Fractures of the proximal humeral epiphysis.

Displacements of the proximal humeral epiphysis at the epiphyseal plate result from extension injuries. The configuration of the epiphyseal plate and the thickness of the periosteum surrounding the epiphysis make slight to moderate displacements relatively stable injuries, which can be treated successfully with external support. In patients with more severe displacement, flexion, abduction, and slight external rotation of the distal fragment bring the metaphysis into alignment with the proximal fragment, correcting the anterior angulation. The thick periosteal sleeve attached to the physis through which the metaphysis tears out anteriorly has great potential for remodeling the persistant bowing that remains after healing of the fracture. Although shortening and residual angulation results from closed treatment are almost always good and open surgery is rarely indicated.