Proximal humerus fracture (peds): Difference between revisions
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== Background | ''This page is for <u>pediatric</u> patients; for adult patients see [[proximal humerus fracture]]'' | ||
==Background== | |||
*Occurs predominantly during adolescence | *Occurs predominantly during adolescence | ||
*Proximal fractures classified using the Neer classification system based on number of component fractures | *Proximal fractures classified using the Neer classification system based on number of component fractures | ||
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{{Proximal arm fracture DDX}} | {{Proximal arm fracture DDX}} | ||
== | ==Evaluation== | ||
*XR AP Lateral, scapular Y - asses | *XR AP Lateral, scapular Y - asses fracture and rule out [[shoulder dislocation|dislocation]] | ||
* | *[[Ultrasound]] may be used in newborns before ossification centers present | ||
== | ==Management== | ||
*Depends on the age of the child and degree of displacement | *Depends on the age of the child and degree of displacement | ||
'''Non-Operative''' | '''Non-Operative''' | ||
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*Intraarticular fracture | *Intraarticular fracture | ||
== Disposition | ==Disposition== | ||
*Slightly displaced fracture: Sling and ortho | *Slightly displaced fracture: Sling and ortho follow up | ||
*Displaced >30 degrees: may need closed reduction | *Displaced >30 degrees: may need closed reduction | ||
== See Also == | ==See Also== | ||
*[[Humerus fracture]] | *[[Humerus fracture]] | ||
Latest revision as of 18:01, 28 September 2019
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 Fracture Types
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
References
- Harwood Nuss
- Orthobullets