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

Clinical Features

Differential Diagnosis

Humerus Fractures

Humeral anatomy

Adult
- Proximal
- Shaft
- Distal humerus fracture
Pediatric

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

Sling and swathe splint, or coaptation splint
Gentle ROM in 1-2 weeks as tolerated

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

Humerus fracture

References

Harwood Nuss
Orthobullets

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