There are few published reports regarding remodeling of long bone deformities in infants. Humeral fractures occur during difficult deliveries and the exact treatment remains controversial including the amount of reduction necessary. The goal of this study was to report the outcome of birth fractures of the humeral diaphysis at a single institution. Records were reviewed over a four year time and 16 infants were identified with humeral diaphysis fractures. Radiographs were used to access the initial fracture displacement, the amount of reduction and the subsequent remodeling.
In the 16 infants, 17 fractures were encountered. There were 9 fractures in 8 children with radiographic follow-up greater than 4 months. Initial angulation was 26 degrees in the coronal plane with a range from 3 degrees of valgus to 66 degrees of varus. In the sagittal plane, the angulation averaged 25 degrees with a range from 19 degrees apex posterior to 14 degrees apex interior. Displacement varied considerably ranging from 0 to 130%.
At follow-up of the 9 fractures in 8 children, there was a residual mean angulation of 5 degrees in coronal plane and 7 degrees in the sagittal plane. No patient had formal fracture reduction and immobilization varied from splint to a velpou.
Fractures of the humerus remodel considerably and minimal intervention is necessary. This case study demonstrates the tremendous capacity of the infants to remodel and the figures within the manuscript are impressive. These findings indicate that attempts of reduction are not necessary and allowance for remodeling should be considered. The limits of this study are the small cohort with adequate follow-up. Nonetheless, our clinical practice is simply immobilization as rapid callous formation and healing has been noted. This article supports this common practice.