Treatment of Closed Complete Transverse Proximal Humeral Fracture in a 7-Year-Old Boy
For a 7-year-old boy with a closed, complete transverse proximal humeral fracture, nonoperative treatment with immobilization is the recommended approach, as the proximal humerus has tremendous remodeling potential at this age and can accommodate significant displacement and angulation. 1
Initial Management Approach
Conservative treatment is strongly recommended for this patient based on the following factors:
- The proximal humeral physis is responsible for 80% of the entire bone's growth, providing exceptional remodeling capacity in children, particularly at age 7 1
- The majority of pediatric proximal humeral fractures can be treated nonoperatively with excellent outcomes 1, 2
- In a large series of 91 children with proximal humeral fractures, 96% achieved good to excellent clinical results with nonsurgical treatment 2
Specific Treatment Protocol
Immobilization options include:
- Shoulder spica cast after closed reduction (most commonly used in displaced fractures) 2
- Desault bandage for minimally displaced fractures 2
- Hanging cast as an alternative 2
The choice depends on fracture stability and displacement, but closed reduction with shoulder spica cast was used successfully in 62 of 82 conservatively treated cases 2.
Indications That Would Change Management
Operative treatment would be indicated ONLY if the following conditions are present:
- Open fracture 1, 3
- Associated neurovascular injury 1, 3
- Ipsilateral elbow or forearm injury 1
- Polytrauma 1
- Failure to achieve or maintain adequate closed reduction in an older child/adolescent with minimal growth remaining 1, 4
Critical caveat: At age 7, this patient has substantial growth remaining (typically 5+ years until skeletal maturity), making operative intervention rarely necessary even with significant displacement 1, 5.
Expected Outcomes
- Radiographic union typically occurs within 4-7 weeks 4, 2
- Full, pain-free shoulder range of motion is expected 4, 2
- Minor residual varus deformity may be visible radiographically but typically does not affect function and remodels over time 2
- Return to pre-injury activities is the norm 4
Common Pitfalls to Avoid
Do not pursue operative treatment based solely on radiographic appearance of displacement in a 7-year-old child. The literature demonstrates that even severely angulated fractures (up to 40-50 degrees) remodel successfully in younger children due to the proximity to the physis 1, 5. Surgery in this age group risks physeal damage and is associated with complications including infection, without providing superior functional outcomes compared to conservative management 2.