Epihyseal Separation of Lower end Humerus in A Neonate-Diagnostic and Management Difficulty

Birth injuries are common phenomenon. But commonly encountered birth injuries are clavicle fracture, humerus fractures and uncommonly femur fracture. Incidence of Distal humerus Epiphyseal injuries as birth injury are rare. As the first secondary centre around elbow-capitellum appears at 3-9 months, its radilological assessment of alignment with elbow or the radius shaft is not possible in neonates. It is difficult to differentiate elbow dislocation from epiphyseal injury in neonates.

Here we are reporting a case of lower end humerus epiphyseal injury, as birth injury, detected in early neonatal period. This injury is unique for the reasons that detection by conventional radiography is difficult as it mimics elbow dislocation and on reduction it is unstable injury to treat by just closed reduction. The fine resolution sonography differentiates the epiphyseal separation from elbow dislocation. Till date few such cases are reported in English literature but only two in last 10 years. Though all the previously reported cases have been treated with just closed reduction, none have reported grossly unstable reduction. Here we are reporting the Lower end humerus epiphyseal injury in early neonatal period and use of thin k wire for stability for gross instability after reduction.

Epiphyseal injuries, though rare, are very deceptive. They have to be diagnosed properly and appropriately managed.