summary Humeral Shaft Fractures in the pediatric population are usually traumatic in nature, although nonaccidental trauma and pathologic lesions can not be overlooked. Diagnosis is made with plain radiographs. Treatment is almost always immobilization due to the high remodeling potential of the pediatric humerus. Epidemiology Incidence represent <10% of humerus fractures in children Etiology Pathophysiology mechanism of injury typically associated with trauma pathomechanics neonates login to view 1 more bullet adolescents login to view 1 more bullet pathophysiology consider a pathologic process if fracture is a result of a low energy mechanism may be associated with child abuse if age <3 and fracture pattern is spiral Associated conditions radial nerve palsy associated with up to 5% of humeral shaft fractures Presentation History history of traumatic event Symptoms pain arm deformity Physical exam inspection mid-arm swelling and deformity open fractures are rare palpation tenderness to palpation motion weakness or absence of wrist and digit extension if radial nerve palsy is present pseudoparalysis login to view 2 more bullets Imaging Radiographs recommended views full length AP and lateral views of humerus optional views orthogonal views of shoulder and elbow login to view 1 more bullet findings typical fracture patterns are transverse and oblique examine closely for pathologic lesions Treatment Nonoperative immobilization in splint or brace indications login to view 9 more bullets techniques login to view 4 more bullets Operative open reduction internal fixation indications login to view 6 more bullets techniques login to view 2 more bullets Complications Radial nerve palsy occurs in <5% most commonly associated with middle and distal 1/3 fractures typically due to a neuropraxia spontaneous resolution is expected exploration is rarely needed if function has not returned in 3-4 months, EMGs are performed and exploration considered Malunion rarely produces functional deficits, due to the wide range of motion at the shoulder up to 20-30° of angulation is associated with excellent outcomes Delayed union rare may consider ultrasound bone stimulation Limb length discrepancy commonly occurs, but rarely causes functional deficits Physeal growth arrest proximal and distal humerus growth plates contributes 80:20 percent to overall humeral length Prognosis Excellent associated with enormous remodeling potential and rarely requires surgical intervention up to 20° of angulation is associated with excellent outcomes due to the large range of motion of the shoulder