Fractures in the shoulder region are common in children. Proximal humerus fractures are frequently displaced. Previous authors have indicated a high success rate with non-operative treatment. The proximal part of the humerus has significant ability to remodel, and displacement can be readily accepted. In fact, open reduction is associated with diminished outcome. Some authors have expressed concern about interposition of soft-tissues within the fracture site, such as the long head of the biceps. This study sought to define a position of the biceps tendon in widely displaced proximal humerus fracture. The MRI was used to study the position of the biceps in completely displaced proximal humerus fractures in children.
This study consisted of a convenient sample of four patients that presented over a two-year period. The history of each case is presented within the manuscript. All four patients had completely displaced proximal humerus fracture and all underwent magnetic resonance imaging. Despite the wide displacement, none of the patients had interposition of the biceps within the fracture site. In addition, an adult cadaver was utilized to simulate a proximal humerus fracture. In the cadaver, one displacement pattern that resulted in contact with the long head of the biceps was when the distal fragment was displaced 100% anteriorly.
This study lends further support for non-operative treatment of proximal humerus fractures. The authors highlight that the greatest fallacy is to think that accurate reduction of an epiphyseal fracture at the proximal end of the humerus is important enough to require open reduction. All of these children with completely displaced proximal humerus fracture were followed until full activity was achieved. The authors believe that if significant clinical concern exists for soft tissue interposition, then MRI is warranted prior to open reduction. This principle stresses the non-operative approach to proximal humerus fractures.
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Journal of Pediatric Orthopaedics