The fractures of the humerus shaft and of the proximal humerus in childhood turn off less than 1% of all fractures. Healing is unproblematic, according the literature the non operative treatment is the treatment of choice.

Under the influence of the ESIN (Elastic Stable Intramedullary Nailing) the readiness to operate children’s fractures has changed completely. The reasons for it are multiple. According to this trend, also is to recognize a change in the treatment of the humeral fractures in childhood obviously.

The presentation on hand shall show the reasons of this paradigm change more nearly. The classic indications for the operative therapy of humeral fractures were: 3∞ open fractures, comminuted fractures, secondary complications.

We have asked whether, today, this concept is still valid in Europe. The tendency towards more operative treatment becomes apparent in the documentation of children’s fractures that has started by the international working group for children’s trauma in collaboration with the AO – Doc in 1991.

We think every unstable humerus fracture should be stabilized today. We posit in the rest, that if a general anaesthesia for reduction of humeral fracture is indicated, we aim at a definitive, stable and save fixation, i.e. potentially unstable fractures should be reduced in the OR. In our hands and relying on our experience we prefer to stabilize humeral fractures with ESIN.