Pediatric fractures of the humerus.

Humeral shaft fractures constitute only 3% of fractures in children younger than age 16 years. They are most common in children younger than 3 and older than 12 years old. They can be classified according to the fracture pattern, location, and tissues damaged. Fractures resulting from minor trauma may be caused by an occult unicameral bone cyst. Each age group requires different diagnosis, treatment, and prognosis. Fractures at birth are seen mostly with macrosomic and breech presentation. In children younger than 3 years, humeral fractures often are linked to child abuse. In those older than 10 years, fractures are related to direct or indirect trauma. Sports activities have been reported also to cause injuries in skeletally immature patients. Most humeral fractures are controlled nonoperatively; however, potential operative indications include open fractures, multiple trauma, bilateral injuries, compartment syndromes, pathological fracture, significant nerve injuries, and inadequate closed reduction.