You are here

Pediatric Proximal Humerus Fracture S42.209A 812.00

synonyms:Pediatric proximal humerus fracture, shoulder fracture, broken shoulder

Pediatric Proximal Humerus Fracture ICD-10

 

A- initial encounter for closed fracture

B- initial encounter for open fracture

D- subsequent encounter for fracture with routine healing

G- subsequent encounter for fracture with delayed healing

K- subsequent encounter for fracture with nonunion

P- subsequent encounter for fracture with malunion

S- sequela

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 ICD-10

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.
  • Also associated with aneurysmal and unicameral bone cysts and radiation therapy for malignant tumors.

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.
  • Secondary ossification center for humeral head appears by 4 to 6 months of age. 
  • Ossification centers for greater tuberosities develop by ages 3
  • Ossification centers for lesser tuberosities develop by 5
  • Tuberosities fuse at 5 to 6 years old. 
  • Proximal humeral physis between humeral head and the shaft fuses at age 16 to 19 years.

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°

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer