Fragility fractures in the upper limb: proximal and distal humerus.

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Abstract

[Indexed for MEDLINE] 12. ANZ J Surg. 2024 Apr;94(4):743-748. doi: 10.1111/ans.18900. Epub 2024 Feb 17. Outcomes of proximal humerus fractures in children: a retrospective cohort study. Abbot S(1)(2)(3), Proudman S(3), Bednarz J(4)(5), Williams N(2)(6). Author information: (1)Department of Orthopaedics and Trauma, Lyell McEwin Hospital, Adelaide, South Australia, Australia. (2)Department of Orthopaedics and Trauma, Women's and Children's Hospital, Adelaide, South Australia, Australia. (3)Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia. (4)SAHMRI Women and Kids Theme, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia. (5)School of Public Health, The University of Adelaide, South Australia, Australia. (6)Centre for Orthopaedic and Trauma Research, University of Adelaide, South Australia, Australia. OBJECTIVE: Paediatric proximal humerus fractures (PHFs) have historically been treated non-operatively. However, the management of severely displaced PHFs in older children has been debated over the years, with contemporary studies advocating for surgery. The purpose of this study was to review the outcomes of a cohort of paediatric patients treated for a PHF to guide management of future paediatric PHFs. METHODS: The records of the Women's and Children's Hospital in South Australia were reviewed to identify paediatric PHFs occurring between 1 January 2010 and 1 June 2020. Participants completed the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), the Shoulder Pain and Disability Index, and the Paediatric Outcomes Data Collection Instrument via phone interview. Participants' shoulder range-of-motion was assessed via telehealth using Zoom. Multivariable logistic regression was used to identify patient and clinical variables that were associated with a poorer outcome. RESULTS: Of 307 patients contacted, 125 participated. Forty-six patients met the definition of a poorer clinical outcome, defined as a QuickDASH score of ≥2. Fractures of greater severity were predictive of a poorer outcome, and patients aged ≥12 years old at the time of injury had higher total QuickDASH scores. The findings did not suggest that these subgroups of patients have superior outcomes if treated surgically. CONCLUSION: The majority of paediatric PHFs have an acceptable clinical outcome, irrespective of treatment methodology. Multicentre prospective studies are required to establish the indications for surgery for adolescent patients with severely displaced PHFs. © 2024 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons. DOI: 10.1111/ans.18900