Pediatric Humerus

Posted on: April 18, 2020, by :

Introduction:  

  • Proximal: Relatively common physeal and metaphyseal fracture seen in children with a peak age of 15 years.
    • Salter-Harris 1 is most frequent in <5 yo
    • Salter-Harris 2 is most frequent in >12 yo
    • Metaphyseal Fractures tend to be in 5-12 yo
  • Shaft: mostly traumatic but occasionally from non-accidental trauma.
    • Up to 5% with radial nerve palsy
  • Distal: *see elbow module for details*


Complications:

  • Axillary nerve injuries (<1%) usually are neuropraxias
    • associated with a medially displaced shaft
  • Radial nerve injuries (<5%) usually are neuropraxias
    • associated with a middle or distal 1/3 shaft


Alternative Diagnosis:

  • Little League Shoulder
    • Overuse injury in throwers that may show minimal physeal widening (NOT A FRACTURE)
    • Consider obtaining comparison view of contralateral shoulder

    • Treatment: Nonoperative
      • refrain from pitching for 3 months and begin PT. May start progressive throwing program once symptoms resolved
Pitch Count Recommendations
Age (years of age)  Pitches per Game Max Games per Week
8-10 yrs. 52 2
11-12 yrs. 68 2
13-14 yrs. 76 2
15-16 yrs. 91 2
17-18 yrs. 106 2

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Haroon Shaukat MD
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