Proximal humerus fractures in children and adolescents. The most common fractures of the distal humerus in children are supracondylar humerus fractures, lateral condyle fractures, medial epicondyle fractures, and transphyseal humerus fractures. Metaphyseal fractures account for 70% troversy of all phfs. We report the first case of a salter type 3 physeal fracture with posterior dislocation of the proximal humerus in a 16yearold boy.
These fractures cross through a portion of the growth plate and break off a piece of the bone end. Physeal fractures are twice as common in boys as in girls. This fracture typically occurs in children younger than 2 years and can be misdiagnosed as elbow dislocation on radiographs 1 7. Proximal humerus salter type iii physeal injury with. Fracture separation of the proximal humeral epiphyses in. Each of these fractures is discussed in detail, outlining their radiographic features, principles of treatment, and potential complications. With glenohumeral dislocation 11b3 these fractures represent three part fractures, or fracture dislocations by the neer classification. Growth plate injuries accounted for 30% of fractures. The code is not valid for the year 2021 for the submission of hipaacovered transactions.
Cross sectional area greater at physis thus less chance for tilting, i. Physeal line more proximal in infants thus more chance of separation with hyperextension in infants. Computed tomography 3 weeks later shows anterolateral displacement of the radius and ulna, as well as periosteal callus formation on the lateral side. These ossification centres appear in a typical order, starting with the capitellum, followed by the medial epicondyle, the trochlea, and finally the lateral epicondyle. All patients presented with pain, swelling, or disuse. It is therefore essential that the clinician assessing the injured child keep this diagnosis in mind. These fractures break through part of the bone at the growth plate and crack through the bone shaft, as well. Fractures involving the prox imal humeral epiphyseal plate. A proximal humerus fracture is also a com mon birthrelated injury in neonates 3.
Management of physeal injuries and fractures in adolescent. Pediatric proximal humerus fractures are a relatively common physeal and metaphyseal fracture of the proximal humerus seen in children with a peak age of 15 year of age. Distal humerus physeal separation dhps is an injury that occurs in young children due to blunt trauma to the elbow joint. Articular fracture with slight displacement impacted valgus fracture 11c1 3. Dec, 2006 salter type 3 fractures of the proximal humerus are rare injuries. A case of proximal humeral physeal separation in a newborn. Specific fractures a entire distal humerus must differentiate from supracondylar fracture.
Pdf in the pediatric population, sports participation, falls, and motor. Pdf proximal humerus salter type iii physeal injury with. Incidence of fractures of the proximal humerus in children 197677 table 2. Terms also used to describe o proximal humeral epiphysiolysis3 o osteochondrosis of proximal humeral epiphysis o stress fracture of proximal humeral epiphyseal plate 4. The dislocated humeral head was locked behind the glenoid labrum.
Eight percent of all canine fractures involve the humerus 3. Fractures involving the humerus, radius, ulna, femur, tibia, and fibula were classified according to salter and harris. Module trans ment of distal reductionally fixing and basic supports. Both acute and chronic physeal injuries related to participation in sports have been reported to occur, although injury incidence data are somewhat limited. It should not be used for hipaacovered transactions as a more specific code is available to choose from below. Definitive diagnosis of fracture separation of the distal humeral epiphysis in neonates by ultrasonography pediatric radiology, vol. Physeal fractures are also commonly called salterharris fractures because the dominant and ubiquitous classification for these injuries is the salterharris classification. Distal humeral physeal injuries, in particular, fracture separation of the distal humeral epiphysis, can be seen in abused infants. Medial condyle fracture kilfoyle type iii of the distal. Distal humerus physeal separation pediatric pediatrics. Common causes of a proximal humerus fracture include.
