A Clinical Study on the Fractures of the Proximal Humerus in Children

Kim, Sung Jae; Oh, Kuk Hwan

Abstract

Fractures of the proximal humerus in children are rare and according to Neer and Horwitz, fractures of the proximal humeral epiphysis constitute 3% of all epiphyseal injury. The most frequently reported complications are humeral shortening, varus angulation, and neurovascular complications. Closed anatomic reduction in frscture of the proximsl humerus is very difficult, so reported modes of treatment have ranged from aggressive attempts at reduction to simple neglect. Twenty nine fractures of the proximal humerus in children which were treated at Seve- rance Hospital, Yonsei University, College of Medicine from July 1982 to December 1986 were snalyzed both clinically and radiologically and the following results were obtained. 1. The age of the patients in this series ranged from 3 years to 18 years and the most frequently between the age of 12 years to maturity. And the oldest age was 18 years in male and 17 years in female. 2. Among the 29 frsctures, 21 cases were involving the proximal humeral epiphysis and all the injuries were Salter-Harris type Il epiphyse14 fracture. And 8 cases were fracture through the proximal humeral metaphysis not involving epiphysis. 3. Sixteen cases(55%) hsd associated injuries and the common associated injuries were fracture of the lower extremity, and fracture of same upper extremity were 5 cases(17%). 4. The fracture were graded according to their initial displacement(Neer snd Horwitz) and grade I, 6 cases, grade II, 3 csses, grade , 5 cases and grade IV were 15 cases. 5. Eight cases of grade I and II fractures were treated by simple immobilization. And among the twenty cases of grade III and 1V fractures, 12 cases were trested by closed reduction and immobilization and 9 cases, by open reduction. 6. Regardless of displacement of fractures and modes of treatment, all cases were united between six weeks to twelve weeks with full range of motion and no pain. 7. There were two cases of K-wire loosening, two cases of transient nerve palsy and one case of varus angulation.