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Pediatric + proximal + humerus + fractures

Ghazi Fannouch, Yasser I Al Khalife, Abdulaziz S Al Turki, Ayman H Jawadi
Background: Although rare, pediatric proximal humerus fractures may coexist with glenohumeral dislocations. Most of these injuries are Salter -Harris type of injuries. The treatment usually consists of closed or open reduction and k- wires fixation. The case: In this case report; a 10-year-old girl presented with a rare traumatic humeral surgical neck fracture with a posterior shoulder dislocation that was treated by closed reduction and flexible intramedullary nailing...
June 2017: Trauma Case Reports
Kenneth M Lin, Evan W James, Elad Spitzer, Peter D Fabricant
PURPOSE OF REVIEW: The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and clinical management of pediatric and adolescent patients following a first-time shoulder dislocation. RECENT FINDINGS: Shoulder instability is becoming increasingly common as pediatric and adolescent patients engage in earlier organized sports competition. Recommended treatment following a first-time glenohumeral dislocation event in adolescents depends on several factors, but surgical stabilization is becoming more frequently performed...
February 2018: Current Opinion in Pediatrics
Michelle C Burke, Christopher Minnock, Christopher B Robbins, Matthew D Abbott, Michelle S Caird, Frances A Farley, Jacob Kirsch, Jared Thomas, Ying Li
BACKGROUND: Multiple studies have shown low intrarater and interrater agreement of radiographic classification systems for proximal humerus fractures (PHFs) in adults. There is no standardized method of measuring angulation of pediatric PHFs, nor is there consensus as to the amount of angulation and displacement that require operative fixation of adolescent PHFs. We propose a new standardized method to measure fracture angulation that is similar to the method used to measure the epiphyseal-shaft angle for slipped capital femoral epiphysis...
October 3, 2017: Journal of Pediatric Orthopedics
T Ergönenç, H Can, S Gökhan Beyaz
The brachial plexus is commonly blocked at the interscalene level for shoulder and proximal humeral surgery. There are only a few publications about the interscalene technique in pediatric patients for a peripheral nerve block. Ultrasound-guided peripheral nerve block has become increasingly more popular for pediatric patients because of high success rates and safety concerns. We used ultrasound-guided interscalene brachial plexus block in an 18-month-old child with an acute upper respiratory infection who had a supracondylar fracture of the humerus...
October 2017: Der Anaesthesist
Dominique Barbier, Benoît De Billy, Philippe Gicquel, Sophie Bourelle, Pierre Journeau
BACKGROUND: There are several options for reconstruction of proximal humerus resections after wide resection for malignant tumors in children. The clavicula pro humero technique is a biologic option that has been used in the past, but there are only scant case reports and small series that comment on the results of the procedure. Because the longevity of children mandates a reconstruction with potential longevity not likely to be achieved by other techniques, the clavicula pro humero technique may be a potential option in selected patients...
October 2017: Clinical Orthopaedics and related Research
Ronnie L Shammas, Yash J Avashia, Alfredo E Farjat, Anthony A Catanzano, L Scott Levin, William C Eward, Brian E Brigman, Detlev Erdmann
BACKGROUND: The vascularized free fibula epiphyseal transfer provides an option for the preservation of limb lengthening after resection of the proximal humerus in pediatric sarcoma patients. The purpose of this study was to provide a long-term follow-up of longitudinal growth patterns and outcomes after free fibula epiphyseal transfer in upper extremity reconstruction. METHODS: A retrospective review of 4 patients who underwent free fibula epiphyseal transfer after oncologic resection of the proximal humerus for osteosarcoma was performed...
May 2017: Plastic and Reconstructive Surgery. Global Open
Do Young Park, Jae Ho Cho, Doo-Hyung Lee, Wan-Sun Choi, Jun Young Bang, Xiang Yun Yin
OBJECTIVE: To determine the 3-dimensional morphology of pediatric lateral condylar physeal fractures using 3-dimensional computed tomography (3D-CT) and to identify optimal pin positions for percutaneous pinning. DESIGN: Prospective case series of consecutively treated patients. SETTING: Tertiary university hospital setting. PATIENTS: Preoperative 3D-CTs in pediatric surgical candidates diagnosed with lateral condylar physeal fractures...
