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). The emergency clinician should assess for other possible associated injuries
including clavicle fractures, rib fractures, pneumothorax, thoracic vertebral
fractures, and fractures of the humerus. Fractures of the body and neck of the
scapula are generally well visualized on plain radiographs; however, adequate
definition of glenoid injuries may require a CT scan. Fracture management is
often conservative, with a sling and swathe, or a shoulder immobilizer for patient
comfort, graduating to gentle range of motion exercise after 2 weeks. Orthopedic
consultation is recommended given the infrequency of this injury and its
association with other injuries. Complications are not common except for
possible malunion or functional impairment arising from associated thoracic
injuries.

Injuries of the Humerus
CLINICAL PEARLS AND PITFALLS
Humeral fractures are associated with high-energy direct blows; any
fracture with minimal trauma should raise suspicion for pathologic
fracture or abuse.
Children in early adolescence are particularly high risk for proximal
humerus physeal injuries due to the rapid growth and relative
weakness of this portion of the bone.
Humerus fractures may result in radial nerve injury, which may be
identified by numbness of the dorsum of the hand between the first and
second metacarpals and decreased motor strength with wrist and
thumb extension and forearm supination.
Orthopedic consultation is indicated for any humeral shaft fractures with
rotational deformity or angulation greater than 15 to 20 degrees.
Proximal Humerus Fractures
Injuries to the proximal humerus or humeral physis can occur after a fall on
outstretched hand (FOOSH) ( Fig. 111.13 ). Caution should be exercised in the
evaluation of the infant patient, as these fractures may also be sustained in the
setting of birth trauma and physical abuse. On examination, the child may hold

the arm in abduction and extension, with focal tenderness to palpation, localized
swelling, and occasionally shortening of the affected extremity. Routine
radiographs are generally sufficient for diagnosis, and comparison views may be
helpful in distinguishing a fracture from the normal physeal line. The vast