Proximal humeral fractures in children
- Leticia Manning Ryan, MD, MPH, FAAP
Leticia Manning Ryan, MD, MPH, FAAP
- Assistant Professor of Pediatrics
- Division of Emergency Medicine
- Johns Hopkins Children's Center
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Proximal humeral fractures represent fewer than 5 percent of all pediatric fractures [1,2]. These fractures may occur either through the physis (growth plate) or in the metaphysis. One of the most important features of humeral fractures is their ability to remodel. The majority of these fractures can be treated with a sling and swathe or with a shoulder immobilizer.
This review addresses proximal fractures of the humerus in children. Fractures of the midshaft and distal humerus, including supracondylar fractures, are presented separately. (See "Evaluation and management of supracondylar fractures in children" and "Epicondylar and transphyseal elbow fractures in children" and "Evaluation and management of condylar elbow fractures in children" and "Midshaft humeral fractures in children".)
The humerus is the largest bone in the upper extremity. The proximal humerus articulates with the glenoid of the scapula to form the glenohumeral (shoulder) joint. The muscles and tendons of the rotator cuff, the acromion, and ligamentous attachments such as those between the coracoid process of the scapula and the acromion, serve to both stabilize the glenohumeral articulation and provide for a wide range of shoulder joint motion.
The pediatric humerus has distinctive structural features that influence fracture risk, fracture pattern, and the potential for healing [3,4]:
●Periosteum – In the humerus bone, a thick periosteal sleeve is present along the shaft which limits fracture displacement and promotes healing in proximal humeral fractures . (See "General principles of fracture management: Fracture patterns and description in children", section on 'Fracture patterns'.)
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- PERTINENT ANATOMY
- MECHANISM OF INJURY
- Children and adolescents
- Pathologic fracture
- Child abuse
- PHYSICAL FINDINGS
- Proximal humerus fractures
- Neonatal fracture
- Associated findings
- RADIOGRAPHIC FINDINGS
- Proximal humeral fractures
- Neonatal fractures
- Proximal humeral fracture description
- INITIAL TREATMENT
- Orthopedic consultation
- Child protection
- DEFINITIVE CARE
- Children and adolescents
- FOLLOW-UP CARE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS