Treatment of Proximal Humerus Fracture in a 7-Year-Old
Yes, you can use a sugar-tong or U-mold cast (also called hanging arm cast) for immobilization of this proximal humeral fracture in a 7-year-old, as nonoperative immobilization is the appropriate treatment for most pediatric proximal humerus fractures at this age.
Key Distinction: This is NOT a Supracondylar Fracture
The available guidelines address supracondylar humerus fractures (distal humerus/elbow injuries), not proximal humerus fractures (shoulder region). These are completely different injuries with different treatment algorithms 1, 2. The AAOS supracondylar fracture guidelines do not apply to your proximal humerus fracture case.
Treatment Approach for Pediatric Proximal Humerus Fractures
Nonoperative Management is Standard at Age 7
Immobilization with a sling or hanging arm cast is the treatment of choice for displaced proximal humerus fractures in young children like your 7-year-old patient 3.
The proximal humeral physis is responsible for 80% of the growth of the entire humerus, giving these fractures tremendous remodeling potential in younger children 4, 3.
Most pediatric proximal humerus fractures can be treated nonoperatively with excellent outcomes, particularly in younger patients 5.
Specific Immobilization Options
Both sling and hanging arm cast (U-mold/sugar-tong type) are acceptable immobilization methods for these fractures 3, 6.
Recent evidence shows that even for displaced fractures, immobilization without reduction (INR) has similar radiographic and clinical outcomes compared to closed reduction followed by immobilization 6.
The hanging arm cast or sling should be used for approximately 3 weeks, though this is based on standard practice rather than high-quality evidence 7.
When to Consider Operative Management
Operative treatment is not indicated for your 7-year-old unless specific criteria are met 4, 5:
- Open fractures
- Ipsilateral elbow or forearm injury
- Associated neurovascular injury
- Polytrauma patients
- Older adolescents (typically >12 years) with minimal growth remaining and significantly displaced fractures
Age-Based Decision Making
Children under 10-11 years: Nonoperative management is almost always appropriate due to excellent remodeling capacity 4, 5.
Adolescents 12-16 years: Consider operative management for significantly displaced fractures, though even in this age group, nonoperative treatment often yields good results 6.