J Korean Orthop Assoc.  2012 Aug;47(4):250-256. 10.4055/jkoa.2012.47.4.250.

Operative Treatment of Pediatric Humeral Diaphyseal Fractures with Flexible Intramedullary Nails

• Kwak YH
• Min SK
• Lee YB
• Park KB

• KMID: 2185371
• DOI: http://doi.org/10.4055/jkoa.2012.47.4.250

Abstract

PURPOSE
Most humeral fractures of children are treated satisfactorily with conservative method, thus surgical treatment is often reserved for limited conditions. In cases of an open fracture, inadequate reduction or multiple traumas, children with humeral shaft fractures require operative treatment. The aim of our study was to evaluate results and complications of pediatric humeral shaft fractures that were treated with flexible intramedullary nails.
MATERIALS AND METHODS
A retrospective study was performed for 12 patients who were treated operatively by flexible intramedullary nails between March 2009 and September 2011. Surgical indications were an open fracture, an inability to maintain an adequate reduction, concomitant fractures, refractures and combined radial nerve injury. All patients were treated with 2 titanium flexible intramedullary nails by antegrade or retrograde techniques, according to the site of the fractures.
RESULTS
The mean follow-up period was 15 months, and all patients achieved union status without major complications. There were no neurovascular injuries or infection during surgical procedures. However, 4 patients showed irritation at the insertion site of the nail, and 2 of them underwent early removal of nails at about 6 weeks due to skin lesions as well as pain and discomfort. One boy showed a fracture next to the proximal insertion site of the antegrade nail. All patients showed a full range of motion, and went back to daily life by the final follow-up.
CONCLUSION
Flexible intramedullary nails are considered as a good option for the fracture of the pediatric humeral shaft. Surgeons should pay attention and use proper techniques to avoid complications.

Keyword

humerus; shaft; fracture; elastic nails

MeSH Terms

Child
Follow-Up Studies
Fractures, Open
Humans
Humeral Fractures
Humerus
Multiple Trauma
Nails
Radial Nerve
Range of Motion, Articular
Retrospective Studies
Skin
Titanium
Titanium

Figure

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  Figure 1 Patient 12. (A) Anteroposterior radiograph of the humerus with proximal 1/3 shaft fracture. (B) Fracture was stabilized with 2 titanium elastic nails by 2 lateral retrograde insertions.

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  Figure 2 Patient 1. (A-C) A 12-year-old boy with distal 1/3 shaft fracture of the humerus. It was an open fracture and reduction was not maintained by closed method. (D) Fracture was stabilized with 2 nails by antegrade insertion. (E) After 6 months, there was fracture next to insertion site by minor injury. (F) Anteroposterior radiograph showed fracture union with conservative treatment.

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  Figure 3 Patient 9. (A) Reduction was maintained by closed method and U plaster. (B) After 6 weeks, this 10-year-old boy was hit by his friend and refracture happened. (C) Fracture was fixed with 2 titanium elastic nails. (D) After 13 months, anteroposterior radiograph showed well union status without complications.

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