Proximal Humerus Open Fracture in Pediatrics: A Case Report and Literature Review
Abstract
Background: Proximal humerus fracture (PHF) in pediatrics is managed with different options: nonoperative or operative. However, proximal humerus open fractures are sparse in the literature.
Case Report: We present a 9-year-old boy who presented to our institution with proximal humerus open fracture (type IIIA of Gustilo classification). After irrigation and debridement, reduction was satisfactory. We preferred to immobilize the fracture using sling- and-swathe and U-slab splint.
Conclusion: Satisfactory union, angulation, and range of motion (ROM) were achieved.
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2. Popkin CA, Levine WN, Ahmad CS. Evaluation and management of pediatric proximal humerus fractures. J Am Acad Orthop Surg. 2015;23(2):77-86. doi: 10.5435/jaaos-d-14-00033. [PubMed: 25624360].
3. Hannonen J, Hyvönen H, Korhonen L, Serlo W, Sinikumpu JJ. The incidence and treatment trends of pediatric proximal humerus fractures. BMC Musculoskelet Disord. 2019;20(1):571. doi: 10.1186/s12891-019-2948-7. [PubMed: 31775692]. [PubMed Central: PMC6882178].
4. Cruz AI, Jr., Kleiner JE, Gil JA, Goodman AD, Daniels AH, Eberson CP. Inpatient surgical treatment of paediatric proximal humerus fractures between 2000 and 2012. J Child Orthop. 2018;12(2):111-6. doi: 10.1302/1863-2548.12.170220. [PubMed: 29707048]. [PubMed Central: PMC5902743].
5. Neer CS, 2nd, Horwitz BS. Fractures of the proximal humeral epiphysial plate. Clin Orthop Relat Res. 1965;41:24-31. [PubMed: 5832735].
6. Shrader MW. Proximal humerus and humeral shaft fractures in children. Hand Clin. 2007;23(4):431-5, vi. doi: 10.1016/j.hcl.2007.09.002. [PubMed: 18054670].
7. Dameron TB, Jr., Reibel DB. Fractures involving the proximal humeral epiphyseal plate. J Bone Joint Surg Am. 1969;51(2): 289-97. [PubMed: 5767320].
8. Kohler R, Trillaud JM. Fracture and fracture separation of the proximal humerus in children: report of 136 cases. J Pediatr Orthop. 1983;3(3):326-32. doi: 10.1097/01241398-198307000- 00010. [PubMed: 6874929].
9. Baker C, Larson N, Shaughnessy W, Stans A, Milbrandt T. Rate of Complications and Subsequent Shoulder Complaints for Non-operatively Managed Pediatric Proximal Humerus Fractures. Front Surg. 2020;7:48. doi: 10.3389/fsurg.2020.00048. [PubMed: 32850945]. [PubMed Central: PMC7418452].
10. King EC, Ihnow SB. Which Proximal Humerus Fractures Should Be Pinned? Treatment in Skeletally Immature Patients. J Pediatr Orthop. 2016;36(Suppl 1):S44-8. doi: 10.1097/bpo.0000000000000768. [PubMed: 27100038].
11. Wang X, Shao J, Yang X. Closed/open reduction and titanium elastic nails for severely displaced proximal humeral fractures in children. Int Orthop. 2014;38(1):107-10. doi: 10.1007/s00264- 013-2122-z. [PubMed: 24091418]. [PubMed Central: PMC3890129].
12. Binder H, Tiefenboeck TM, Payr S, Schurz M, Aldrian S, Sarahrudi K. Treatment of proximal humerus fractures in children and young adolescents. Wien Klin Wochenschr. 2016;128(3-4):120-4. doi: 10.1007/s00508-015-0879-3. [PubMed: 26546351].
13. Canavese F, Marengo L, Samba A, Rousset M, Mansour M, Andreacchio A, et al. Evaluation of upper extremity function of displaced diaphyseal humeral fractures in children treated byelastic stable intramedullary nailing: preliminary results. J Pediatr Orthop B. 2016;25(5):399-405. doi: 10.1097/bpb.0000000000000318. [PubMed: 27058818].
14. Dobbs MB, Luhmann SL, Gordon JE, Strecker WB, Schoenecker PL. Severely displaced proximal humeral epiphyseal fractures. J Pediatr Orthop. 2003;23(2):208-15. [PubMed: 12604953].
15. Kim AE, Chi H, Niknam K, Swarup I. Management of pediatric proximal humerus fractures. J Pediatr Soc North Am. 2023;5(1):580. doi: 10.55275/JPOSNA-2023-580.
16. Larsen CF, Kiaer T, Lindequist S. Fractures of the proximal humerus in children. Nine-year follow-up of 64 unoperated on cases. Acta Orthop Scand. 1990;61(3):255-7. doi: 10.3109/17453679008993512. [PubMed: 2371822].
17. Song HR, Song MH. Operative Versus Nonoperative Management of Pediatric Proximal Humerus Fractures: A Meta-Analysis and Systematic Review. Clin Orthop Surg. 2023;15(6):1022-8. doi: 10.4055/cios23077. [PubMed: 38045578]. [PubMed Central: PMC10689228].
18. Hohloch L, Eberbach H, Wagner FC, Strohm PC, Reising K, Südkamp NP, et al. Age- and severity-adjusted treatment of proximal humerus fractures in children and adolescents-A systematical review and meta-analysis. PLoS One. 2017;12(8):e0183157. doi: 10.1371/journal.pone.0183157. [PubMed: 28837601]. [PubMed Central: PMC5570290].
