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

Fette, Andreas; Mayr, Johannes

doi:10.1055/s-0031-1281660

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…In a more recent retrospective analysis about long-bone fractures in newborns, only two among 34.519 live births (0.006 %) had a humerus fracture, but none was transphyseal [6]. Other authors reported an incidence of about 1:35,000 births [7,8].…”

Section: Introductionmentioning

confidence: 96%

Transphyseal elbow fracture in newborn: review of literature

et al. 2015

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Transphyseal elbow fracture is a rare entity in newborns, and in the last century, only case reports or small case series have been published; however, precise epidemiological data lack. Such fractures occur more often in emergency Caesarian section or vaginal delivery. The differential diagnosis with elbow dislocation can be challenging. Radiography, arthrography, magnetic resonance, ultrasound or a combination of these have already been described to make diagnosis, but guidelines for the management of this injury in the neonate are not well established. A review of the literature of the last century about distal transphyseal fracture of the humerus in newborns was performed. A bibliographic search was conducted accessing usual medical databases. The work-up methods, treatments, results at follow-up and the rate of complications were collected. Twenty case reports or small retrospective case series reporting a total of 33 cases were included. A posteromedial displacement of the radioulnar complex was found in 21 elbows (64 %). Four patients (12 %) underwent surgical treatment, whilst 29 (88 %) were managed without surgery. An attempt of reduction was reported in 23 cases (69 %). At follow-up, 88 % recovered completely the carrying angle and 80 % range of motion. A relationship between the type of treatment (conservative or surgical, with attempt of reduction or not) and results at follow-up could not be demonstrated. The most common complication was cubitus varus. Transphyseal elbow fractures are rare among newborns. Regardless of the treatment choice, such lesions are in most cases associated with a good prognosis.

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Section: Introductionmentioning

confidence: 96%

Transphyseal elbow fracture in newborn: review of literature

et al. 2015

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“…Ultrasound diagnosis of pediatric fractures in different body regions has been studied for several years [ 9 ]—in particular, for the ribs and sternum [ 10 ]. In the past few years, the ultrasound diagnosis of upper-extremity fractures in adults and children has been studied [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. A recent validation study in Germany conducted in five study centers included a total of 498 children [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Non-Inferiority of Point-of-Care Ultrasound Compared to Radiography to Diagnose Upper Extremity Fractures in Children

et al. 2022

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Conventional X-ray imaging for fracture diagnosis is time-consuming and exposes patients to ionizing radiation. Additionally, the positioning of the injured limb for standardized X-ray imaging is painful. Point-of-care ultrasound (POCUS) is increasingly available in medical offices and emergency rooms. This study aimed to prove the non-inferiority of POCUS compared to X-ray imaging with respect to diagnostic sensitivity, pain, and investigation time in the diagnosis of long-bone fractures of the upper extremity in children. Children and adolescents (1–18 years old) presenting to the UKBB emergency service between May 2020 and May 2021 with suspected upper extremity fracture were included in the study. Before obtaining X-ray images, we conducted a POCUS examination of the injured limb. Pain scores at inclusion as well as maximum pain scores during X-ray and ultrasound examinations were documented. The duration of POCUS and X-ray examinations was compared. We examined 403 children with POCUS and plain X-ray imaging. The mean age (±SD) of the children was 10.6 (±3.5) years. The non-inferiority of POCUS compared to X-ray was confirmed with an estimated sensitivity of 0.95 and a lower confidence interval of 0.93. Maximum pain during POCUS was significantly lower compared to pain at inclusion (p = 0.002) or maximum pain during radiographic examination (p = 0.03). POCUS examination took 3.9 (±2.9) min in the mean whilst the mean duration for obtaining the X-ray images was 16 (±37) min (p < 0.001). POCUS for diagnosing upper extremity fractures in children proved as sensitive as standard X-ray imaging and was significantly faster and less painful. Future prospective studies are required to confirm our findings.

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