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Reducing resource utilization during non-operative treatment of pediatric proximal humerus fractures - 08/02/17

Doi : 10.1016/j.otsr.2016.09.022 
A.Z. Gladstein a, b, , A.T. Schade c, A.W. Howard d, M.W. Camp d
a Pennsylvania Hospital, Sports Medicine, 800, Spruce street, Philadelphia, PA 19103 United States 
b Texas Children's Hospital Department of Orthopaedic Surgery, 6620 Fannin, St. Houston, TX 77030, United States 
c Royal Stoke University Hospitals, Stoke on Trent, St4-6QG, United Kingdom 
d Department of Orthopaedic Surgery, The Hospital for Sick Children, M5G 1X8 Toronto, Ontario, Canada 

Corresponding author. Pennsylvania Hospital, Sports Medicine, 800, Spruce street, Philadelphia, PA 19103 United States.

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Abstract

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.

Material and methods

We retrospectively reviewed the records of 239 patients treated for proximal humerus fractures over a 5-year period. There were 225 who were treated non-operatively. Records were reviewed for the number of clinic visits and radiographs, as well as any change to operative management based on follow-up X-rays.

Results

The primary outcome of the study was the proportion of proximal humerus fractures, initially treated non-operatively, for which displacement or angulation on follow-up radiographs led to a change to operative treatment. Secondary outcomes were the number of follow-up radiographs obtained after the initial diagnosis and initiation of non-operative treatment. Of the 225 patients that were initially managed non-operatively, only 1 patient required subsequent surgical management. This patient underwent a proximal humerus epiphysiodesis 365 days from injury after development of a partial growth arrest. The mean number of fracture clinic visits for patients managed non-operatively was 2.67 (±1.24). The mean number of radiology department visits and radiographs obtained was 3.57 (±1.44) and 8.36 (±3.89) respectively. No clinical or radiographic non-unions were identified in these patients. No patients suffered a refracture during the review period.

Discussion

This study shows that of the 239 uncomplicated pediatric proximal humerus fractures treated at our hospital over a 5-year period, only 1 had a change in treatment plan, from non-operative to operative, based on follow-up radiographs. These data suggest that non-operative treatment of proximal humerus fractures seldom results in displacement that warrants operative intervention. Moreover, they suggest that there is little utility to the routine use of postoperative radiographs in follow-up of these patients.

Study design

Retrospective case series.

Level of evidence

IV.

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Keywords : Proximal humerus fractures, Reducing radiation, Reducing costs


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Vol 103 - N° 1

P. 115-118 - février 2017 Retour au numéro
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