We need a quick answer please! Our 11-year-old daughter broke her arm way up by the shoulder. I guess it’s pretty bad. The surgeon wants to use some kind of curved titanium “nail” to hold the pieces together instead of putting her in a cast. We’ve been told this is safe but it’s a relatively new method. Are there any downsides to this treatment? Should we say yes? We have about 20 minutes to decide.

You may be referring to the use of titanium elastic nails (TENs). Fractures of the proximal humerus (upper arm near the shoulder) can be very challenging. The break can be very close to the growth plate and sometimes even goes through the growth plate. TENs are used to treat severe, displaced (separated), or irreducible (bone cannot be lined up) fractures.

The technique has been around for 40 years. It was first introduced in 1970 by a French surgeon by the name of Metaizeau. But it has been very successful and is being adopted by surgeons around the world. For appropriate patients, this technique eliminates the need to attempt closed reductions that can be very dangerous. It is a minimally invasive approach to the problem.

Functional results are improved because there is less risk of nerve and blood vessel injury. Being able to stabilize severe fractures also reduces the number of arm deformities and limb shortening. And finally, when compared with conservative (nonoperative) care with immobilization, this operative treatment is preferred by families. Children experience less pain, a shorter healing time, and faster time getting back to their daily activities including recreation and sports.