Significantly displaced proximal humeral physeal fracture in an older adolescent (2 or less years of growth remaining)

 Closed injury

 No distal trauma (ipsilateral elbow fractures)

 Adequate anteroposterior (AP) (Fig. 1A) and orthogonal radiographs, either an axillary lateral or a scapular Y view (Fig. 1B), are needed to visualize the position of the fracture.

 This procedure uses a lateral epicondylar approach to the distal humerus.

 The radial nerve is at risk from excessive dissection proximally or anteriorly.

 The extensor origins are at risk distally, inserting onto the epicondyle.

 The beach chair position can be used with relative ease, allowing for adequate fluoroscopic imaging (Fig. 2).