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Management of paediatric humeral shaft fractures and associated nerve palsy

PURPOSE: The aim of this study is to review the management of all paediatric humerus diaphyseal fractures treated at a single institution over a 20-year period. METHODS: Retrospective review from between 1996 and 2016 identified 96 humerus shaft fractures in paediatric patients (0 to 17 years). Afte...

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Autores principales: O’Shaughnessy, M. A., Parry, J. A., Liu, H., Stans, A. A., Larson, A. N., Milbrandt, T. A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Editorial Society of Bone & Joint Surgery 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808073/
https://www.ncbi.nlm.nih.gov/pubmed/31695818
http://dx.doi.org/10.1302/1863-2548.13.190012
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author O’Shaughnessy, M. A.
Parry, J. A.
Liu, H.
Stans, A. A.
Larson, A. N.
Milbrandt, T. A.
author_facet O’Shaughnessy, M. A.
Parry, J. A.
Liu, H.
Stans, A. A.
Larson, A. N.
Milbrandt, T. A.
author_sort O’Shaughnessy, M. A.
collection PubMed
description PURPOSE: The aim of this study is to review the management of all paediatric humerus diaphyseal fractures treated at a single institution over a 20-year period. METHODS: Retrospective review from between 1996 and 2016 identified 96 humerus shaft fractures in paediatric patients (0 to 17 years). After excluding those deceased from inciting trauma, pathological and perinatal fractures, 80 patients remained for analysis. Data collected included age, fracture type, displacement, nerve palsy, treatment, complications and time to union. Radiographs were reviewed at the time of injury and at latest follow-up. RESULTS: Of 80 paediatric humeral diaphyseal fractures, 65 (81%) were treated with immobilization. In all, 15 (19%) fractures were treated with surgical stabilization. Most common indications were fracture displacement, open fractures and to improve mobilization in patients with multiple injuries. Fractures were stabilized with a plate (eight), flexible nails (five), external fixation (one) and percutaneous pinning (one). The operative group, compared with the nonoperative group, was older, had more high-energy mechanisms, more open fractures and increased fracture displacement. All patients in the nonoperative and operative groups went on to union with minimal complications. A nerve palsy was present in five patients (6%)with three of the five involving the radial nerve (4%). All nerve palsies were observed and had full neurological recovery. CONCLUSION: Over a 20-year period nonoperative management of paediatric humerus shaft fractures was successful in the majority of patients. Operative stabilization, when rarely indicated, had a low complication rate and improved radiographic alignment. All nerve injuries fully recovered without surgical intervention. LEVEL OF EVIDENCE: IV
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spelling pubmed-68080732019-11-06 Management of paediatric humeral shaft fractures and associated nerve palsy O’Shaughnessy, M. A. Parry, J. A. Liu, H. Stans, A. A. Larson, A. N. Milbrandt, T. A. J Child Orthop Original Clinical Article PURPOSE: The aim of this study is to review the management of all paediatric humerus diaphyseal fractures treated at a single institution over a 20-year period. METHODS: Retrospective review from between 1996 and 2016 identified 96 humerus shaft fractures in paediatric patients (0 to 17 years). After excluding those deceased from inciting trauma, pathological and perinatal fractures, 80 patients remained for analysis. Data collected included age, fracture type, displacement, nerve palsy, treatment, complications and time to union. Radiographs were reviewed at the time of injury and at latest follow-up. RESULTS: Of 80 paediatric humeral diaphyseal fractures, 65 (81%) were treated with immobilization. In all, 15 (19%) fractures were treated with surgical stabilization. Most common indications were fracture displacement, open fractures and to improve mobilization in patients with multiple injuries. Fractures were stabilized with a plate (eight), flexible nails (five), external fixation (one) and percutaneous pinning (one). The operative group, compared with the nonoperative group, was older, had more high-energy mechanisms, more open fractures and increased fracture displacement. All patients in the nonoperative and operative groups went on to union with minimal complications. A nerve palsy was present in five patients (6%)with three of the five involving the radial nerve (4%). All nerve palsies were observed and had full neurological recovery. CONCLUSION: Over a 20-year period nonoperative management of paediatric humerus shaft fractures was successful in the majority of patients. Operative stabilization, when rarely indicated, had a low complication rate and improved radiographic alignment. All nerve injuries fully recovered without surgical intervention. LEVEL OF EVIDENCE: IV The British Editorial Society of Bone & Joint Surgery 2019-10-01 /pmc/articles/PMC6808073/ /pubmed/31695818 http://dx.doi.org/10.1302/1863-2548.13.190012 Text en Copyright © 2019, The author(s) http://creativecommons.org/licenses/by-nc/4.0/ Open Access This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.
spellingShingle Original Clinical Article
O’Shaughnessy, M. A.
Parry, J. A.
Liu, H.
Stans, A. A.
Larson, A. N.
Milbrandt, T. A.
Management of paediatric humeral shaft fractures and associated nerve palsy
title Management of paediatric humeral shaft fractures and associated nerve palsy
title_full Management of paediatric humeral shaft fractures and associated nerve palsy
title_fullStr Management of paediatric humeral shaft fractures and associated nerve palsy
title_full_unstemmed Management of paediatric humeral shaft fractures and associated nerve palsy
title_short Management of paediatric humeral shaft fractures and associated nerve palsy
title_sort management of paediatric humeral shaft fractures and associated nerve palsy
topic Original Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808073/
https://www.ncbi.nlm.nih.gov/pubmed/31695818
http://dx.doi.org/10.1302/1863-2548.13.190012
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