Proximal humerus fracture (peds)

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Background

  • Occurs predominantly during adolescence
  • Proximal fractures classified using the Neer classification system based on number of component fractures
Prox humerus fracture.jpeg

Clinical Features

Differential Diagnosis

Humerus Fractures

Humeral anatomy

Evaluation

  • XR AP Lateral, scapular Y - asses fracture and rule out dislocation
  • US 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

References


  • Harwood Nuss
  • Orthobullets