Neer and Horwitz review 89 proximal humeral epiphysial plate fractures treated over 34 years, comparing outcomes of aggressive reduction techniques (pre-1953) against a conservative approach (post-1953). The study asks: what are the true anatomic and functional outcomes by displacement severity and patient age, and is reduction ever necessary?
When you see a proximal humeral physeal fracture in a child under 11, counsel confidently: remodeling will be complete and open reduction is not indicated regardless of displacement grade.
In adolescents 11–15 with Grade III–IV displacement, warn parents that permanent shortening up to 3 cm is possible even with successful reduction — but functional outcomes remain excellent because glenohumeral mobility compensates.
Neer and Horwitz review 89 proximal humeral epiphysial plate fractures treated over 34 years, comparing outcomes of aggressive reduction techniques (pre-1953) against a conservative approach (post-1953). The study asks: what are the true anatomic and functional outcomes by displacement severity and patient age, and is reduction ever necessary?
When you see a proximal humeral physeal fracture in a child under 11, counsel confidently: remodeling will be complete and open reduction is not indicated regardless of displacement grade.
In adolescents 11–15 with Grade III–IV displacement, warn parents that permanent shortening up to 3 cm is possible even with successful reduction — but functional outcomes remain excellent because glenohumeral mobility compensates.