Type II Epiphyseal Frx: of Proximal Humerus

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- Discussion:
    - seen in older children and adolescents;
    - fragment of metaphysis remains attached to posterior medial epiphysis;
    - articular surface is tilted inferiorly;
    - deforming forces:
            - humeral shaft is drawn upward, forward, & inward due to pectoralis major,
                  latissimus, & teres major;
            - arm is abducted due to pull of deltoid;
    - periosteum may be stripped off lateral aspect of humeral diaphysis while
            periosteum is preserved on posteromedial aspect, holding fragments
            together, complicating closed reduction difficult;

- Treatment:
    - non displaced / minimally displaced;
          - modified Velpeau bandage for   four weeks;
    - minimal displacment w/ angulation < 20 deg
          - it is not necessary to reduce frx into its normal anatomical
                alignment, for remodeling will correct any deformity;
    - moderate angulation: >   20 deg;
          - frx should be manipulated to < 20 deg;
          - this is best carried out under general anesthesia;
          - reduction is complicated by the fact that upper humeral epiphysis,
                which is small, & difficult to grasp and stabilize during manipulation;
          - immobilize w/ modified Velpaeu bandage is applied;