The location of the biceps tendon in completely displaced proximal humerus fractures in children: a report of four cases with magnetic resonance imaging and cadaveric correlation.

Abstract

The location of the biceps tendon is a matter of concern for clinicians treating completely displaced proximal humeral fractures in children. This article describes four patients (one 12-year-old boy, two 12-year-old girls, and one 14-year-old girl) who underwent magnetic resonance imaging evaluation of their fractures to discern the location of the biceps tendon. In no case did the tendon become entrapped in the fracture site. At latest follow-up (1.5, 2, 1, and 2 years, respectively), full pain-free shoulder function and only mild radiographic abnormality were documented. Further investigation of proximal humeral fracture displacement using an adult cadaver model revealed that even extreme fracture displacement did not result in biceps tendon entrapment. The only displacement pattern that resulted even in fracture fragment contact with the biceps tendon was one where the shaft fragment was displaced 100% anteriorly.