The patient is a 3.520 kg term girl with a footling breech presentation; delivery of the upper limbs and trunk was difficult. Forceps/vacuum were not used. Absence of active movement of the right shoulder and an undisplaced mid-third fracture of the clavicle were observed before discharge. Finger movements were normal. The first diagnosis was obstetrical Erb's paralysis and clavicle fracture. At the 14-day follow-up, swelling and point tenderness above the clavicle resumed while right ipsilateral elbow was swollen without direct signs of trauma. Passive elbow movement in a range of 20 -908 was possible if done very gently. Radiographs ( Fig. 1 a and b) showed the radius and ulna were not in alignment with the distal humerus. Radiographs of the opposite elbow were normal. Perinatal child abuse was ruled out.An ultrasound (US) of the elbow was obtained with a 7.5 MHz linear transducer. The examination was consistent with physeal separation of the distal humerus with posterior and medial displacement. On longitudinal view one can see the periostal elevation while the subperiostal space in the distal humerus is seen to be hyperechogenic thus being consistent with incipient callus. The transverse view showed posteromedial physeal displacement (Fig. 2 a and b). The standard sonographic examination should include examination of the controlateral elbow.The baby was taken to the operation room. An arthrogram was done to confirm the diagnosis and rule out a "T" pattern and to obtain a closed reduction. Indeed the diagnosis of Salter-Harris II physeal separation posteromedially displaced was confirmed (Fig. 3 a and b). By gentle flexion to 1208 while pushing on distal humerus, the alignment was improved. The elbow was splinted in hyperflexion for 3 weeks. There was an uneventful clinical AstractAmong musculo-skeletal injuries at birth the most common are fracture of the clavicle, brachial plexus injury and long bone fractures. Physeal separation of the distal humerus does not appear in statistics; only sporadic cases have been reported. Here we report a new case and discuss diagnostic and treatment alternatives. ZusammenfassungUnter den muskulo-skelettalen Geburtstraumen finden sich am häufigsten Klavikulafrakturen, Armplexusläsionen und Frakturen langer Röhrenknochen. Epiphysenlösungen am distalen Humerus sind statistisch nicht erfasst, bisher wurden nur Einzelfälle berichtet. Die Autoren berichten über ein solches Ereignis und diskutieren die diagnostischen und therapeutischen Mög-lichkeiten.
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