Humeral Fractures
Conditions
Brief summary
To date, the clinical benefits and harms of surgical intervention in proximal humerus fractures in children remain debatable. The practical question raised by orthopaedic surgeons is: for children and adolescent, are the clinical and radiological outcomes after non-operative management as equivalent as after surgical management for proximal humerus fractures? The investigators' hypothesis is that due to the healing potential of the proximal humerus, the outcome from this fracture is usually excellent. The investigators have applied for Caldicott approval to identify a cohort of eligible patient from NHS Tayside's radiography service. With the community health index (CHI) number, the investigators can review all shoulder X-rays performed in children and adolescents, aged from 10 to 18-year-old in NHS Tayside, from 2008 to 2015. The Caldicott approval also allowed the investigators to obtain clinical communication from the Clinical Portal (electronic summary healthcare records). The investigators will then conduct mail questionnaires, based on the Upper Extremities Functional Index (UEFI). The investigators will send out invitation letter with participation information and the UEFI questionnaires to the eligible patients; with return postages. If no response within 2 weeks, the investigators will send out 1 further reminder. If no further response, the patient will be excluded from the study.
Detailed description
Proximal humerus fractures in children are relatively uncommon and most of them do not require surgical treatment due to the healing potential in children. The management of proximal humerus fractures in children subsequently underwent a major change with the introduction of surgical metal rod nailing. Despite that, the best criteria for choosing between these two treatment options are still not agreed upon. To date, the clinical benefits and harms of surgical intervention in proximal humerus fractures in children remain debatable. The investigators hypothesised that the outcomes of the non-operative management for proximal humerus fractures to remain excellent due to the healing ability of children. If good clinical results are achieved in our patient cohort, the investigators would like to send out the message that non-operative treatment for proximal humerus fractures in children should be recommended, even for those severely displaced fractures. With Caldicott approval, the investigators can review the X-rays performed in children and adolescents, aged from 10 to 18-year-old in NHS Tayside, from 2008 to 2015. By using the Picture Archiving and Communication System (PACS), the investigators will be able to identify the cohort of patients who had proximal humerus fractures from the X-rays. The Caldicott approval also allowed the investigators to obtain clinical communication from Clinical Portal. The identified potential participants will be approached by the paediatric orthopaedic team. An invitation letter, a participant information sheet and questionnaire, based on UEFI will be sent to all potential participants by the care team via post. If no response within 2 weeks, the investigators will send out 1 further reminder. If no further response, the patient will be excluded from the study.
Interventions
None listed
Sponsors
NHS Tayside
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
10 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* Within age limit * Had proximal humerus fracture within study year * Return questionnaire
Exclusion criteria
* No proximal humerus fractures * Not return mail questionnaire
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Indicated Status as Assessed by Mail Questionnaire Upper Extremities Functional Index (UEFI) | From year 2008 to 2015 | Mail questionnaires based on the Upper Extremities Functional Index (UEFI) with return postages were sent out to the eligible cohort. UEFI range between 0 to 59, where the higher the UEFI, the better the functional outcomes. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Indicated Outcomes as Assessed by Radiological Parameters | From year 2008 to 2015 | All shoulder X-rays performed in patients aged from 10 to 18-year-old and from 2008 to 2015 were reviewed. Radiological parameters, including degree of displacement and angulation; and any radiological residual deformities were recorded. |
Participant flow
Recruitment details
From 01/11/2016 to 01/03/2017 in Tayside.
Pre-assignment details
All children who sustained proximal humerus fracture at age of 10 to 18 years old in Tayside.
Participants by arm
| Arm | Count |
|---|---|
| Children With Proximal Humerus Fractures Children aged from 10 to 18-year-old in NHS Tayside whom sustained proximal humerus fractures during year 2008 to 2015. | 118 |
| Total | 118 |
Baseline characteristics
| Characteristic | Children With Proximal Humerus Fractures |
|---|---|
| Age, Categorical <=18 years | 118 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants |
| Age, Continuous | 12 years |
| Region of Enrollment United Kingdom | 118 Participants |
| Sex: Female, Male Female | 56 Participants |
| Sex: Female, Male Male | 62 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 118 |
| serious Total, serious adverse events | 0 / 118 |
Outcome results
Primary
Number of Participants With Indicated Status as Assessed by Mail Questionnaire Upper Extremities Functional Index (UEFI)
Mail questionnaires based on the Upper Extremities Functional Index (UEFI) with return postages were sent out to the eligible cohort. UEFI range between 0 to 59, where the higher the UEFI, the better the functional outcomes.
Time frame: From year 2008 to 2015
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Children With Proximal Humerus Fractures | Number of Participants With Indicated Status as Assessed by Mail Questionnaire Upper Extremities Functional Index (UEFI) | Presence of Pain | 4 Participants |
| Children With Proximal Humerus Fractures | Number of Participants With Indicated Status as Assessed by Mail Questionnaire Upper Extremities Functional Index (UEFI) | Any difference between injured and non-injured arm | 4 Participants |
| Children With Proximal Humerus Fractures | Number of Participants With Indicated Status as Assessed by Mail Questionnaire Upper Extremities Functional Index (UEFI) | UEFI of 59 points | 24 Participants |
Secondary
Number of Participants With Indicated Outcomes as Assessed by Radiological Parameters
All shoulder X-rays performed in patients aged from 10 to 18-year-old and from 2008 to 2015 were reviewed. Radiological parameters, including degree of displacement and angulation; and any radiological residual deformities were recorded.
Time frame: From year 2008 to 2015
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Children With Proximal Humerus Fractures | Number of Participants With Indicated Outcomes as Assessed by Radiological Parameters | Surgical neck fracture | 91 Participants |
| Children With Proximal Humerus Fractures | Number of Participants With Indicated Outcomes as Assessed by Radiological Parameters | Presence of displacement | 56 Participants |
| Children With Proximal Humerus Fractures | Number of Participants With Indicated Outcomes as Assessed by Radiological Parameters | Presence of angulation | 84 Participants |
| Children With Proximal Humerus Fractures | Number of Participants With Indicated Outcomes as Assessed by Radiological Parameters | Residual angulation at follow up | 55 Participants |
| Children With Proximal Humerus Fractures | Number of Participants With Indicated Outcomes as Assessed by Radiological Parameters | Worsened angulation | 25 Participants |