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Proximal humeral fractures in children

Leticia Manning Ryan, MD, MPH, FAAP
Section Editor
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH


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 [5]. (See "General principles of fracture management: Fracture patterns and description in children", section on 'Fracture patterns'.)

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Literature review current through: Nov 2017. | This topic last updated: Feb 27, 2017.
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