Displaced Proximal Humerus Fracture in 15 Year Old

Abstract

Pediatric proximal humerus fractures account for less than 5% of pediatric fractures. Children <5 most frequently sustain Salter Harris I fractures, 5–11-year-olds most often sustain metaphyseal fractures, and children >11 typically sustain Salter Harris II fractures. The injury is usually from a fall onto the outstretched arm, but indirect trauma may be responsible, as in the chronic Salter Harris I fracture, Little Leaguer’s shoulder. Typically the proximal fragment is abducted and externally rotated, related to the pull of the rotator cuff muscles. The distal fragment (shaft) is typically anteriorly translated, adducted, and shortened due to pull of the pectoralis and deltoid muscles. The proximal humeral growth plate closes at 14–17 in girls and 16–18 in boys. The proximal humerus is responsible for 80% of humeral growth, thus there is extensive remodeling potential in children with 1–2 years or more of growth remaining. Even without complete remodeling, due to the relatively unconstrained motion at the shoulder, significant deformity can be tolerated. Proximal humerus fractures may be classified by the Neer-Horowitz Classification or the AO Pediatric Comprehensive Classification of Long Bone Fractures system.