Comparative analysis of clinical outcomes of different internal fixation techniques for severely displaced proximal humeral fractures in older children: A retrospective study analysis

This study aims to compare the clinical effects of 2 different techniques in the treatment of severely displaced proximal humeral fractures in older children. A retrospective study was conducted on the clinical data of 56 older children with severely displaced proximal humeral fractures who were admitted from February 2019 to March 2025. Among them, 31 patients were treated with a single elastic stable intramedullary nail (ESIN) (designated as Group A) and 25 patients were treated with percutaneous Kirschner wire fixation (designated as Group B). The age, sex, body mass index (BMI), causes of injury, affected side, fracture site, Neer–Horwitz classification, operative duration, and intraoperative fluoroscopy times were statistically analyzed for these 2 groups, respectively. At the last follow-up, the shoulder joint function of the patients was evaluated using the Neer scoring system. The operative duration and fluoroscopy times in Group A [(43.1 ± 13.3 minutes), (10.7 ± 2.6)] were markedly lower than those in Group B [(57.6 ± 20.1 minutes), (19.6 ± 4.6)], demonstrating a statistically significant difference ( P  < .05). Nevertheless, no statistically significant differences were observed between the 2 groups regarding age, gender, BMI, causes of injury, affected side, fracture site, and Neer–Horwitz classification ( P >.05). The Kirschner wires were removed between 4 and 8 weeks postoperatively, and ESINs were extracted from 4 to 6 months postoperatively. Four patients in Group B exhibited symptoms of pin-tract infection, while the remaining patients did not experience complications such as internal fixation loosening, vascular, and nerve injuries. The fractures in both groups healed well. At the last follow-up, there was no statistically significant difference in the Neer scores of shoulder joint function between the 2 groups ( P  > .05). These 2 different techniques can achieve satisfactory therapeutic effects in the treatment of severely displaced proximal humeral fractures in older children. Compared with Kirschner wire fixation, the single ESIN technique not only can save operative duration but also reduce the radiation exposure of pediatric patients during the surgery.