Percutaneous Fixation of Pediatric Proximal Humerus Fractures

Proximal humerus fractures can be seen in children and adolescents after a fall or following significant trauma, like motor vehicle accidents. Significant remodeling potential from the proximal humeral physis along with the wide arc of motion of the shoulder allows for good outcomes with nonoperative care for minimally displaced fractures and fractures in younger children. Operative management is reserved for fractures with greater displacement and angulation, particularly in adolescents nearing skeletal maturity. Closed reduction techniques in the operating room can be difficult due to patient size, fracture displacement, interposed tissue, and deforming forces acting on the proximal humerus. Skeletal stabilization after closed reduction can include percutaneous pins, screws, and flexible nails. Here, we describe a technique for percutaneous reduction and fixation of the difficult-to-reduce proximal humerus fracture. Key Concepts•The proximal humeral physis has considerable remodeling potential, allowing for significant tolerance of deformity in skeletally immature children.•Radiographic and age-based indications for reduction and fixation of proximal humerus fractures remain controversial, but multiply injured patients and significantly displaced fractures in those nearing skeletal maturity are most likely to benefit from surgical management.•Percutaneous reduction techniques can aid in improving fracture alignment when closed maneuvers fail without the need for an extensive open approach.•Screw fixation may provide certain advantages in comparison to pin fixation.