Abstracts / Injury Extra 43 (2013) 71–127 77

[1A.17]

Open reduction and internal fixation of closed fractures ofclavicle in children

S. Radha, S. Senevirathna, M. Shenouda ∗, S. Rajeev

Queen Elizabeth Hospital, Gateshead, United Kingdom

Background: Fractures of the clavicle are common in both adultsand children. Recent studies in the treatment of adult fractures haveindicated that improved outcomes are achieved after open reduc-tion and internal fixation. The aim of this study was to analyzeoutcomes after open reduction and internal fixation of displacedclavicle fractures in children.

Materials and methods: We analyzed a retrospective case seriesof 14 children whose displaced clavicle fractures were treated withopen reduction and internal fixation. Special attention was paid tothe rate of healing, radiographic outcomes, functional outcomes,and complications.

Results: Fourteen children with an average age of 13.8 years(range 13–16 years) had their closed unilateral clavicle fracturestreated with open reduction and internal fixation. All the patientswere boys. The right side was affected in 7 and left in 7 patients.There were 13 mid shaft fractures and one lateral end fracture.Patients were followed for an average of 12 months. There wereno deep or superficial infections and no non-union. Eighty-five per-cent (12 of 14) of children returned to unrestricted sports activities.Two patients suffered from scar sensitivity. All fractures healed and5 orthopaedic implants were later electively removed including thehook plate used to fix the lateral end of clavicle.

Conclusion: In the past most of the clavicle fractures in chil-dren were treated conservatively regardless of the displacementand the location of fractures; with variable outcomes. We con-clude that open reduction and internal fixation of displaced clavicleshaft fractures in children can be performed safely. It gives pre-dictable results especially with healing periods and functionaloutcomes.

http://dx.doi.org/10.1016/j.injury.2012.07.210

[1A.18]

Patient characteristics of proximal humeral fractures in adistrict general hospital

A. Ved ∗, D.K. Jain, F. Mohammed, R. Singh

Wrexham Maelor, United Kingdom

Aim: Proximal humerus fractures are common in elderly withosteoporotic bones. The aim of the study was to look at character-istics of patients with proximal humeral fractures.

Material and methods: 92 consecutive proximal humerus frac-tures at Wrexham maelor hospital over a 2 year period between2008 and 2010 were retrospectively analysed for age, sex, Neer clas-sification, quick DASH score, social circumstances, mode of injury,smoking, alcohol intake, illicit drug intake and treatment used. Theinformation was obtained from case notes and radiographs.

Result: The mean patient age was 68 (range 25–95) years. Themean quick DASH score was 23 (range 12–43). 59% of these were2 part fractures, 28% were 3 part and 12% were 4 part fractures. 81patients (88%) sustained the fracture following mechanical fall andthe rest a combination of RTA, assault or other causes. 50% patientslived with partners, 45% alone and the rest in nursing/residentialhomes. 76 patients (82%) were non-smokers and none of ourpatients were on illicit drugs. 47 (51%) of the 92 patients were non-alcoholics, 27 (29%) were moderate alcohol consumers and 10%heavy drinkers drinking more than 2 units a day. 65 (70%) fractures

were treated conservatively, 22 (24%) were treated by plating andonly 4 (6%) were treated by hemiarthroplasty/nail.

Conclusion: Proximal humeral fracture is a commonly encoun-tered problem, the most common variant is 2 part fracture andmost of these are managed conservatively with good results. Thereappears to be a higher incidence amongst heavy alcohol consumerswhich needs to be further investigated.

http://dx.doi.org/10.1016/j.injury.2012.07.211

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Evaluation of a novel humeral brace – Can Charnley’s principleof 3 point fixation be applied to the management of humeralshaft fractures?

R.L. Gelder 3, C.E. Uzoigwe 1, R.G. Middleton 1, H.G.F. Burnand 3,P.S. Young 2, A. Modi 1, C.L. Cheesman 3,∗

1 Leicester Royal Infirmary, Leicester, United Kingdom2 Glasgow Royal Infirmary, Glasgow, United Kingdom3 Cheltenham General Hospital, Cheltenham, United Kingdom

Humeral shaft fractures are a common injury, with functionalbracing the mainstay of conservative management. The prefabri-cated humeral brace is the most commonly used design. Since itwas first described by Sarmiento in 1977 there has been little evo-lution in the design. We provide the first evaluative study on theefficacy of a new 3-point fixation brace. This is a novel design whichutilises Charnley’s principles of 3 point moulding to achieve andmaintain fracture reduction.

All patients presenting with a humeral shaft fracture, betweenAugust 2010 and February 2011, were managed in the Clasby brace.This was applied at first fracture clinic presentation (within oneweek). Pre and post brace radiographs were taken. Patients wereseen at 2 and 4 weeks initially for clinical and radiographic followup. Pain control and overall satisfaction was evaluated using visualanalogue scores. Brace was used until clinical and radiographicunion was achieved.

27 patients were included in the study. Mean age was 61. Therewas a 96% union rate. Mean time to union was 11 weeks. Therewere no cases of mal-union (defined as angulation greater than 25degrees in any plane). These results were superior to the most com-prehensive results reported for the prefabricated humeral brace(p < 0.05). Mean satisfaction score was 8.3 (out of 10).

This novel 3-point fixation brace resulted in an excellent rate ofunion without mal-union. It was effective at controlling pain andyielded high patient satisfaction scores. These results are compara-ble to studies evaluating the commonly used prefabricated humeralbrace. However, unlike the prefabricated humeral brace, it is ableto reduce and hold fractures, and could be used earlier on in thepatients treatment without waiting for swelling to subside. TheClasby brace has been adopted as first line treatment for humeralshaft fractures in our department.

http://dx.doi.org/10.1016/j.injury.2012.07.212

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The use of the Halder nail to stabilise pathological lesions in thehumerus – The ideal implant?

P.A.L. Foster ∗, E. Mills, S.C. Halder

Calderdale and Huddersfield, United Kingdom

Some pathological humeral fractures with pan-medullary ordistal involvement can be difficult to stabilise with conventionalanterograde nailing. The Halder nail is a retrograde intramedullary