Proximal humerus fracture (peds)

Background

• Occurs predominantly during adolescence
• Proximal fractures classified using the Neer classification system based on number of component fractures

Differential Diagnosis

Humerus Fracture Types

Humeral anatomy

• Adult
  • Proximal
  • Shaft
  • Distal
    • Capitellum
    • Trochlea
    • Condylar
• Pediatric
  • Proximal
  • Shaft
  • Distal
    • Supracondylar
    • Lateral epicondyle
    • Medial epicondyle

Diagnosis

• XR AP Lateral, scapular Y - asses fracture 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 follow up
• Displaced >30 degrees: may need closed reduction

See Also

• Humerus fracture

References

• Harwood Nuss
• Orthobullets