The word «humerus» covers very different fractures. The upper part near the shoulder, the diaphysis, and the lower part near the elbow have different rules, risks and treatment techniques.
The proximal humerus, near the shoulder, has one of the highest remodelling potentials of the body. That is why many fractures — even visually striking on X-ray — are treated conservatively with a shoulder brace and follow-up.
The indication for surgery depends on skeletal age, displacement, angulation and the overall presentation. Options include retrograde ESIN, with elastic nails inserted from the distal humerus towards the shoulder. Closed realignment is attempted; direct access may be needed if adequate reduction cannot be achieved.
Diaphyseal humerus fractures are less common but deserve attention also for their close relationship with the radial nerve. In younger children many heal well with a functional brace; in older children and adolescents, especially when alignment is unsatisfactory, ESIN may be indicated.
Everything involving the lower humerus — supracondylar, lateral condyle, medial epicondyle fractures — belongs to elbow trauma and is covered in the dedicated page: see «Elbow fractures».
Two elastic nails introduced through small incisions above the elbow and advanced across the fracture to stabilise the fragments. Resumption of movement depends on stability and the surgeon’s instructions.
Displaced or unstable diaphyseal or proximal fractures, in older children or adolescents.
The nails are removed in a planned second operation once healing is complete.
Rigid fixation reserved for selected cases, typically adolescents near skeletal maturity or multifragmentary fractures.
When ESIN is not indicated, in complex cases or revisions.
After realignment, one or more screws are inserted under the skin to stabilise the fracture without opening it.
Selected fragments whose location, size and geometry allow secure screw purchase while respecting the physis. This is not a generic alternative to elastic nails in shaft fractures; indication and stability must be established for the specific injury.
Conservative strategy for many diaphyseal fractures in young children or for proximal humerus with good alignment.
When alignment is acceptable and the child tolerates immobilisation well.
Bring the ER report and the X-rays. A focused paediatric orthopaedic visit can clarify indication, timing and alternatives.
Book a visitContent for general informational purposes only. It does not replace a medical evaluation.