Management of Pediatric Proximal Humerus Fractures

Abstract

Proximal humerus fractures have an outstanding potential to remodel due to their proximity to the proximal humeral physis. Fractures in young children can be treated nonoperatively with excellent outcomes. The incidence peaks in adolescent patients and these injuries most commonly occur after a fall or direct trauma. The muscle attachments of the proximal humerus act as deforming forces and anatomic structures such as the periosteum and biceps tendon may act as blocks to reduction. Operative management is uniformly indicated for patients with open fractures, ipsilateral elbow or forearm injury, associated neurovascular injury, or poly-trauma patients. Operative treatment may be further considered in older children with minimal growth remaining and with fractures that are considered significantly displaced by available classification systems. Unfortunately, there are significant challenges in recommending treatment based on displacement and age alone. The purpose of this paper is to review what is known about these injuries and how they can be treated in light of current deficiencies in the literature; this may stimulate further work to refine indications for treatment based upon age and displacement. Key Concepts• The proximal humerus physis is responsible for 80% of the growth of the entire bone, and proximal humerus fractures have tremendous potential to remodel.• Proximal humerus fractures occur most commonly due to a fall or direct trauma but other causes include overuse injury and pathologic lesions.• Treatment indications for pediatric proximal fractures are guided by age of the patient, fracture displacement, and associated injuries; the majority of these injuries may be treated nonoperatively.• Outcomes after operative and nonoperative management of proximal humerus fractures are generally good.

Redução fechada assistida por Kapandji e fixação percutânea com fio de Kirschner em fraturas do úmero proximal em adolescentes: Nota técnica

“…A redução é considerada em fraturas com desvio superior a 33% (Neer III ou IV) ou angulação superior a 40 graus em pacientes até 2 anos antes de atingir a maturidade esquelética (meninos com idade ≥ 14 anos e meninas com idade ≥ 12 anos). 5 O paciente é posicionado em decúbito dorsal ou em cadeira de praia modificada para permitir a obtenção de imagens ortogonais ( Figs. 1 e 2 ).…”

“…Reduction is considered for fractures that are displaced by more than 33% (Neer III or IV) or fractures exhibiting an angulation of over 40 degrees in patients who are within 2 years of reaching skeletal maturity (boys aged ≥ 14 years and girls aged ≥ 12 years). 5 The patient is positioned in the supine or modified beach chair position to allow orthogonal imaging ( Figs. 1 and 2 ).…”