The physis is the weakest component of immature long bones, and physeal fractures constitute about 30%. Fracture and fracture separation of the proximal humerus in children. In icd9cm, physeal fractures like most other types of fractures are reported by denoting the location of the fracture and whether the fracture is open or closed. Physeal fractures are most common in 10to15yearold. Nonphyseal fractures occurred twice as often in the upper extremity as in the lower extremity. A lesson on physeal and apophyseal pediatric fractures. Icd10cm coding of physeal fractures using the salter. Physeal fractures cover 1520 % of all major longbone fractures 15 and even 34 % of pediatric hand fractures 15. It has been stated in the literature that non physeal fractures are far more common than physeal fractures. At our department of trauma surgery, 303 children and adolescent patients with fractures of the proximal humeral epiphysis were treated from 1992 to 2009. Risk factors o between ages 1116 average 14 age when proximal humeral physeal growth is at its peak o overhead sports baseball, tennis, volleyball, swimming. These codes can be used for all hipaacovered transactions. Salterharris type iii physeal fracture of upper end of humerus, left arm.
Physeal fractures of the humerus can affect the proximal or distal physes. Growth plate physeal fractures differential diagnoses. Detection of physeal injury in an infant or toddler may indicate the possibility of unsuspected abuse, particularly when an appropriate history explaining the circumstance of the fracture is lacking. Most pediatric patients with proximal humerus fractures have favorable results, and complications are infrequent. Physeal fractures represent 35% of all skeletal injuries in children ref. Icd10cm coding of physeal fractures using the salterharris. The purpose of this report is to demonstrate our unusual case and discuss surgical. Icd10 code for salterharris type ii physeal fracture of. Distal humerus epiphyseal separation transphyseal distal humeral fracture is rare and has been described only in case reports and small case series. Seventytwo fractures of the proximal humerus clas sified according to type neer and horwitz 1965 and duration of treatment weeks age groups yo m 59 1015 type of dislocation no. Computed tomography 3 weeks later shows anterolateral displacement of the radius and ulna, as well as. Summer was the season when the fracture incidence was the highest.
Icd10cm code for salterharris type i physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with malunion s49. The fall doesnt need to be from any great height, falling from a standing height. Distribution of physeal and nonphyseal fractures in 2,650. Pediatric supracondylar fractures and pediatric physeal elbow. Neonatal distal humeral physeal fractures are rare and difficult to diagnose. Articular fracture with gleno humeral dislocation 11c3. This is the most common type of growth plate fracture. The fracture pattern could not be evaluated by simple radiography, but was possible with the aid of mri. The purpose of this study was to document the late outcome of a group of patients with neer grade iiiiv proximal humeral physeal fractures who were treated with reduction of the fracture and.
Fractures of the proximal humerus represent approximately 0. Salterharris type iii physeal fracture of upper end of humerus, right arm. Bare medial epicondyle physeal fracture of the humerus. The salterharris classification system for physeal fractures is in common use figure 2 and was devised by robert salter and robert harris in 1963. Percutaneous fixation of neonatal humeral physeal fracture. Highest surgical treatment rate 50% was seen in supracondylar humerus fractures. Kirschnerwire fixation on fracture stability in salterharris type i fractures of the proximal humeral physis in a porcine cadaveric model jiawen ma1, tian wang2, vedran lovric2, kenneth a. The most common cause of a proximal humerus fracture is falling over onto an outstretched hand. The most common physeal fractures involve the phalanges. Fractures of the proximal humerus in children and adolescents. Icd10 code for salterharris type i physeal fracture of. The radius and capitellum remain congruent so the diagnosis of a displaced flexion type distal humeral physeal injury was made. Pdf fractures of the proximal humerus in children researchgate.
Proximal humerus fractures account for a majority of fractures of the upper arm and 5% of all fractures. However, separation of the distal humeral epiphysis is very rare, especially in the newborn. Basic principles in the assessment and treatment of fractures. Pediatric supracondylar fractures and pediatric physeal. It was originally designed to prognosticate about outcomes following fracture repair, with salter and harris reporting the outcomes following experimentally induced physeal fractures of each type.
Pdf evaluation and management of pediatric proximal humerus. Case report neonatal distal humeral physeal separation during. Operative versus nonoperative treatment of displaced proximal humeral physeal fractures. Management of physeal injuries and fractures in adolescent athletes jason yoder, dpt objectives.
