Pediatric emergency medicine trisk 0861 0861
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FIGURE 43.2 An older adolescent patient with left anterior glenohumeral joint dislocation.
Notice the sharp contour of the shoulder, the fullness below the glenoid fossa, and the
prominent acromion.
Before adolescence, proximal humerus fractures are usually transverse
metaphyseal or Salter–Harris type I (fracture through the physis). The epiphyseal
growth plate closes between 16 and 18 years of age in males and about 1 year
earlier in females. The injury occurs because of direct or indirect trauma (e.g., fall
onto an outstretched hand). The patient usually has mild swelling and local
tenderness. AP and lateral radiographs can confirm the diagnosis, although they
are less reliable in infants and children because the epiphysis is mainly
cartilaginous. Even in older children, slight widening of the physis may be
difficult to appreciate, and comparison views of the uninjured side may be useful.
If the child is tender over the physis and has normal radiographs, suspect a
Salter–Harris I fracture. In infants <1 year of age strongly consider a skeletal
survey and social work consultation due to risk of child abuse (see Chapter 87
Child Abuse/Assault ).
