to achieve a closed intramedullary fixation of humeral shaft fractures. The objective of this study was to evaluate the efficacy of intramedullary K-wires for the treatment of humeral shaft fracture in children.Patients and Methods:This prospective study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from June 2005 to June 2010. Sixty-eight children with a mean age of 7.7 years (range, 2-14 years) were recruited from Emergency and out patient department having closed fracture of humerus shaft. All patients were operated under general anaesthesia. All patients were followed for 12 months.Results:Out of 68 patients, 64 patients underwent union in 42-70 days with a mean of 56 days. Complications found in four patients who had insignificant delayed union which were united next 3 weeks. Intramedullary K-wires were removed after an average of 5 months without any complications. The results were excellent in 94.11% and good in 5% children.Conclusion:This technique is simple, quick to perform, safe and reliable and avoids prolonged hospitalization with good results and is economical.

Pediatric Humerus Fractures: Indications and Technique for Flexible Titanium Intramedullary Nailing

Background: Most fractures of the humeral diaphysis in children can be treated nonoperatively. In unusual situations surgical stabilization may be required. The purpose of this study is to describe the indications and surgical technique of titanium elastic nail fixation of humeral shaft fractures in children. Methods: Diaphyseal humerus fractures in children have been treated with intramedullary stabilization using titanium elastic nails. Complicating features that required operative stabilization include open fractures, fractures in which reasonable alignment could not be maintained without internal fixation, and patients with ipsilateral forearm fractures (floating elbow) and poly-trauma with associated lower extremity fractures necessitating early upper extremity weight bearing. Results: All fractures united without infectious or neurovascular complications. Nail migration requiring nail trimming or early implant removal occurred in a small number of patients and is the most frequent complication of the procedure. Conclusions: In situations in which surgical stabilization of pediatric humeral shaft fractures is necessary, titanium elastic nails provide an effective and simple option, allowing early motion and weight bearing.

Die elastische stabile intramedulläre Nagelung als Therapiealternative in der Versorgung kindlicher Humerusschaftfrakturen

We report about our experiences with the elastic stable intramedullary nailing (ESIN) of traumatic humeral shaft fractures in children and adolescents. Children with traumatic humerus shaft fractures who were treated by ESIN were included. All patients underwent clinical follow-up examinations. 31 children (average age 11.4 years) with traumatic humeral shaft fractures could be included. There were 14 oblique, 12 transverse and 5 wedge fractures. In 5 cases the fracture was located in the proximal third, in 22 cases in the middle third and in 4 cases in the distal third. After an average period of 32 months a follow-up-examination with the Constant-Murley score was performed. All children attained 100 points and all patients could take part in sports activities like before the accident. 30 children and their parents were very satisfied with the treatment success and 1 patient was satisfied. The following complications were seen: 1 postoperative damage of the radial nerve in a patient with secondary fracture dislocation (complete remission), 1 skin irritation, 1 fracture dislocation with axial deviation, 1 secondary dislocation of the nails after a second accident and 1 secondary axial deviation. Elastic stable intramedullary nailing (ESIN) of humerus shaft fractures has a low complication rate if attention is paid to biomechanical principles. The observed complications are based on mistakes concerning the indication or technical errors. The ESIN shows very good functional and cosmetic results. It allows an early functional and cast-free follow-up with a quick pain reduction. The ESIN of humeral shaft fractures is a minimally invasive, simple and well reproducible technique with a steep learning curve. Because of the excellent objective and subjective results, the operative stabilization of humerus shaft fractures with ESIN should be recommended to the patients and their parents.

Frugal wiring of humeral shaft fractures in children

Frugal wiring of humeral shaft fractures in children