β£Classification of Paeds Proximal Humerus #?Neer and HorwitzType 1 < 5mm displacement2 < 1/3 width of shaft3 = 2/3 of shaft width4 = > 2/3 shaft widthβ£Why is there high threshold for surgery?Proximal growth plate responsible for 80% of growth in humerus; remodelling potential is highβ£Limits of displacement for surgery?Dobbs et al. 2003 JPO published an algorithm with good outcomes with the below limits of displacement for conservative mx.< 7 yo < 70 Β°8-11 yo < 60 Β°> 12yo < 45 Β°β£Management?Grade 1/2 = Non OpGrade 3/4 = controversial based on age and extent of displacement = CRPPβ£What approach if require to open?Deltopectoral approach if need open.β£What are the potential blocks to reduction?long head of biceps tendonHumeral Shaft Fractures β£Management by age?< 3yo = Hanging cast> 3yo = Sarmiento bracingIf op = TENS nail