|Beitragstitel||Plate fixation for irreducible proximal humeral fractures in children: a case series of six patients|
INTRODUCTION: Recommended treatment for severely displaced proximal humeral fractures in children is closed reduction and percutaneous fixation by K-wires or intramedullary nailing. We present a case series, in which closed reduction was not possible due to tendinous or osseous interposition within the fracture.
METHODS: From September 2014 to September 2016, 6 children/adolescents (one female, age range 8 to 16 years) were treated surgically for severely displaced proximal humeral fractures. All patients had fractures with a dorsally dislocated humeral head. There were five type III and one type IV fracture according to the Neer-Horowitz classification. In all patients an attempt of closed reduction was made. Five patients were surgically treated with direct open reduction and internal fixation with plate fixation, one patient was initially treated with closed reduction and percutaneous pinning, due to secondary displacement an open reduction and second operation with internal fixation was necessary. The humeral head was fixed with an angular stable T-plate without affecting the growth plate. Plate removal was scheduled 3-4 months postoperatively in all cases.
RESULTS: In all six cases dorsal dislocation of the fracture was not reducible due to interposition of tendinous or osseous structures. In two cases the long biceps tendon interposed, in two cases periosteal-tissue, in one case a bony fragment and in one patient the long biceps tendon and the conjoint tendons. Postoperative follow-up after a mean of 6 months showed excellent clinical results with a mean Constant score of 92 (range 88 to 95). Radiologic follow-up showed in all patients early consolidation and no loss of reduction.
CONCLUSION: If a proximal humeral fracture is not reducible by closed means, a tissue entrapment (mostly biceps tendon) should be considered. Treatment with open reduction and plate fixation yields excellent clinical and radiological results.