Proximal Humerus Fracture in children is also known as proximal humerus growth plate fracture. Proximal humerus fracture is a pathological condition of the shoulders joint found in children following fall on outstretched hands while playing. The child ends up with a fracture at the end of humerus bone near shoulder joint, which is still in the developing phase. The proximal humerus fracture results in pain in the upper part of the arm or shoulder. This condition is known as Proximal Humerus Fracture or Proximal Humerus Growth Plate Fracture.
In this article, we will discuss in detail about:
- Causes of Proximal Humerus Fracture
- Symptoms of Proximal Humerus Fracture
- Treatments for Proximal Humerus Fracture
How Do We Define Proximal Humerus Fracture In Children?
Proximal Humerus Fracture is found in children and may happen to a young adolescent while playing or even an infant who falls off of bed. The infants and toddlers often fall while playing. All fall may not result in any major injury. In few cases proximal humerus fracture is observed when child falls on an outstretched arm. Humerus fracture results from the direct impact on humerus bone or the speed of the fall along with the impact caused by hitting the arm on floor. A Proximal Humerus Growth Plate Fracture also is called as Epiphysis Plate Fracture. The fracture occurs at one of the end of a bone while the bone has not yet fully developed. The proximal end of the humerus is in the form of cartilage, which is yet to become a hard bone. This occurs in the upper part of the arm near the shoulder.
Causes Of Proximal Humerus Fracture In Children
A Proximal Humerus Fracture or Proximal Humerus Growth Plate Fracture in Children as stated is generally caused due to a fall on outstretched hands. Some of the symptoms of Proximal Humerus Fracture are immediate pain in the upper part of arm and shoulder following the injury with swelling in the shoulder region. Any attempts at moving the injured shoulder results in significant pain. There is a possibility that the shoulder may look deformed as well.
The long bones of the body like the Humerus grow from the ends. At each end of the bone, there is a growth plate or an epiphyseal plate, which is the last part of the bone to develop. Hence, it is more prone to injuries. Proximal Humerus Fracture or Proximal Humerus Growth Plate Fracture occurs in children and teenagers as the bones in adults have already developed.
Symptoms Of Proximal Humerus Fracture In Children
Some of the symptoms of Proximal Humerus Fracture or Proximal Humerus Growth Plate Fracture as stated above are:
- Immediate pain and swelling in the shoulder following the injury
- Pain with any movement of the injured shoulder
- Sometimes there may be numbness in the hand in case of a nerve injury
- Inability to completely straighten the elbow.
Diagnosis of Proximal Humerus Fracture In Children
After taking a detailed history of the injury, the treating physician will conduct a physical exam of the injured arm to specifically look for:
During the physical examination, your doctor will check to see whether there is any damage to the nerves or blood vessels.
Apart from the physical examination, the physician will also order imaging studies like X-Rays of the arm. X-Ray picture provides details of area of fracture and other injuries like dislocation.
CT Scan or MRI is often not necessary unless fracture observed in X-ray is not conclusive.
Ultrasound examination is performed to diagnose fracture humerus in children.2
Treatment For Proximal Humerus Fracture In Children
If a fracture is identified on examination and imaging studies, the first thing the physician will do is to immobilize the arm with the use of a cast or a sling. A nondisplaced fracture is treated conservatively with immobilization for a few weeks for healing to take place followed by rehabilitation to restore lost strength and motion. Most of the proximal humerus fracture is treated with conservative treatment.1
Surgery may be required for fractures that are displaced. The surgical procedure will be done to realign the bones to their normal position and keep them in place with the help of pins and wires again followed by a period of Immobilization to allow the wounds to heal. After complete healing, rehabilitation is done to restore strength and motion.
Aggressive treatment is necessary to prevent bone deformity, angulation of the fracture bone and mal-alignment.3
Complications Of Proximal Humerus Fracture In Children
Following complications are observed in few cases.
- Shortening of the arm4
1. Fractures of the proximal humerus in children.
Di Gennaro GL1, Spina M, Lampasi M, Libri R, Donzelli O.
Chir Organi Mov. 2008 Sep;92(2):89-95.
2. Fractures of the humerus in the neonatal period.
Sherr-Lurie N1, Bialik GM, Ganel A, Schindler A, Givon U.
Isr Med Assoc J. 2011 Jun;13(6):363-5.
3. Physeal injuries of the proximal humerus: long-term results in seventy two patients.
Binder H1, Schurz M, Aldrian S, Fialka C, Vécsei V.
Int Orthop. 2011 Oct;35(10):1497-502. doi: 10.1007/s00264-011-1277-8. Epub 2011 May 24.
4. Humerus varus: a complication of neonatal, infantile, and childhood injury and infection.
Ellefsen BK1, Frierson MA, Raney EM, Ogden JA.
J Pediatr Orthop. 1994 Jul-Aug;14(4):479-86.