Upper extremity fractures cook childrens medical center. Thus, missed diagnoses and delayed healing are possible. Pdf fractures of the humerus leonid solomin academia. Fractures of the lateral condyle fig 4b are relatively common, comprising approximately 10% to 20% of all fractures in the region of the elbow and up to 25% of all physeal injuries of the elbow. Fixation of physeal fractures with bioabsorbable implants. At our department of trauma surgery, 303 children and adolescent patients with fractures of the proximal humeral epiphysis were treated from.
Two cases resulted from suspected or confirmed nonaccidental injury. A retrospective study of humeral fracture cases in dogs and cats found that 4% of these fractures were proximal physeal fractures 4. Separation of the entire distal humeral epiphysis radiology. Listed below are all medicare accepted icd10 codes under s49. This injury is frequently associated with nonaccidental injury up to 50% 1. Assembly and align extraarticular fractures of the distal part of the humerus. Basic principles in the assessment and treatment of. Distal humeral epiphyseal separation in young children. Few studies have reported surgical treatment, because a callus may develop at the fracture site 5 d after the fracture, resulting in difficult reduction, and reduction of the limb may cause further physeal injury. Proximal humeral epiphysiolysis little league shoulder.
This type of fracture is more common in older children. Of particular concern is the growing number of stress. Treatment is nearly always nonoperative in younger patients due to the remodeling potential of the proximal humerus. The humeral head or the greater tubercle can separate independently, but more commonly the two epiphyses can stay confluent. Most fractures involving the entire distal humeral physis occur before the age of 5 or 7 and are most common under the age of 2. So a physeal fracture of the distal femur would be reported as 821. Unique fracture occuring at time of physeal closure leary et al. Salter type 3 fractures of the proximal humerus are rare injuries. Proximal humeral physeal separations phpss represent 3% of all physeal injuries, which represent about onethird of all pediatric fractures. The most useful approach for these fractures is a combined approach to the craniolateral region of the shoulder joint and the proximal humerus. Salterharris type iii physeal fracture of upper end of humerus, unspecified arm.
Presenting complaint, initial diagnosis, and time to correct diagnosis were recorded. Fractures and physeal injuries of proximal humeral end in children. Pdf ninetyone children who had been treated for fractures of the proximal humerus 59 metaphyseal fractures. Proximal humeral fractures tend to occur due to vehicular trauma 5. The occurrence of physeal fractures shows a small but steady increase during early childhood, with peaks between the ages of 9 and 16 years peterson et al. Proximal humerus fracture pediatric pediatrics orthobullets. Pediatric proximal humerus fractures are a relatively common physeal and metaphyseal fracture of the proximal humerus seen in children with.
Aug 01, 2017 a direct blow to the medial elbow can lead to medial epicondyle fracture. Distal humerus transphyseal fracture, also referred to as transphyseal separation, is a physeal periarticular elbow injury found most commonly in young children between birth and 3 years of age. Of 101 children aged 3 or younger with elbow fractures, 7 were noted to have distal humerus physeal separation. Pdf neonatal distal humeral physeal separation during. A biomechanical comparison of kirschnerwire fixation on. Patterns of single segment nonphyseal extremity fractures in. Fractures of the humeral head are usually salterharris type i and ii. The distal condylar physis has usually fused by six months in the dog and three months in the cat. Fractures and physeal injuries of proximal humeral end in. The forearm was the most commonly seen fracture site.
In children, fracture separation of the epiphyseal plate near the elbow joint is a common occurrence. This could be explained by the fact that the physes are open for a longer period of time in boys. Physeal fractures traditionally believed to occur primarily through zone of hypertrophy recent studies show fractures often traverse more than one zone growth disturbancearrest potentially related to location of fracture within physeal zones disruption of vascularity jaramillo et al, radiology, 2000. There have been very few reports of this rare injury since 1926.
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