Birth-related distal humerus epiphyseal separation: Outcome following surgical management

Aldossari, Ali Mohammed; Alsagr, Ghadeer A; Alotaibi, Raghad; Shogair, Majed M; Alharbi, Hani; Alrashedan, Bander S

doi:10.4103/jmsr.jmsr_44_20

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“…The mechanism of injury could be a combination of rotational, angulation, and extension forces. Due to the application of the considerable amount of traction at birth, such injuries have been described in the literature, as secondary to birth trauma [ 1 , 3 , 5 ]. It classically presents a few days later with diffuse swelling around the elbow joint along with the inability to do a full range of motion around the joint.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanisms of injury generally responsible for such trauma are either fall on an outstretched hand or hyperextension and forceful rotation of the forearm and elbow [ 1 ]. Hence, chondro-epiphyseal separation of the distal humerus can rarely occur as a consequence of excessive traction on the upper extremity accompanying a dystocic birth or one complicated by cephalopelvic disproportion [ 4 , 5 ]. Apart from birth-related trauma, this rare pattern of injury occurring in bilateral upper limbs is also possible with either a skeletal developmental defect or child abuse.…”

Section: Introductionmentioning

confidence: 99%

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Bilateral Distal Humeral Physeal Separation-From Birth Trauma to Family Trauma

Siddiqui,

Abbas,

Anwer

et al. 2023

jocr

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Introduction: Chondro-epiphyseal separation of the distal humerus is a rare injury, which can occur as a consequence of excessive traction on the upper extremity accompanying a dystocic birth or one complicated by cephalopelvic disproportion. Such fracture patterns can also result from a combination of rotatory and shear forces, also typically seen following child abuse. It can be easily mistaken for a posterior elbow dislocation, creating a delay in diagnosis. Since unossified cartilage cannot be seen radiographically, these injuries are better appreciated by ultrasound or magnetic resonance imaging. Case Report: We present a case of an 8-day-old neonate who presented with pseudoparesis of the left arm following birth. Posterior displacement of the elbow joint was identified on the radiograph. On ultrasound, a trans-physical supracondylar distal humerus fracture was identified. This was presumed as trauma secondary to a difficult delivery. At the 11th week of follow-up, the patient presented with a fracture of the right proximal tibia, followed by a fracture shaft left femur at 5 months of follow-up. Chest X-ray at this time revealed uniting rib fractures with callus formation. After ruling out any congenital collagen disorder (osteogenesis imperfecta), the patient was diagnosed with a case of battered baby syndrome. The case was reported to child protection services and parents were questioned and counseled for the same. Conclusion: This case report highlights the importance of a high degree of suspicion of child abuse in any child with a rare fracture pattern, uncommon serial fracture occurrence, and unconventional clinic-radiological presentation. Keywords: Neonate, birth trauma, physeal separation, battered baby, child abuse.

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Section: Discussionmentioning

confidence: 99%