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Comparison of conservative treatment outcomes for proximal humeral epiphyseal fractures in patients of different ages

Vergleich der konservativen Behandlungsergebnisse für proximale humerale epiphysäre Frakturen bei Patienten unterschiedlichen Alters

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Abstract

Background

Several studies have suggested that excellent therapeutic outcomes can be achieved with conservative treatment of proximal humeral epiphyseal fractures in patients younger than 11 years old; however, the outcomes of conservative treatment for children older than 11 years are controversial. To address this problem, this study compared outcomes of conservative treatment for proximal humeral epiphyseal fractures in pediatric patients of different ages.

Methods

The patients were divided into two groups for comparative purposes based on age. Group I consisted of 34 patients who were less than 11 years old (average age: 5 years) and group II included 21 patients who were 11 years of age or older (average age: 14 years). Patients in both groups underwent conservative treatment and follow-up examination, where they first were examined with X‑radiography for assessment of deformity, fracture union and loss of reduction. At the final follow-up after 2 years, patients were assessed by an interview and a detailed physical examination including the assessment of shoulder function using the Constant-Murley score.

Results

There were no significant differences in the grading scale of varus deformity between the two groups (P > 0.05) after immediate postreduction X‑radiography; however, there were significant differences in the grading scale of varus deformity between group I and group II at the 2‑year follow-up (P < 0.05). There were no significant differences between the two groups with respect to the Constant-Murley score and arm length discrepancy (P > 0.05) at final follow-up examinations.

Conclusion

In general, the results suggested that the outcomes, as measured with radiographs, for both older and young children were comparable after immediate postreduction roentgenograms. For long-term follow-up there was a difference between the two groups and the degree of angulation and displacement might be associated with treatment outcomes for older children. Thus, these factors should be considered when treating and evaluating the outcomes for older children.

Zusammenfassung

Hintergrund

Mehrere Studien haben gezeigt, dass durch die konservative Behandlung proximaler humeraler epiphysärer Frakturen bei Patienten <11 Jahren exzellente therapeutische Ergebnisse erzielt werden können. Jedoch sind die Ergebnisse der konservativen Behandlung bei Kindern >11 Jahren kontrovers. Um dieses Problem zu adressieren, verglich man in dieser Studie die Ergebnisse der konservativen Behandlung proximaler humeraler epiphysärer Frakturen bei Kindern unterschiedlichen Alters.

Methoden

Gruppe I bestand aus 34 Patienten, die jünger als 11 Jahre waren (Durchschnittsalter 5 Jahre), und Gruppe II schloss 21 Patienten ein, die 11 Jahre oder älter waren (Durchschnittsalter: 14 Jahre). Die Patienten beider Gruppen erhielten eine konservative Behandlung sowie eine Follow-up-Untersuchung, bei der sie mittels Röntgenaufnahmen untersucht wurden, um Deformität, Frakturheilung und den Reduktionsverlust zu beurteilen. Beim letzten Follow-up nach 2 Jahren wurden die Patienten mittels eines Interviews und einer detaillierten körperlichen Untersuchung bewertet, einschließlich der Beurteilung der Schulterfunktion mittels Constant-Murley-Score.

Ergebnisse

Es gab keine signifikanten Unterschiede in der Klassifikationsskala für Varusdeformität zwischen den 2 Gruppen (p > 0,05) nach der sofortigen Röntgenaufnahme nach Reduktion. Jedoch gab es signifikante Unterschiede in der Klassifikationsskala für Varusdeformität zwischen Gruppe I und Gruppe II beim 2‑Jahres-Follow-up (p < 0,05). Hinsichtlich des Constant-Murley-Scores und der Armlängendiskrepanz (p > 0,05) wurden zwischen den beiden Gruppen bei der letzten Follow-up-Untersuchung keine signifikanten Unterschiede festgestellt.

Schlussfolgerung

Im Allgemeinen zeigten die Ergebnisse, dass die mittels Röntgenaufnahmen erfassten Outcomes sowohl bei älteren als auch bei jüngeren Kindern nach einer sofortigen Röntgenaufnahme nach Reduktion vergleichbar waren. Im Langzeit-Follow-up wurde ein Unterschied zwischen den beiden Gruppen festgestellt, und dass Angulationsgrad und Dislokation mit den Behandlungsergebnissen älterer Kinder assoziiert sein könnten. Daher sollten diese Faktoren bei der Behandlung und Evaluation der Ergebnisse älterer Kinder berücksichtigt werden.

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Abbreviations

ADL:

Activities of daily living

CRIF:

Closed reduction and internal fixation

ED:

Emergency department

ORIF:

Open reduction and internal fixation

ROM:

Range of motion

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Acknowledgements

The authors would like to thank the members of the hospital for helpful discussion of the manuscript.

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Authors and Affiliations

  1. Department of Orthopaedics, the First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, Guangxi Province, China

    Sheng-Wang Wei &  Jin-Min Zhao

  2. Department of Orthopaedics, liuzhou workers Hospital, Liuzhou, Guangxi Province, China

    Zhan-Ying Shi, Hao Wu, Ju-Zheng Hu & Zhan-Zhu Huang

  3. Department of Orthopaedics, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China

    You-Ming Zhao

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  1. Sheng-Wang Wei
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Correspondence to Jin-Min Zhao.

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Conflict of interest

S.-W. Wei, Z.-Y. Shi, Y.-M. Zhao, H. Wu, J.-Z. Hu, Z.-Z. Huang and J.-M. Zhao declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study or their legal guardians.

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Sheng-Wang Wie and Zhan-Ying Shi contributed equally to the manuscript

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Wei, SW., Shi, ZY., Zhao, YM. et al. Comparison of conservative treatment outcomes for proximal humeral epiphyseal fractures in patients of different ages. Orthopäde 48, 119–124 (2019). https://doi.org/10.1007/s00132-018-03677-3

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  • DOI: https://doi.org/10.1007/s00132-018-03677-3

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