The Outcomes of Proximal Humerus Fractures in Children
Condition: Humeral Fractures
MeSH terms: Fractures, Bone; Humeral Fractures
Study type: Observational

Summary: 
      To date, the clinical benefits and harms of surgical intervention in proximal humerus
      fractures in children remain debatable. The practical question raised by orthopaedic surgeons
      is: for children and adolescent, are the clinical and radiological outcomes after
      non-operative management as equivalent as after surgical management for proximal humerus
      fractures? The investigators' hypothesis is that due to the healing potential of the proximal
      humerus, the outcome from this fracture is usually excellent.

      The investigators have applied for Caldicott approval to identify a cohort of eligible
      patient from NHS Tayside's radiography service. With the community health index (CHI) number,
      the investigators can review all shoulder X-rays performed in children and adolescents, aged
      from 10 to 18-year-old in NHS Tayside, from 2008 to 2015. The Caldicott approval also allowed
      the investigators to obtain clinical communication from the Clinical Portal (electronic
      summary healthcare records). The investigators will then conduct mail questionnaires, based
      on the Upper Extremities Functional Index (UEFI). The investigators will send out invitation
      letter with participation information and the UEFI questionnaires to the eligible patients;
      with return postages. If no response within 2 weeks, the investigators will send out 1
      further reminder. If no further response, the patient will be excluded from the study.
    

Detailed description: 
      Proximal humerus fractures in children are relatively uncommon and most of them do not
      require surgical treatment due to the healing potential in children. The management of
      proximal humerus fractures in children subsequently underwent a major change with the
      introduction of surgical metal rod nailing. Despite that, the best criteria for choosing
      between these two treatment options are still not agreed upon. To date, the clinical benefits
      and harms of surgical intervention in proximal humerus fractures in children remain
      debatable. The investigators hypothesised that the outcomes of the non-operative management
      for proximal humerus fractures to remain excellent due to the healing ability of children. If
      good clinical results are achieved in our patient cohort, the investigators would like to
      send out the message that non-operative treatment for proximal humerus fractures in children
      should be recommended, even for those severely displaced fractures.

      With Caldicott approval, the investigators can review the X-rays performed in children and
      adolescents, aged from 10 to 18-year-old in NHS Tayside, from 2008 to 2015. By using the
      Picture Archiving and Communication System (PACS), the investigators will be able to identify
      the cohort of patients who had proximal humerus fractures from the X-rays. The Caldicott
      approval also allowed the investigators to obtain clinical communication from Clinical
      Portal. The identified potential participants will be approached by the paediatric
      orthopaedic team. An invitation letter, a participant information sheet and questionnaire,
      based on UEFI will be sent to all potential participants by the care team via post. If no
      response within 2 weeks, the investigators will send out 1 further reminder. If no further
      response, the patient will be excluded from the study.
    

Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Children aged from 10 to 18-year-old in NHS Tayside who had proximal humerus fractures
        during year 2008 to 2015.