Immobilization

Proximal humeral fractures require control of the shoulder to limit movement and increase fracture stability.

Advantages are:

• Easy to remove and reapply
• Earlier functional use of arm
• Inexpensive

Stabilization of the arm to the body can be achieved by wrapping the arm as illustrated or using commercially available devices.

Obstetric fractures are usually immobilized with the arm inside clothing until the child is pain free.

Indications:

• Fracture of the proximal humerus
• Shoulder injuries

Goal:

• Stabilization of the proximal humerus and the shoulder

Immobilization may be sufficient with a simple sling. These are readily available and managed by the patient and carers.

Discomfort around the neck can be a disadvantage of this type of immobilization.

A shoulder immobilizer is a good alternative in an older child and can be applied with or without a body strap.

Metaphyseal and epiphyseal fractures of the proximal humerus usually require 2–4 weeks of immobilization for adequate healing, depending on the age of the child.

Immobilization may be discontinued as symptoms improve.

AP and lateral x-rays should be taken to assess the fracture position.

Obstetric fractures do not generally require radiological surveillance.

Recovery of movement is usually rapid and rarely requires physiotherapy.

Resumption of unrestricted physical activity is a matter of judgment by the treating surgeon.