Distal Humerus Physeal Separation: Diagnostic Challenges and Implications

Distal humerus physeal separation is an uncommon and often misdiagnosed injury in infants and young children, frequently resulting in delayed treatment. We report three cases of distal humerus physeal separation that presented with different clinical scenarios with different management approaches. The first case describes a nine-month-old girl who was initially treated for presumed elbow cellulitis before presentation to our centre six weeks later. Conservative management, with further observation, noted remodelling of the distal humerus and full elbow range of motion (ROM) after 18 months. The second case involves a two-year-old girl with Kawasaki disease who underwent delayed closed reduction and percutaneous pinning after one week due to concurrent antiplatelet therapy. At four-month follow-up, there was cubitus varus deformity with slight limitation in elbow flexion. The third case is of a five-day-old male neonate with a right elbow deformity following an elective caesarean delivery at another hospital. Gentle manipulation was performed with a splint to improve alignment and immobilisation. The fracture united after five weeks. There was varus deformity but otherwise a full range of motion. These cases underscore the challenges in early diagnosis and management of distal humerus physeal separation in young children. Delayed treatment can lead to favourable outcomes, but follow-up is essential to observe for potential remodelling and residual deformity.