Proximal Humerus Fractures in Children: To Fix or Not to Fix?

Proximal humerus fractures are a common upper extremity injury that the pediatric orthopaedic surgeon will certainly encounter. Most of these fractures are managed with closed reduction with expectant remodeling. However, inevitably, some fractures are not well suited to minimal or nonsurgical management. Whether the fracture alignment would cause functional impingement or rotational impairment, if the fracture is irreducible, or if the patient is an adolescent with minimal remodeling potential, there are various treatment options. Closed reduction and creative immobilization techniques can adequately treat some otherwise unacceptable fracture patterns. Some fractures require surgical intervention with open reduction to release entrapped soft tissues. Fixation strategies ranging from percutaneous pin fixation, percutaneous screw fixation, flexible nailing, and plates and screws are valuable assets in the pediatric orthopaedic surgeon's toolbox.