- 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