Proximal humerus fracture (peds): Difference between revisions
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*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''' | ||
**For almost all children, will approach non operatively | **For almost all children, will approach non-operatively | ||
**Excellent remodeling ability of bone and ROM to shoulder | **Excellent remodeling ability of bone and ROM to shoulder | ||
**Ortho consult is needed to determine the best approach | **Ortho consult is needed to determine the best approach | ||
Revision as of 05:06, 26 May 2016
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
Diagnosis
- XR AP Lateral, scapular Y - asses fx and r/o dislocation
- US may be used in newborns before ossification centers present
Treatment
- 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 f/u
- Displaced >30 degrees: may need closed reduction
See Also
Source
- Tintinalli
- Harwood Nuss
- Orthobullets