2. Popkin CA, Levine WN, Ahmad CS. Evaluation and management of pediatric proximal humerus fractures. J Am Acad Orthop Surg. 2015;23(2):77-86. doi: 10.5435/jaaos-d-14-00033. [PubMed: 25624360].
3. Hannonen J, Hyvönen H, Korhonen L, Serlo W, Sinikumpu JJ. The incidence and treatment trends of pediatric proximal humerus fractures. BMC Musculoskelet Disord. 2019;20(1):571. doi: 10.1186/s12891-019-2948-7. [PubMed: 31775692]. [PubMed Central: PMC6882178].
4. Cruz AI, Jr., Kleiner JE, Gil JA, Goodman AD, Daniels AH, Eberson CP. Inpatient surgical treatment of paediatric proximal humerus fractures between 2000 and 2012. J Child Orthop. 2018;12(2):111-6. doi: 10.1302/1863-2548.12.170220. [PubMed: 29707048]. [PubMed Central: PMC5902743].
5. Neer CS, 2nd, Horwitz BS. Fractures of the proximal humeral epiphysial plate. Clin Orthop Relat Res. 1965;41:24-31. [PubMed: 5832735].
6. Shrader MW. Proximal humerus and humeral shaft fractures in children. Hand Clin. 2007;23(4):431-5, vi. doi: 10.1016/j.hcl.2007.09.002. [PubMed: 18054670].
7. Dameron TB, Jr., Reibel DB. Fractures involving the proximal humeral epiphyseal plate. J Bone Joint Surg Am. 1969;51(2): 289-97. [PubMed: 5767320].
8. Kohler R, Trillaud JM. Fracture and fracture separation of the proximal humerus in children: report of 136 cases. J Pediatr Orthop. 1983;3(3):326-32. doi: 10.1097/01241398-198307000- 00010. [PubMed: 6874929].
9. Baker C, Larson N, Shaughnessy W, Stans A, Milbrandt T. Rate of Complications and Subsequent Shoulder Complaints for Non-operatively Managed Pediatric Proximal Humerus Fractures. Front Surg. 2020;7:48. doi: 10.3389/fsurg.2020.00048. [PubMed: 32850945]. [PubMed Central: PMC7418452].
10. King EC, Ihnow SB. Which Proximal Humerus Fractures Should Be Pinned? Treatment in Skeletally Immature Patients. J Pediatr Orthop. 2016;36(Suppl 1):S44-8. doi: 10.1097/bpo.0000000000000768. [PubMed: 27100038].
11. Wang X, Shao J, Yang X. Closed/open reduction and titanium elastic nails for severely displaced proximal humeral fractures in children. Int Orthop. 2014;38(1):107-10. doi: 10.1007/s00264- 013-2122-z. [PubMed: 24091418]. [PubMed Central: PMC3890129].
12. Binder H, Tiefenboeck TM, Payr S, Schurz M, Aldrian S, Sarahrudi K. Treatment of proximal humerus fractures in children and young adolescents. Wien Klin Wochenschr. 2016;128(3-4):120-4. doi: 10.1007/s00508-015-0879-3. [PubMed: 26546351].
13. Canavese F, Marengo L, Samba A, Rousset M, Mansour M, Andreacchio A, et al. Evaluation of upper extremity function of displaced diaphyseal humeral fractures in children treated byelastic stable intramedullary nailing: preliminary results. J Pediatr Orthop B. 2016;25(5):399-405. doi: 10.1097/bpb.0000000000000318. [PubMed: 27058818].
14. Dobbs MB, Luhmann SL, Gordon JE, Strecker WB, Schoenecker PL. Severely displaced proximal humeral epiphyseal fractures. J Pediatr Orthop. 2003;23(2):208-15. [PubMed: 12604953].
15. Kim AE, Chi H, Niknam K, Swarup I. Management of pediatric proximal humerus fractures. J Pediatr Soc North Am. 2023;5(1):580. doi: 10.55275/JPOSNA-2023-580.
16. Larsen CF, Kiaer T, Lindequist S. Fractures of the proximal humerus in children. Nine-year follow-up of 64 unoperated on cases. Acta Orthop Scand. 1990;61(3):255-7. doi: 10.3109/17453679008993512. [PubMed: 2371822].
17. Song HR, Song MH. Operative Versus Nonoperative Management of Pediatric Proximal Humerus Fractures: A Meta-Analysis and Systematic Review. Clin Orthop Surg. 2023;15(6):1022-8. doi: 10.4055/cios23077. [PubMed: 38045578]. [PubMed Central: PMC10689228].
18. Hohloch L, Eberbach H, Wagner FC, Strohm PC, Reising K, Südkamp NP, et al. Age- and severity-adjusted treatment of proximal humerus fractures in children and adolescents-A systematical review and meta-analysis. PLoS One. 2017;12(8):e0183157. doi: 10.1371/journal.pone.0183157. [PubMed: 28837601]. [PubMed Central: PMC5570290].
| Files | ||
| Issue | Vol 11 No 3 (2025) | |
| Section | Case Report | |
| DOI | https://doi.org/10.18502/jost.v11i3.19408 | |
| Keywords | ||
| Pediatrics Fractures Open Fractures Humerus Fractures Treatment Outcome | ||
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How to Cite
1.
Zandi R, Talebi S, Farahmandi F, Nodehi S, Ehsani A. Proximal Humerus Open Fracture in Pediatrics: A Case Report and Literature Review. J Orthop Spine Trauma. 2025;11(3):129-32.
