Salter-Harris I fracture of the distal humerus in a neonate: imaging appearance of radiographs, ultrasound, and arthrography

Abstract

Neonatal Salter-Harris I fractures of the distal humerus are a rare injury. This injury can be easily mistaken for a posterior elbow dislocation, creating a delay in diagnosis. We present a case of a neonate with a distal humerus Salter-Harris I fracture secondary to trauma during delivery. The patient presented with pseudoparesis of the left arm following birth. Posterior displacement of the elbow was identified on radiographs. Ultrasound of the elbow was performed after a gentle closed reduction of the left elbow was unsuccessful. A transphyseal supracondylar distal humerus fracture was identified on ultrasound. The patient subsequently had an intraoperative left elbow arthrogram to assist in visualization of the supracondylar fracture during closed reduction and percutaneous pinning. At 2-month follow-up, the patient was neurologically intact with full passive range of motion and had normal alignment of the capitellar ossification center and distal humerus on follow-up radiographs.

Deslocamento epifisário de úmero em recém-nascido por trauma intraparto: um relato de caso

“…Some authors claim that a simple radiography, in the appropriate anteroposterior and profile views, generally establish the diagnosis of transfision fracture, the most important indicator of the elbow posteromedial displacement (Figure 1), differentiating from dislocation, in which the displacement is posterolateral and has never been described in children under four years of age 3,9,[13][14] . In addition, it is possible to identify on the radiography of some cases the sign of a fat pad, which is usually present in transfisional fractures because it represents intra-articular bleeding, not identified in the image of the case presented 15 .…”

“…There are difficulty in interpreting the radiographic peculiarities of neonates, doctors resort to complementary exams such as ultrasound, magnetic resonance and arthrography for a diagnostic clarity 18 . Davidson 19 and collaborators have highlighted the use of ultrasound in these cases, since it provides information about nonossified cartilaginous elbow structures and is generally available in services, in addition to being less expensive and avoiding child exposure to radiation, however it requires specialization significant for realization and interpretation 13,19 . Magnetic resonance imaging has been shown to be useful as an additional method to identify radiographically hidden fractures, however it requires the use of general anesthesia or immobilization to hold the child, white also being an expensive and not always an available technique 14,20 .…”

Ultrasonography-guided closed reduction in the treatment of displaced transphyseal fracture of the distal humerus

“…We achieved a satisfactory successful rate of closed reduction which was 84% (27/32). Some researchers doubted that US may have limited use because of the requirement of significant expertise in performing and interpreting the examination [ 23 , 24 ]. In fact, we simplified the complicated procedures of US adopted in the diagnostic examination which need multi-plane scanning [ 15 ], as the preoperative imaging examination has shown the displacements of the fracture comprehensively.…”

Ulrasonography guided Closed Reduction in the Treatment of Displaced Transphyseal Fracture of the Distal Humerus

“…We achieved a satisfactory successful rate of closed reduction which was 84% (27/32). Some researchers doubted that ultrasound may have limited use because of the requirement of signi cant expertise in performing and interpreting the examination [23,24] . In fact, we simpli ed the complicated procedures of utrasonography that adopted in the diagnostic examination which need to multi-planes scanning [15] .…”