OBJECTIVETo evaluate the results of manipulative reduction and percutaneous pin fixation for the treatment of severely displaced proximal humeru fracturess in children.

METHODSFrom January 2006 to December 2010, 43 patients with severely displaced proximal humeru fractures were treated with manipulative reduction and percutaneous pin fixation. There were 28 boys and 15 girls,ranging in age from 3 to 17 years,with an average of 11.1 years. Preoperative diagnoses were confirmed by the X-ray films as Neer-Horwitz type III or IV fractures. All the patients were close fractures without nerve or vascular injuries. Under C-arm X-ray machine, anatomical reduction was achieved by manipulative reduction according to the bone fracture type. The fractures were fixed by percutaneous pinning. Postoperative X-ray confirmed anatomical reduction. Follow-up index were recorded: intra-operative and postoperative complications, postoperative radiographic examination, upper extremity length and range of shoulder motion. Neer score system was used to evaluate shoulder function.

RESULTSAll the patients were followed up, and the duration ranged from 3 to 37 months with an average of 20.4 months. The mean Neer score of the injured side was (95.0 +/- 4.3) (ranged, 85 to 100). Thirty-eight patients got an excellent result, 5 good. The X-ray showed all the fractures healed without shortening deformity or epiphyseal arrest at early stage. All the patients could participate in the normal physical activities and had a normal range of motion and excellent strength of the shoulder joint.

CONCLUSIONThe method of manipulative reduction and percutaneous pin fixation is relatively reliable treatment for severely displaced proximal humerus fractures in children.