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Jennifer E Thomson1, O Folorunsho Edobor-Osula
1Department of Orthopaedic Surgery - Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Insights
Pediatric proximal humerus fractures are increasingly treated operatively for older children with significant deformity. Younger children with less severe fractures are typically managed nonoperatively due to excellent bone remodeling potential.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Proximal humerus fractures are common in children.
- Management strategies are evolving with increased operative interventions.
- Understanding age-related treatment differences is crucial.
Purpose of the Study:
- To review considerations for managing pediatric proximal humerus fractures.
- To outline current operative and nonoperative treatment options.
- To discuss potential complications associated with fracture management.
Main Methods:
- Review of recent scientific literature on pediatric proximal humerus fractures.
- Analysis of treatment trends, including operative vs. nonoperative approaches.
- Evaluation of factors influencing management decisions, such as patient age and fracture severity.
Main Results:
- An increasing trend towards operative management for proximal humerus fractures in children.
- Operative treatment shows excellent outcomes in older children with significant deformity.
- Nonoperative management remains standard for younger children (under 12) and less severe fractures (Neer grade I and II).
Conclusions:
- Management decisions should be individualized based on radiographic parameters, patient age, and skeletal maturity.
- Adolescents with Neer Horowitz grade 3 and 4 fractures may benefit from surgical intervention.
- The high remodeling potential in younger children supports nonoperative treatment even for displaced fractures.
Purpose Of Review:
We aimed to review considerations, current treatment options, and complications in the management of pediatric proximal humerus fractures.
Recent Findings:
Recent literature has shown an increased incidence of operative management of proximal humerus fractures. With increased age, and increased deformity, studies report excellent outcomes after operative treatment. Still, patients under the age of 12 and with Neer grade I and II fractures are consistently treated nonoperatively.
Summary:
Indications for operative management of proximal humerus fractures in skeletally immature patients have become increasingly widened. Current literature emphasizes the stratification of patients based on displacement, angulation, and shortening, with overall positive outcomes. Each case should be considered on individual bases, accounting for both radiographic parameters, developmental stages of patients, and potential complications. In the authors' opinion, adolescent patients with Neer Horowitz 3 and 4 fractures surgical management should be considered. In younger patients with nonoperative management, even with significant displacement, is the mainstay of treatment because of the tremendous remodeling potential of the proximal humerus in children.
Video Abstract:
http://links.lww.com/MOP/A56.
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