Fractures of the proximal humerus (upper arm near the shoulder) are not the most common bone breaks in children but they aren’t rare either. Sports injuries, bike accidents, and stunts like jumping or falling out of a two-story window account for many of these fractures. A simple break can be put in a cast or immobilizer until it heals — usually in about six weeks’ time.
Bone fractures in children repair quickly because the already rapidly growing bone aids in this process. A complete fracture that splinters into pieces or separates and then buttonholes (one end of the bone pops through the muscle) cannot be easily put back into place and held there until healing takes place.
Fractures that extend up into the growth plate can be another serious complication. But there are some tools surgeons can use in cases like these to help everything heal up without deformities, limb length differences, or interruption of bone growth.
One tool that is especially helpful is the titanium elastic nail. The nails are very thin and prebent in a slight C-shape to help prevent rotation of the bone and displacement of the healing fracture.
TENs were first used in the early 1970s by a French surgeon. Since that time, the technique has made its way around the world. Using TENs allows the surgeon to perform the surgery procedure without a long incision. This is called a closed reduction.
Studies show that this minimally invasive Metaizeau TEN approach to upper arm fractures involving the growth plate in skeletally immature children and teens has changed the way these injuries are treated around the world. There is no need to make repeated attempts to reduce the fracture without surgery and no need for open incision fracture reduction.
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.