No incidence of glenohumeral joint dislocation in a review of 220 paediatric proximal humerus fractures

PURPOSE: Proximal humerus fractures in adults are approached with a high suspicion for potential associated glenohumeral dislocation. Axillary views of the shoulder can be painful and possibly even lead to dynamic angulation of the proximal humerus fracture. The incidence of associated glenohumeral dislocation in the paediatric population is unclear and it would be useful to determine whether children with proximal humerus fracture require specific axillary view imaging to rule out dislocation. METHODS: We retrospectively reviewed 220 proximal humerus fractures in 218 total children. Imaging and follow-up clinic notes were reviewed for potential glenohumeral dislocation. RESULTS: Average patient age was 9.8 years SD 3.8 with 55% of the patients male and a wide variety of mechanisms of injury. None of the 220 fractures evaluated showed radiographic evidence of a shoulder dislocation, and all 218 children had a follow-up appointment at least 21 days after the injury without any clinical concern of a missed shoulder dislocation. CONCLUSION: No paediatric patients presenting with proximal humerus fractures had a corresponding glenohumeral joint dislocation in our relatively large series. We recommend obtaining this additional imaging only in cases with higher energy mechanisms, if there is suspicion of subluxation or dislocation on anteroposterior and scapular-Y views or if there is clinical concern. LEVEL OF EVIDENCE: Level III Diagnostic