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Published on: January 7, 2019
Presentation of distal humerus physeal separation
Shawn R Gilbert1, Michael J Conklin
1Department of Surgery, Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA. shawng@uab.edu
Pediatric Emergency Care
|November 17, 2007
Summary
Distal humerus physeal separation is an uncommon elbow fracture in young children, often missed initially. Early recognition requires careful radiographic review and suspicion, especially in cases of nonaccidental injury.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Pediatric Trauma
Background:
- Physeal separation of the distal humerus is a rare elbow injury in children.
- Accurate diagnosis is crucial for appropriate management and to rule out nonaccidental injury.
Purpose of the Study:
- To describe the clinical presentation of distal humerus physeal separation in young children.
- To review the radiographic findings associated with this injury.
- To highlight diagnostic challenges and delays.
Main Methods:
- Retrospective review of medical charts of children aged 3 years or younger with elbow injuries.
- Identification of cases with distal humerus physeal separation.
- Recording of presenting symptoms, initial diagnoses, and time to correct diagnosis.
Main Results:
- Seven cases of distal humerus physeal separation were identified among 101 children with elbow fractures.
- All patients presented with pain, swelling, or disuse.
- Diagnosis was delayed in all cases, ranging from 2 to 14 days; initial diagnosis was not made by emergency physicians or radiologists.
- Two cases were associated with suspected or confirmed nonaccidental injury.
Conclusions:
- Distal humerus physeal separation, though unusual, represents a significant proportion of elbow fractures in this age group.
- Radiographic assessment of the ulna-humerus relationship and a high index of suspicion are vital for diagnosis.
- Nonaccidental injury should be considered in the differential diagnosis.
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