Comparative analysis of different modifications of elastic nail osteosynthesis in the treatment of children with extra-articular proximal humeral fractures

Introduction The relevance of studying the treatment of proximal humeral fractures in children stems from the high incidence of fractures in this anatomical region and the absence of a standardized treatment approach. This highlights the need for further research to develop treatment protocols that account for the unique characteristics of the pediatric body and the specific features of these fracture types. Objective of the study was to analyze and compare the outcomes of treating children with extra-articular proximal humeral fractures using double-nail versus single-nail modifications of intramedullary osteosynthesis with elastic nails. Materials and Methods Patients were divided into two groups. The study group ( n = 39) patients underwent surgical treatment with a single elastic rod while patients in the control group ( n = 32) received treatment using a double-nail modification of osteosynthesis. Treatment efficacy was analyzed in both inpatient and outpatient settings with clinical, radiological, and sociological assessment methods. Results Postoperative parameters (duration of pain syndrome, hospitalization period, return to school, and fracture consolidation time) were comparable in both groups, indicating similar efficacy of the treatment methods in these studied parameters. Statistically significant differences were observed only in operative time, directly linked to the specific surgical techniques employed in each group. The proposed method in the main study group allowed for faster surgery and did not significantly affect other key parameters of anatomical and functional recovery. Patients in both groups were satisfied with the treatment outcomes. Discussion Unlike the conventional two-nail configuration, the single-rod approach significantly reduces operative time, thereby lowering the risks associated with anesthesia, and slightly reduces the duration of pain syndrome. The study had limitations, including a short follow-up period (no more than 12 months post-injury and 1 month post-implant removal) and a lack of differentiation between fracture configurations (metaphyseal vs. epiphyseal fractures). Conclusion The single elastic nail osteosynthesis method provides functional recovery of the injured segment and restoration of the child’s overall activity comparable to the double-nail technique. Fracture consolidation occurs with correct fragment alignment within standard timeframes.