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ELASTIC STABLE INTRAMEDULLARY NAILING FOR TREATMENT OF BENIGN LESIONS OF HUMERUS COMPLICATING BY PATHOLOGICAL FRACTURE IN CHILDREN

LUO Leiming,LU Xiaobo,GE Jianhua,YE Lizi,WANG Yuanhui.Department of Bone and Joint Surgery,the Affiliated Hospital of Luzhou Medical College,Luzhou Sichuan,646000,P.R.China.  
Objective To exploere the effectiveness and advantages of elastic stable intramedullary nail(ESIN) combined with curettage and graft for the treatment of benign lesions of humerus complicating by pathological fracture in children.Methods ESIN internal fixation combined with curettage and graft was used to treat benign lesions of the humerus complicating by pathological fracture in 11 children patients between January 2007 and January 2011.Of 11 patients,7 were boy and 4 were girl,aged from 5 to 14 years(mean,9.4 years).The disease duration ranged from 2 to 14 days(mean,6 days).All fractures were closed fracture,which locations were the proximal humerus in 6 cases,the humeral shaft in 4 cases,and the distal humerus in 1 case;benign lesions of the humerus included aneurysmal bone cyst in 1 case,simple bone cyst in 7 cases,and fibrous dysplasia in 3 cases.Based on imaging studies,preoperative diagnosis was almost clear.The time from hospitalization to operation was 3-5 days Results Healing of incision by first intention was obtained in all cases,with no infection.The mean follow-up was 25.6 months(range,12-36 months).All patients achieved pain relief at 6 weeks postoperatively and fractures healed completely at 3 to 4 months after operation(mean,3.3 months).No recurrence or re-fracture was observed during follow-up.The ESIN was removed at 10-14 months after operation(mean,12.5 months).The lesion disappeared completely in 8 cases and partially in 3 cases.No pain of affected limb or motion limitation of shoulder and elbows was observed.One patient had limb shortening of 2 cm at last follow-up,but he had no function problem.According to Neer shoulder and Mayo elbow function scores,the results were excellent in 11 cases.Conclusion It is a good method to treat benign lesions of the humerus complicating by pathological fracture in children to use ESIN internal fixation combined with curettage and graft.After only a single operation intervention,it can provide early mechanical stability and rapid fracture healing and allow early rehabilitation exercise.
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