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Study: Radiological follow-up not useful for proximal humerus fractures in adolescents
The study showed displaced fractures were usually treated operatively and slightly displaced fractures healed well without operative intervention.
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Despite a trend in the literature for surgery for proximal humerus fractures in adolescent patients, researchers recently reported there is no need to increase the surgical rates for the management of these fractures because they are stable and benign and there is no need for additional radiographic follow-up after the initial intervention.
Tuomas Lähdeoja, MD, of Helsinki, Finland, and colleagues conducted a short-term retrospective study of children 10 years to 16 years old treated for proximal humeral fractures between 1995 and 2005. They set out to clarify the need for follow-up appointments for these adolescents to determine the stability of their fractures.
“The take-home message is that once an adequate treatment decision has been made based on good quality initial X-rays and sufficient expertise, these fractures do not dislocate during follow-up, based on our 230 fractures, and hence routine X-ray follow up is not useful,” Lähdeoja told Orthopaedics Today Europe.
Lähdeoja and colleagues wrote in the abstract of the study that operative rates seem to be increasing for many types of pediatric fractures, including proximal humerus fractures.
Increases in surgical rates unnecessary
While there is a general consensus among surgeons and physicians that follow-up visits for these type of injuries are necessary, Lähdeoja and colleagues noted there is little published contemporary evidence to guide treatment in these patients.
Their study included 229 patients with 230 proximal humeral fractures treated at the Hospital for Children and Adolescents in Helsinki. The researchers analyzed the cases for clinical and radiologic outcomes.
Forty-six patients underwent surgical treatment and 184 patients were treated conservatively. None of the patients’ radiographs led to an intervention and none of their 472 follow-up visits led to any other type of treatment based on new information obtained during the visits, according to the study.
No follow up required
The proximal humerus fractures in adolescents are stable and benign fractures. Intervention after the initial treatment is typically rare, according to Lähdeoja, and the need to increase operative rates for these types of injuries is unwarranted.
Furthermore, the investigators noted in the study that radiographic follow-up does not contribute to treatment or management of the injury and it is unnecessary and costly.
Lähdeoja, who presented the results of this study at the Nordic Orthopaedic Federation Congress, told Orthopaedics Today Europe the study has only been presented as a congress abstract to date and has yet to be published in a peer-reviewed journal. – by Robert Linnehan
- Reference:
- Lähdeoja T. Oral presentation #60. Presented at: Nordic Orthopaedic Federation Congress; May 7-9, 2014; Helsinki.
- For more information:
- Tuomas Lähdeoja, MD, can be reached at the Institute of Clinical Medicine, Department of Medicine, Biomedicum Helsinki, Helsinki University Central Hospital, Helsinki FIN-00029 HUS, Finland; email: tuomas.lahdeoja@hus.fi.
Disclosure: Lähdeoja has no relevant financial disclosures.