Operative Versus Nonoperative Treatment of Displaced Proximal Humerus Fractures in Adolescents: Results of a Prospective Multicenter Study.

Autor:	Hosseinzadeh P; Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, MO., Torres-Izquierdo B; Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, MO., Tippabhatla A; Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, MO., Denning J; Department of Orthopedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH., Vidyadhar U; Department of Orthopedic Surgery, Rady Children's Hospital-San Diego, San Diego, CA., Sanders J; Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, CO., Goldstein R; Department of Orthopedic Surgery, Children's Hospital Los Angeles, Los Angeles, CA., Baldwin K; Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.
Jazyk:	angličtina
Zdroj:	Journal of pediatric orthopedics [J Pediatr Orthop] 2024 Oct 01; Vol. 44 (9), pp. e823-e829. Date of Electronic Publication: 2024 Jun 24.
DOI:	10.1097/BPO.0000000000002755
Abstrakt:	Background: Proximal humerus fractures (PHFx) constitute around 2% of all pediatric fractures. Although younger children with displaced fractures often undergo nonoperative treatments, optimal treatment for adolescents is not well defined. The study aimed to assess the outcomes of operative versus nonoperative treatment of displaced proximal humerus fractures in adolescents via a prospective multicenter study. Methods: This prospective study assessed adolescents aged 10 to 16 years with displaced PHFx from 2018 to 2022 at 6 level 1 trauma centers. Displacement criteria for inclusion were >50% shaft diameter or angulation >30 degrees on AP/lateral shoulder X-rays. Operative versus nonoperative treatment was decided by the treating physician. Radiographic and clinical data were collected at 6 weeks, 3, and 6 months. Patient-reported outcomes (PROs) included: Patient Reported Outcome Measures (PROMIS), Shoulder Pain and Disability Index (SPADI), and QuickDASH questionnaires. Patients were further grouped into a severe displacement cohort, defined as angulation >40° or displacement >75%. Clinical and radiographic data were compared between the 2 treatment cohorts. Results: Out of 78 enrolled patients, 36 (46%) underwent operative treatment. Patients treated operatively were significantly older (13.5 vs. 12.2 y, P <0.001) and exhibited greater mean angulation on AP shoulder view at presentation (31.1° vs. 23.5°, P <0.05). All PROs improved over time. At 6 weeks, operative patients demonstrated superior PROMIS upper extremity scores based on the minimally clinically important difference (MCID) (46.4 vs. 34.3, P =0.027); however, this distinction disappeared by 3 months. In a subanalysis of 35 patients with severe displacement, 21 (60.1%) underwent surgical intervention. No metrics showed significant differences between treatment modalities, with all PROs achieving population norm values by 3 months. Range of motion showed no difference between operative and nonoperative treatments, irrespective of fracture displacement. Conclusion: We found no differences in PROs and ROM between operative and nonoperative treatments of PHFx. If not contraindicated, nonoperative treatment may reduce healthcare costs and risks associated with surgery and should be considered for displaced adolescent proximal humerus fractures, irrespective of fracture displacement. Level of Evidence: II. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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