Displaced Proximal Humerus Fracture in 8-Year-Old

Abstract

Proximal humerus fractures account for less than 5% of pediatric fractures. Most frequently, children <5 sustain Salter-Harris 1 fractures, 5–11-year-olds sustain metaphyseal fractures, and children >11 typically sustain Salter-Harris 2 fractures. The injury is usually from falling onto an outstretched arm, but indirect trauma can also be responsible, as in the chronic SH1 fracture, Little Leaguer’s shoulder. Typically the proximal fragment is abducted and externally rotated, due to the pull of the rotator cuff muscles. The distal fragment (shaft) is typically anteriorly translated, adducted and shortened due to the pull of the pectoralis and deltoid muscles. The proximal humeral growth plate closes at 14–17 in girls, and 16–18 in boys. The proximal humerus is responsible for 80% of humeral growth; thus there is extensive remodeling potential in children with 1–2 years or more of growth remaining. Even without complete remodeling, due to the relatively unconstrained motion at the shoulder, significant deformity can be tolerated. Proximal humerus fractures may be classified using the Neer-Horowitz Classification or the AO Pediatric Comprehensive Classification of Long Bone Fractures system (Slongo et al (2007) Suppl J Orthop Trauma 21(10):135–160).