Hand clinics
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Four-part proximal humerus fractures represent a difficult entity in the management of upper extremity trauma. Most of these fractures are not amenable to operative fixation; thus, surgical address is necessarily one of fracture arthroplasty. ⋯ Hence, shoulder arthroplasty for fracture should be considered an augmented osteosynthesis, with precise prosthetic implantation supplementing anatomic tuberosity reconstruction. Further investigations are ongoing regarding the use of specific fracture implants and biologic substrates in an attempt to improve further the rate of tuberosity healing in the older patient population after this operation.
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Proximal humerus fractures and fractures of the humeral shaft are relatively rare in children. The incidence of the former is about 1 to 3 cases/1000 population per year, comprising fewer than 3% of all pediatric fractures. Fractures of the humeral shaft represent fewer than 10% of all humerus fractures in children. ⋯ Simple swaddling with a sling or swaddling cloth can be the solution. For older children, splints and braces may be necessary for short periods of time. Fractures can sometimes be a sign of parental child abuse, so suspicion should remain high when evaluating children with these injuries.