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Fractures of the shoulder girdle, shoulder and arm of the child

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Clavicle

These fractures generally require orthopedic treatment with the use of a sling for 3-4 weeks + 3 weeks of sports protection (Figure 10).

Surgical treatment is recommended when there is risk of cutaneous perforation of bone ends.
 

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Figure 10
. Fractured of the middle clavicle, angled and slightly displaced. Treatment was performed with a sling.

Obstetric clavicular fracture  (Fig 6)

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It is the most frequent obstetric fracture (produced during labor). It is produced in difficult births and it is very important to rule out congenital brachial plexus palsy (objectify active flexion of the elbow). This type of fracture heals very rapidly, forming a large callus, that remodels over time. Placing the extremity under clothing for a week is enough.

No X-ray is needed for diagnosis nor monitoring of repair.
 


Proximal humerus

Fractures of the proximal humerus have a great capacity for remodeling, since its physis has great growth potential. Thus, we can use non-surgical treatment for fractures with fair displacement or angulation (especially in young patients) (Fig. 11).

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Figure 11. Proximal humerus fracture in a young child. Complete remodeling.

Most are Salter-Harris physeal fractures type I and II. They are immobilized with a sling for 2-3 weeks.
We propose surgical treatment for severely displaced fractures in adolescents, by closed reduction and percutaneous fixation with Kirschner wires or screws.


Shaft of the humerus

In general, the recommended treatment is non-surgical, by immobilization with a U cast.
In adolescence there is a greater tendency to shift. Therefore, closed reduction and internal fixation with intramedullary elastic needles (Metaizeau) is the treatment of choice. Fig 12.
 

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Figure 12. Low humeral shaft fracture treated with elastic intramedullary pins.


Obstetrical humerus fracture

It is the second most common obstetric fracture. Treatment by tube traction for 10 days (Fig 13). With this “crafty” method, residual angulation is perfectly reshaped due to early age.

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Figure 13
. Obstetric humeral fracture treated with tube traction.

Obstetric brachial palsy
Brachial Plexus Birth Palsy: Definition and Mechanisms of Injury:
Risk of brachial plexus birth palsy. Necessary diagnostic tests.
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Shoulder problems in children with BPBP
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Diagnosis and Treatment of Shoulder Dysplasia
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Fractures of the shoulder girdle, shoulder and arm of the child
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