الفهرس 
Patients and methodsOnly 14 pages are availabe for public view
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Abstract
Fractures of the proximal humerus in adolescents are fractures with a low incidence of 6.8 fractures/10000 children per year with a major proportion of those fractures occurring in the age of 11-15 years.
Adolescence is defined as a transitional phase of growth and development between childhood and adulthood. The World Health Organization (WHO) defines an adolescent as any person between ages 10 and 19.
Proximal humeral fractures in children include both physeal and metaphyseal fractures, which account for less than 5 % of all pediatric fractures. The majority of proximal humeral fractures are either undisplaced or minimally displaced (Neer-Horowitz grade I–II) and can be managed non-operatively with a satisfactory outcome. However, in cases of severe humeral fractures with significant bone displacement (Neer- Horowitz grade III–IV), especially in teenagers, non-operative treatment is controversial.
The high remodeling potential of the physis of the proximal humerus was expected to correct axial deviations and arm length discrepancies especially in younger children as it seems to be responsible for about 80% of the longitudinal growth potential of the humerus.
An important concern of surgeons while dealing with pediatrics proximal humeral fractures is the growth of the bone and the resulting remodeling potential. In fact, approximately 80% of the longitudinal growth of the humerus comes from the proximal humeral physis.
Therefore, some surgeons in recent years have recommended closed or open reduction and internal fixation for proximal humerus fractures in children, especially in teenagers.
The methods of internal fracture fixation include percutaneous: K-wires, staples, screws or plates. However, complications such as pin tract infection, pin migration, osteomyelitis and loss of reduction have been reported using these modes of fracture fixation.
In this study we aimed to evaluate the clinical, radiological and functional outcome of Titanium flexible intramedullary nails (Nancy nails) for treatment of proximal humeral fractures in older children and adolescents.
A prospective study was conducted on 25 adolescent patients with proximal humerus fracture treated by fixable intra-medullary nail. The study was conducted in Menoufia University Hospitals and Elmogama Al Teby medical insurance hospital in Tanta
In this study, 25 patients had a mean age of 14.5 years ranged from 10 to 19 years. Males represented 60% of the total number of patients (15 patients) and females represented 40% (10 patients). Out of 25 patients; 11 cases (44%) had fracture in the right side and all of them are right-handed. 14 cases (56%) had fracture in the left side and one of them is left-handed. The mechanism of injury was Falling from height was the most common mechanism of trauma that represented 44% (11patients), followed by direct trauma to the arm which represented 28% (7 patients). In 25 patients the fracture was reduced by Titanium flexible intramedullary nails (Nancy nails). The duration of return to full activity ranged from 8-12 weeks with mean 9.2±1.6 weeks. There were two cases of delayed union which finally reached good union, and no case of nonunion or mal union. The mean functional score in end of follow up DASH score was Excellent(4.7).