Glenohumeral joint dislocation is rare in children with proximal humeral fractures: a descriptive study and literature review

Successful Management of a Rare Pediatric Proximal Humerus Fracture-Dislocation Using K-Wire Fixation: A Case Report

Introduction

Proximal humerus fractures are uncommon in children, accounting for <5% of pediatric fractures, with glenohumeral dislocation being an even rarer occurrence. These injuries are challenging due to the complex shoulder anatomy and the risk of growth disturbances, as the proximal humeral physis contributes ~80% of humeral growth. While many fractures can be managed conservatively, severe displacement or associated dislocations, such as Neer-Horwitz Type IV fractures, may require surgical intervention. Treatment options include K-wires, elastic stable intramedullary nailing, and plate fixation, with K-wires offering a less invasive alternative. We present a case of a 12-year-old boy with a Neer-Horwitz Type IV fracture-dislocation, successfully treated with closed reduction and K-wire fixation, demonstrating the effectiveness of this technique in preserving growth potential while achieving stability.

Case Report

We present the case of a 5-year-old right-hand dominant girl who sustained a severely displaced proximal humerus fracture with anterior glenohumeral dislocation after falling from a train berth. She landed on her outstretched left hand, resulting in severe pain, deformity, and loss of arm function. Radiographs and CT imaging confirmed a Neer-Horwitz Type IV fracture with significant displacement and varus angulation. Closed reduction and percutaneous K-wire fixation were performed under general anesthesia using the Kapandji and Jyoctiky maneuver, achieving satisfactory fracture alignment and joint reduction. Postoperatively, the arm was immobilized with a Dynaplast bandage, allowing for early pendulum exercises. The patient was discharged on post-operative day two with maintained reduction and proper K-wire positioning. This case highlights the efficacy of minimally invasive techniques for complex pediatric fractures, preserving growth potential while restoring joint stability.

Conclusion

This case highlights the effectiveness of closed reduction and K-wire fixation in managing complex pediatric proximal humerus fracture dislocations. The technique provides adequate stability while minimizing iatrogenic physeal damage, leading to excellent functional outcomes. However, each case should be approached individually, considering factors such as age, fracture pattern, and surgeon experience.

Application of 3D printing technology in preoperative planning and treatment of proximal humerus fractures: a retrospective study

BACKGROUND

The application of 3D printing technology in preoperative planning and treatment of these fractures has shown promise in improving surgical efficiency, trauma, and patient outcomes. This study aims to demonstrate the advantages of applying 3D printing technology to the treatment of proximal humeral fractures by comparing cases selected for 3D printing with a control group (conventional surgery group), in order to further promote the application of 3D technology in a broader range of trauma treatments.

METHODS

This study conducted the clinical data of 51 patients with proximal humeral fractures. Inclusion criteria encompassed patients diagnosed with Neer II and III type proximal humerus fractures. Among them, 24 patients underwent traditional surgery, while 27 patients underwent surgery with 3D printing technology support. Intraoperative parameters, functional outcomes, radiographic results at 6 months, and pain scores were collected and analyzed.

RESULTS

The 3D printing group demonstrated significantly reduced total surgery time compared to the traditional surgery group (P < 0.05). Implant placement accuracy was significantly higher in the 3D printing group compared to the traditional surgery group (P < 0.05). Functional outcomes at 6 months favored the 3D printing group, with higher Constant-Murley Score and lower Disability of the Arm, Shoulder, and Hand (DASH) Score compared to the traditional surgery group (P < 0.05). Additionally, the 3D printing group showed a significantly lower prevalence of heterotopic ossification compared to the traditional surgery group (P < 0.05). Preoperative and early postoperative pain scores were significantly lower in the 3D printing group compared to the traditional surgery group (P < 0.05).

CONCLUSION

The integration of 3D printing technology into the preoperative planning and treatment of complex proximal humerus fractures demonstrated significant advantages in surgical efficiency, functional outcomes, radiographic prognosis, and pain management.

A Rare Combined Injury in Children during Side Impact: The Possible Mechanism and Treatment Results

OBJECTIVE

Proximal humeral fracture combined with contralateral midshaft clavicle fracture is an extremely rare injury in children. Few studies focus on the injury mechanism and treatment scheme. The aim of this study is to propose the possible mechanism of this injury and present the treatment results.

METHODS

This retrospective study included children diagnosed with proximal humeral fractures combined with contralateral midshaft clavicle fractures from August 2016 to March 2019 in the corresponding author's institution. The patients received elastic stable intramedullary nails and external fixation as treatment. The radiological and clinical outcomes of treatments were evaluated using the imaging and the Constant-Murley score (CMS) in follow up.

RESULTS

Twelve patients (eight males and four females) with an average age of 7.83 years old (age 5-12) were included in this research. All the patients had suffered a side impact in a road traffic accident or outdoor environment. Hypothesis about the mechanism was the proximal humerus was directly impacted at first and caused the surgical neck fracture, then the contralateral shoulder hits the solid object and the contralateral midshaft clavicle was fractured. During the average 45.2 months (range 36-57) follow-up, all the patient's fractures achieved clinical and radiological union before 14 weeks without complications. Every patient had a satisfactory score (range from 92 to 100) on the CMS criteria for both shoulders.

CONCLUSION

The hypothesis about the mechanism of this combined injury in this study sounds reasonable. It highlights the need for safety-related education about using a safety seat or wearing a seat belt to parents and caregivers, so as to avoid such injury even if the treatment with external fixation (EF) and proximal humeral and elastic stable intramedullary nailing (ESIN) showed good results.

Management of Pediatric Proximal Humerus Fractures

Proximal humerus fractures have an outstanding potential to remodel due to their proximity to the proximal humeral physis. Fractures in young children can be treated nonoperatively with excellent outcomes. The incidence peaks in adolescent patients and these injuries most commonly occur after a fall or direct trauma. The muscle attachments of the proximal humerus act as deforming forces and anatomic structures such as the periosteum and biceps tendon may act as blocks to reduction. Operative management is uniformly indicated for patients with open fractures, ipsilateral elbow or forearm injury, associated neurovascular injury, or poly-trauma patients. Operative treatment may be further considered in older children with minimal growth remaining and with fractures that are considered significantly displaced by available classification systems. Unfortunately, there are significant challenges in recommending treatment based on displacement and age alone. The purpose of this paper is to review what is known about these injuries and how they can be treated in light of current deficiencies in the literature; this may stimulate further work to refine indications for treatment based upon age and displacement. Key Concepts•The proximal humerus physis is responsible for 80% of the growth of the entire bone, and proximal humerus fractures have tremendous potential to remodel.•Proximal humerus fractures occur most commonly due to a fall or direct trauma but other causes include overuse injury and pathologic lesions.•Treatment indications for pediatric proximal fractures are guided by age of the patient, fracture displacement, and associated injuries; the majority of these injuries may be treated nonoperatively.•Outcomes after operative and nonoperative management of proximal humerus fractures are generally good.