Pediatric Humerus Fractures: Need for Custom Fixators?

Comminuted fracture of the left humerus?

Hello Dr.
Chen: My child had a bicycle accident and suffered a comminuted fracture of the left humerus (broken in the middle).
Surgery has been performed to implant a steel rod.
The doctor mentioned that we will assess the bone growth in about 1.2 years to decide whether to remove it.
However, a cast was not applied, and we need to have a "humeral brace" custom-made by a vendor at a cost of approximately 7,500 NTD.
It is made of "polymeric material." Is this really necessary? Is the price too high? The struggling mother is burning the candle at both ends.
I would appreciate your guidance.
Thank you for your assistance.

PANDA, 40~49 year old female. Ask Date: 2006/11/15

Dr. Chen Xingyuan reply Orthopedics

Dear Netizen,
Even after surgical reduction and fixation with nails or plates, comminuted fractures can still be unstable.
It is common to refer patients to the rehabilitation department to create a lightweight splint made of a plastic-like material for protection.
As for whether a custom-made "humeral brace" is necessary, you may consult your attending physician about the benefits and purposes of using a custom "humeral brace" versus whether a splint could suffice, as the surgeon is most familiar with the situation.
Of course, you can also seek opinions from other physicians at different hospitals.
Wishing you health and safety!
Sincerely,
Dr.
Chen

Reply Date: 2006/11/15

More Info

When it comes to pediatric humerus fractures, especially those that are comminuted (meaning the bone is broken into several pieces), the treatment approach can vary significantly based on the specific circumstances of the injury, the age of the child, and the expected growth patterns of the bone. In your case, it sounds like your child has undergone surgery to implant nails for stabilization, which is a common and effective method for managing such fractures.

Regarding the need for a custom fixator, there are several factors to consider. Custom fixators, like the one you mentioned made from high molecular polymer, can provide additional stability and support during the healing process. They are particularly useful in cases where traditional casting may not be feasible or effective, especially in complex fractures or in children who may not tolerate a cast well. The custom fixator can help maintain proper alignment of the bone fragments and allow for some degree of mobility, which can be beneficial for muscle preservation and overall recovery.

However, the cost of such devices can be a significant burden, as you noted. The price of $7,500 for a custom fixator may seem steep, and it’s understandable that you are concerned about the financial implications. It’s important to discuss with your orthopedic surgeon the necessity of this device in your child's specific case. They should be able to provide insight into whether the fixator is essential for optimal healing or if other less expensive options could suffice.

In many cases, if the fracture is stable and well-aligned after surgical intervention, additional external fixation may not be necessary. The surgeon may recommend close monitoring and possibly physical therapy to ensure proper healing and regain function. It’s also worth asking about the expected timeline for recovery and whether the fixator is truly needed for the entire duration of that timeline.

As for the follow-up after 1.2 years to assess bone growth, this is a standard practice. Pediatric bones heal differently than adult bones, and their growth plates remain open for a longer period, which can influence the healing process. Regular follow-ups will help ensure that the bone is healing correctly and that any necessary adjustments can be made in a timely manner.

In summary, while a custom fixator can be beneficial in certain situations, it’s crucial to weigh the benefits against the costs and to have a thorough discussion with your child's orthopedic surgeon. They can provide tailored advice based on the specifics of the fracture and your child's overall health and growth patterns. Always advocate for your child's best interests, and don't hesitate to seek a second opinion if you feel uncertain about the recommended treatment plan.

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Sure!