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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°


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