Proximal humerus fracture (peds)

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


  • 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 Fracture Types

Humeral anatomy


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


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


    • 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


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

See Also


  • Harwood Nuss
  • Orthobullets