Humerus Fractures

Midshaft and proximal humeral fractures account for approximately 10% of pediatric fractures and possess an extraordinary capacity for remodeling due to a thick periosteal sleeve. Midshaft injuries, often resulting from direct blows or falls, typically require immobilization in a sling and swath or coaptation splint, with surgical intervention rarely necessary unless significant angulation or neurovascular compromise exists. Proximal fractures, frequently involving the physis which accounts for 80% of humeral growth, are remarkably forgiving; children under five can tolerate up to 70 degrees of angulation without reduction. While radial nerve neuropraxias may occur in midshaft injuries, they generally resolve spontaneously. Clinicians must maintain a high index of suspicion for non-accidental trauma in infants with these injuries, though most cases in older children follow normal trauma patterns and achieve excellent outcomes with conservative management and orthopedic follow-up within ten days.