FIGURE 43.2 An older adolescent patient with left anterior glenohumeral joint dislocation Notice the sharp contour of the shoulder, the fullness below the glenoid fossa, and the prominent acromion Before adolescence, proximal humerus fractures are usually transverse metaphyseal or Salter–Harris type I (fracture through the physis) The epiphyseal growth plate closes between 16 and 18 years of age in males and about year earlier in females The injury occurs because of direct or indirect trauma (e.g., fall onto an outstretched hand) The patient usually has mild swelling and local tenderness AP and lateral radiographs can confirm the diagnosis, although they are less reliable in infants and children because the epiphysis is mainly cartilaginous Even in older children, slight widening of the physis may be difficult to appreciate, and comparison views of the uninjured side may be useful If the child is tender over the physis and has normal radiographs, suspect a Salter–Harris I fracture In infants