![]() The hospital was the only pediatric trauma center in the study area and the respective children population at risk was 84.500–88.100 during the study time, according to the official statistics by Statistics Finland. This population-based study consisted of 300 children younger than 16 years old, who had a proximal humerus fracture in the Oulu University Hospital district between 20. The purpose of this research was to study the local incidence and treatment trends of proximal humerus fractures in children. Pediatric upper extremity fractures in general have increased since the beginning of the 2000s, but closer epidemiological description and the recent treatment trends of the proximal humerus fractures are mostly unknown. This technique is reported to have no increased association to skin irritation or infections and the bone healing is effective and the functional outcome appears to be good. Plate and screw fixation are rarely justified however, many surgeons recommend the elastic stable intramedullary nailing (ESIN) technique because it is stable enough and safe regarding the surrounding soft tissues. Percutaneous Kirschner wire pinning is the most usual fixation in children, often combined with closed reduction. Surgical fixation has traditionally been recommended in proximal humerus fractures when closed reduction is unsatisfactory due to interposed long head of biceps tendon, deltoid muscle or capsule, and in cases of nerve or artery injuries. Persistent deformity, such as shortening, may decrease the outcome. However, the more displaced the fractures and the older the children are, the poorer the results will be. Further, the periosteum is metabolically active in the immature skeleton therefore, bone healing and spontaneous remodeling of proximal humerus fractures in children are usually good and non-operative treatment preferred. The proximal growth plate of the humerus is responsible for 80% of the bone’s longitudinal growth. Displacement and angular deformity can be summarized using the Neer classification. Fractures involving the growth plate are classified with the Salter-Harris (SH) fracture classification. Diagnosis is based on plain radiographs and fractures are classified according to their severity and anatomic location. The fractures are either metaphyseal, which occur mostly in children 5–12 years of age, or epiphyseal separations. They are usually caused by sport injuries, motor vehicle accidents, or birth trauma, while the usual mechanism of injury is hyperextension combined with external rotation of the shoulder. Proximal humerus fractures in children comprise approximately 2% of all pediatric fractures. However, their operative treatment increased compared to nonoperative treatment, but the evidence supporting that trend remains unclear. ConclusionĬontrary to most upper extremity fractures in children, proximal humerus fractures did not increase during the long study period. The most usual recreational activities were horse riding, downhill skiing, snowboarding, and trampolining. Higher age was also associated with operative treatment ( P = 0.002). Bayonet displacement increased the risk of surgical fixation up to 16-fold (95% CI 4.8–51.4, P < 0.001) in a multivariate analysis when adjusted with other potential risk factors. The majority (92%) was treated nonoperatively, however, there was an increase of operative fixation from 0 to 16% during the study time (Difference 16, 95% CI 0.3 to 34.9%, P = 0.045). The annual incidence of childhood proximal humerus fractures was mean 31.4/100,000 and no variation trend was found. Annual incidence was based on the child population at risk, which changed between 84.500 and 88.100 in the study time. ![]() Radiographs were reviewed, and patients, injuries, treatments, and outcomes were comprehensively studied. ![]() MethodsĪll 300 children, aged < 16 years, who suffered from a proximal humerus fracture in the catchment area of Oulu University Hospital, Finland, between 20, were included. The aim was to study the incidence and treatment trends of proximal humerus fractures in children. However, recent trends of proximal humerus fractures are not analyzed yet. In general, upper extremity fractures have increased in children. Proximal humerus fractures comprise approximately 2% of all pediatric fractures.
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