Proximal humerus fracture (peds)

This page is for pediatric patients; for adult patients see proximal humerus fracture

Background

  • Occurs predominantly during adolescence
  • Proximal fractures classified using the Neer classification system based on number of component fractures

Differential Diagnosis

Humerus Fractures

Evaluation

  • XR AP Lateral, scapular Y - asses fracture and rule out dislocation
  • Ultrasound may be used in newborns before ossification centers present

Management

  • Depends on the age of the child and degree of displacement

Non-Operative

    • For almost all children, will approach non-operatively
    • Excellent remodeling ability of bone and ROM to shoulder
    • Ortho consult is needed to determine the best approach

Operative Indications

  • More than 45 degrees of angulation
  • Less than 50% apposition of proximal humerus and shaft
  • Open fractures
  • Neurovascular injury
  • Intraarticular fracture

Disposition

  • Slightly displaced fracture: Sling and ortho follow up
  • Displaced >30 degrees: may need closed reduction

See Also

References

    • Harwood Nuss
    • Orthobullets
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