Comparison Of Open Reduction And Internal Fixation With Plate And Titanium Elastic Intramedullary Nail In Treating Pediatric Humeral Fracture

Objective: To investigate the therapeutic efficacy of titanium elastic intramedullary nail (TEN) and open reduction and internal fixation with plate (ORIF) in the treatment of humeral fracture in children.Methods: A retrospective study was carried out in a total of 69 patients who were admitted to the hospital from January 2013 to December 2018. These patients, including 41 males and 28 females, were aged from 6 to 12 years old with a median of 8 years. These patients were diagnosed with humeral fracture and underwent the surgery of ORIF (n = 22) or TEN (n = 47). The intraoperative bleeding, operation time, length of stay (LOS), and fracture healing time were compared between the two groups. The therapeutic effect was assessed by the shoulder range of motion, the elbow range of motion, the UCLA shoulder function score, and the Mayo elbow performance score (MEPS) 6 months after the surgery.Results: The intraoperative bleeding (97.20 +/- 27.83 mL vs 185.60 +/- 37.50 mL, P < 0.05), the operation time (53.70 +/- 11.87 min vs 73.50 +/- 13.33 min, P < 0.05), and the fracture healing time (9.30 +/- 4.23 weeks vs 13.45 +/- 3.67 weeks, P < 0.05) in the TEN group was significantly decreased than those in the ORIF group. There was no significant difference in the LOS between the two groups. The length of follow-up is 3 and 6 months. The shoulder range of motion (110.88 degrees +/- 15.82 degrees vs 98.37 degrees +/- 16.22 degrees at 3 months and 162.88 degrees +/- 17.29 degrees vs 117.65 degrees +/- 19.38 degrees at 6 months, both P < 0.05), the elbow range of motion (105.23 degrees +/- 2.81 degrees vs 87.12 degrees +/- 4.73 degrees at 3 months and 137.47 degrees +/- 4.82 degrees vs 109.67 degrees +/- 5.83 degrees at 6 months, both P < 0.05), and the UCLA shoulder function score (28.58 +/- 4.74 vs 21.64 +/- 7.23 at 3 months and 33.05 +/- 3.27 vs 25.78 +/- 3.87 at 6 months, both P < 0.05), and the MEPS (80.76 +/- 3.53 vs 65.33 +/- 9.43 at 3 months and 97.48 +/- 1.23 vs 88.22 +/- 3.65 at 6 months, both P < 0.05) in the TEN group were greater than those in the ORIF group. In the TEN group, complications occurred in three of 47 cases (6.38%), including one case (2.13%) of bone nonunion and two cases (4.25%) of irritation response around the nail. In the ORIF group, complications occurred in four of 22 cases (18.18%), including one case (4.55%) of delayed healing, one case (4.55%) of deep infection, and two cases (9.08%) of radial nerve injury. The complication rate was not significantly different between the two groups.Conclusion: TEN can be a good technique for the treatment of humeral fracture in children, with the advantages of less intraoperative bleeding, shorter operative time, quicker healing, and better recovery of shoulder range of motion and elbow range of motion.