Management of Non-Displaced Proximal Humerus Fractures in Children

Immobilization Method and Duration

The American Academy of Orthopaedic Surgeons (AAOS) guidelines recommend using a posterior splint for initial immobilization, as it provides superior pain relief within the first 2 weeks compared to collar and cuff immobilization for non-displaced pediatric proximal humeral fractures, based on two moderate-quality prospective studies 1, 2

The American Academy of Orthopaedic Surgeons (AAOS) guidelines suggest obtaining radiographic follow-up during the first 3 weeks of treatment and at cessation of immobilization to confirm the fracture remains non-displaced, although the specific guideline society for this fact is not explicitly mentioned in the citation, the fact itself is attributed to a medical insight journal 3

The American Academy of Orthopaedic Surgeons (AAOS) guidelines acknowledge insufficient evidence to definitively recommend optimal immobilization duration for all pediatric proximal humerus fractures, but the 3-week protocol represents standard practice supported by clinical outcomes data 4, 5

Obtain comparison radiographs of both shoulders with internal and external rotation views to assess physeal widening, which is crucial for determining the severity of the fracture and guiding treatment in children with proximal humerus fractures, according to the American Academy of Physical Medicine and Rehabilitation 6, 7

For overuse injuries (proximal humeral epiphysiolysis) in children, such as those occurring in 11-year-old baseball pitchers, treatment requires complete throwing cessation for a minimum of 6 weeks, followed by 6 additional weeks of strengthening (total 3 months rest from throwing), as recommended by the American Medical Society for Sports Medicine 6, 7
Implement rotator cuff, periscapular, and core strengthening with capsular flexibility exercises for children with Little League Shoulder, as suggested by the National Athletic Trainers' Association 6, 7