Abstract：
OBJECTIVE: Paediatric proximal humerus fractures (PHFs) have historically been treated non-operatively. However, the management of severely displaced PHFs in older children has been debated over the years, with contemporary studies advocating for surgery. The purpose of this study was to review the outcomes of a cohort of paediatric patients treated for a PHF to guide management of future paediatric PHFs.
METHODS: The records of the Women\'s and Children\'s Hospital in South Australia were reviewed to identify paediatric PHFs occurring between 1 January 2010 and 1 June 2020. Participants completed the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), the Shoulder Pain and Disability Index, and the Paediatric Outcomes Data Collection Instrument via phone interview. Participants\' shoulder range-of-motion was assessed via telehealth using Zoom. Multivariable logistic regression was used to identify patient and clinical variables that were associated with a poorer outcome.
RESULTS: Of 307 patients contacted, 125 participated. Forty-six patients met the definition of a poorer clinical outcome, defined as a QuickDASH score of ≥2. Fractures of greater severity were predictive of a poorer outcome, and patients aged ≥12 years old at the time of injury had higher total QuickDASH scores. The findings did not suggest that these subgroups of patients have superior outcomes if treated surgically.
CONCLUSIONS: The majority of paediatric PHFs have an acceptable clinical outcome, irrespective of treatment methodology. Multicentre prospective studies are required to establish the indications for surgery for adolescent patients with severely displaced PHFs.
METHODS: The records of the Women\'s and Children\'s Hospital in South Australia were reviewed to identify paediatric PHFs occurring between 1 January 2010 and 1 June 2020. Participants completed the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), the Shoulder Pain and Disability Index, and the Paediatric Outcomes Data Collection Instrument via phone interview. Participants\' shoulder range-of-motion was assessed via telehealth using Zoom. Multivariable logistic regression was used to identify patient and clinical variables that were associated with a poorer outcome.
RESULTS: Of 307 patients contacted, 125 participated. Forty-six patients met the definition of a poorer clinical outcome, defined as a QuickDASH score of ≥2. Fractures of greater severity were predictive of a poorer outcome, and patients aged ≥12 years old at the time of injury had higher total QuickDASH scores. The findings did not suggest that these subgroups of patients have superior outcomes if treated surgically.
CONCLUSIONS: The majority of paediatric PHFs have an acceptable clinical outcome, irrespective of treatment methodology. Multicentre prospective studies are required to establish the indications for surgery for adolescent patients with severely displaced PHFs.
摘要：
目的：小儿肱骨近端骨折（PHFs）历来非手术治疗。然而,多年来，大龄儿童中严重流离失所的PHF的管理一直存在争议，当代研究提倡手术。这项研究的目的是回顾一组接受PHF治疗的儿科患者的结果，以指导未来儿科PHF的管理。
方法：回顾了南澳大利亚妇女儿童医院的记录，以确定2010年1月1日至2020年6月1日期间发生的儿科PHF。参与者完成了手臂的快速残疾，肩和手（QuickDASH），肩痛和残疾指数，和儿科结果数据收集仪器通过电话采访。使用Zoom通过远程健康评估参与者的肩部活动范围。多变量逻辑回归用于确定与较差预后相关的患者和临床变量。
结果：在联系的307名患者中，125参加。46名患者符合较差临床结果的定义，定义为QuickDASH评分≥2。严重程度较高的骨折预示着较差的结果，受伤时年龄≥12岁的患者的QuickDASH总分较高。研究结果并不表明这些患者亚组如果手术治疗有更好的预后。
结论：大多数儿科PHF具有可接受的临床结果，不管治疗方法如何。需要进行多中心前瞻性研究，以确定严重流离失所的PHF青少年患者的手术指征。
方法：回顾了南澳大利亚妇女儿童医院的记录，以确定2010年1月1日至2020年6月1日期间发生的儿科PHF。参与者完成了手臂的快速残疾，肩和手（QuickDASH），肩痛和残疾指数，和儿科结果数据收集仪器通过电话采访。使用Zoom通过远程健康评估参与者的肩部活动范围。多变量逻辑回归用于确定与较差预后相关的患者和临床变量。
结果：在联系的307名患者中，125参加。46名患者符合较差临床结果的定义，定义为QuickDASH评分≥2。严重程度较高的骨折预示着较差的结果，受伤时年龄≥12岁的患者的QuickDASH总分较高。研究结果并不表明这些患者亚组如果手术治疗有更好的预后。
结论：大多数儿科PHF具有可接受的临床结果，不管治疗方法如何。需要进行多中心前瞻性研究，以确定严重流离失所的PHF青少年患者的手术指征。
