A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not Changed
Introduction: Humeral shaft fractures have traditionally been treated non-operatively due to their good union and low rate of functional impairment. In the recent years, upper extremity fractures and their operative treatment have increased in children. Nevertheless, the trends of humeral shaft frac...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-11-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2020.580272/full |
| _version_ | 1828803429797986304 |
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| author | Juuli Hannonen Juuli Hannonen Juuli Hannonen Elina Sassi Elina Sassi Elina Sassi Hanna Hyvönen Hanna Hyvönen Hanna Hyvönen Juha-Jaakko Sinikumpu Juha-Jaakko Sinikumpu Juha-Jaakko Sinikumpu |
| author_facet | Juuli Hannonen Juuli Hannonen Juuli Hannonen Elina Sassi Elina Sassi Elina Sassi Hanna Hyvönen Hanna Hyvönen Hanna Hyvönen Juha-Jaakko Sinikumpu Juha-Jaakko Sinikumpu Juha-Jaakko Sinikumpu |
| author_sort | Juuli Hannonen |
| collection | DOAJ |
| description | Introduction: Humeral shaft fractures have traditionally been treated non-operatively due to their good union and low rate of functional impairment. In the recent years, upper extremity fractures and their operative treatment have increased in children. Nevertheless, the trends of humeral shaft fractures are not clear.Materials and Methods: All children aged <16 years, with a humeral shaft fracture in the geographical catchment area of Northern Finland Hospital District, with a yearly child population-at-risk of ~86 000 from the year 2001 until the end of 2015 were included. There were 88 cases, who comprised the study population. Radiographs were available of all. Injury, patient, and treatment characteristics were reviewed from hospital databases.Results: There was an increasing trend of surgical fixation of humeral shaft fractures during the 15 years' study period (β = 1.266, 95% CI 0.17 to 2.36, p = 0.035). However, we found no patient or fracture-related reasons that could have explained the increasing trend of surgical care. Comminuted fracture increased the risk of operative treatment 8-fold (Odds Ratio, OR 7.82, 95% CI 1.69 to 36.3, p = 0.009). Higher age, greater angular deformity or greater diameter of the humerus were not associated with the increased operation risk.Conclusions: The treatment philosophy concerning pediatric humeral shaft fractures has presented a shift from conservative care to surgical fixation. To authors' understanding there is not evidence supporting the increasing rate of osteosynthesis. |
| first_indexed | 2024-12-12T07:22:59Z |
| format | Article |
| id | doaj.art-cc96c1ab382c428d8e1ec0163ecf9e10 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-12T07:22:59Z |
| publishDate | 2020-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-cc96c1ab382c428d8e1ec0163ecf9e102022-12-22T00:33:16ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602020-11-01810.3389/fped.2020.580272580272A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not ChangedJuuli Hannonen0Juuli Hannonen1Juuli Hannonen2Elina Sassi3Elina Sassi4Elina Sassi5Hanna Hyvönen6Hanna Hyvönen7Hanna Hyvönen8Juha-Jaakko Sinikumpu9Juha-Jaakko Sinikumpu10Juha-Jaakko Sinikumpu11Department of Children and Adolescents, Pediatric Surgery and Orthopaedics, Oulu University Hospital, Oulu, FinlandResearch Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO Research Unit), University of Oulu, Oulu, FinlandMedical Research Center Oulu, Oulu, FinlandDepartment of Children and Adolescents, Pediatric Surgery and Orthopaedics, Oulu University Hospital, Oulu, FinlandResearch Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO Research Unit), University of Oulu, Oulu, FinlandMedical Research Center Oulu, Oulu, FinlandDepartment of Children and Adolescents, Pediatric Surgery and Orthopaedics, Oulu University Hospital, Oulu, FinlandResearch Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO Research Unit), University of Oulu, Oulu, FinlandMedical Research Center Oulu, Oulu, FinlandDepartment of Children and Adolescents, Pediatric Surgery and Orthopaedics, Oulu University Hospital, Oulu, FinlandResearch Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO Research Unit), University of Oulu, Oulu, FinlandMedical Research Center Oulu, Oulu, FinlandIntroduction: Humeral shaft fractures have traditionally been treated non-operatively due to their good union and low rate of functional impairment. In the recent years, upper extremity fractures and their operative treatment have increased in children. Nevertheless, the trends of humeral shaft fractures are not clear.Materials and Methods: All children aged <16 years, with a humeral shaft fracture in the geographical catchment area of Northern Finland Hospital District, with a yearly child population-at-risk of ~86 000 from the year 2001 until the end of 2015 were included. There were 88 cases, who comprised the study population. Radiographs were available of all. Injury, patient, and treatment characteristics were reviewed from hospital databases.Results: There was an increasing trend of surgical fixation of humeral shaft fractures during the 15 years' study period (β = 1.266, 95% CI 0.17 to 2.36, p = 0.035). However, we found no patient or fracture-related reasons that could have explained the increasing trend of surgical care. Comminuted fracture increased the risk of operative treatment 8-fold (Odds Ratio, OR 7.82, 95% CI 1.69 to 36.3, p = 0.009). Higher age, greater angular deformity or greater diameter of the humerus were not associated with the increased operation risk.Conclusions: The treatment philosophy concerning pediatric humeral shaft fractures has presented a shift from conservative care to surgical fixation. To authors' understanding there is not evidence supporting the increasing rate of osteosynthesis.https://www.frontiersin.org/articles/10.3389/fped.2020.580272/fullhumeral shaft fracturechildren and adolescentsoperative treatmentinternal fixationepidemiologychanging trends |
| spellingShingle | Juuli Hannonen Juuli Hannonen Juuli Hannonen Elina Sassi Elina Sassi Elina Sassi Hanna Hyvönen Hanna Hyvönen Hanna Hyvönen Juha-Jaakko Sinikumpu Juha-Jaakko Sinikumpu Juha-Jaakko Sinikumpu A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not Changed Frontiers in Pediatrics humeral shaft fracture children and adolescents operative treatment internal fixation epidemiology changing trends |
| title | A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not Changed |
| title_full | A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not Changed |
| title_fullStr | A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not Changed |
| title_full_unstemmed | A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not Changed |
| title_short | A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not Changed |
| title_sort | shift from non operative care to surgical fixation of pediatric humeral shaft fractures even though their severity has not changed |
| topic | humeral shaft fracture children and adolescents operative treatment internal fixation epidemiology changing trends |
| url | https://www.frontiersin.org/articles/10.3389/fped.2020.580272/full |
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