October 2017: Journal of Orthopaedic Trauma
Ayman M Ali, Sallam I Fawzy, Medhat Moaty, Mohamed Abelaziz
Although most pediatric proximal humeral fractures can be successfully treated conservatively with satisfactory results, many operative techniques have been described for the treatment of displaced proximal humeral fractures. The aim of this study is to evaluate the efficacy of percutaneous fixation using a modified palm tree technique for proximal humerus fractures in children. Between March 2011 and May 2013, the modified palm tree technique was used for the management of 30 children (20 boys and 10 girls) with displaced proximal humeral fractures...
March 2018: Journal of Pediatric Orthopedics. Part B
A Z Gladstein, A T Schade, A W Howard, M W Camp
INTRODUCTION: The majority of proximal humeral fractures in the skeletally immature are treated non-operatively. Operative indications vary but are largely based on degree of displacement. Non-union is rare. Non-operatively treated fractures are typically monitored radiographically to assess healing. HYPOTHESIS: We hypothesize that the decision to treat fractures operatively is made at the time of first imaging and that follow-up X-rays do not lead to a change in management...
February 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
James E Moyer, Jennifer M Brey
Shoulder injuries in pediatric athletes are typically caused by acute or overuse injuries. The developing structures of the shoulder lead to injury patterns that are distinct from those of adult athletes. Overuse injuries often affect the physeal structures of the proximal humerus and can lead to pain and loss of sports participation. Shoulder instability is common in pediatric athletes, and recurrence is also a concern in this population. Fractures of the proximal humerus and clavicle are typically treated with conservative management, but there is a trend toward surgical intervention...
October 2016: Orthopedic Clinics of North America
Ido Stahl, Mark Eidelman
Pediatric proximal humerus fractures are uncommon and mostly treated conservatively. However, surgical treatment should be considered in displaced fractures classified as Neer-Horowitz grade III-IV in children older than 11 years. We describe a three-point fixation method of applying two Kirschner wires, prebent into a wave shape, and inserted into the proximal humerus through a single cortical hole. In this minimally invasive approach, we treated four boys, obtaining accurate reduction and stable fixation, with all patients starting pendulous exercises the day after surgery...
January 2017: Journal of Pediatric Orthopedics. Part B
Shivanand M Bandekar, Mihir R Desai
INTRODUCTION: Injuries around the elbow are common in pediatric population. Amongst them, most common is fractures of the supracondylar part of humerus, followed by condylar fractures. Fractures of the neck of the radius account for five-ten percent of the total injuries. Various techniques for closed reduction of the fracture have been described in literature. Open reduction and fixation is indicated when closed reduction fails to provide satisfactory results and the angulation remains more than 45-60 degrees...
October 2015: Journal of Orthopaedic Case Reports
Tomoki Nakamura, Akihiko Matsumine, Kunihiro Asanuma, Takao Matsubara, Akihiro Sudo
The aim of the present study was to investigate the mid- to long-term clinical performance of calcium phosphate cement (CPC) in the treatment of benign bone tumors in pediatric patients with a follow-up of at least 2-years. The cases of 33 patients with benign bone tumors treated by curettage and subsequent implantation of CPC were retrospectively reviewed. The patients consisted of 13 males and 20 females, with a median age of 13 years and median follow-up time of 79 months. All patients were alive at the time of review...
January 2016: Oncology Letters
Joseph Benevenia, Francis Patterson, Kathleen Beebe, Kimberly Tucker, Jeffrey Moore, Joseph Ippolito, Steven Rivero
Limb-salvage for primary malignant bone tumors in pediatric patients presents a unique challenge when resection includes an active physis. Early expandable prostheses required open surgical procedures to achieve lengthening. Newer prostheses are capable of achieving expansion without open procedures through the use of an electromagnetic field. This study reports our results with 90 consecutive expansion procedures using the Repiphysis(®) prosthesis. We retrospectively reviewed the records of 20 patients (22 limbs) who underwent limb-salvage using the Repiphysis(®) prosthesis from 2003 to 2015...
