Dr. Day: The patient is a 10-year-old black boy who fell from a slide while playing on a school playground and immediately complained of pain in the left shoulder and inability to elevate the left arm. When he was examined in the hospital emergency room, rather marked swelling was present about the left shoulder girdle. There was generalized tenderness about the shoulder and the proximal end of the humerus and exquisite pain on any attempt at movement of the shoulder. The skin was intact. There was no neurologic or vascular deficit. Elbow, forearm, wrist, and hand function were normal. There was no evidence of other injury.
X-ray films (Fig 1 and 2) were obtained which revealed a fracture through the proximal humeral metaphysis with lateral displacement of the distal fragment and overriding.
Dr. Schneider: Fractures of the proximal end of the humeral shaft in children are relatively uncommon.1