Short-term efficacy of single retrograde elastic intramedullary nailing for proximal humerus fractures in children

Shen Yang; Sun Qingzeng; Li Dajin

doi:10.3969/j.issn.1009-4237.2025.03.006

Abstract：Objective To investigate the application and short-term clinical effect of single retrograde elas-tic intramedullary nailing in the treatment of proximal humerus fractures in children.Methods Clinical data of 46 patients with proximal humerus fractures(Neer-Horwitz types Ⅲ and Ⅳ)treated in our department with closed re-duction retrograde elastic intramedullary nail internal fixation from Jun.2018 to Jan.2022 were retrospectively ana-lyzed.There were 34 males and 12 females,with the age range of 8-16 years(mean 13.8 years);23 cases affected the left side and 23 the right side.According to the intramedullary nailing methods,patients were divided into single nailing group(20 cases,13 Neer-Horwitz type Ⅲ and 7 type Ⅳ)and double nailing group(26 cases,16 Neer-Hor-witz type Ⅲ and 10 type Ⅳ).The perioperative information,functional recovery and imaging data of the two groups were compared.Results General data,injury types and severity were revealed no significant difference between the two groups(all P>0.05).Closed reduction was completed in both groups without vascular or nerve injuries.The single nailing group showed shorter operation time(min,42.15±4.37 vs.66.62±6.27),fewer times of intraopera-tive fluoroscopy(12.55±3.32 vs.19.35±4.02)and shorter incision length(cm,1.38±0.35 vs.2.99±0.57),re-vealing significant differences compared with the double nailing group(all P<0.001);while the length of hospital stay was similar(d,4.35±0.93 vs.4.19±0.90,P=0.564).Bone union was obtained in all patients after surgery without malunion or epiphyseal closure.At 3 and 6 months,follow-up results showed no significant difference in shoulder Neer score or reduction quality and fracture healing time by imaging assessment(all P>0.05).Comparison of the postoperative complications was also insignificant.Conclusion Single retrograde elastic intramedullary nail-ing can well manage severe proximal humerus fractures as double nailing in children,but the former has the advanta-ges of shorter operation time and less intraoperative fluoroscopy.