Proximal Humerus Fractures in Children: Experience from a Central London Paediatric Orthopaedic Service
Woojin Chae1, *, Akib Khan2, Sarah Abbott3, Angelos Assiotis2
1 School of Medicine, South Kensington Campus, Imperial College London, London, UK
2 Trauma and Orthopaedics, Chelsea and Westminster Hospital, London, UK
3 Trauma and Orthopaedics, West Middlesex Hospital, Islewrth, UK
Proximal humeral fractures are commonly observed in children who sustain falls whilst running, or from heights. Appropriate and correct treatment is key in order to avoid limb length discrepancy and functional deficiencies. Current treatment methods include non-operative management such as collar and cuff immobilisation, and operative methods such as elastic stable intramedullary nails or Kirschner wires. This paper aims to present the demographics of this patient population and our experience in managing patients with proximal humerus fractures in an urban tertiary referral centre.
We assessed 41 cases across two sites in central London, identified via hospital electronic notes and our radiology digital system. We analysed patient demographics, mechanism of injury, time to discharge from orthopaedic services taking into account radiological and clinical union, and the treatment methods utilised.
The mean age of the cohort was 8.6 years old. 70% of the injuries were due to falls and 85% of cases were treated without an operation. The mean time to discharge from our service following radiological and clinical union was 46 days (9 – 161 days). Mean radiological and clinical union were 21.8 and 36.2 days respectively.
These results support a non-operative approach, especially in cases with patients under 10 years of age. Surgery should only be undertaken in patients who have severe displacement and who have failed attempts at closed reduction. We would advocate a similar approach in institutions dealing with a comparable population of patients, as long as there are provisions for referral of more complex cases that require surgical stabilisation.
Keywords: Proximal humeral fractures (PHF), physeal fractures, Paediatric Orthopaedic, Urban tertiary referral centre, Severe displacemen, Surgical stabilisation.
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