Proximal Metaphyseal and Diaphyseal Humerus Fractures

Pediatric humeral proximal metaphyseal and diaphyseal fractures are mostly caused by trauma. Pathological fractures and stress fractures should always be ruled out. Nonoperative treatment is the preferred modality of treatment for most of these fractures. Operative treatment is indicated for open fractures, vascular injuries or if adequate functional reduction cannot be maintained. For pediatric proximal humeral metaphyseal fractures, percutaneous pinning and flexible intramedullary nailing may be necessary, both of which are reported to have good outcomes. For humeral diaphyseal fractures which cannot be managed nonoperatively, elastic intramedullary nailing or plate and screw fixation can be used with good outcomes. These methods of fixation are usually associated with low complication rates. Complications are mainly related to skin and soft tissue irritation by pins or nails or radial nerve injury. External fixation can also used for open fractures with extensive soft tissue injury. While postoperative stiffness is feared complication after surgical fixation of humeral fractures in adults, it is not a common complication after fixation of pediatric fractures. Similarly, nonunions and malunion requiring corrective osteotomy are not common. (C) 2019 Elsevier Inc. All rights reserved.