Surgical Management of Displaced Pediatric Proximal Humerus Fractures: Clinical Outcomes and Pattern Analysis from a Tertiary Trauma Center in Southern Saudi Arabia

Abstract

Background: The management of pediatric proximal humerus fractures (PHFs) are both challenging due to growth remodel potential of the physis and the variable displacement. Minimal displacement fractures generally remain a non-operative management, while further displaced or unstable fractures warrant operation. Limited information is available on the patterns of operative surgical management in southern Saudi Arabia.
Objective: The aim of this study is to analyze the demographic profile, mechanism of trauma, technique of operative management and short term results of children with displaced PHFs.
Methodology: A retrospective cohort study of sixty-five children (0-13 y/o) undergoing surgical reduction of displaced PHFs from 2017 to 2023 in the southern region of Saudi Arabia was performed. The study includes analysis of age of the patient, mechanism of trauma, injury to surgical period (trauma period), procedure used, and post operative early morbidity. The study also analyzed statistical correlations using Fisher's Exact Test or Pearson's Chi square test for categorical variables.
Results: There was a male preponderance of 36 (55.4%) than female patients 29 (44.6%). The mean age of the patients was 5.34 + 2.75 yrs. Majority of the injuries were due to falls 61(93.8%), while 4(6.2%) occurred in road traffic accidents (RTAs). Most cases are treated with closed reduction and K-wire fixation 58 (89.2%), ESIN 5 (7.7%), plate osteosythesis 2(3.1%) respectively. Surgical approach was statistically dependent upon mechanism of trauma (p<0.001 Fisher's) and trauma period (p<0.001 Fisher's). There were no post-operative complications observed such as infections, nerve injuries, or loss of reduction.
Conclusion: Closed reduction with percutaneous K wire internal fixation is a very effective and safe form of management in severe cases of PHFs in the pediatric age group when surgery is indicated. Modification on the procedure should be guided by the condition of each individual patient, trauma time and magnitude of trauma.