Related Experiment Video
Updated: Dec 10, 2025
Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion
Published on: February 14, 2025
Rate of Complications and Subsequent Shoulder Complaints for Non-operatively Managed Pediatric Proximal Humerus
Courtney Baker1, Noelle Larson1, William Shaughnessy1
1Mayo Clinic, Rochester, MN, United States.
Insights
Non-displaced pediatric proximal humerus fractures treated non-operatively rarely cause complications. These fractures, managed without surgery, generally have good outcomes and may be monitored by primary care providers after initial orthopedic assessment.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Pediatric proximal humerus fractures are common injuries.
- Non-operative management is frequently employed for non-displaced or minimally displaced fractures.
- Understanding potential complications is crucial for optimal patient care.
Purpose of the Study:
- To describe early complications and delayed shoulder complaints in pediatric proximal humerus fractures treated non-operatively.
- To evaluate the outcomes of non-operative management for these specific fracture types.
Main Methods:
- Retrospective review of pediatric proximal humerus fractures (2001-2016).
- Inclusion criteria: non-displaced/minimally displaced fractures with adequate radiographs and open physis.
- Exclusion criteria: pathologic fractures, re-fractures, metabolic bone disorders.
Main Results:
- 13.0% of fractures showed altered exams at follow-up; 1.4% experienced re-fracture.
- Extraphyseal fractures showed increased angulation but no increased complications.
- Only 4.3% of patients presented with subsequent shoulder complaints, managed conservatively.
Conclusions:
- Non-operative treatment of non-displaced/minimally displaced pediatric proximal humerus fractures results in rare short and long-term complications.
- These fractures typically do not require subsequent operative intervention.
- Surveillance by primary care or allied orthopedic staff may be appropriate after initial pediatric orthopedic evaluation.
Abstract:
Purpose: The purpose of the study was to describe the early complications and delayed shoulder complaints of non-displaced or minimally displaced pediatric proximal humerus fractures treated non-operatively. Methods: Retrospective review of all pediatric proximal humerus fractures at a single institution from 2001 to 2016. Inclusion criteria were: AP and axillary radiographs upon presentation and final follow up, one follow up appointment, either a non-displaced or minimally displaced fracture, and open physis. Exclusion criteria were: pathologic fractures, re-fractures, bone metabolic disorders. Patient demographics, injury characteristics, radiographic measurements and clinical exam findings were reviewed. Delayed shoulder complaints were defined as a visit to any provider for an ipsilateral shoulder or arm complaint after final scheduled fracture appointment. Results: Sixty-nine of 177 total pediatric proximal humerus fractures met inclusion criteria. Mean age was 10 years (SD = 3.4). Sixty-five had angulation <20 degrees. Median time to last scheduled follow up was 1.4 months (Interquartile range 0.8-1.4). At last scheduled follow up, 9 (13.0%) fractures had an altered exam. One (1.4%) fracture had a complication of a fall and re-fracture. Extraphyseal fractures were more likely to increase in angulation at short term follow up, but had no association with short or long term complications. No patient initially treated with non-operative management subsequently underwent operative treatment. There were three presentations (4.3%) to health professionals for subsequent shoulder complaints; one was treated with short courses of physical therapy and the other two were simply observed. Conclusions: Non-displaced or minimally displaced proximal humerus fractures treated non-operatively sustain rare short or long term complications with no cross over to operative management. Once non-operative management is pursued, these fractures may be amenable to surveillance with primary care or allied orthopedic staff after initial evaluation by pediatric orthopedic providers. Level of Evidence: Level III retrospective cohort study.
Related Concept Videos
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:19Bones of the Upper Limb: Humerus
01:09Changes in the Appendicular Skeleton with Age
Initially, the limb buds consist of a core of mesenchyme covered by a layer of ectoderm. The ectoderm at the end of the limb bud thickens to form a narrow crest called the apical ectodermal ridge. This ridge stimulates the underlying...