The use of the pediatric physeal slide-traction plate in the treatment of neer-horwitz grade IV proximal humeral fractures in children: A case report and literature review

Abstract

Background: Proximal humeral fractures (PHFs) are rare in children. Currently, the recommended surgical methods for severely displaced PHFs are closed reduction and percutaneous fixation using K-wires or intramedullary nailing, which can't provide firm internal fixation, especially for older and high-weight children. This study aimed to introduce a novel surgical approach, pediatric physeal slide-traction plate fixation (PPSP), for Neer-Horwitz grade IV PHFs in children.

Case summary: A 9-year-old boy presented with left shoulder pain and swelling due to a car accident. Physical examination revealed a positive shoulder deformity and local tenderness. On physical examination, we palpated bone friction without vascular and nerve damage. Based on imaging findings, we diagnosed Neer-Horwitz grade IV PHF. In view of the patient's condition, we performed PPSP after careful communication with the patient's parents. After 22 months of follow-up, the patient's left shoulder function was satisfactory, and there was no restriction of activities.

Conclusion: According to previous studies, PPSP is only used for femur fractures. To the best of our knowledge, this is the first in the treatment for PHFs. Given the satisfactory outcomes, it is a safe and effective method and may provide a reference to cure analogous patients in the future.

Keywords: case report; children; literature review; pediatric physeal slide-traction plate; proximal humeral fracture.

Figure 1

Images of the pediatric physeal slide-traction plate.

Figure 2

Radiographs of a proximal fracture of the left humerus in a 9-year-old boy by a traffic accident. (A) Preoperative lateral radiography shows proximal humeral fractures, Neer–Horwitz grade IV. (B) Intraoperatively, the internal fixation device is found to be in good position. (C) Lateral radiography at 6 weeks after surgery. (D) Lateral radiography at 3 months after surgery. (E) Lateral radiography at 6 months after surgery. (F) Postoperatively, slide plate removal.

Figure 3

The internal fixation device is removed completely after surgery without fracture. (A) The front view. (B) The side view.

Figure 4

Measurement results of the length of the affected limb.

Figure 5

The patient's left shoulder has a normal range of motion without dysfunction after 6 months of removing the internal fixation device.