Authors of section

Authors

Anna Clarke, Dorien Schneidmüller

Executive Editor

Mamoun Kremli

General Editor

Fergal Monsell

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Proximal humeral anatomy

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  • 1/2 – Developmental anatomy
  • 2/2 – Axillary nerve

1. Developmental anatomy

An understanding of the development of the proximal humerus is necessary for accurate fracture diagnosis.

The appearance of secondary ossification centers is as follows:

  • Proximal humeral epiphysis; 6 months
  • Greater tuberosity; 3 years
  • Lesser tuberosity; 5 years

Other important radiological events include:

  • Coalition of tuberosities; 5–7 years
  • Fusion of tuberosities with humeral epiphysis; 7–13 years
  • Fusion of physis; 14–17 years in females, 16–18 years in males

In a neonatal injury, MRI or ultrasound may be required for diagnosis.

Developmental anatomy of the proximal humerus in the age range of 6 month to >14 years old children

The proximal humeral physis is responsible for 80% of humeral longitudinal growth and remodeling can therefore be expected.

Fracture types according to age

Salter-Harris I: <5 years

Metaphyseal fractures: 5–11 years

Salter-Harris II: >11 years

In patients with closing physes (>13 for females and >15 for males), consider management as for adults.

2. Axillary nerve

The most important anatomical consideration in the proximal humerus is the location of the axillary nerve, about 5 cm below the tip of the acromion in children older than 6 years.

This is particularly important in the younger child as the window for safe K-wire insertion is smaller.

The deltoid insertion is also a reproducible landmark.

Key anatomical consideration: axillary nerve location, ~5 cm below acromion in children >6 years. Important for younger children due to smaller safe zone for K-wire insertion. Deltoid insertion is a reliable landmark.
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