title: Proximal humerus fractures in children and adolescents.
abstract: Proximal humerus fractures are rare in paediatric traumatology. Metaphyseal fractures account for about 70% of cases and epiphyseal separation for the remaining 30%. The development and anatomy of the proximal humerus explain the various fracture types, displacements, and potential complications; and also help in interpreting the radiographic findings, most notably in young children. Physicians should be alert to the possibility of an underlying lesion or pathological fracture requiring appropriate diagnostic investigations, and they should consider child abuse in very young paediatric patients. Although the management of proximal humerus fractures remains controversial, the extraordinary remodelling potential of the proximal humerus in skeletally immature patients often allows non-operative treatment without prior reduction. When the displacement exceeds the remodelling potential suggested by the extent of impaction, angulation, and patient age, retrograde elastic stable intramedullary nailing (ESIN) provides effective stabilisation. As a result, the thoraco-brachial abduction cast is less often used, although this method remains a valid option. Retrograde ESIN must be performed by a surgeon who is thoroughly conversant with the fundamental underlying principles. Direct percutaneous pinning is a fall-back option when the surgeon's experience with ESIN is insufficient. Finally, open reduction is very rarely required and should be reserved for severely displaced fractures after failure of closed reduction. When these indications are followed, long-term outcomes are usually excellent, with prompt resumption of previous activities and a low rate of residual abnormalities.
authors.affiliation: Service de chirurgie pédiatrique, hôpital des Enfants, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France. Electronic address: yan.lefevre@chu-bordeaux.fr.
authors.forename: Y
authors.initials: Y
authors.lastname: Lefèvre
authors.affiliation: Service de chirurgie d'orthopédie infantile, hôpital d'Enfants, CHU de Nancy, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
authors.forename: P
authors.initials: P
authors.lastname: Journeau
authors.affiliation: Service de chirurgie pédiatrique, hôpital des Enfants, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Angelliaume
authors.affiliation: Service de chirurgie pédiatrique, hôpital des Enfants, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Bouty
authors.affiliation: Service de chirurgie pédiatrique, hôpital des Enfants, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
authors.forename: E
authors.initials: E
authors.lastname: Dobremez
mesh_terms: D000293:Adolescent; D001846:Bone Development / Q000502:physiology; D016723:Bone Remodeling / Q000502:physiology; D002648:Child; D002649:Child Abuse / Q000175:diagnosis; D002675:Child, Preschool; D004838:Epiphyses / Q000293:injuries / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005598:Fractures, Spontaneous / Q000145:classification / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D012784:Shoulder Fractures / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D014463:Ultrasonography
keywords: Paediatric patient; Proximal humerus; Retrograde elastic stable intramedullary nailing