Presentation of distal humerus physeal separation.
OBJECTIVE
The study was undertaken to describe the presenting features of children with physeal separation of the distal humerus and review the radiographic features of the diagnosis.


METHODS
The charts of all children with elbow injuries aged 3 or younger were reviewed to find those with distal humerus physeal separation. Presenting complaint, initial diagnosis, and time to correct diagnosis were recorded.


RESULTS
Of 101 children aged 3 or younger with elbow fractures, 7 were noted to have distal humerus physeal separation. All patients presented with pain, swelling, or disuse. Two cases resulted from suspected or confirmed nonaccidental injury. In no case was a diagnosis of distal humerus physeal separation assigned by the emergency physician or radiologist. Delay in assignment of final diagnosis ranged from 2 to 14 days.


CONCLUSIONS
Physeal separation of the distal humerus is an unusual injury but accounts for a significant number of elbow fractures in children 3 or younger. Attention to the radiographic relationship of the ulna and humerus and an appropriate index of suspicion are keys to diagnosis. Nonaccidental injury should be considered as an etiology.
Gilbert
Shawn R
SR
Department of Surgery, Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA. shawng@uab.edu
Conklin
Michael J
MJ
D002649:Child Abuse / Q000175:diagnosis; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006132:Growth Plate / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D007103:Immobilization; D007223:Infant; D007231:Infant, Newborn; D011859:Radiography; D000072042:Salter-Harris Fractures; D000092464:Elbow Injuries