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Proximal humerus fractures in children have some of the greatest remodeling potential of all pediatric fractures, due to the amount of growth that occurs from the proximal humeral physis (80%).Proximal humerus fractures account for < 5% of fractures in children. Nonoperative management is generally indicated with acceptable alignment. For patients <10 years old, generally any degree of angulation is accepted. For those 10-12 years old, up to 60-75° of angulation is accepted. For those >12 years old, up to 45° of angulation or 2/3 displacement is accepted. The proximal humerus has significant remodeling potential and the vast majority of humeral growth occurs secondary to the proximal humeral physis.Popkin et al. reviewed pediatric proximal humerus fractures. They reported that the proximal humeral growth plate is responsible for up to 80% of the growth of the humerus and the remodeling of these fractures in children is tremendous. They concluded that most of these injuries can be treated with a sling or hanging arm cast, although older children with decreased remodeling capacity may require surgery. Bahrs et al. reviewed possible reasons for the failure of closed reduction of proximal humerus fractures in children and adolescents. They reported that failed closed reduction should be interpreted as a possible soft tissue entrapment most likely because of the long biceps tendon. They concluded that if anatomical reduction is achieved and maintained until fracture healing, excellent functional and radiological results can be expected from an age- and deformity-focused treatment regimen for children and adolescents with proximal humeral fractures.Pahlavan et al. performed a systematic review of the literature to identify operative indications for proximal humerus fractures in children and to compare the results by age, displacement, and treatment modality. They reported that the currently available literature supports a non-operative treatment approach, particularly in younger children with more growth remaining. They concluded that older patients (>13 years) with more widely displaced fractures may benefit from anatomic reduction with stabilization. Incorrect Answers:Answers 1-3,5: Proximal humeral physis contributes approximately 80% of humeral growth.
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