Pediatric Proximal Humerus Fracture

synonyms:

Pediatric Proximal Humerus Fracture ICD-9

• 812.0_(closed); 812.1_(open)
• 812._0(fracture of humerus, upper end, unspecified)
• 812._1(fracture of humerus, upper end, surgical neck)
• 812._2(fracture of humerus, upper end, anatomic neck)
• 812._3(fracture of humerus, upper end, greater tuberosity)
• 812._9(fracture of humerus, upper end, other; head, upper epiphysis)

Pediatric Proximal Humerus Fracture Etiology / Epidemiology / Natural History

• Generally occur between 11 and 17 yrs old.
• Often associated with athletic participation: direct blow during contact sport or fall onto outstretched arm.

Pediatric Proximal Humerus Fracture Anatomy

• Proximal humeral physis accounts for 80% of the longitudinal growth of the humerus.
• Proximal humeral epiphysis does not begin to ossify until @ 6months old.

Pediatric Proximal Humerus Fracture Clinical Evaluation

• Shoulder pain and swelling generally after fall onto oustretched arm/shoulder.

Pediatric Proximal Humerus Fracture Xray / Diagnositc Tests

• AP, scapular lateral and axillary views. Fracture generally easily identified in patients >6months old. Must rule out associated dislocation with axillary view.
• MRI, ultrasound or arthrogram may be needed in patietns younger than 6 months old.

Pediatric Proximal Humerus Fracture Classification / Treatment

• Salter Harris Type I: most common in pts <5y/o.
• Salter Harris Type II: most common in pts >11y/o.
• Salter-Harris Type III: uncommon
• Salter-Harris Type IV: uncommon
• Metaphyseal fracture: most common in pts 5-11y/o.
• Acceptable Reduction:
  -<5y/o: 70° angulation, 100% displacement
  -5-12y/o: 40°-70° angulation
  ->12y/o: 40° angulation, 50% displacement.
• Surgery: closed reduction, percutaneous pin fixation. Closed reduction may be prevented by interposed biceps tendon or periosteal flap.
• AO Classification

Pediatric Proximal Humerus Fracture Associated Injuries / Differential Diagnosis

• Shoulder dislocation
• Brachial plexus palsy
• Clavicle Fracture
• Shoulder sepsis
• Osteomyelitis

Pediatric Proximal Humerus Fracture Complications

• Shoulder stiffness
• Malunion
• CRPS
• Pain
• Infection

Pediatric Proximal Humerus Fracture Follow-up Care

• Review of 30 pts age 8-15 with proximal humeral epiphyseal fractures ranging 5-100% displaced and treated with no reduction to open reduction.  Despite a maximum of 2cm of shortening all pts had full ROM and no functional complaint with insignificant angular deformity.  This great remodeling is due to the fact that 80% of humeral growth comes from the proximal growth plate. This author recommends open treatment for open or tented skin and neurovascular compromise only and closed treatment is unneeded.
• Baxter MP, Wiley JJ: Fractures of the proximal humeral epiphysis: Their influence on humeral growth.  J Bone Joint Surg 1986;68B:570-573.

Pediatric Proximal Humerus Fracture Review References

• Neer CS II, Horwitz BS: Fractures of the proximal humeral epiphyseal plate.  Clin Orthop 1965;41:24-31.
• Baxter MP, Wiley JJ: Fractures of the proximal humeral epiphysis: Their influence on humeral growth.  J Bone Joint Surg 1986;68B:570-573°