University of Oulu

Hannonen, J., Hyvönen, H., Korhonen, L. et al. The incidence and treatment trends of pediatric proximal humerus fractures. BMC Musculoskelet Disord 20, 571 (2019).

The incidence and treatment trends of pediatric proximal humerus fractures

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Author: Hannonen, Juuli1; Hyvönen, Hanna1; Korhonen, Linda1;
Organizations: 1Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, PoB 23, 90029 OYS, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Springer Nature, 2019
Publish Date: 2020-02-14


Background: Proximal humerus fractures comprise approximately 2% of all pediatric fractures. In general, upper extremity fractures have increased in children. However, recent trends of proximal humerus fractures are not analyzed yet. The aim was to study the incidence and treatment trends of proximal humerus fractures in children.

Methods: All 300 children, aged < 16 years, who suffered from a proximal humerus fracture in the catchment area of Oulu University Hospital, Finland, between 2005 and 2015, were included. Radiographs were reviewed, and patients, injuries, treatments, and outcomes were comprehensively studied. Annual incidence was based on the child population at risk, which changed between 84.500 and 88.100 in the study time.

Results: The annual incidence of childhood proximal humerus fractures was mean 31.4/100,000 and no variation trend was found. The majority (92%) was treated nonoperatively, however, there was an increase of operative fixation from 0 to 16% during the study time (Difference 16, 95% CI 0.3 to 34.9%, P = 0.045). Bayonet displacement increased the risk of surgical fixation up to 16-fold (95% CI 4.8–51.4, P < 0.001) in a multivariate analysis when adjusted with other potential risk factors. Higher age was also associated with operative treatment (P = 0.002). The most usual recreational activities were horse riding, downhill skiing, snowboarding, and trampolining.

Conclusion: Contrary to most upper extremity fractures in children, proximal humerus fractures did not increase during the long study period. However, their operative treatment increased compared to nonoperative treatment, but the evidence supporting that trend remains unclear.

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Series: BMC musculoskeletal disorders
ISSN: 1471-2474
ISSN-E: 1471-2474
ISSN-L: 1471-2474
Volume: 20
Issue: 1
Article number: 571
DOI: 10.1186/s12891-019-2948-7
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © The Author(s). 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.