![]() Little League Shoulder is a proximal physeal overuse injury found in overhead throwing athletes. The proximal humerus is a common site of overuse injuries that mimic fractures. In a child less than 3 years of age who presents with a proximal humerus fracture the treating physician should consider nonaccidental trauma. (Neer, 1965 Popkin, 2015) Another potential cause of proximal humeral fractures are traumatic births in neonates. Most fractures are the result of a fall onto the shoulder or from a direct blow to the proximal arm. Proximal humeral fractures are 3-4 times more likely to occur in boys than girls. The proximal humeral physis remains open until approximately 16-19 years of age. The three ossification centers coalesce by 6 years of age. (Landin, 1997 Neer, 1965) The proximal humeral epiphysis forms from three early ossification centers: a humeral head center present at or near birth, a greater tuberosity center that appears at age 3 years, and a lesser tuberosity center that appears at age 5 years. Proximal humeral physeal injuries account for approximately 2-3% of all physeal fractures. ![]() Fractures involving the proximal humeral physis are categorized by the Salter Harris classification system and fractures of the metaphysis are described by the amount of angulation and displacement at the fracture site. Proximal humerus fractures include fractures involving the proximal humeral physis and metaphysis. For patients closer to skeletal maturity when the remodeling potential is diminished, one might consider surgical treatments to improve fracture alignment and reduce the possibility of malunion.Nonsurgical management is appropriate for the majority of young children with proximal humeral fractures.As such, there is extensive remodeling potential in fractures in younger, skeletally immature patients. The proximal humeral physis contributes approximately 80% of the growth of the humerus.Study Guide Proximal Humerus Fractures Key Points:
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