title: Traumatic separation of the distal epiphysis of the humerus sustained at birth.
abstract: We reviewed the clinical and radiological results of six patients who had sustained traumatic separation of the distal epiphysis of the humerus at birth. The correct diagnosis was made from plain radiographs and often supplemented with ultrasonography, MRI and arthrography. An orthopaedic surgeon saw two patients within two days of birth, and the other four were seen at between nine and 30 days. The two neonates underwent unsuccessful attempts at closed reduction. In the remaining patients, seen after the age of eight days, no attempt at reduction was made. All six displaced fractures were immobilised in a cast with the elbow at 90 degrees of flexion and the forearm pronated. When seen at a mean of 58 months (16 to 120) after injury, the clinical and radiological results were excellent in five patients, with complete realignment of the injury. In one patient the forearm lay in slightly reduced valgus with the elbow in full extension. Traumatic separation of the distal epiphysis of the humerus may be missed on the maternity wards and not diagnosed until after discharge from hospital. However, even when no attempt is made to reduce the displaced epiphysis, a good clinical result can be expected.
authors.affiliation: Department of Orthopaedic Surgery, The Marshfield Clinic, Marshfield, Wisconsin 54449, USA. jacobsen.f.stig@marshfieldclinic.org
authors.forename: S
authors.initials: S
authors.lastname: Jacobsen
authors.forename: G
authors.initials: G
authors.lastname: Hansson
authors.forename: J
authors.initials: J
authors.lastname: Nathorst-Westfelt
mesh_terms: D001720:Birth Injuries / Q000000981:diagnostic imaging* / Q000628:therapy; D002370:Casts, Surgical; D004838:Epiphyses / Q000293:injuries; D005260:Female; D017102:Fracture Healing / Q000502:physiology; D005596:Fractures, Closed / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging* / Q000628:therapy; D006811:Humerus / Q000293:injuries*; D007231:Infant, Newborn; D004204:Joint Dislocations / Q000000981:diagnostic imaging* / Q000628:therapy; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome