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Type II Epiphyseal Frx: of Proximal Humerus

- Discussion:
    - seen in older children and adolescents;
    - fragment of metaphysis remains attached to posterior medial epiphysis;
    - articular surface is tilted inferiorly;
    - deforming forces:
           - humeral shaft is drawn upward, forward, & inward due to pectoralis major, latissimus, & teres major;
           - arm is abducted due to pull of deltoid;
    - periosteum may be stripped off lateral aspect of humeral diaphysis while periosteum is preserved on posteromedial aspect, holding fragments together, complicating closed reduction difficult;

- Treatment:
    - non displaced / minimally displaced;
          - modified Velpeau bandage for  four weeks;
    - minimal displacment w/ angulation < 20 deg
         - it is not necessary to reduce frx into its normal anatomical alignment, for remodeling will correct any deformity;
    - moderate angulation: >  20 deg;
         - frx should be manipulated to < 20 deg;
         - this is best carried out under general anesthesia;
         - reduction is complicated by the fact that upper humeral epiphysis, which is small, & difficult to grasp and stabilize during manipulation;
         - immobilize w/ modified Velpaeu bandage is applied