Fracture of the Distal Humeral Chondroepiphysis in the Neonate

Abstract

Fracture of the distal humeral chondroepiphysis in the neonate is an unusual injury easily mistaken for a posterior dislocation of the elbow. Physical examination reveals the nature of the injury. Nonoperative management results in a satisfactory outcome, as demonstrated in the following illustrative case. CASE REPORTA 36-hour-old infant was noted at delivery to have a deformity of the right elbow. A difficult forcep delivery was required to assist a doublefootling breech presentation. The elbow was noted to be flaccid, but right shoulder and right wrist activity were normal. The baby was delivered at full term, weighed 3950 g and was otherwise normal. The initial roentgenograms appeared to demonstrate a posterior dislocation of the elbow. An attempt at reduction of the elbow was unsuccessful; hence, the patient was transferred to the Albany Medical Center Hospital. During transfer the right elbow was notably swollen and ecchymotic, but no circulatory compromise was evident. Active motion was limited to the shoulder, hand and fingers. Examination revealed proximal displacement of the epicondylar region, shortening of the acromiocondylar distance on the involved side, and an apparently painful "muffled" crepi-

Epiphyseal Separation of Distal Humerus in Newborn: A Case Report

“…Dias and Menon reported similar injuries and found that the forearm extension was restricted by 12°and 10°, respectively, after closed reduction (6, 7). Downs presented a case in which the elbow extension was restricted by 12°at six months post-surgery but there were no obvious limitations in elbow bending or function (8). Barret et al presented a case in which the elbow extension was restricted by 20°at 24 months after closed reduction and external splintage (4).…”

Physeal Separation of the Distal Humerus, a Rare Consequence of Trauma at Birth. Case Report

“…The condition is very rare. Downs and Wirth cited 11 cases of fracture separation of distal chondroepiphysis in the newborn [2]. To date in our search we have found two additional cases [1,4].…”

“…Capitulum and trohlea are still unossified at this age [1,2,4]. To differentiate from posterior elbow luxation Ruo describes that medial displacement of forearm is common in PSDH while lateral displacement is usual in elbow dislocations [5].…”

Slipped Distal Humerus Epiphysis in Tiny Infants Easily Detected and Followed-Up by Ultrasound

“…The characteristic postero-medial displacement of the distal humerus epiphysis associated with this kind of lesion was first emphasized by Valdiserri and Kelescian [2 -6], and is still confirmative if seen in any elbow X-ray, arthrogram or ultrasound scan [3, 4, 6 -8]. According to some authors, this type of fracture separation in young infants is still described as an uncommon variant of the well-known pediatric supracondylar humerus fracture [3,4,9]. Sound knowledge of the sequence of appearance of the elbow ossification centers is essential for correct diagnosis, since at birth none of the four distal humerus epiphysis ossification centers found at the termination of growth are visible.…”

“…In the majority of cases, they do not progress until skeletal maturity. However, they are mainly, but not exclusively, reported for the infant age [4,6,11,23], while in comparable cases newborns showed a complete recovery within 3 weeks to 3 months [4,8,18,20]. Of course, traditional plane X-rays have been positive at some time in almost all cases, maybe even essential for the diagnostic work-up, since they are still considered to be superior for estimating angles and deformities [3 -5, 7, 8, 11, 19, 20, 23].…”