University of Oulu

Hannonen J, Sassi E, Hyvönen H and Sinikumpu J-J (2020) A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not Changed. Front. Pediatr. 8:580272. doi: 10.3389/fped.2020.580272

A shift from non-operative care to surgical fixation of pediatric humeral shaft fractures even though their severity has not changed

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Author: Hannonen, Juuli1,2,3; Sassi, Elina1,2,3; Hyvönen, Hanna1,2,3;
Organizations: 1Department of Children and Adolescents, Pediatric Surgery and Orthopaedics, Oulu University Hospital, Oulu, Finland
2Research 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, Finland
3Medical Research Center Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
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Language: English
Published: Frontiers Media, 2020
Publish Date: 2020-12-11


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.

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Series: Frontiers in pediatrics
ISSN: 2296-2360
ISSN-E: 2296-2360
ISSN-L: 2296-2360
Volume: 8
Article number: 580272
DOI: 10.3389/fped.2020.580272
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © 2020 Hannonen, Sassi, Hyvönen and Sinikumpu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.