2015: SpringerPlus
Jonathan S Zember, Zehava S Rosenberg, Steven Kwong, Shefali P Kothary, Maria A Bedoya
A growing number of magnetic resonance (MR) imaging studies of the shoulder are being performed as a result of greater and earlier participation of children and adolescents in competitive sports such as softball and baseball. However, scant information is available regarding the MR imaging features of the normal sequential development of the shoulder. The authors discuss the radiographic and MR imaging appearances of the normal musculoskeletal maturation patterns of the shoulder, with emphasis on (a) development of secondary ossification centers of the glenoid (including the subcoracoid and peripheral glenoid ossification centers); (b) development of preossification and secondary ossification centers of the humeral head and the variable appearance and number of the secondary ossification centers of the distal acromion, with emphasis on the formation of the os acromiale; (c) development of the growth plates, glenoid bone plates, glenoid bare area, and proximal humeral metaphyseal stripe; and (d) marrow signal alterations in the distal humerus, acromion, and clavicle...
July 2015: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Sijohn Hong, Jae-Hwi Nho, Chang-Ju Lee, Jun-Bum Kim, ByungSung Kim, Hyung-Suk Choi
In pediatric patients, proximal humeral physeal fractures are uncommon injuries compared with distal physeal fractures. Usually, the growth plate is the most vulnerable site of fracture in the proximal humerus. Proximal humeral physeal fractures accompanying posterior shoulder dislocation are very rare. There are few recent reports on the combination of glenohumeral dislocation and proximal humerus fractures. Here, we describe a case of posterior shoulder dislocation with ipsilateral proximal humerus type 2 physeal fracture in a 9-year-old boy...
May 2015: Journal of Pediatric Orthopedics. Part B
Frank Fitoussi, Brice Ilharreborde
BACKGROUND: Resection of primary malignant tumors often creates large bony defects. In children, this creates reconstructive challenges, and many options have been described for limb salvage in this setting. Studies have supported the use of an induced-membrane technique after placement of a cement spacer to aid in restoration of bone anatomy. QUESTIONS/PURPOSES: We asked: (1) What complications are associated with the induced-membrane technique? (2) How often is bone healing achieved after resection greater than 15 cm using this technique? (3) What is the functional outcome of patients treated with this technique? METHODS: We performed a retrospective evaluation of eight patients with a mean age of 13...
June 2015: Clinical Orthopaedics and related Research
Charles A Popkin, William N Levine, Christopher S Ahmad
In the pediatric population, sports participation, falls, and motor vehicle accidents can result in proximal humerus fractures. Because the proximal humeral growth plate is responsible for up to 80% of the growth of the humerus, the remodeling of these fractures in children is tremendous. Most of these injuries can be treated with a sling or hanging arm cast, although older children with decreased remodeling capacity may require surgery. Special considerations should be taken for management of proximal humerus fractures that occur in the context of Little League shoulder, lesser tuerosity avulsion fractures, fracture-dislocations, birth fractures, and fractures associated with cysts...
February 2015: Journal of the American Academy of Orthopaedic Surgeons
Riazuddin Mohammed, Prabhudheer Bhogadi, Sreenivasulu Metikala
PURPOSE: Study of a biplanar crossed pin construct by two crossed Kirschner wires in the management of displaced extension type supracondylar humeral fractures in children. METHODS: Sixty-four patients with such fractures were included and treated according to the study protocol: after achieving closed reduction under general anesthesia with fluoroscopic control, two crossed Kirschner wires of equal diameter were inserted percutaneously. The first lateral wire tracts from the posterolateral corner of the epicondyle to the anteromedial cortex proximally...
October 2014: Journal of Children's Orthopaedics
T Slongo
OBJECTIVE: Closed, anatomical reduction and reliable fixation of type III and IV supracondylar fractures that are either difficult or impossible to treat with conventional methods. INDICATIONS: According the Pediatric Comprehensive AO Classification for long bones this technique is preferred for type III and IV supracondylar fractures that cannot be reduced using closed standard manipulative techniques, where stable fixation using standard percutaneous wire configurations cannot be achieved, when severe swelling, open fracture, primary neurological or vascular problems ("pulseless pink hand") or multiple injuries indicate that optimal management of the injured limb should be free from cast...
February 2014: Operative Orthopädie und Traumatologie
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